Associations between primary care physician satisfaction and self-reportedaspects of utilization management

Objective. To evaluate the association between physician-reported utilizati on management (UM) techniques in capitated physician groups and physician s atisfaction with capitated care. Study Setting. 1,138 primary care physicians from 89 California capitated p hysician groups in 1995. Study Design. Eighty percent of physicians (N = 910) responded to a mail su rvey regarding the UM policies in their groups and their satisfaction with the care they deliver. Physician-reported UM strategies measured included g roup-mandated preauthorization (number of referrals requiring preauthorizat ion, referral denial rate, and referral turnaround time), group-provided ex plicit practice guidelines, and group-delivered educational programs regard ing capitated care. We also measured two key dimensions of satisfaction wit h capitated care (multi- item scales): (1) satisfaction with capitated care autonomy and quality, and (2) satisfaction with administrative burden for capitated patients. Extraction Methods. We constructed two multivariate linear regression model s to examine associations between physician-reported UM strategies and phys ician satisfaction, controlling for demographic and practice characteristic s and adjusting for clustering. Principal Findings. Physician-reported denial rate and turnaround time were significantly negatively associated with capitated care satisfaction. Phys icians who reported that their groups provided more guidelines were more sa tisfied on both dimensions, while physicians who reported that their groups sponsored more educational programs were more satisfied with administrativ e burden. The number of clinical decisions requiring preauthorization was n ot significantly associated with either dimension of satisfaction. Conclusions. Physicians who reported that their groups used UM methods that directly affected their autonomy (high denial rates and long turnaround ti mes) were less satisfied with care for capitated patients. However, a preau thorization policy for referrals or tests was not, in and of itself, associ ated with satisfaction. Indirect control mechanisms such as guidelines and education were positively associated with satisfaction.