Independent doctors say the deck is stacked against them.
Because they lack the leverage of big hospitals and health systems, their pay has stayed essentially flat for years, they say.
And they find themselves on the losing end of the fight over patients.
âThese big institutions have their own insurance products now, and if they donât employ a certain physician, that physician is automatically a âtier twoâ provider, which means patients who go there have higher out-of-pocket costs or the physician gets paid less,â Bob Orzechowski said.
Heâs chief operating officer of Lancaster Cancer Center, an independent business with three practicing physicians and about 25 full-time employees.
âItâs an economic gun to the head,â Orzechowski added.
But some independent physicians in south-central Pennsylvania are deploying a strength-in-numbers strategy of their own.
Theyâve joined the Harrisburg-based Medical Group of Pennsylvania, which started last summer and now boasts about 425 doctors across 11 counties, although its strongest presence is in Dauphin County. Three Lancaster County practices are members.
âWe know how to provide care very cheaply, but nobody is listening to us,â said Dr. David Silbert, who owns Conestoga Eye in Lancaster Township. âI believe â if weâre going to save health care and not see the system collapse â we have to do something.â
Dr. Safa Farzin, CEO of the new group, said itâs starting by offering services like group purchasing and facilitating contract negotiations between members and insurers.
âPreviously they would deal with 75 separate groups,â he said of insurers. âNow they have not only a centralized person to communicate with, but thereâs this structure via our administrative staff and our subcommittees thatâs really connected to these practices and providing support through the process.â
The change, he said, could help members better emphasize the quality and cost-effectiveness of the care they provide.
A key related initiative is to form a network of their own. That will make it easier for members to tackle rising health insurance costs for their own employees by becoming self-insured, Farzin said. Eventually they may start offering the network to other self-insured companies as well.
The group is still looking to grow, Farzin said, but it now has a good mix of members to set up a network, with about a third in primary care and the rest in a wide range of specialties.
Itâs also looking at ways to tackle issues that are difficult for a single practice to address, such as case management and population health.
âWhen we talk about navigating through a complicated health care system, we want to make sure we have or begin to develop the infrastructure to do that,â he said….