Dr. Machata, small practice, huge quality.

I have known Dr. Machata for 40 years. He is the best type of doctor: intelligent, curious, well-trained, compassionate and a doctor who puts patient care above all other concerns. Will he and his kind become extinct?

MY TURN: How Big medicine harms R.I. Patients

By John Machata, M.D. Family Practice

Posted Mar 18, 2019 at copied with permission from https://www.providence journal. com/opinion/20190318/my-turn-john-machata-how-big-medicine-harms-ri-patients

During a recent appearance on the Providence Journal podcast “The Insiders, with Ed Achorn,” Lifespan CEO Timothy Babineau stated: “Market forces don’t apply to health care.”

Of course, economic and political forces apply to health care! Big Medicine’s most powerful entities (insurers, hospitals, medical schools, pharmacies and government agencies) formulate health-care policy to enrich themselves at the expense of patients and small independent medical practices.

I am an independent family doctor. My practice’s existence is in jeopardy. Small physician practices are being devoured by big medical practices, such as Coastal Medical, which improves Coastal’s negotiating position with insurers. Hospitals buy practices to extend and defend turf. Insurers reimburse small practices at lower rates than large groups. These actions are driving small, independent medical practices out of business at an alarming rate.

Dr. Babineau argues that limiting patient choice will decrease costs and improve quality. Dr. Farzad Mostashari rebuts this, stating: “Consolidation has not resulted in lower prices, higher quality, or better care experiences.” He also points out that the main effect of consolidation is to increase market power which is used to extract higher prices from payers and to prevent any efficiencies from being passed on to consumers.

Consolidation works for some industries, but not for others. Amazon has succeeded by offering selection, convenience and prompt delivery (though at the cost of putting many local mom-and-pop stores out of business). But medicine is not a shopping emporium; medicine is personal. Large medical practices rarely offer patients the convenience, prompt service and personalized approach they desire.

Americans are worried that the trend toward Big Medicine will be costly and jeopardize their health. A 2018 survey showed that:

— 69 percent favor congressional action to limit consolidation of health care.

— 60 percent view purchasing of independent practices as a threat to affordable care.

— 25 percent saw consolidation as a direct threat to their health.

My practice’s costs per patient are low and my quality metrics are excellent. But low costs and high quality offer no guarantee of success when faced with a system seemingly dedicated to getting rid of small practices. Medicare’s soon-to-be implemented value-based reimbursement program will penalize 87 percent of solo practices whereas most large practices will be rewarded.

In a “Robin Hood in reverse” move, Blue Cross & Blue Shield of Rhode Island pays incentives based on the number of members meeting goals, with a big caveat. If the number of patients in a quality measure is under 10, the practice earns only 25 percent of the money that is paid to a practice with 30 or more patients! This discriminatory program costs Rhode Island’s family doctors and small practices tens of thousands of dollars annually. BCBSRI candidly admits that its policy is intended to encourage small practices to join larger groups.

Small practices are better for patients. A 2014 study showed that patients of small practice physicians have a lower rate of preventable hospital re-admissions. Small practices provide a greater responsiveness to patient needs at a lower average cost per patient. Patients trust independent physicians more than employed doctors.

Small practices are better for doctors. Independent physicians are less likely to experience burnout. Small practices have deeper relationships with their patients. Doctors in small independent practices are happier and report greater professional satisfaction.

Small independent practices will not survive without a profound shift in the regulatory climate. To ensure fair compensation, promote competition and protect patient choice, policies must include:

— Primary care payment rates for small independent practices at parity with large groups.

— Decreased regulatory burdens.

— Investigation of hospitals that engage in coercive monopolies, forcing patients to use services within their system, thereby denying patients choice.

Small independent practices offer patients cost-effective, high-quality and personalized health care. If the choice of personal medical care offered by small independent practices is to be preserved, the rules of the game must change.

John Machata, M.D., is a family doctor in North Kingstown.

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