Bring Back the Mystery Shopper Survey

Today’s Managing Health Care Cost Indicator is $8.76 billion

The Obama Administration announced yesterday that it would halt its “mystery shopper” survey,  which would have assessed potential primary care access problems.  Under the program, a survey company would have called physician offices three times – posing as a new patient with an urgent problem (coughing up blood) or a routine need (annual physical exam).   The mystery shopper survey would have sampled just under 5000 physicians in 9 states, and about 500 of them would have gotten a third call,  asking on behalf of the Department of Health and Human Services if the office accepted private insurance, public insurance, and self-pay patients. 

Physicians expressed anger at the proposed mystery shopper survey – likening it to “snooping” and “Big Brother.”  One physician said

Is this a good use of tax money? Probably not. Everybody with a brain knows we do not have enough doctors.

The survey was to have cost $347,370.  

Although there is a general sense that there is a shortage of primary care physicians, not everyone agrees that we have a physician shortage. 

The senior researchers of the Dartmouth Atlas,   for instance, point out that newly trained physicians often don’t choose primary care, and they mostly settle in areas that already appear to have adequate or excess supply.   Without question, training more physicians costs more federal dollars (Medicare paid $8.76 billion toward graduate medical education in 2008.)  Furthermore, new physicians will generate more bills for their own services, and will order tests and drugs and other physician referrals, leading to still more expenses.

I know it's hard to find a primary care physician in metro Boston, but I’m not sure of the right answer about whether we need more physicians.  I believe that we need a differential way to drive new physicians toward primary care rather than specialties.  Further, I believe we need to get physicians out of doing work that can be done by nonphysicians, and increase use and supply of nurse practitioners and physician assistants.

The mystery shopper survey appears to me to be a well-designed and much-needed study. How can we be sure we have the right diagnosis if we don’t collect the right information?  The Obama Administration should not have backed down.