Obamacare worries small family practices

Posted: October 20, 2013

Tom Shaffrey is an old-fashioned family doctor, the kind who calls his patients by their first name and can tell the severity of their problem just by listening to them.

But he's worried that he and other small New Jersey primary-care physicians won't be able to keep practicing their brand of personal medicine because insurers are elbowing them out of business through narrow provider networks in the new plans under the Affordable Care Act.

"We have no way to know exactly how this is going to play out, but the indication is that our members will be dropped, will be excluded from seeing patients that they may have known for a majority of their lives," said Shaffrey, president of the New Jersey Academy of Family Physicians. "I think it is going to have a tremendous impact."

In the last several years, solo and small family medical practices have been under considerable economic pressure across the country. Narrow provider networks have contributed to squeezing New Jersey family practitioners out of business, Shaffrey said. And the family practices that do get contracts with insurers are seeing payment for services sharply reduced. Add to that the growing popularity of stand-alone clinics that are drawing away patients.

"That has been going on in New Jersey for many years," said Shaffrey, who practices in Bound Brook. "With the reductions now in the networks associated with the ACA exchanges, I think it's going to accelerate. I think people and insurance companies are looking at this as if every physician is easily replaceable by any other physician. I really don't believe that is true."

In Southeastern Pennsylvania, insurers' physician networks have traditionally been very broad.

Among the new online plans that began enrolling people on Oct. 1, Independence Blue Cross has introduced three-tiered networks for doctors and hospitals for the first time that will make patients pay more for care in second- or third-tier facilities.

For now, the tiered networks apply only to those in the individual insurance market, not those in large employer plans or on Medicare. And the new plans involved won't go live until Jan. 1.

No one knows for sure if narrow networks and the tiering system created by insurers to control costs is having an effect on the availability of doctors in Pennsylvania.

"We frankly haven't heard from" our members, said Brent Ennis, vice president of government affairs for the Pennsylvania Academy of Family Physicians. "Certainly there is some angst about changes that may occur to the existing networks. But this is such a developing story that we don't have empirical data. It could be something that changes after the new year when the plans go into effect."

A spokesperson for Independence Blue Cross said patients on the marketplace might pay more if they go to a doctor outside the network. They need to check their plans carefully.

Independence Blue Cross, the largest health insurer in Southeastern Pennsylvania, lists more than 12,000 doctor groups under Find a Doctor on its website. Horizon Blue Cross and Blue Shield of New Jersey has 8,000 primary-care practitioners, including family and primary-care doctors, in its network.

The talk about networks and tiering has patients asking their physicians if they will be able to continue seeing them when their new insurance takes effect on Jan. 1. It's a question that physician Mary Campagnolo is hearing.

"They definitely have been asking," said Campagnolo, an NJAFP past president. "Patients are asking what do you think of the new environment and are you going to be able to keep taking care of us. I allay their fears in that I tell the people I already know and am taking care of, I certainly can keep taking care of them."

Campagnolo said that with everything that has already happened and the coming changes of the ACA, there has been a big shift that has seen more primary-care and family physicians leaving solo and small practices to go with health-system or large group practices.

"Across the country I believe now there is something like 52 percent of physicians in employed situations," said Campagnolo, who practices with Virtua Medical Family Mansfield in Bordentown. "There is a big shift in that in the Delaware Valley area and in New Jersey."

And why not? There are significant benefits to belonging to a larger group, including staffing economies, more leverage when negotiating contracts with insurers, and better access to technology.

"I think what we had before may not have always been perfect in many ways," she said. "I think we are seeing an evolution toward the patient-centered medical [model] which is more of a team approach to taking care of patients. At the base is always the primary-care physician as the leader of team and the person with the highest level of relationship with the patient."


This article was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health-policy research and communication organization not affiliated with Kaiser Permanente.

R.Calandra@comcast.net

215-836-0101

www.inquirer.com/health_science

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