More physicians working without managed care contracts

WASHINGTON, D.C.-There's no mass exodus, but slightly more U.S. doctors are practicing without any contracts with managed care organizations (MCOs). The no-contract cadre accounted for 11.5% of physicians in 2005, compared with 9.2% in 2000, according to a study by the Center for Studying Health System Change (HSC).

This small, but significant, increase could mean "higher out-of-pocket costs for patients and a decline in patient access to physicians," says HSC President Paul Ginsburg.

Without managed care contracts, independent physicians bill patients directly or require cash payments. The independent physicians tend to be older Westerners in small practices.

Also, an increase in patients in PPOs that reimburse for out-of-network care may be encouraging more physicians to curb direct contracting.

The full report, "No Exodus: Physicians and Managed Care Networks," is at http:// http://www.hschange.org/.