As they say, you can’t make this stuff up. A little over two months ago, the US Department of Health and Human Services posted a benign-sounding notice in the numbingly dense Federal Register, announcing a study to gauge the availability of primary care physicians (PCPs) to see patients covered by Medicare and Medicaid. Concerned about the looming shortage of PCPs (particularly because over 32 million Americans will be obtaining health insurance coverage under the Affordable Care Act passed last year), the Obama administration wanted to find out if PCPs would be accepting those publicly-insured patients, and if not, why not.
So far, so good. No one would argue that the government shouldn’t be concerned about and engaged in finding solutions to the impending shortage of physicians, especially in the primary care specialties. The notice of the project even cited recent studies that predict the PCP shortfall to be somewhere between 40,000 and 200,000 physicians by 2025. It’s how the government wanted to obtain the information that makes you scratch your head and wonder what they were thinking.
The government proposed using the so-called “mystery shopper” approach to collecting data from primary care physician offices. The mystery shopper would basically be a fictitious patient, reading a script claiming made-up symptoms and coverage from either public or private insurance programs, who would ask offices if they would take them as a patient. A follow-up phone call from a government representative would ask a generic question of the physician or clinic about whether they would take Medicare or Medicaid patients, and then the answers would be compared to see if the physicians were being honest about their answers. The study planned to contact nearly 4200 physicians in nine states (Kansas was not one of the states in the study).
Now, some might consider this research approach to be perfectly harmless, because after all, lots of retail corporations utilize fictitious shoppers to either see what the competition is doing, or to get an objective view of their own operations. To me, it is just one more example of a pervasive attitude in government that physicians are merely vendors in the commerce of health care services. And, more cynically, it sends a message that physicians can’t be trusted to answer questions about their how their practices will respond to the increased demand for services created by the health care reform law. There is abundant research in the literature about reasons why physicians don’t accept new patients from Medicaid and Medicare. Of course, the obvious answers (poor pay, excessive program complexity and hassle, intrusion into clinical matters, etc.) are not solutions government will embrace.
In the end, the plug was mercifully pulled on the mystery shopper caper. Reaction from physicians and public alike were that at best the plan was silly, and at worst, just plain wasteful of time and resources. Good riddance.