Do patients continue to see physicians who are removed from a PPO network?

Area of Science:

• Health Services Research
• Health Economics

Background:

• Preferred provider organization (PPO) networks often adjust their physician network composition.
• Understanding patient response to network changes is crucial for healthcare management.

Purpose of the Study:

• To evaluate the impact of physician exclusion from a PPO network on patient care utilization.
• To determine if excluding physicians leads to increased demand for emergency or inpatient services.

Main Methods:

• Analysis of a natural experiment involving PPO network narrowing.
• Panel data analysis compared patient discontinuation rates for excluded physicians before and after network changes.
• Propensity score-matched comparison groups analyzed office visits, emergency department visits, and inpatient admissions.

Main Results:

• Physician exclusion significantly reduced the likelihood of patients continuing care with those doctors (OR, 0.18; P <.001).
• Patients seeing excluded physicians decreased office visits by 0.9 visits/year more than control groups (P <.001).
• No significant changes in emergency department or inpatient admissions were observed for patients of excluded physicians.

Conclusions:

• Substantial copayment differentials can effectively guide patients toward network-compliant physicians.
• Tiered networks, if based on quality and cost data, may enhance healthcare value.