A study in the American Journal of Managed Care that measured patient satisfaction and quality of care in managed care organizations, or MCOs, against primary care provider turnover rates found that higher primary care provider turnover rates were tied to lower patient satisfaction scores.
Primary Care Provider Turnover Rates Affect How Patients View MCO Quality
By News Staff
11/13/2007
"Primary Care Provider Turnover and Quality in Managed Care Organizations," investigates associations between primary care provider -- defined as physicians, nurse practitioners and physician assistants -- turnover rates and quality-of-care indicators, including measures of member satisfaction and preventive care. The data for the retrospective study came from the National Committee for Quality Assurance, or NCQA, and included all commercial MCOs that reported data to NCQA on the variables measured from 1998 to 2000.
The study looked at two types of outcomes. First, the authors looked at data that measures member experiences in three domains: overall satisfaction with the health care provider (e.g., overall rating, listening skills); satisfaction with the timeliness of care (e.g., ability to obtain appointments, how often a member had to wait in the clinic for longer than 15 minutes); and overall satisfaction with health care and the health plan. Second, the authors looked at data that measures preventive care, including the percentage of childhood immunizations by age 2, well-child visits within the first 15 months of life, cardiovascular secondary disease prevention screening, cancer screening, and diabetes management.
The authors found that turnover rates for primary care providers in MCOs ranged from 0 to 53.3 percent. The median turnover rate was 7.1 percent. Organizations with the highest turnover rates were in the East North Central and South Central regions of the country, were most often health maintenance organizations, had fewer members with a greater than high-school education and had more non-white members.
In terms of member satisfaction measures, organizations that had the highest rates of primary care provider turnover had lower ratings in the areas of satisfaction with personal physicians, getting appointments, wait time in the clinic and satisfaction with the health plan and health care. A 10 percent higher primary care provider turnover rate was associated with 0.9 percent fewer members rating their overall satisfaction with their health care as greater than 7 out of 10.
In addition, in terms of preventive care measures, the study authors found that higher primary care provider turnover was associated with lower rates of childhood immunizations, well-child visits in the first 15 months of life, cholesterol screening and cervical cancer screening. Managed care organizations that had a 10 percent higher provider turnover rate had a 2.7 percent lower rate of child members receiving well-child visits in the first 15 months of life, a 1.5 percent lower rate of childhood immunizations, a 1.7 percent lower rate of cholesterol screening after a heart attack and a 1.2 percent lower rate of cervical cancer screening.
According to the study's authors, "Our results align with the continuity of care literature, suggesting that providers who remain in an organization are able to build and maintain a relationship with their patients and, consequently, have more satisfied patients." They suggest that managed care organizations monitor primary care provider turnover rates as a "potential measure of quality."
"Measures implemented at the organizational level to decrease primary care provider turnover may potentially improve (MCO) member satisfaction and preventive care, with the goal of improving retention and overall quality of care," say the authors.
The study looked at two types of outcomes. First, the authors looked at data that measures member experiences in three domains: overall satisfaction with the health care provider (e.g., overall rating, listening skills); satisfaction with the timeliness of care (e.g., ability to obtain appointments, how often a member had to wait in the clinic for longer than 15 minutes); and overall satisfaction with health care and the health plan. Second, the authors looked at data that measures preventive care, including the percentage of childhood immunizations by age 2, well-child visits within the first 15 months of life, cardiovascular secondary disease prevention screening, cancer screening, and diabetes management.
The authors found that turnover rates for primary care providers in MCOs ranged from 0 to 53.3 percent. The median turnover rate was 7.1 percent. Organizations with the highest turnover rates were in the East North Central and South Central regions of the country, were most often health maintenance organizations, had fewer members with a greater than high-school education and had more non-white members.
In terms of member satisfaction measures, organizations that had the highest rates of primary care provider turnover had lower ratings in the areas of satisfaction with personal physicians, getting appointments, wait time in the clinic and satisfaction with the health plan and health care. A 10 percent higher primary care provider turnover rate was associated with 0.9 percent fewer members rating their overall satisfaction with their health care as greater than 7 out of 10.
In addition, in terms of preventive care measures, the study authors found that higher primary care provider turnover was associated with lower rates of childhood immunizations, well-child visits in the first 15 months of life, cholesterol screening and cervical cancer screening. Managed care organizations that had a 10 percent higher provider turnover rate had a 2.7 percent lower rate of child members receiving well-child visits in the first 15 months of life, a 1.5 percent lower rate of childhood immunizations, a 1.7 percent lower rate of cholesterol screening after a heart attack and a 1.2 percent lower rate of cervical cancer screening.
According to the study's authors, "Our results align with the continuity of care literature, suggesting that providers who remain in an organization are able to build and maintain a relationship with their patients and, consequently, have more satisfied patients." They suggest that managed care organizations monitor primary care provider turnover rates as a "potential measure of quality."
"Measures implemented at the organizational level to decrease primary care provider turnover may potentially improve (MCO) member satisfaction and preventive care, with the goal of improving retention and overall quality of care," say the authors.
