Friday, June 3, 2011
Long Island Business News: Doctors cautiously join IPAs
After decades in which patient privacy concerns, a culture of independence and antitrust issues divided doctors, physicians are banding together in groups, largely due to encouragement from insurers and the federal government.
The idea is that they can provide better care by sharing data and adhering to shared standards.
"It's like herding cats," said Michael Guarino, who is organizing the Nassau/Suffolk County Independent Physician Association, of efforts to overcome a culture of independence and isolation. "They've all been trained to be independent and think that way. They're the captain of the ship in the OR. Now someone's trying to put them in a group."
The result is the equivalent of bulldozing the Berlin Wall as doctors continue to run their practice, while participating in entities that set standards and procedures and help negotiate contracts and group purchasing.
On Long Island, The Beacon Independent Physician Association and East End Physician Hospital Organization formed recently. The North Shore-Long Island Jewish Health System also operates an IPA.
"Beacon IPA physicians are working together to produce regular performance reports, determine specific quality and safety benchmarks, and identify potential issues in patient care," Beacon CEO Dr. Simon Prince said.
Beacon last week reached a landmark, signing its first contract with an insurer, Empire BlueCross BlueShield, enhancing reimbursements in return for accepting standards.
"It's more of a partnership with Beacon in a different approach to managing care," John Caby, Empire's vice president of provider engagement and contracting, told LIBN. "They'll agree on certain parameters to justify reimbursement on an ongoing basis."
Beacon will pool data and take measures, including extending office hours, which Empire believes will save money and improve care.
"You should see a reduction in ER visits," Caby said. "I don't need to go in the ER in that scenario. It impacts total cost of care."
Despite their promise, IPAs face potential problems, including the fact that earlier efforts to band together in the 1990s largely failed and there's no guarantee cooperation will improve care and cut costs.
"We learned people took on risk and weren't capable of managing the risk," Caby said of those earlier, failed efforts. "That created a financial problem."
IPAs under managed care typically were paid per patient, which Caby said resulted in rates so low some couldn't survive. He said the new generation of IPAs, at least so far, isn't paid per patient.
"It's a big difference, except there is an expected outcome," Caby said. "Although there may not be a budget established for Beacon, at the end of the day, you expect to see lower costs of care with higher-quality outcomes."
Others said electronic data makes it easier for doctors to share and track information.
Some doctors worry the new generation of IPAs may also fail.
"They never worked before. Are they going to work?" asked Dr. Dort Ben-Moha, a physician in Plainview who belongs to the North Shore-LIJ IPA. "What's going to happen to the little person like me not employed by the hospital, not in a large practice?"
She doesn't believe she's obtained big benefits by belonging to the North Shore-LIJ IPA.
"Our rates only keep going down," she said. "Has it got better? No. Our malpractice (insurance) is still sky high."
Although some IPAs like Beacon and Nassau/Suffolk County were created exclusively by doctors, hospitals are helping set up their own physician groups.
"There are benefits and disadvantages," Guarino said of organizations involving hospitals. "You can't have two masters. Am I worried about the physicians or the hospital system?"
Rules are still forming regarding these groups and reimbursement, leaving a big question mark.
"There are a lot of challenges these organizations face," Manko said. "As government tries to incentivize providers to create networks, the government has to come out with new regulations."
Caby said groups need to use data to benefit patients, eliminating duplicate tests and providing follow up and more prevention.
"They need to be clinically integrated and have the physician leadership to make it work," Caby said. "Clinical integration is a very big obstacle. If physicians don't work together, you can be pulled in different ways. The resources expended don't always result in better outcomes."
Manko also said it's easier to form these groups than to make them work, noting "they're not complicated to do from a legal standpoint, but achieving clinical integration is difficult."
Guarino believes they also can provide economic benefits, by pooling physicians for group purchasing.
"They're all small businesses," Guarino said. "They buy 10 vaccines. I could buy 10,000."
David Manko, a partner specializing in health care law at Uniondale-based Rivkin Radlersaid physicians are "going to have to do something, because staying by themselves isn't really an alternative anymore" as health care reform requires greater cooperation.
"The main goal is how to aggregate the data so we can change the way healthcare is delivered," Guarino said. "For independent physicians, this is what we have to do. We have to get this started."