In part, that's because employers tend to have a much more direct relationship with employees than health plans do with enrollees. Employers also pay more attention to patient satisfaction surveys and often offer more choice in their provider panels. While physicians who contract directly with employers may not face the micromanagement of clinical decision-making used by some health plans, they will have to continuously demonstrate a high level of business competence to secure and renew contracts with employers. Banding together in IPAs and networks can improve physicians' contracting capabilities, but it may also complicate patient relationships. Patients who are used to being billed directly by their physician office may be unhappy having to work out billing issues with a larger, more centralized group administration.
Doctors also face tough ethical issues, particularly when they accept risk contracts.
Dr. Goold pointed out that the traditional doctor-patient relationship, which is based on vulnerability and trust, is now changing to a financial relationship based on cost and utilization considerations. One of the biggest challenges that doctors have to confront under managed care is how to continue to advocate for their patients while receiving financial incentives to reduce utilization. Dr. Goold also said that managed care's insistence on containing costs has meant a shift in the profession as a whole away from providing charity care. As doctors embrace more direct and risk-bearing contracts, their biggest ethical dilemma will be how to care for the uninsured, she concluded. All rights reserved.