An. Demaria et al., MANAGED CARE INVOLVEMENT BY CARDIOVASCULAR SPECIALISTS - PREVALENCE, ATTITUDES AND INFLUENCE ON PRACTICE, Journal of the American College of Cardiology, 23(5), 1994, pp. 1245-1253
Objectives. The purpose of this study was to determine the involvement
in and attitudes toward managed care by cardiovascular specialists an
d the influence of such programs on their practices. Background. No in
-depth study has measured the impact of managed care on cardiovascular
specialists, Therefore, we conducted a mail survey to determine the p
revalence of managed care arrangements among cardiovascular specialist
s and variations among pediatric and adult cardiologists and cardiovas
cular surgeons; the types of managed care arrangements in which cardio
vascular specialists are engaged; the reasons why those not participat
ing in managed care have chosen not to do so; and the general attitude
s among cardiovascular specialists with regard to various aspects of m
anaged care. In addition, we evaluated the impact of managed care amon
g several aspects of cardiovascular practice. Methods. A questionnaire
was mailed in the spring of 1993 to 4,577 practicing, domestic, Ameri
can College of Cardiology (ACC) members selected at random from within
each primary cardiovascular specialty group (adult cardiologists, ped
iatric cardiologists and cardiovascular surgeons). Additional data con
cerning practice characteristics were cross tabulated using results fr
om the 1992 ACC membership profile survey. Results. In total, 1,961 of
the 4,577 members responded to the survey, representing a 43% respons
e rate. Of all survey respondents, 76% reported entering into at least
one relationship with a health maintenance organization (HMO) or pref
erred provider organization (PPO), Of those not participating in manag
ed care arrangements, the most frequently mentioned reason was ''conce
rn over the quality of care.'' This reason was cited by 51% of those n
ot entering into HMO relationships and 41% of those not participating
in PPOs. The majority of respondents indicated that they do not strong
ly object to the gatekeeper approach to managing nonemergent patients,
although more than half indicated concern that gatekeepers may not be
appropriate in the manage ment of cardiac emergencies. In addition, c
ardiovascular specialists report that under managed care, referrals ha
ve not increased, income has decreased, and managed care formularies h
ave not substantially affected their ability to prescribe appropriate
medication to their patients. Conclusions. Despite concerns over the q
uality of care and contract requirements and general philosophical opp
osition of cardiovascular specialists, most are becoming integrated in
to managed tare environments.