Editor’s note: This commentary is by Amy Cooper, executive director of HealthFirst, Vermont’s independent practice association.
[A]s of this month, three major independent medical practices have either become owned by the University of Vermont Health Network or have decided to leave the state. With public payer shortfalls and unbalanced payments from private insurers, it has simply become too hard for independent practices to continue to offer their personalized, lower-cost services to Vermonters.
Associates in Orthopaedic Surgery in South Burlington and Green Mountain Orthopaedic Surgery in Barre were acquired by the UVM Health Network on April 1, and an independent general surgical practice in Colchester will be closing its doors next month.
As a result, the cost of joint replacements, broken bones and arthroscopic procedures for patients with commercial insurance has increased dramatically. Before the change, Blue Cross paid the independent doctor $1,350 for performing a minimally invasive shoulder procedure; after the change, Blue Cross pays UVM Medical Center $3,140 so the same doctor (now a UVM Medical Center employee) can perform the same procedure, in the same office. The cost of orthopedic care in north-central Vermont just became 232 percent higher.
These are real numbers, obtained by a concerned patient who took the time to call and find out. These numbers accurately reflect the difference across most procedures and for most commercial insurance companies.
Unfortunately, from now on you won’t be able to find another independent orthopedic practice to serve your needs in a lower-cost, more personalized way, because as of this month, there aren’t any more.
Health reform aims to reduce the cost of health care while improving quality and access. We fail at controlling costs and maintaining access when independent practices are consumed by larger systems that charge higher prices for the same services, or when lower-cost, high-quality doctors are forced to close their doors and leave their communities.
Here are some of the values that I would like to see encouraged as we work together to solve the health care cost crisis: cooperation among different provider types rather than control; respect for unique private practice models rather than indifference; and recognition that even small practitioners in the health care delivery system have valuable roles to contribute to care.
In the end, the dominant hospital system will not be able to fill all of our vacancies and solve all of our health care problems — not all doctors want to work for corporate administrators, and not all patients want to receive care from providers who are part of a larger institutional system. It is in all of our interests to preserve and protect the ecosystem of small independent practices, alongside the hospital, if we truly want to build a better health care system.
