Oncologists in a Survey Detail Managed Care's 'Hassle Factor'

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 surveyby the Association of Community Cancer Centers (ACCC) has found.

The ACCC sent four-page questionnaires to 2,000 randomly selected adultmedical oncologists and received 322 (16.1%) usable responses. The associationconducted the survey to measure the perceived impact of managed care onthe ability of oncologists to deliver care and to determine if paymentdenials affect their clinical judgment.

"We call this the 'hassle factor' survey," ACCC president-electJames L. Wade III, MD, said at the National Cancer Advisory Board (NCAB)meeting.

Among the survey findings:

Contract restrictions: Two thirds of coverage contracts imposeda gatekeeper; 29% of physicians reported that their patients regularlyhad to switch oncologists due to contract provisions; and 32% said thatpatients had to make prolonged journeys for services due to their contractrestrictions.

Clinical trials: More than one third of oncologists (37%) saidthat insurers had refused to allow patients to participate in a clinicaltrial; 77.3% of the oncologists hesitated to enroll managed care patientsin clinical trials because of previous denials, compared with 41.8% forMedicare patients, 33.9% for patients in capitated plans, and 32.2% forpatients with commercial insurance.

Transplants and chemotherapy: Most respondents (87.4%) said thatthey hesitated to prescribe a bone marrow transplant and 53.7% hesitatedto prescribe expensive chemotherapy for patients in managed care plans.

Increased paperwork: More than half of those surveyed (56%) reportedthat their practices had added staff because of increased paperwork; 55%reported difficulty reaching plans to clarify coverage; 43% of the oncologistssaid they personally handled managed care appeals. "There is realdifficulty 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 theleast problems. The top quartile had the second least problems, while thetwo middle quartiles reported "the most hassles," Dr. Wade said.