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MINNEAPOLIS-A study indicating that many Twin Cities clinics are failing to provide patients with adequate preventive health services attributes the result in part to a cost squeeze exerted by the area's powerful business health care purchasing coalition.

But a coalition executive says the study's findings are being misinterpreted. In addition, he said, his consortium in the future may offer cash rewards to health plans that score high on preventive services.

And one of the study's authors says bashing the coalition was not the intent of the article.

The study, which appeared last month in the Rochester, Minn.-based Mayo Medical Center's Mayo Clinical Proceedings, polled patients of 44 primary care clinics in the Minneapolis and St. Paul, Minn., area. It concluded that physicians discuss with patients measures such as influenza shots and cholesterol tests less than half the time, and sometimes less than one-third of the time, even though the doctors told researchers such services were important.

While some doctors reported that they simply are "unable to find time" to supply much preventive service, the article also speculated that the collective managed care purchasing activities of about two dozen employers could be driving down prices so low that providers can't afford such activities.

In the Twin Cities area, 26 large employers purchase health insurance together through the Buyers Health Care Action Group, which has attained significant clout in negotiating better health insurance rates with local managed care plans.

"Although these actions are being taken to set the stage for better health care in the future. . .the fiscal pressures generated by the consortium have led many clinics to feel the need to devote almost all of their attention to maintaining solvency," the article's authors wrote.

While not disputing that physicians should devote more attention to prevention, Steve Wetzell, executive director of public policy and public affairs for BHCAG, called the allegations against the coalition unfair.

"We weren't surprised at the conclusion, but we were really surprised they pointed the finger at us," he said. "We think there's absolutely no truth to it.

"The study was based on patient data from 1994, a time when providers could obtain virtually all the funding they wanted for preventive services through BHCAG plans on a fee-for-service basis.

"There was absolutely no incentive to under-serve our population on preventive service," Mr. Wetzell said.

Today, clinics contracting with the BHCAG are organized into "care systems" that submit budgets to the coalition, which sets fee schedules for each group of providers. Depending on whether the budget is approved, clinics may or may not receive all the money they request for preventive services, he said.

BHCAG will try to encourage preventive care by approving as much funding as possible toward this goal; by surveying patients on their satisfaction with preventive care and publishing the results; by continuing to distribute a brochure on preventive care to doctors; and by recognizing providers with good preventive care programs through marketing and cash rewards, Mr. Wetzell said.

BHCAG employers represent only about 5% of the population served by clinics in the study reported by Mayo, so it is tenuous to draw conclusions about how the consortium affects the overall region, he said.

Also playing down the importance of BHCAG in weakening preventive care was Dr. Leif Solberg, clinical director of research at Group Health Foundation, the research group owned by Bloomington, Minn.-based HealthPartners, a leading managed care plan in the region.

HealthPartners and Blue Plus, another managed care network serving Minnesotans, are overseeing the study of preventive care with a $3.5 million federal grant, and Dr. Solberg co-wrote the Mayo article.

"I'm sorry we even mentioned that in there," he said, apologizing for the reference to the coalition's influence. "I think all (the article) was trying to say was primary care physicians are feeling a lot of time and cost pressures.

"Fewer than 10% of patients responding to the survey talked about flu shots with their doctors, and one in three said their doctors did not discuss any preventive services at their last clinic visits, the study found. Only 20% received any written materials about preventive care, and just 1% received written information on flu shots.

The study said clinics know how to use patient data for billing but have less experience using it for preventive purposes.

More current data will be available in about six months, Dr. Solberg said.