Physician perceptions of HMO care for older persons

OBJECTIVE: Physician attitudes may be a key factor in effective managed car e for older patients. We sought to explore physicians' views of the influen ce of health maintenance organization (HMO) policies on the care of their o lder patients. DESIGN: A self-administered one-page questionnaire consisting of questions about physician demographics, the impact of HMOs on physician practice, pat ient care, HMO policies, and respondents' personal use of managed health ca re plans. PARTICIPANTS: The survey was mailed to 838 randomly selected primary care p hysicians affiliated with two large, nonprofit, academically-oriented, Medi care HMOs in Massachusetts. RESULTS: Completed surveys were received from 516 of 797 eligible primary c are physicians, affiliated with either Secure Horizons (Tufts Associated He alth Plan) or FirstSeniority (Harvard Pilgrim Health Care). About half (55% ) of the physician respondents reported they had sufficient time to spend w ith their older patients. Most (81%) respondents indicated that overall, pa tients aged 65 and older received either better care or no change in care a fter joining an HMO. The majority of physicians reported that HMO affiliati on had increased the frequency with which they addressed geriatric issues w ith their older patients. There were several patterns of response that emer ged with respect to beliefs about key HMO policies. CONCLUSIONS: The majority of physicians working in two nonprofit, academica lly oriented Medicare HMOs in Massachusetts believed that the overall quali ty of care that older patients received after joining an HMO either did not change or improved.