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) meeting.
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 restrictions.
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.