ACA expected to test patient loyalty to physicians

Washington Cost and accessibility issues might persuade some patients to switch primary care physicians as more coverage options become available under the Affordable Care Act starting in 2014.

HealthPocket, a website that ranks and compares health plans, asked 713 consumers if they would be willing to change physicians if it meant saving money on insurance premiums. Respondents also were asked how much money they would need to save annually to make that switch. Thirty-four percent thought keeping down out-of-pocket insurance costs was more important than retaining their doctors.

In addition, the savings wouldn't have to be that significant — more than half of those willing to make a switch “would do so for the lowest savings amount presented by the survey, $500 to $1,000 annually,” according to a summary of the findings. This compares to the 7.5% who would change doctors only if they saved $3,000 or more per year.

Although roughly four in 10 respondents said they would not change their physicians, the results show that some people “are surprisingly open to moving around based on cost,” said Steve Zaleznick, HealthPocket's executive director for consumer strategy and development.

Zaleznick said in an interview that HealthPocket didn't focus its survey questions on the ACA, because consumer views on health system reforms are just beginning to take shape. What these findings suggest, however, is that the law ultimately might test loyalty to physicians when consumers are able to choose from a broader assortment of plan options starting in 2014. About 30 million additional people are expected to gain insurance through the coverage expansions, which include new state insurance exchanges or marketplaces where people can shop for plans based in part on price.

HealthPocket geared its findings toward the individual and small-group markets that will operate on and off the exchanges, because these are the markets the ACA would affect the most.

Although a certain amount of loyalty toward physicians may exist, “we live in the real world, where patients might say: 'I like my physician, but this other plan is more affordable, and I might change physicians,' ” said Glen Stream, MD, board chair of the American Academy of Family Physicians. The potential downside is that care may become too fragmented if people change plans and physicians too often, even for understandable economic reasons, he noted.

One of the most valuable things that stable physician-patient relationships offer is continuity of care and the trust that those relationships build over time, Dr. Stream said.

Network effect on patient choices

Whether a patient's established doctor participates in a particular plan is another factor that could affect a decision, the HealthPocket survey found. There's an expectation that insurers will tighten networks that serve both the individual and small-group markets on and off the health insurance exchanges.

“Given the variety of price pressures that come with the changes in the law — essential benefits, lack of underwriting, guaranteed issue, those kinds of things — there's going to have to be offsetting pressure to keep costs in control,” Zaleznick said. Narrower networks serve as one way to lower insurers' costs by offering lower rates to a more select pool of physicians in exchange for the promise of more patients.

In the current economic climate, it's understandable that patients would want to change physicians if they could save money, said Tim Norbeck, CEO of the nonprofit Physicians Foundation. Because doctors generally rank high on public opinion polls, patients assume that they could get good care from other doctors, even if they're fond of the ones they have, he said.

But Norbeck wondered how many patients in HealthPocket's survey actually would switch doctors if faced with such a choice. Among the one-third who said they would be willing to change physicians, there probably are patients who see their doctors infrequently. An elderly patient who visits his or her physician once a week is going to develop a greater bond with the caregiver than someone who sees a doctor once or twice a year, he said.

The foundation's own research determined that nearly 80% of patients said they were satisfied with the care they received from their primary care doctors.