Mystery shoppers would compare wait times to see doctors

HHS wants to use people posing as potential patients to gauge access to primary care for those with public and private insurance.

By Charles Fiegl — Posted June 6, 2011

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The Dept. of Health and Human Services plans to assess how long patients typically must wait to see primary care physicians by secretly surveying practices using so-called mystery shoppers.

The department has proposed using people posing as potential new patients to help gauge the availability of primary care physicians, according to an April 28 notice in the Federal Register. HHS hopes the effort will help determine whether primary care doctors accept new privately insured patients more or less readily than they take on new Medicare or Medicaid patients. The department also wants to gauge the timeliness of available primary care services, and find out why certain availability may be limited.

If the department moves forward with the plan, it would use mystery shoppers to contact more than 4,000 physician offices in nine states. Shoppers would call on each practice twice -- once posing as a patient with private coverage and then as a patient in a public plan.

More than 450 of the practices would be contacted a third time. The office would be informed of the study and then asked again if it accepts new patients and how long it would take for one to see the doctor. "The purpose of this additional data collection component is to evaluate the validity of the mystery shopper approach in generating accurate estimates of physician availability and timeliness of services," the proposal said.

The notion of using pretend patients to extract information from practices does prompt some concerns, said Anders Gilberg, vice president of public and private economic affairs with the Medical Group Management Assn. But, he said, the study could provide new access to information that HHS and Congress could use to improve the health care system.

"We all know in certain areas of the country there are serious issues with access to primary care physicians," Gilberg said. "That's not the fault of primary care. That comes from problems with uncertainties created by Medicare and payment rates."

A 2010 MGMA survey showed 92% of group practices accepted new Medicare patients. However, 67% of those surveyed said they would consider limiting new Medicare patients if scheduled pay cuts occurred.

Private and public entities have studied physician availability many times. Merritt Hawkins & Associates, a physician research and consulting group, surveyed physician practices in 2009 and found that about 65% of 278 family physician practices surveyed accepted Medicaid. The average wait time for new patients was about 20 days.

A Medicare Payment Advisory Commission report from March 2011 found that about 75% of Medicare patients reported no problems scheduling routine appointments, compared with 72% of privately insured patients who reported never having to wait longer than anticipated for care.

Finding a primary care physician appeared to be more difficult for patients with private insurance than Medicare patients, MedPAC reported. Among patients looking for a new primary care doctor, 20% of Medicare patients and 31% of privately insured individuals said they had trouble scheduling appointments.

Secret reviewers have been used before

Using callers posing as health care consumers isn't entirely new for HHS. The Centers for Medicare & Medicaid Services has used the strategy to monitor marketing and sales presentations led by Medicare private plans. CMS conducted 858 secret reviews of 136 Medicare Advantage events during the annual open enrollment period in 2010. CMS found more than four in 10 of those events to be deficient in some way.

"The most common deficiencies reported for public sales events during the [2010] surveillance season were related to accuracy/completeness of drug coverage information," CMS said in a 2010 August report. CMS said it notified insurers that were found to have problems with their sales events. The agency said plans demonstrated a willingness to correct the issues.

The Government Accountability Office also used secret shoppers to examine Medicare's own help line, 800-MEDICARE, and the customer service representatives handling beneficiary calls in 2004. The GAO called the help line 420 times and determined that nearly 30% of the answers were incorrect and about 60% were accurate. About 10% of questions posed could not be answered by representatives.

Health insurance plans, hospitals and even physician offices also have used mystery shoppers on their own operations to uncover potential areas for improvement.

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How to comment on HHS mystery shoppers

The Dept. of Health and Human Services has proposed using mystery shoppers to check the availability of primary care physicians to patients with private and public insurance plans. HHS will accept comments on the proposal via email until June 27 (link). Comments should refer to the document identifier, OS-0990-New.

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