Assessment of Unreimbursed Care among Community Primary Care Physicians

Assessment of Unreimbursed Care among Community Primary Care Physicians

Attachment 4 11-21-06

Assessment of Unreimbursed Care among Community Primary Care Physicians

OMB: 0935-0129

Document [doc]
Download: doc | pdf

Thank you for taking the time to complete this survey. Your answers are very important and will be used to analyze the current state of unreimbursed care provided in the offices of primary care physicians.

If you have any questions about your rights as a research subject, you are encouraged to contact Jacqelyn Admire, AAFP IRB Administrator, at (800)274-2237 ex. 3110 or [email protected].


For This Survey, unreimbursed care refers to free or reduced-cost care. This does not include scenarios when payment was expected and not received, care provided to Medicare or Medicaid recipients, payments from insurance companies that are below your billable rate, or care provided as a professional courtesy to the families of colleagues.





1) How many hours do you provide direct patient care during a typical week?

<16


GO TO page 14

16-25

26-35

36-45

>45




2) Approximately how many patients do you personally see during a typical week?

<25

25-50

51-75

76-100

101-125

>125




3) In your current practice setting do you provide unreimbursed care to patients?

Yes


GO TO question 4

No







3a) In the past did you provide unreimbursed care to your patients?

Yes


GO TO question 3c

No








3b) What are the reasons you do not provide unreimbursed care?

Please check all that apply.

There is no need in my community

There is no tradition in my practice of providing unreimbursed care

I do not have the financial ability to provide unreimbursed care

I do not think that it is part of my responsibilities as a physician to provide unreimbursed care

I am not able to take on unreimbursed care patients because I am fully booked with my other patients

I am not in a position to decide which patients I see and which I do not see

Other (Specify)




GO TO Question 3d



3c) What are the reasons you no longer provide unreimbursed care?

Please check all that apply.

The practice has considered the matter and feels it no longer has the financial ability to provide unreimbursed care

The practice has considered the matter and for reasons other than financial has decided not to provide unreimbursed care

I have changed practices and my new practice has a policy discouraging unreimbursed care

I have recently started a new practice and I am just getting established. I may provide unreimbursed care in the future

There are new options for safety-net care in the community and I refer patients to them

I felt like my patients took advantage of me in the past when I provided unreimbursed care

Other (Specify)




3d) Which of the following would be needed in order for you to begin providing unreimbursed care?

Please check all that apply.

A system to determine eligibility for unreimbursed care that reduces decision making burden

Tax credits to allow me to defray some of the costs of providing unreimbursed care

More support from the local health care system with referrals and hospitalizations

Increased availability of state and Federal assistance for unreimbursed care

Increased appreciation from the patients to whom I provide unreimbursed care

More flexibility in determining the patients that I am able to see

More time to get my medical practice established

Increased need within my community

More support from ancillary services (labs, radiology, pharmacy)

None of the above

Other (Specify)



GO TO Page 14


4) What kind of unreimbursed care do you currently provide?



Never

Daily


Weekly


Monthly or less


0

1

2

3

4

5

Free service in the office

Discounted service in the office

Discounted or free service outside the office (i.e. home visit)

Other (Specify)




4a) How often do you provide unreimbursed care to patients in each age group?


Never

Daily


Weekly


Monthly or less


0

1

2

3

4

5

<19 years

19-65 years

>65 years



4b) How often do you provide the following services for your unreimbursed care patients?



Never

Daily


Weekly


Monthly or less


0

1

2

3

4

5

Evaluation of acute problem

Chronic problem (routine follow-up)

Chronic problem (flare up)

Pre/post surgery/injury follow-up

Non-illness care (prevention, screening)

Administrative office services (i.e. completion of forms, photocopying)

Other (Specify)





5) In the past, have you provided unreimbursed care to patients with whom you have not established a relationship (i.e. new patients)?

Yes

No




6) When a patient receives unreimbursed care from you, who determines their eligibility?


Never

Sometimes

Always


1

2

3

It is my individual decision

It is a decision made by the administrative staff within my office

It is a decision made by the administrative staff within our institution but not in my office

It is a decision made by an outside agency that reports a patient's eligibility to our practice




7) What does your practice or outside agency require to determine a patient's eligibility for unreimbursed care?

Please check all that apply.

No written verification required

Previous year's tax returns

Recent W2 or paystub

Qualification for other Federal/State assistance

Document that another organization has previously verified eligibility (i.e. Hospital Social Services)

Do not know

Other (Specify)



8) Over the past year, how has the amount of unreimbursed care you provided changed?

Decreased

Stayed about

the same

Increased


If you answered “Stayed about the same,” Please GO TO Question 9



8a) What was the reason for this change?

Please check all that apply.

Change in leadership/ownership of practice

Change in the need for unreimbursed care

Change in the environment outside the practice (i.e. closing or opening of safety net provider)

Other (Specify)


9) What do you expect will happen to the level of unreimbursed care that you provide in the next year?

Decrease

Stay about the same

Increase



10) How important are the following factors in determining your willingness to offer unreimbursed care?



Not

Important

Somewhat Important

Very Important


1

2

3

4

5

Desire to provide continuity of care to patients who have lost their insurance coverage

Needs from new patients requesting appointments

Responsibility for follow-up care of patients I have seen in the ER

Tradition in my practice

Tradition among my peers and colleagues

Requests from the friends and family of clinic staff

The economic stability of my practice allows me to provide unreimbursed care

My personal or religious values

My involvement in a teaching program

My desire to help my community

My patient's appreciation of the unreimbursed care they receive from me

My personal satisfaction as a physician

Other (Specify)



11) How important are the following factors in limiting your ability to provide unreimbursed care?


Not

Important

Somewhat Important

Very Important


1

2

3

4

5

Availability of sufficient alternatives within the community

Medical liability concerns

Discomfort of regular patients with the presence of charity patients in my waiting room

Corporate policies

*Pressure to be productive with time

**Declining profitability of practice or revenue per patient

Other (Specify)





*11a) Many physicians feel that pressure to be productive with their time limits the amount of unreimbursed care they can provide. What is the source of the pressure?

Please check all that apply.

This is not a concern for my practice

The need for higher volume of paying patients to maintain profitability

The need for higher volume of paying patients to keep practice profitability growing

Specific incentives or demands from employer/manager

Specific financial incentives from managed care organizations or other payers

The high need of paying patients and lack of time to serve non-paying patients

Other (Specify)




**11b) Many physicians feel that a decline in the profitability of their practice limits the amount of unreimbursed care they are able to provide. What has been the cause of this decline?

Please check all that apply.

This is not a concern for my practice

Rising costs

Declining payments

Both rising costs and declining payments

Other (Specify)



12) How often have you done the following in order to provide unreimbursed care to a patient?


Never

Daily

Weekly

Monthly or less


0

1

2

3

4

5

Down coded a visit for an unreimbursed care patient

Discarded the billing slip for an unreimbursed care patient

Evaluated an unreimbursed care patient before insurance coverage is verified

Provided more than usual information during a phone consult to an unreimbursed care patient in order to avoid an office visit

Used email to prevent unreimbursed care patients from having to incur office visit charges

Wrote a prescription for an insured patient that is meant for a family member

Called a colleague (including specialists) on behalf of an unreimbursed care patient

Called a lab/radiology service on behalf of an unreimbursed care patient

Gave an unreimbursed care patient medical supplies from your office

Examined two family members but only billed for the insured person

Personally provided an administrative service that would otherwise be charged to the patient

Provided unreimbursed care patients with sample medications from your office

Other (Specify)





13) To what extent do your own personal financial gains derived from your practice affect the amount of unreimbursed care you are willing to provide?

Not at All

Somewhat

Greatly

1

2

3

4

5


14) How often do you have difficulty referring unreimbursed care patients out for specialist care?

Never

Sometimes

Always

1

2

3

4

5






If you selected “Never,” Please GO TO Question 15




14a) Is this difficulty in referring to specialists related to?

Please check all that apply.

A general lack of specialists in the region

A lack of a mechanism for referring unreimbursed patients from the office

General unwillingness of specialists to accept unreimbursed care patients

Unwillingness of patients to see specialist

Formal policies that restrict referral of patients

Cost associated with specialist care

None of the above

Other (Specify)





15) How often do you have difficulty referring unreimbursed care patients out for lab services?

Never

Sometimes

Always

1

2

3

4

5






If you selected “Never,” Please GO TO Question 16




15a) Is this difficulty in referring unreimbursed patients to labs related to?

Please check all that apply.

A general lack of laboratory services in the region

A lack of a mechanism for referring unreimbursed patients from the office

General unwillingness of laboratories in your region to accept unreimbursed care patients

The existence of formal policies that restrict the patient's ability to obtain laboratory services

Cost associated with laboratory testing

None of the above

Other (Specify)




16) How often do you have difficulty referring unreimbursed care patients out for radiology or imaging services?

Never

Sometimes

Always

1

2

3

4

5






If you selected “Never” Please GO TO Question 17




16a) Is this difficulty in referring unreimbursed care patients out for radiology or imaging services related to?

Please check all that apply.

A general lack of radiology services in your region

A lack of a mechanism for referring unreimbursed patients from the office

General unwillingness of radiology or imaging departments to accept unreimbursed care patients

The existence of formal policies that restrict a patient's ability to obtain radiology services

The cost associated with radiology service

None of the above

Other (Specify)





17) How often do you have difficulty accessing medications for unreimbursed care patients?

Never

Sometimes

Always

1

2

3

4

5






If you selected “Never” Please GO TO Page 14





17a) Is this difficulty in accessing medications related to?

Please check all that apply.

A general lack of available pharmacies in your region

A lack of a mechanism for referring unreimbursed patients from the office

General unwillingness of pharmacies to accept unreimbursed care patients

The existence of formal policies that restrict a patient's ability to obtain medications

The cost associated with filling prescriptions

Medication assistance program requirements are too onerous

There are no local medication assistance programs accessible to my patients

Local medication assistance program requirements are too onerous

None of the above

Other (Specify)



Please tell us a little about yourself



What is your gender?

Male

Female




What year were you born?




What year did you graduate from medical school?





Are you of Hispanic/Latino origin?

Yes

No



What is your race?

Please check all that apply.

American Indian or Alaskan Native

Asian

Black or African American

Pacific Islander/Native Hawaiian

White

Other






Please tell us a little about your group practice

Does your practice have more than one location?

Yes

No

Including yourself, how many clinicians (MDs, NPs, PAs) are associated with your group? Please include full and part time clinicians.

1

2-3

4-7

8-12

>12

Is this a single- or multi- specialty practice?

Single Specialty Practice

Multi-Specialty Practice

Other


Are you a full- or part-owner, employee, or an independent contractor?

Owner

Employee

Contractor

Other


Who owns the practice?

Physician or physician group

HMO

Community health center

Academic health center

Non-academic hospital system

Other health care corporation

Other


Please tell us about the practice location where you see most of your ambulatory patients.

Including yourself, how many clinicians (MDs, NPs, PAs) provide direct patient care at the location where you see most of your patients? Please include full and part time clinicians.

1

2-3

4-7

8-12

>12



How would you identify the geographic location where you provide the most direct patient care?

Urban: Central City

Urban: Non-central City

Suburban

Rural



In what zip code is the location at which you provide the most direct patient care? (This information will be used to describe the individual characteristics of your practice location, not to identify you personally)











Thank you for taking the survey. The information will assist the Agency for Healthcare Research and Quality (AHRQ) and the American Academy of Family Physicians (AAFP) to understand the factors affecting the current state of safety net care in the family practice environment.



17


File Typeapplication/msword
File TitleThank you for taking the time to complete this survey
Authorhamlin-ben
Last Modified Byhamlin-ben
File Modified2006-11-21
File Created2006-11-21

© 2024 OMB.report | Privacy Policy