Reports from the Field-Managed care
Docs control referrals to specialists
A recent study of primary care physician referrals to specialists in a large managed care organization (MCO) found that referral rates and variations in referral rates remained very stable over time and for various diagnoses, even after adjusting for differences in patient mix.
The MCO in the study used an independent practice association (IPA) model, in which neither primary physicians or specialists were capitated. Each patient was assigned a primary physician, and more than 95% of local primary physicians participated in the IPA.
Researchers analyzed referral rates for adults 25 and older enrolled in the MCO during 1995 and 1996. In the study, family physicians referred significantly fewer patients than internists, and older physicians made more referrals than younger physicians. The large variations in primary physician referral rates from 5% to more than 60% were only minimally affected by patient mix.
The study concludes that primary physician referral rates largely reflect a physician-driven behavior that is stable over time. Researchers now are studying what physician characteristics drive referral behavior and the impact of referrals on costs and patient outcomes.
[See: Franks P, Zwanziger J, Mooney C, et al. Variations in primary care physician referral rates. Health Services Research 1999; 34: 323-329.]
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