BETHESDA, Md--Managed care, more than other types of medical coverage,
imposes a "hassle factor" on oncologists and their patients,
and restrains patients from participating in clinical trials, a survey
by the Association of Community Cancer Centers (ACCC) has found.
The ACCC sent four-page questionnaires to 2,000 randomly selected adult
medical oncologists and received 322 (16.1%) usable responses. The association
conducted the survey to measure the perceived impact of managed care on
the ability of oncologists to deliver care and to determine if payment
denials affect their clinical judgment.
"We call this the 'hassle factor' survey," ACCC president-elect
James L. Wade III, MD, said at the National Cancer Advisory Board (NCAB)
Among the survey findings:
Contract restrictions: Two thirds of coverage contracts imposed
a gatekeeper; 29% of physicians reported that their patients regularly
had to switch oncologists due to contract provisions; and 32% said that
patients had to make prolonged journeys for services due to their contract
Clinical trials: More than one third of oncologists (37%) said
that insurers had refused to allow patients to participate in a clinical
trial; 77.3% of the oncologists hesitated to enroll managed care patients
in clinical trials because of previous denials, compared with 41.8% for
Medicare patients, 33.9% for patients in capitated plans, and 32.2% for
patients with commercial insurance.
Transplants and chemotherapy: Most respondents (87.4%) said that
they hesitated to prescribe a bone marrow transplant and 53.7% hesitated
to prescribe expensive chemotherapy for patients in managed care plans.
Increased paperwork: More than half of those surveyed (56%) reported
that their practices had added staff because of increased paperwork; 55%
reported difficulty reaching plans to clarify coverage; 43% of the oncologists
said they personally handled managed care appeals. "There is real
difficulty in getting answers back from plans as to what is covered,"
Dr. Wade said.
Difficulties among practices varied, in an inverted U-shaped curve.
The quartile of practices with the least managed care patients had the
least problems. The top quartile had the second least problems, while the
two middle quartiles reported "the most hassles," Dr. Wade said.