Mystery shoppers may be used to check up on TN doctors

Access issues:
Federal researchers hope to gauge whether doctors are open to seeing new Medicaid patients.
Where will this happen?:
The U.S. Department of Health and Human Services hopes to use mystery shopping by telephone in nine states, including Tennessee, starting
this fall.

Why some argue that Medicaid patients can mean more work and red tape for doctors:

• Billing requirements are more complex.
• Reimbursements can be delayed.
• Patients tend to be sicker than the general population and can require more time to treat.

Retailers and bankers are already familiar with the concept. And soon doctors in Tennessee could learn what it means to get a call from the mystery shopper.

Tennessee is among nine states where some physicians’ offices could receive cold telephone calls from researchers posing as patients in a bid to gauge whether primary-care doctors are willing to see patients on Medicaid or private insurance.

“We’re working to expand access to primary care nationally while also tracking the success of those efforts at the community level,” said Richard Kronick, a deputy assistant secretary with the U.S. Department of Health and Human Services.

Under the proposal, which is up for public comment for much of this month, the mystery shopper program would try to gauge how quickly patients are able to get an appointment — especially to see a doctor for the first time.

The mystery shopping idea is bubbling up as a possible strategy as federal health officials make Americans’ access to medical care one of the top national health-care goals.

Doctors here aren’t sure mystery shopping is a wise use of federal resources, though.

“Mystery shoppers are fine for retail and for customer service, but to learn more about the difficulties patients face acquiring appointments, they should talk to patients,” said Russ Miller, a spokesman with the Tennessee Medical Association trade group.

But some patients like the idea and say it could pay dividends.

Nashville resident Phyllis Shelton got health insurance coverage under TennCare and Medicare after a court fight recently, but is still searching for a primary-care physician. Shelton recalls calling a doctor after seeing a sign at a local hospital that said new patients were being accepted only to be told that it didn’t include people on Medicare or Medicaid.

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