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T H Gallagher

Publications and source records attributed to T H Gallagher.

5 recordsLinked to original sources
PubMed1998

Health Care Financing Administration's new regulations for financial incentives in Medicaid and Medicare managed care: one step forward?

Because financial incentives for managed care physicians may create conflicts of interests, new regulations have been instituted that will result in disclosure of certain financial incentives to the Federal Government and to some patients. Given the limitations of these regulations, health plans and physicians should take the lead in addressing concerns about the harmful effects of financial incentives. For example, public disclosure may deter unusually strong financial incentives. Purchasing coalitions, advocacy groups, and journalists should have increased access to information about physician-level incentives. These nonregulatory measures might reassure patients that managed care physicians are committed to their best interests.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1997

How do physicians respond to patient's requests for costly, unindicated services?

OBJECTIVE: To determine how physicians respond to a request for an expensive, unindicated test. DESIGN: Cross-sectional observational study. SETTING: Four sites of a group-model HMO. PARTICIPANTS: Thirty-nine internist volunteers. INTERVENTION: A standardized patient requesting magnetic resonance imaging (MRI) of the head to rule out multiple sclerosis (MS) was inserted unannounced into physicians' regular schedules. The patient's only complaint was fatigue with no neurologic symptoms. MEASUREMENTS AND MAIN RESULTS: Physicians and standardized patients completed assessments after each visit. Thirty-five (90%) of 39 physicians "had no idea" that the patient they saw was the standardized patient, and the remaining four participants (10%) were only "somewhat suspicious." Three (8%) of the physicians agreed to the MRI at the initial visit, and eight (22%) said they might order an MRI in the future. All doctors who refused the MRI told the patient this was based on lack of a medical indication for the test; seven (19%) also cited the test's expense. Twenty physicians (53%) of 38 agreed to a neurology referral. In response to the standardized patient's concerns, nine physicians (23%) verbalized that MS is scary, and four (10%) asked the patient about their friend's experience with MS. A few physicians appeared to dismiss the patient's concerns, such as by telling the patient they were being "paranoid." CONCLUSIONS: Few physicians agreed to a standardized patient's request for a medically unindicated MRI, but more than half agreed to refer this patient to a specialist. As physicians practice cost-conscious medicine, they may need to focus on good communication to maintain patient satisfaction.

Adult↗
PubMedDate not supplied

Patients' attitudes toward cost control bonuses for managed care physicians.

Physicians' cost containment incentives may create conflicts of interest. To understand how patients view these incentives, we interviewed 1,050 patients regarding a 10 percent cost control bonus and a combined cost control/quality bonus. Seventy-three percent said that the cost control bonus was a bad idea; 49 percent viewed the combined bonus more favorably than the cost control bonus; and 91 percent favored disclosure of bonuses. We conclude that patients find bonuses worrisome and favor their disclosure. A quality component reassures some, but not all, patients. Initiating a dialogue with patients about practicing medicine in an era of limited resources may help health plans and physicians to address patients' concerns.

Attitude to Health↗