Editor’s note: This commentary is by Jon W. Asselin, COO/CFO of Primary Care Health Partners, which is a regional association of community-based primary care health centers in Vermont and upstate New York.
[D]o you remember the classic game of Jenga? The rules of play are simple: Each player pulls a block from the structure and then stacks the block on top. The game ends when that catastrophic event occurs, the tower falls over.
Unfortunately, Jenga somewhat symbolizes the world of independent practitioners. Government and commercial payers alike have been pulling from the foundation of independent practices while laying more and more burden on top. In 2015, the loss of Medicaid parity was one of those plays where everyone gasped. The structure shifted; a catastrophe seemed eminent. It teetered … it swayed … and through perseverance, it struggles to stay erect.
It is through the perseverance of independent practices like Primary Care Health Partners (PCHP) that Vermonters have enhanced access to primary care. But government and commercial payers (or should that be players?) seem poised to allow independent practices to be toppled. In the case of PCHP, with pediatric, family medicine, and internal medicine practices, the practitioners anticipate seeing a reduction of almost $1 million in Medicaid funding from the loss of parity with Medicare rates. With rising costs and declining revenues, no one will come in to shore up the finances … no one that is except for the physician owners who have not enjoyed the stereotypical wealth associated with physicians. Meanwhile weight continues to be added on top of the organization with the introduction of various pilot programs by the payers. Do the math … if you cut or do not increase funding, where do the resources come from to take on new initiatives?
While there has been increased awareness as to the cost shift government payers have transferred to commercial payers, it should not be assumed that cost shift had equally benefited everyone delivering care in Vermont.
The way the game is played today, winning Primary Care Jenga will come at the cost of losing independent practices. And why should Vermonters care about independent practitioners? Access. Preserving access. The concept of being an independent practitioner is deeply seated in strong beliefs — commitment to the best care for the patients and professional satisfaction for the practitioner. Preserving the independent model is about preserving career choices for practitioners to pursue having a practice in Vermont. It provides an alternative means to attract and retain practitioners for the benefit of enhancing health care access.
Yet, for years, commercial payers have enjoyed the benefit of paying independent practitioners a fraction of that paid to larger counterparts with little appreciation for the toll they have taken in diminishing the positive experience of being an independent practitioner. While there has been increased awareness as to the cost shift government payers have transferred to commercial payers, it should not be assumed that cost shift had equally benefited everyone delivering care in Vermont. Like blocks being pulled from their foundation, independent practitioners have struggled for years to achieve fair contracts. And, fortunate to achieve anything, you can bet it comes with more blocks on top.
To be clear, inadequate reimbursements from both commercial and government payers have taken their toll. But the past two years were obviously better with Medicaid at Medicare rates. Unheard of in this game, it seemed like a block was inserted into the Jenga stack helping to improve stability, only to be knocked out in 2015. It is hoped legislators can see what is transpiring for the independent practitioners. Independent practices need to be supported before it is too late, before all we’re left with is just the pieces to pack away. One thing is certain, when the game is over for independent practices, Vermonters will not walk away winners.
