More California physicians rejecting new HMO patients

In the state considered managed care's bellwether, more physicians are feeling empowered to limit themselves to PPO and cash-paying patients.

By Robert Kazel, AMNews staff. Jan. 13, 2003.

Fewer doctors are accepting HMO insurance coverage in California, the state that once was viewed as a vast laboratory of managed care innovation, a study said.

Just 58% of physicians in the state are accepting new HMO patients, according to the California Workforce Initiative's December 2002 report. And only 77% of office-based primary care doctors in the state had any HMO patients in 2001, compared with 80% five years earlier.

"In a state like California, that led the charge into managed care, the retreat really has now sounded for managed care," said Kevin Grumbach, MD, principal author of the CWI report, "California Physicians 2002: Practice and Perceptions," and director of research at the University of California, San Francisco, Center for the Health Professions.

Doctors in the state are feeling more empowered to exclude HMOs and limit their practices to patients willing to pay cash upfront or those from preferred provider organizations or point-of-service organizations, said Dr. Grumbach, an associate professor in the Dept. of Family and Community Medicine at UCSF. "Previously, doctors in solo, small offices got dragged kicking and screaming into HMOs because they saw it as an economic necessity."

The CWI report said that the "California model" of managed care, in which many private physician practices remain independent from insurers but are loosely linked to them through HMO contracts, is "unraveling," partly because fewer doctors are part of an independent practice association. Those associations traditionally were most closely aligned with HMO networks in California.