FP Anxiety Grows Over 'Distressed Practice Environments'

ORLANDO – Do you practice family medicine in a region where Medicare is the "better payer," where there is a low number of primary care physicians per capita, and/or where residents get their training but leave to practice elsewhere?

If so, you might be in a "distressed practice environment," and the American Academy of Family Physicians wants to hear from you.

Alerted to these dire circumstances by the New Jersey Academy of Family Physicians, the national academy is in "information gathering mode" to determine a strategy to help family physicians in the affected areas – but concerns reach beyond the Garden State, AAFP President Glen Stream said.

"We are concerned that this is happening in other states in the country," Dr. Stream said at a town hall session held during the annual Congress of Delegates of the American Academy of Family Physicians. "We want detailed information on how to proceed to get objective data to inform our advocacy in this regard."

"This is an issue we feel is very important, not only to New Jersey, but as you said, there are many other areas around the country. We heard that loud and clear from some other chapters," said Dr. Robert Eidus, president of the New Jersey chapter.

New Jersey has the third fewest primary care physicians per capita and ranks fourth highest nationwide in terms of specialists, Dr. Eidus said. "That creates a situation, not surprisingly, where costs are high. What do payers do at this point? They ratchet down fees, not using a scalpel but using a bludgeon."

In some regions of the state, family physicians receive private insurance payments that are 50%-60% of the Medicare rate.

"Having an oligopoly of payers is another issue," said Dr. Eidus, a family physician with a private practice in Cranford, N.J.

Although it varies, a distressed practice environment can arise when two or three major health plans hold the great majority of market share in an area, Dr. Stream said in an interview. "As a result, they offer contracts at a very low payment."

The national academy plans to develop a strategy to encourage private health plans to increase payments for primary care services, including adoption of the Medicare 10% initiative for primary care, according to a report issued by the AAFP board of directors at the congress.

"Pay particular attention to paragraph nine [of the report]," said Dr. Dennis F. Saver, a delegate from Florida. "It is wonderfully understated as a ‘particularly vexing problem’ that insurance companies who are members of the Patient-Centered Primary Care Collaborative [PCPCC] are paying primary care physicians less than the going rate." They need to be held accountable, he added.

That portion of the report states, in part, that some private health plans that are "actively involved in Patient-Centered Medical Home pilots with the intention of shoring up primary care are the very same plans that are offering preferred provider organization (PPO) contracts to family physicians that only pay a fraction of Medicare payment, threatening the financial viability and survival of small practices."

The national academy brought the conflict to the attention of the PCPCC board of directors, Dr. Stream said, and the board plans to meet with key health plans during their annual summit in October. At the same time, the AAFP plans to hold one-on-one meetings with the five top insurers involved in PCPCC, starting with United Healthcare.

Those meetings with top insurer members of the PCPCC are important, Dr. Eidus said, because "they talk the talk but are not walking the walk."

At a recent meeting of the physician advocacy board for Humana Insurance, "I pointed out that in southwestern Ohio, the Cincinnati area, there are now many physicians who are under Medicare for their payment schedules," said Dr. Brian Bachelder, an alternate delegate from Ohio. "Humana, as of Sept. 1, brought their payment levels down to what other competitors in the area were paying," Dr. Bachelder said. "Yet at the meeting, they were talking about going out and trying to engage more primary care physicians – particularly family physicians – in the Humana fold, and even hiring family physicians to work for Humana.

"I pointed out the contradiction ... and they had nothing to say about it," Dr. Bachelder asserted.

A net loss of new physicians is another adverse effect of distressed practice environments, Dr. Eidus said. "We have a fair amount of residency programs in the state, but we’re net exporters. We’re exporting more ... despite the fact that we have a shortage in primary care.

"We also recognize that it’s not in the best interest of the citizens of New Jersey, or any other state, to have family medicine or primary care deserts," Dr. Eidus said. "We have that happening in New Jersey."

The AAFP Commission on Quality and Practice will review all feedback and data collected on distressed practice environments. Dr. Stream said the issue will be a major focus at the next leadership forum in May 2012.

ORLANDO – Do you practice family medicine in a region where Medicare is the "better payer," where there is a low number of primary care physicians per capita, and/or where residents get their training but leave to practice elsewhere?

If so, you might be in a "distressed practice environment," and the American Academy of Family Physicians wants to hear from you.

Alerted to these dire circumstances by the New Jersey Academy of Family Physicians, the national academy is in "information gathering mode" to determine a strategy to help family physicians in the affected areas – but concerns reach beyond the Garden State, AAFP President Glen Stream said.

"We are concerned that this is happening in other states in the country," Dr. Stream said at a town hall session held during the annual Congress of Delegates of the American Academy of Family Physicians. "We want detailed information on how to proceed to get objective data to inform our advocacy in this regard."

"This is an issue we feel is very important, not only to New Jersey, but as you said, there are many other areas around the country. We heard that loud and clear from some other chapters," said Dr. Robert Eidus, president of the New Jersey chapter.

New Jersey has the third fewest primary care physicians per capita and ranks fourth highest nationwide in terms of specialists, Dr. Eidus said. "That creates a situation, not surprisingly, where costs are high. What do payers do at this point? They ratchet down fees, not using a scalpel but using a bludgeon."

In some regions of the state, family physicians receive private insurance payments that are 50%-60% of the Medicare rate.

"Having an oligopoly of payers is another issue," said Dr. Eidus, a family physician with a private practice in Cranford, N.J.

Although it varies, a distressed practice environment can arise when two or three major health plans hold the great majority of market share in an area, Dr. Stream said in an interview. "As a result, they offer contracts at a very low payment."

The national academy plans to develop a strategy to encourage private health plans to increase payments for primary care services, including adoption of the Medicare 10% initiative for primary care, according to a report issued by the AAFP board of directors at the congress.

"Pay particular attention to paragraph nine [of the report]," said Dr. Dennis F. Saver, a delegate from Florida. "It is wonderfully understated as a ‘particularly vexing problem’ that insurance companies who are members of the Patient-Centered Primary Care Collaborative [PCPCC] are paying primary care physicians less than the going rate." They need to be held accountable, he added.

That portion of the report states, in part, that some private health plans that are "actively involved in Patient-Centered Medical Home pilots with the intention of shoring up primary care are the very same plans that are offering preferred provider organization (PPO) contracts to family physicians that only pay a fraction of Medicare payment, threatening the financial viability and survival of small practices."

The national academy brought the conflict to the attention of the PCPCC board of directors, Dr. Stream said, and the board plans to meet with key health plans during their annual summit in October. At the same time, the AAFP plans to hold one-on-one meetings with the five top insurers involved in PCPCC, starting with United Healthcare.

Those meetings with top insurer members of the PCPCC are important, Dr. Eidus said, because "they talk the talk but are not walking the walk."

At a recent meeting of the physician advocacy board for Humana Insurance, "I pointed out that in southwestern Ohio, the Cincinnati area, there are now many physicians who are under Medicare for their payment schedules," said Dr. Brian Bachelder, an alternate delegate from Ohio. "Humana, as of Sept. 1, brought their payment levels down to what other competitors in the area were paying," Dr. Bachelder said. "Yet at the meeting, they were talking about going out and trying to engage more primary care physicians – particularly family physicians – in the Humana fold, and even hiring family physicians to work for Humana.

"I pointed out the contradiction ... and they had nothing to say about it," Dr. Bachelder asserted.

A net loss of new physicians is another adverse effect of distressed practice environments, Dr. Eidus said. "We have a fair amount of residency programs in the state, but we’re net exporters. We’re exporting more ... despite the fact that we have a shortage in primary care.

"We also recognize that it’s not in the best interest of the citizens of New Jersey, or any other state, to have family medicine or primary care deserts," Dr. Eidus said. "We have that happening in New Jersey."

The AAFP Commission on Quality and Practice will review all feedback and data collected on distressed practice environments. Dr. Stream said the issue will be a major focus at the next leadership forum in May 2012.

ORLANDO – Do you practice family medicine in a region where Medicare is the "better payer," where there is a low number of primary care physicians per capita, and/or where residents get their training but leave to practice elsewhere?

If so, you might be in a "distressed practice environment," and the American Academy of Family Physicians wants to hear from you.

Alerted to these dire circumstances by the New Jersey Academy of Family Physicians, the national academy is in "information gathering mode" to determine a strategy to help family physicians in the affected areas – but concerns reach beyond the Garden State, AAFP President Glen Stream said.

"We are concerned that this is happening in other states in the country," Dr. Stream said at a town hall session held during the annual Congress of Delegates of the American Academy of Family Physicians. "We want detailed information on how to proceed to get objective data to inform our advocacy in this regard."

"This is an issue we feel is very important, not only to New Jersey, but as you said, there are many other areas around the country. We heard that loud and clear from some other chapters," said Dr. Robert Eidus, president of the New Jersey chapter.

New Jersey has the third fewest primary care physicians per capita and ranks fourth highest nationwide in terms of specialists, Dr. Eidus said. "That creates a situation, not surprisingly, where costs are high. What do payers do at this point? They ratchet down fees, not using a scalpel but using a bludgeon."

In some regions of the state, family physicians receive private insurance payments that are 50%-60% of the Medicare rate.

"Having an oligopoly of payers is another issue," said Dr. Eidus, a family physician with a private practice in Cranford, N.J.

Although it varies, a distressed practice environment can arise when two or three major health plans hold the great majority of market share in an area, Dr. Stream said in an interview. "As a result, they offer contracts at a very low payment."

The national academy plans to develop a strategy to encourage private health plans to increase payments for primary care services, including adoption of the Medicare 10% initiative for primary care, according to a report issued by the AAFP board of directors at the congress.

"Pay particular attention to paragraph nine [of the report]," said Dr. Dennis F. Saver, a delegate from Florida. "It is wonderfully understated as a ‘particularly vexing problem’ that insurance companies who are members of the Patient-Centered Primary Care Collaborative [PCPCC] are paying primary care physicians less than the going rate." They need to be held accountable, he added.

That portion of the report states, in part, that some private health plans that are "actively involved in Patient-Centered Medical Home pilots with the intention of shoring up primary care are the very same plans that are offering preferred provider organization (PPO) contracts to family physicians that only pay a fraction of Medicare payment, threatening the financial viability and survival of small practices."

The national academy brought the conflict to the attention of the PCPCC board of directors, Dr. Stream said, and the board plans to meet with key health plans during their annual summit in October. At the same time, the AAFP plans to hold one-on-one meetings with the five top insurers involved in PCPCC, starting with United Healthcare.

Those meetings with top insurer members of the PCPCC are important, Dr. Eidus said, because "they talk the talk but are not walking the walk."

At a recent meeting of the physician advocacy board for Humana Insurance, "I pointed out that in southwestern Ohio, the Cincinnati area, there are now many physicians who are under Medicare for their payment schedules," said Dr. Brian Bachelder, an alternate delegate from Ohio. "Humana, as of Sept. 1, brought their payment levels down to what other competitors in the area were paying," Dr. Bachelder said. "Yet at the meeting, they were talking about going out and trying to engage more primary care physicians – particularly family physicians – in the Humana fold, and even hiring family physicians to work for Humana.

"I pointed out the contradiction ... and they had nothing to say about it," Dr. Bachelder asserted.

A net loss of new physicians is another adverse effect of distressed practice environments, Dr. Eidus said. "We have a fair amount of residency programs in the state, but we’re net exporters. We’re exporting more ... despite the fact that we have a shortage in primary care.

"We also recognize that it’s not in the best interest of the citizens of New Jersey, or any other state, to have family medicine or primary care deserts," Dr. Eidus said. "We have that happening in New Jersey."

The AAFP Commission on Quality and Practice will review all feedback and data collected on distressed practice environments. Dr. Stream said the issue will be a major focus at the next leadership forum in May 2012.