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Many primary care doctors are not happy about projected Medicaid cuts. They say they're already having trouble keeping their practices alive because insurance companies pay them at lower rates than other specialists. So some are collaborating to increase their market power and stay independent. Karen Brown of New England Public Media reports.
UNIDENTIFIED PERSON #1: All right. So can I have you step up there? Want to get your weight today.
KAREN BROWN, BYLINE: Valley Medical Group has four locations across western Massachusetts. It's been around for decades.
UNIDENTIFIED CHILD: Ow.
UNIDENTIFIED PERSON #2: What hurts?
BROWN: But the primary care practice has rarely been more strained than it is now.
UNIDENTIFIED PERSON #2: So we're talking about belly pain today that's...
UNIDENTIFIED PERSON #3: Yes.
UNIDENTIFIED PERSON #2: ...Been going on...
BROWN: On the day this mother and child came in, the practice had just laid off 40 people - about 10% of its staff, mostly in support positions. CEO Dr. Paul Carlan says there's already a waiting list for appointments, and his providers are stretched thin. And like primary care practices all over, Carlan says Valley Medical doesn't get paid enough for the care it provides. That's largely determined by contracts with insurers.
PAUL CARLAN: I think it has to do with the fact that our contracts don't pay as well as we think they should. The cost of everything is going up.
BROWN: Some practices in this situation join a large hospital system for financial security. But Carlan says that takes away their autonomy and siphons off a lot of the money for the needs of hospitals.
CARLAN: Our priorities get muddled up. Hospitals get paid when their beds are full.
BROWN: In contrast, he says primary care takes time and money to manage or prevent illness. So Valley Medical, like a growing number of practices, has joined what's called an IPA - independent physician association. Like a union, an IPA combines individual primary care offices, giving them power in numbers when it's time to negotiate reimbursement with insurance. Lisa Glenn is with one insurer, Blue Cross Blue Shield of Massachusetts.
LISA GLENN: We're seeing smaller practices that want to deliver care differently, want to have more autonomy and control over their sort of financial and professional destiny.
BROWN: When those practices band together, Glenn says Blue Cross can offer what are called value-based contracts. Instead of getting paid for every visit or procedure, the practice gets a budget for the overall care of patients and has an incentive to keep them healthy. But Glenn says that only works if there's a big enough pool of patients to spread out the risk in case a few get really sick. Otherwise...
GLENN: The risk of ending up above or below the budget becomes somewhat subject to random variation rather than performance.
BROWN: That's why experts say that for value-based contracts to really work for small practices, it helps to have them join together in an IPA. Valley Medical joined Arches IPA outside Boston. Chris Kryder is the CEO.
CHRIS KRYDER: If we keep people out of the ER, keep them out of unnecessary hospitalizations, we save money for the system and we create more income for the PCPs, which is dreadfully needed.
BROWN: But health care leaders point out IPAs won't fix everything. There are hundreds of these groups, and some are actually owned by hospital systems or private equity and less focused on preventative care. Kryder says his IPA is owned and run entirely by physicians, but it needs to recruit more practices that want value-based contracts. Lisa Glenn of Blue Cross says that can be a hard sell, since there's often a lag between the doctor's care and the payment.
GLENN: It doesn't happen overnight, and it does take an investment.
BROWN: That lag is one reason Paul Carlan says Valley Medical Group had layoffs after joining the IPA. But he thinks the practice will become more stable over time, even offer higher salaries and, most importantly, keep the doctors in charge.
For NPR News, I'm Karen Brown in western Massachusetts.
INSKEEP: That story comes from NPR's partnership with New England Public Media and KFF Health News. Transcript provided by NPR, Copyright NPR.
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