Govt. Wants 'Mystery Shoppers' to Probe Docs About the Ease in Getting an Appointment

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In an effort to understand why some research has found that as many as 60 million Americans can't get primary care physicians, the federal government is considering using "mystery shoppers" to investigate whether primary care physicians are accepting or rejecting new patients depending on the type of insurance they have.

According to Christian Stenrud, a spokesman with the Department of Health and Human Services, "understanding access to primary care is a priority of the administration." One of the biggest obstacles is a shortage of primary care physicians.

"Primary care providers are critical to help us meet our goal of ensuring everyone has access to affordable, high-quality health care," Stenrud said.

A government document describing the program says if it's instituted, staff from the Office of the Assistant Secretary for Planning and Evaluation will call 4,185 primary care physicians in nine states. Each office will get two calls -- the person on the phone will act as a prospective new patient with private insurance and at a separate time, as new patient with public insurance. Callers will say they either have an urgent medical need, or request a routine examination.

Later, physicians will get a third call that asks doctors directly whether they are accepting new patients, and how long it takes to get an appointment. That call will also tell doctors about the "mystery shopper" program. While Stenrud didn't address the program's cost, The New York Times, who first reported the mystery shopper proposal, said the first surveys would cost around $350,000.

Before the program gets under way, the government is inviting feedback from doctors and patients.

ABC News asked a number of primary care physicians and health policy experts for their thoughts on the government's "mystery shopper" initiative. The responses varied, with some experts saying the program is deceptive and others saying the findings could be useful.

The American Medical Association is strongly against the government's proposal.

"We know there is a physician shortage in this country that will only grow worse as more people enter Medicare and coverage is expanded to those currently uninsured," said Dr. Cecil Wilson, the AMA's immediate past president. "The government should be working to address this shortage so all patients can have access to the health care they need, rather than using mystery shoppers to tell us what we already know."

"Patients don't want the federal government sneaking around, trying to manipulate their doctors," said Richard Saltman, professor of health policy and management at Emory University's Rollins School of Public Health in Atlanta.

"It is almost laughable to think that our federal government would spend good money during these difficult times to see if we [primary care physicians] are putting up obstacles to deter Medicaid patients from making appointments in our practices," said Dr. J. Jacques Carter, assistant professor of medicine at Harvard Medical School in Boston. He said that repeated surveys indicated there is a growing shortage of primary care physicians for a number of reasons, including retirement and frustration over a seemingly endless amount of paperwork.

He acknowledged that some physicians do try to turn away Medicaid patients, which he called "deplorable," but said doctors get paid so little from Medicaid that it rarely covers the cost of providing medical services.

"All over the country, doctors are dropping out of poorly reimbursing plans," said Dr. Peter Lavine, an orthopedic surgeon and past president of the Medical Society of the District of Columbia.

"No deception is necessary. Just ask: 'Do you accept Medicaid patients?' said Dr. Daniel Blumenthal, associate dean for community health at Morehouse School of Medicine in Atlanta.

Patients with Medicare can generally get appointments, experts say, because Medicare pays physicians more than Medicaid does.

Findings Could be Valuable and Informative, Say Others

In 2014, the Affordable Care Act will provide insurance coverage to millions more Americans, in part by expanding eligibility for Medicaid, which experts believe will place a much greater burden on the health care system unless problems surrounding the availability of care are addressed. The findings from the "mystery shopper" initiative could help determine where the biggest problems lie.

"My guess is that it will find that Medicare patients have some problems, but that Medicaid patients have very big problems getting doctors, especially in states with low reimbursement rates," said Dean Baker, co-director of the Center for Economic and Policy Research in Washington, D.C.

"I believe that ultimately the program will highlight just how challenging it can be for certain persons, and especially groups to gain access to ongoing primary care, especially for persons with chronic disease -- both in Medicare and Medicaid," said Dr. Eric Larson, executive director of the Group Health Research Initiative.

Other experts say the program will help confirm how severe the shortage of primary care physicians is and where the most critical shortages are. There have been disparities between research findings and government data on access to care.

One study published in the May issue of the New England Journal of Medicine done by the Massachusetts Medical Society, for example, found that more than half of primary care practices were not accepting patients. For those practitioners who were taking new patients, the average wait time for an appointment was as long as 48 days.

"I view the [mystery shopper] program as an important empirical study," said Dr. A. Mark Fendrick, professor of health management and policy at the University of Michigan School of Public Health in Ann Arbor. "Either our fear of lack of [primary care physician] access will be confirmed and policies implemented to overcome the shortage, or lessened if access is adequate."

"It is the only way to get a truly accurate measurement of current access to primary care, as it can isolate the impact of insurance status on access," said Dr. Karin Rhodes, director of the Division of Emergency Care Policy and Research at the University of Pennslvania in Philadelphia.

Patients With Private Insurance Have Problems Seeing Doctors Too

Rhodes is also co-author of a 2005 study that also used a "mystery shopper" approach to determine whether the type of insurance affected the ability to get a doctor's appointment.

Callers who said they had private insurance got an appointment easier than those who said they had public insurance, but most callers with private insurance who indicated they had a life-threatening problem still couldn't get an appointment.

A new study published in the current issue of the journal Archives of Internal Medicine found that the number of physcians accepting private insurance decreased from 93.3 percent in 2005 to 87.8 percent in 2008.

Experts hope that if the program takes off, its findings will spur the government into action to improve the accessibility of doctors.

"Doctors shouldn't be allowed to pick and choose patients based on insurance, but they should be paid fairly regardless of what kind of coverage a patient has," said Robert Field, professor of health management and policy at Drexel University School of Public Health in Philadelphia. "Access to health care is a matter of life and death. Few national needs are more urgent."