Why HHS Abandoned “Secret Shopper” Study of Access to Care

by Charles Fiegl, AMNews Staff, reprinted from American Medical News

A proposed initiative using so-called mystery shoppers to determine the level of access to primary care physicians across the country has been put on hold indefinitely following scrutiny of the proposal.

The Department of Health and Human Services decided June 28 not to go forward with the proposed study after reviewing public comments on the plan, an HHS official said.  Instead, the department said it will continue to focus on other initiatives aimed at increasing access to health care services.

HHS had first published a notice about the study on April 28.  The $347,000 study would have targeted more than 4,000 family medicine, pediatric, general medicine, internal medicine and obstetrics-gynecology practices in nine states:  Florida, Hawaii, Massachusetts, Minnesota, New Mexico, North Carolina, Tennessee, Texas and West Virginia, according to supporting documents from HHS.  The practices would have been contacted by a mystery shopper once pretending to have private insurance and a second time posing as an enrollee in a public health program.  Additionally, 465 practices would have been called a third time.  The caller would have informed the practice of the study and asked if it accepted new patients and how long it would take to get an appointment.

Documents for the proposal listed several scenarios for publicly and privately insured patients.  The mystery shopper would have used a script to determine if the practice accepted new patients and if the practice accepted a certain type of insurance more readily than another.  One scenario involved a mystery shopper with private insurance who needed to see the doctor as soon as possible.  The script included a list of symptoms that the caller would have stated when prompted by the front desk staff.

“I’ve had a cough for the last two weeks, and now I’m running a fever,” the caller would say.  “I’ve been coughing up thick, greenish mucus that has some blood in it, and I’m a little short of breath.”

But that script might have failed to produce the results HHS was looking for, said Glen Stream, MD, president-elect of the American Academy of Family Physicians.  Staff probably would have recommended that the caller seek urgent care instead of scheduling an appointment, he said.

Dr. Stream suggested a more direct approach of asking physicians whether they accept patients with public health plans and how long patients wait for an initial appointment.

Before HHS rescinded the proposal, American Medical Association Immediate Past President Cecil B. Wilson, MD, said in a statement that studies have shown patients have experienced access issues when it comes to primary care.  “The government should be working to address this shortage so all patients can have access to the health care they need, rather than using mystery shoppers to tell us what we already know,” Dr. Wilson said.

Detractors of the proposal suggested that the Obama administration was attempting to ensnare physician practices by catching office staff in a lie or demonstrating that practices discriminated against patients with public insurance.

But, in general, limiting the number of Medicare patients compared with the number of appointment slots for private pay patients is not going to get practices in legal trouble, said William Maruca, a health care attorney at Fox Rothschild in Pittsburgh.  Physicians and practice administrators often set ratios for the right payer mix to keep practices financially sustainable, he said.

The mystery shopper plan was first reported by American Medical News on June 6.  An article about the initiative appeared on the cover of The New York Times on June 27, the day the comment period on the survey ended.

HHS says that the decision to pull the plug the following day was based on public comments, not political pressure.  House Republican Policy Committee Chair Tom Price, MD (R, Ga.) was among several Republicans in Congress who cited the Times article and criticized the administration for attempting to “spy on” physicians.

“I was relieved to hear that HHS was suspending this program,” Rep. Michael Burgess, MD (R, Texas), said on June 30.  “The approach that HHS planned to take would yield unintended consequences and would have only further driven physicians away from public insurance.”

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