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(THE RUNDOWN VOLUME 15, NUMBER 47; NOVEMBER 27, 1995)
The changes have been quick and many. Fewer and fewer people can go to any doctor they want, and submit the bills to their insurance companies who will pay most of that cost, while an employer pays the bulk of the insurance bill. Doing it cheaper may have replaced doing it better as the top goal of medical treatment. Access to emergency rooms and medical experts is being restricted.
The impact of all this has just been examined in a major project in Boston. Viewer interest was shown by apparent ratings spikes. This series showed us once again: CONTENT WINS.
To find out what is really happening to health care, WCVB-TV polled the people prescribing and the people receiving treatments: the doctors and the patients. The physicians poll provided rare insights from experts who tend to be conservative and not outspoken. The patients poll showed the actual size and impact of the changes.
The surveys discovered:
"We were looking to find out what people think of the recent changes and managed care. We also realized that no one had heard from the doctors. There were a lot of perceptions of what doctors thought, but what did they really think?" --- Candy Altman News Director, WCVB-TV
Several reports were prepared by the WCVB news team as part of "HMOs: Prescription For Concern?"
As costs have risen for the traditional fee-for-service insurance plans, employers who pay for medical benefits have turned to the promise of contained costs from health maintenance organizations. HMOs attempt managed care --- pressing for reduced hospital stays, limiting access to specialists, paying doctors a fixed salary or a fixed amount for patients they treat.
Managed care has been a choice for health consumers in the greater Boston region for over a decade. Managed care penetration is about 50 percent of the health care market.
"This area has been in the forefront of developing managed care, because of all the medical institutions here. We were looking to find out who likes it, who doesn't? It is what everyone is talking about in relation to their own health care," says News Director Candy Altman.
The intensity of this interest showed in the ratings. "We really thought it was an important topic, and we got a ratings spike from it! We got our highest 6 o'clock number in November from it," she says.
The reports included the polling conclusions, personal examples, and expert opinions about the trends. "Viewers really responded to it. It is one of those things that touches everyone. I felt really good about it, as something that lent some information to the community. It was substantive, and what I was most heartened by was the fact that people responded to it," Altman says. The pieces ran at 6 and 11 over three nights. Reporting was done by Medical Editor Dr. Tim Johnson, anchor Natalie Jacobson and health reporter Heather Kahn.
Managed care is a big subject, and Altman says a poll helps sharpen the storyline. "Issue-oriented reporting sometimes is difficult to wrap your hands around. The poll helped focus the pieces," she says.
The television station worked with The Boston Herald, which is its partner for
political polling. "If you have a newspaper partner in the market, it helps from a
cost standpoint. Polling is expensive," she says. "If you get a partner, it also
serves a cross-promotional value," she adds. WCVB would tease what was coming up next
on its air, and what was coming up in the
Managing Editor Neil Ungerleider spearheaded the project, coordinating polling with the Herald and working with the producers and reporters. "We believe in content," says Ungerleider. "We allowed our reporting to be shaped by the findings of the poll. We did not go into this with a preconceived notion. We went into it believing that the revolution in the way people receive their health care and the kind of insurance they have, was an issue of great importance to virtually everybody who watches us," he explains. The news managers met with their pollster several times to design the questions. They wanted to hear from doctors and patients, and came up with the kinds of concerns they thought were on patients' minds.
The questions and subject areas were similar in the two surveys. They developed a picture of what is being done in practice, and how the two groups feel about this. They reached 411 adult patients and 200 physicians. Both surveys were done in October.
While many patients were satisfied, some had doubts about HMOs. The patients --- at the moment --- seem more satisfied with managed care and the changes than are the medical experts who are doing it every day. "People who were in managed care programs all along were generally very happy. But people who had earlier experience with fee-for-service plans, were not quite as happy," Altman says. More than one-quarter of those who had switched were dissatisfied. Those with doubts about HMOs are questioning restrictions on their access to doctors of their choice, specialists and emergency service. There is also a substantial group that feels business reasons have begun dominating medical considerations when it comes to treatment options.
Key arguments about HMOs were presented by two patients edited in a concise point-counterpoint.
Sharon: "I want to go to a doctor I feel comfortable with."
Pat: "You get the same quality care for a cheaper premium."
Sharon: "I don't want them to give me a book and say these are the doctors you can pick from."
Pat: "Prescriptions are covered also for five dollars."
Pat had toddlers and many visits to doctors. She liked the price for the high volume service. She said her managed care experience had been great. Sharon had felt her HMO's restrictions. When she was five months pregnant, she walked out on her deck, slipped and fell. She crawled back into her house. Instead of placing her first call for help, she had to call an 800- number to get permission to go to the emergency room to have her foot x-rayed.
The poll found that one out of seven HMO participants had been denied emergency treatment. When you combine "denied" treatment with "discouraged from going to an emergency room," the proportion increases to one out of five. A woman left the mass transit at a Dorchester station. "I saw a fellow jump out of the car and that's when I started running," she said. The man attacked her. She hit her head on a fire hydrant and lost consciousness. At a hospital emergency room, the staff called her primary care physician to approve the visit. She was treated for a concussion. The x-rays showed damage to nerves by her spine. Her injury was ruled not an emergency. She was denied reimbursement. She said, "It was a nightmare in itself to have something like that happen to you. But, it was even a bigger nightmare to get a letter like that from the insurance company."
The pollster reached physicians by obtaining a list of doctors licensed to practice in Massachusetts.
"In our survey of doctors, specialists more than general practitioners said they really don't like managed care. They feel they are being squeezed in terms of the amount and kinds of tests they can order," says Altman.
"The hardest, and most important, thing about this is to find doctors who will talk. Doctors have a financial relationship with the insurance companies, and it is very difficult to find doctors who are unhappy to express that unhappiness," Ungerleider says. "That was a lot of work. It took a long time to find doctors who would talk. Patients are relatively easy. You can find people pro and con to talk," says Ungerleider.
A Wellesley doctor who can spend only 15 minutes with most patients called the HMOs bad medicine. "They're managing the care of the patients totally separate from the physicians," said Dr. Burt Hall. This opinion was held by a substantial number of the surveyed doctors. Half believed it is business people who decide your care in an HMO. About the same number thought HMOs prevented doctors from providing needed care in order to save money.
"Now you have to call up and talk to some nurse practitioner and then she makes the decision whether the person should be hospitalized --- not me, who's examining the patient." --- Dr. Bruce Hall Wellesley physician
Dr. Hall said his relationship with some patients has been distanced by managed care. He has had to enforce guidelines of individual HMOs and some patients take it out on him. There were doctors who thought managed care works better for them and their patients. An HMO doctor said, "You join an organization like this and you have the luxury of not having to run a business. You can devote almost all of your energy to running your practice and taking care of your patients."
"We had very frank discussions with doctors who were willing to go on the record about how they feel managed care has impacted them. It wasn't all negative. There were some positive stories about things about managed care that people really felt good about," says Altman.
This is a complex issue. "As Dr. Tim Johnson was quick to point out, this is not a black and white area. There is a lot of gray here, and a lot we still need to learn. Remember, the old system is what brought us here in the first place. The fact is doctors and insurance companies allowed costs to get way out of control, and corporations refused to keep paying the tab," she adds.
WCVB's story was picked up nationally by the AP. ABC network followed up the next with a poll of its own. "The highest interest was in the poll of doctors, because the results from the doctors were pretty startling. The doctors we surveyed believe patients in HMOs get worse care than patients in fee-for-service. That's a pretty strong finding," says Managing Editor Ungerleider.
Ungerleider says other news managers should not feel this issue is just too complicated and large to present effectively.
"It is a high interest subject. It is one of the few subjects you cover in your newscast that affects everybody. By using real life stories, mixed with hard information from polls and other sources, you can produce very interesting pieces," he says. "It's a topic people are really interested in. And, we promoted it for what it was: the first time doctors were speaking out. What does your doctor think about the kind of care he is giving you?" says Altman. "It should remind all of us as news directors that people respond to content. We all do the tie-ins, and some of that works, but it often doesn't work as well as a good, hard-hitting, in-depth investigation. Telling people something they didn't know, should always be the hallmark of what we do," she says.
Copyright 1995, 1996 by Standish Publishing Company. Photocopying, reproduction or quotation is prohibited without the permission of the publisher. THE RUNDOWN (ISSN:0035-9912) is published weekly. Mailing address: Box 335, Ardmore, PA, 19003- 0335.
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