MANAGED CARE INVOLVEMENT BY CARDIOVASCULAR SPECIALISTS - PREVALENCE, ATTITUDES AND INFLUENCE ON PRACTICE

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.