Effect of Selective Contracting on Physician Pricing. Executive Summary and FinalReport

摘要

The principal objectives of the project was a comparison of the rates of growthof the physician fees negotiated by HMOs and the fees paid by indemnity insurance plans. In order to accomplish this four large data sets had to be combined: the survey of negotiated fees, the 'usual, customary and reasonable' fees paid by indemnity plans, census data and managed care penetration data. The first three data sets were created and cleaned in the expected time frame, by the end of month nine in the project, but the managed care data proved to be far more intractable. Managed care plans responding to the SMG survey (the vendors of the managed care plan data) often had inconsistent or ambiguous ways of defining their service areas. As a result, these data required extensive cleaning where data from each plan was examined manually. This cleaning took place over an 18 month period during which the principal investigator reduced expenditures on the project so as to retain the resources that would be needed to complete it when the managed care penetration data would be completed. As a result, approximately $12,000 in direct costs were lost, the amount the principal investigator had intended to use to complete the analysis. The principal investigator is continuing the study at a slower rate using the author's own resources.