title: Associations between primary care physician satisfaction and self-reported aspects of utilization management.
abstract: OBJECTIVE
  To evaluate the association between physician-reported utilization management (UM) techniques in capitated physician groups and physician satisfaction with capitated care.
  
  
  METHODS
  1,138 primary care physicians from 89 California capitated physician groups in 1995.
  
  
  METHODS
  Eighty percent of physicians (N = 910) responded to a mail survey regarding the UM policies in their groups and their satisfaction with the care they deliver. Physician-reported UM strategies measured included group-mandated preauthorization (number of referrals requiring preauthorization, referral denial rate, and referral turnaround time), group-provided explicit practice guidelines, and group-delivered educational programs regarding capitated care. We also measured two key dimensions of satisfaction with capitated care (multi-item scales): (1) satisfaction with capitated care autonomy and quality, and (2) satisfaction with administrative burden for capitated patients.
  
  
  METHODS
  We constructed two multivariate linear regression models to examine associations between physician-reported UM strategies and physician satisfaction, controlling for demographic and practice characteristics and adjusting for clustering.
  
  
  RESULTS
  Physician-reported denial rate and turnaround time were significantly negatively associated with capitated care satisfaction. Physicians who reported that their groups provided more guidelines were more satisfied on both dimensions, while physicians who reported that their groups sponsored more educational programs were more satisfied with administrative burden. The number of clinical decisions requiring preauthorization was not significantly associated with either dimension of satisfaction.
  
  
  CONCLUSIONS
  Physicians who reported that their groups used UM methods that directly affected their autonomy (high denial rates and long turnaround times) were less satisfied with care for capitated patients. However, a preauthorization policy for referrals or tests was not, in and of itself, associated with satisfaction. Indirect control mechanisms such as guidelines and education were positively associated with satisfaction.
authors.affiliation: Ann Arbor VA Center for Practice Management and Outcomes Research, MI 48113-0170, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Kerr
authors.forename: B S
authors.initials: BS
authors.lastname: Mittman
authors.forename: R D
authors.initials: RD
authors.lastname: Hays
authors.forename: J K
authors.initials: JK
authors.lastname: Zemencuk
authors.forename: J
authors.initials: J
authors.lastname: Pitts
authors.forename: R H
authors.initials: RH
authors.lastname: Brook
mesh_terms: D000328:Adult; D002140:California; D002204:Capitation Fee / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000458:organization & administration / Q000523:psychology* / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data; D011897:Random Allocation; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014600:Utilization Review / Q000458:organization & administration* / Q000706:statistics & numerical data; D000078329:Workforce