Gary Pinta is a busy primary care doctor in Cuyahoga Falls.
He’s gotten to know his patients pretty well over the past two decades.
“I know how they think, what makes them tick, why they do things and why they don’t do things."
It’s a deep trust built over years. "We know things about our patients that they’ve told no one."
But it’s a type of care that he says is becoming harder to find as family medicine moves from private practice to hospital-managed primary care.
About 60 percent of primary-care physicians now draw a hospital salary, up from around 20 percent a decade ago, and they are often seeing more patients and spending less time with them.
Some industry watchers say the independent private practice is on life support.
“It’s very hard for those small practices to manage,” says Robert Mechanic, a senior fellow at the Heller School of Social Policy and Management at Brandeis University, and executive director of the Health Industry Forum.
He says hospitals are scooping up family practices because of changes in how insurers will soon be paying a patient’s bills.
A big change in the business of healthcare
Starting in 2017, half of Medicare insurance payments will come through what are called population health contracts.
That’s where, instead of being paid piecemeal, doctors’ payments will be bundled according to patient outcomes.
It’s part of the cost controls built into the federal health overhaul, and Mechanic says it’s one reason hospitals are hiring more family doctors.
“You need the physicians as an asset to manage those contracts,” and to bring in the income attached to insured patients.
“If you control the physicians," says Mechanic, "you can continue to control the referrals.”
Mechanic says the phase-out of the fee-for-service payments under Medicare is quietly changing the business of healthcare.
“The implications of it really haven’t been reported," says Mechanic, "And it’s going to create a very wide difference in financial opportunity between physicians who continue in a Medicare fee-for-service model and physicians who move into a different type of model where they’re taking some risk for the quality and the spending.”
And for family doctors like Gary Pinta, who want to stay independent, that’s a big change.
Under the new system, much of his income will depend on the overall wellness of the patient.
“You’re responsible for all of their health," says Pinta, "not just the advice you give when they come into the office.”
Ohio physicians band together
Pinta is in a practice with four other doctors, and that practice is part of a larger group of about 35 physicians. But he says even that network is not big enough to survive on its own.
That's why this summer Pinta launched the Ohio Independent Collaborative, which in just a few months has attracted 900 primary care doctors and specialists caring for nearly 900,000 patients across Ohio.
“The Ohio Independent Collaborative is our ability to scale up with like-minded groups across the state of Ohio," he says, "so we can do population health.”
Pinta says the collaborative gives independent physicians like himself leverage in negotiating insurance contracts, pooled resources for bulk purchases, and big data for tracking health trends through electronic records.
Pinta is the collaborative’ s president.
The chairman is Dr. Robert Kent, CEO of physician-owned Western Reserve Hospital in Cuyahoga Falls.
Kent and his partners saw the writing on the wall in 2008, just months before the Affordable Care Act kicked in, “so we felt we had to get control of a hospital to control our destiny.”
He says with power shifting from practices to hospitals, they decided to band together in a big way. "And we thought it was very important for us to take control of that piece that is very expensive and coordinate it with our medical groups to make sure our care is seamless.”
Robert Kent says the rampant consolidation in hospital systems and among insurers is now being reflected among private physician groups.
“And it really goes to the scale of it," he says, "you need to have scale in the future of healthcare.”
It’s a reality that rings true to Gary Pinta, who believes that with the collective bargaining power of 900 private physicians behind him he can continue his brand of doctoring.
“The independent doctors have more of a say in the business of medicine,” says Pinta.
He says reform was needed, and costs need to come down, but not at the price of losing that trust built over years between a doctor and their patient.