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Study: Many Primary Care Docs Don't Understand Consumer-Directed Health Plans

By Annie Shuppy, CQ Staff

October 10, 2008 -- A new study in the American Journal of Managed Care on primary care physicians' knowledge of consumer-directed health plans found that many doctors do not understand the financial implications of these plans for their patients.

The Treasury Department estimates that enrollment in consumer-directed health plans (CDHPs), which are patient-focused plans intended to make consumers more cost-conscious about their health care, will reach 25 million by the next decade. At the same time, the study found that 40 percent of primary care physicians are providing care to CDHP enrollees—and a quarter of those physicians said they didn't know much about the plans.

Craig Pollack, a physician researcher at the University of Pennsylvania who co-authored the study with Giridhar Mallya and Daniel Polsky, said even more patients have enrolled in CDHPs since the survey was fielded in the summer of 2007. It is a "positive sign" that physicians who had patients enrolled in CDHPs were more likely to be educated about how they work than those that didn't, he said.

"As more patients continue to enroll in these plans, it will be even more important for physicians to be educated about cost-sharing under CDHPs," Pollack said.

Prior to the study, 43 percent of physicians surveyed reported having heard "a little" or "not at all" about CDHPs. The same number indicated low knowledge of out-of-pocket costs faced by CDHP enrollees. Approximately one-third had low knowledge of how money is contributed to and spent from medical savings accounts.

While almost three-quarters of physicians were ready to discuss issues of cost and cost-effectiveness, less than half were ready to discuss medical budgeting with patients. In terms of specific services, more than two-thirds of physicians were ready to advise patients on office visits, medications, and laboratory testing. Half or less, however, were ready to advise on the costs of radiologic studies, specialist consultation, and hospitalizations.

"I think that patients who are planning to be enrolled or are already enrolled in CDHPs should bear in mind that physicians may not understand certain aspects must be paid for out of pocket until a deductible is reached," Pollack said.

Physicians with CDHP enrollees, who were less likely to be from the Northeast and less likely to care for a high percentage of patients with Medicaid coverage, were more ready to discuss the costs of medications, but were no more ready to discuss the costs of other services.

They were also more likely to have a favorable impression than physicians without CDHP-enrolled patients. Overall, 46 percent of the total physicians reported a favorable impression of CDHPs, 37 percent were neutral, and 17 percent reported an unfavorable impression.

Grace-Marie Turner, president of the Galen Institute and a supporter of CDHPs, said that while the study had good data, "the spin seems quite biased." She said some of the problems highlighted in the study are not just endemic among consumer-directed plans.

"Moving the health sector to a more patient-centered system is an evolutionary process. It does not happen suddenly overnight. You see physicians who are beginning to learn how to engage patients as partners," Turner said.

Another issue revealed by the study was the reliance on quality-of-care information. Less than one-quarter of physicians surveyed agreed that patients can generally trust the quality information provided by government Web sites, and just 8 percent agreed that patients can trust quality-of-care information from insurer Web sites.

Turner noted that this can be a problem under any type of health insurance plan and is a product of the varying levels of veracity of information found on the Internet.

"It speaks to need to really have better and have trusted sources of information that are endorsed by physicians," she said.

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