No mystery shopper required: Private insurance acceptance declines faster than Medicare

July 6, 2011

The controversy may have been focused on the government plan to use mystery shoppers to surreptitiously check how many physician offices were open to Medicare and other public insurance patients. But the bigger problem is acceptance of private insurance by medical practices that have to jump through hoops to get paid, according to a new study.

While the controversy was focused on the Department of Health and Human Services (HHS) plan to use mystery shoppers to check surreptitiously how many physician offices were open to Medicare and other public insurance patients, a new study came out suggesting that the bigger problem is acceptance of private insurance by medical practices.

Late in June, HHS announced it was cancelling the “mystery shopper” program, which would have contacted 4,185 primary care physicians in nine states twice, once with individuals posing as new patients with private insurance and once as a new patient with public insurance. Under that plan-part of an overall initiative to increase physician access under the Patient Protection and Affordable Care Act-callers would contact 11% of the physicians a third time, directly asking whether the office is accepting new patients with private insurance, Medicaid, Medicare, or patients who self-pay.

As it turns out, the question about private insurance may have been the more important one. A survey published in the Archives of Internal Medicine in late June provided some surprising results in terms of access.

“Given the medical profession’s widely reported dissatisfaction with Medicare, we expected to find hard evidence that Medicare patients were being turned away,” says lead author Tara Bishop, MD, assistant professor of public health at Weill Cornell Medical College. Instead, “the survey data showed a more significant decline in their acceptance of patients with private insurance.”

Acceptance of patients with private insurance dropped from 93.3% in 2005 to 87.8% in 2008, whereas acceptance of patients with Medicare only declined from 95.5% to 92.9%.

Bishop suggests that the lower acceptance of private insurance may stem from the greater effort that goes with seeking payment from commercial insurers combined with payment rates that have not kept up with medical practice costs.

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