Physician Satisfaction with Medicaid Managed Care

,

Original Research

Physician Satisfaction with Medicaid Managed Care

J Fam Pract. 2000 January;49(1):20-26

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Physician Satisfaction with Commercial Managed Care

Physicians expressed neutrality toward clinical autonomy (mean = 2.95, standard deviation [SD] = 0.84), neutrality or slight dissatisfaction with organizational autonomy (mean = 2.63, SD = 0.89) and reimbursement (mean = 2.49, SD = 0.98), and neutrality to satisfaction with patient relationships (mean = 3.22, SD = 0.84).

Comparison of Physician Satisfaction Components Among Insurance Types

We compared scores on satisfaction scales by determining the relative mean difference between various insurance types and Medicaid managed care. This was calculated by subtracting mean satisfaction scale scores for different insurance types from mean Medicaid managed care scores and dividing that result by the maximum possible range for that scale. For these comparisons, experienced researchers’ consensus opinion was that a 10% difference would be meaningful. In the Medicaid managed care sample, satisfaction with reimbursement was less with Medicaid managed care than with commercial managed care Table 2. Physicians expressed lower satisfaction with clinical autonomy in a Medicaid managed care system than with their previous traditional Medicaid experience. Satisfaction with Medicaid managed care reimbursement was lower than satisfaction with traditional Medicaid reimbursement measured in the traditional Medicaid sample.

Predictors of Satisfaction

Physicians’ satisfaction with components of satisfaction in a Medicaid managed care system was correlated with overall satisfaction with Medicaid managed care Table 3. Overall satisfaction was also correlated with comfort with workload, caring for patients less than 30 hours per week, being a woman, and being a family physician. Satisfaction was inversely correlated with hours worked, caring for patients more than 60 hours per week, and the number of Medicaid managed care plans in which a physician participated.

We developed 3 stepwise multiple linear regression models using overall satisfaction with Medicaid managed care as the dependent variable. We built 3 models to explore the effects of any instability in the regression models due to missing data. For model 1, satisfaction components were independent variables, and for model 2 all variables that were significant in bivariate analysis were independent variables. Independent variables entered into model 3 were global satisfaction with the practice of medicine, clinical autonomy, workload, number of Medicaid managed care plans in which physicians participated, and whether a physician worked more than 60 hours or less than 30 hours per week in patient care. The resulting models were similar: only model 3 is reported here.* In this regression model, satisfaction with clinical autonomy was the most important predictor of overall satisfaction with Medicaid managed care, accounting for 40% of the variance in overall satisfaction Table 4. Global satisfaction with the practice of medicine, satisfaction with reimbursement, and working less than 30 hours per week in direct patient care were less important predictors of overall satisfaction.

Discussion

This is the first study to measure physician satisfaction with Medicaid managed care in comparison with traditional Medicaid and commercial managed care. Although physicians were less satisfied with Medicaid managed care in comparison with commercial managed care and their previous traditional Medicaid experience, they were not less satisfied with Medicaid managed care in comparison to physician satisfaction with traditional Medicaid measured in the traditional Medicaid sample. This suggests that physicians’ satisfaction level with commercial managed care did not decline from their previous level of satisfaction with traditional Medicaid. The higher satisfaction reported for physicians’ previous experience with traditional Medicaid may be related to implementation of the new Medicaid managed care program.

Physicians’ satisfaction level with clinical autonomy in the Medicaid managed care and commercial managed care systems was similar, indicating that physicians view the methods used to affect their behavior in commercial and Medicaid managed care programs similarly. This finding is supported by the results of a study of Arizona’s Medicaid managed care program.³⁶

Our finding that clinical autonomy was a strong predictor of overall satisfaction with Medicaid managed care is consistent with the findings of other recent studies of physician satisfaction^37,38 and theoretical work that stresses the importance of autonomy in the development of professional identity and functioning.¹⁸ The strength of this association in our study (R2 = .40) highlights the importance physicians place on maintaining their authority to provide the care they believe will best serve their patients. In contrast, satisfaction with reimbursement was a weak predictor of overall satisfaction (R2 = .02). State Medicaid agencies attempting to improve physician satisfaction with Medicaid managed care should work first to improve clinical autonomy while providing reasonable reimbursement. In traditional Medicaid programs, both reimbursement and decreased interference with clinical decision making have been associated with increased rates of participation.^39-41 Increasing physician satisfaction with clinical autonomy in Medicaid managed care plans may result in increased rates of physician participation.