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New patient care delivery system enters health care 'race to get bigger' by keeping things small

Posted: 19th October 2016 09:14

After more than six years since the Affordable Care Act became law inMarch 2010, officials at the Pennsylvania Medical Society say health care reform has created a race within the health care industry to get bigger.

"There's a growing trend within health care to get bigger," says Chuck Cutler, MD, 2017 president of the Pennsylvania Medical Society. "You're seeing hospitals and insurers grow through mega-mergers, affiliations, and buy-outs."

According to a May 2016 column appearing in the LA Times, in 2015, 112 hospital mergers were announced across the country for an 18 percent increase over the prior year and a 70 percent increase since 2010.

Dr. Cutler adds it's all ironic considering President Obama signed the Affordable Care Act to put consumers back in charge of their health care. But he wonders, now as the dust settles, if it's actually making it harder for patients seeking physician care outside corporate structures.

September 2015 story in The Wall Street Journal reported that as the merger frenzy grows, medical practices have become a "side effect of health-care law."

"As physician offices get bought out, historically independent physician practices are becoming a thing of the past," Dr. Cutler says. "Similarly, physicians too are losing the option of practicing without a corporate umbrella over their heads."

The mega-merger frenzy was a concern to Scott Shapiro MD during his year as president of the Pennsylvania Medical Society in 2016, and as the merger trend grew, he says independent physicians started to become creative by forming Independent Provider Networks (IPNs) as the answer to surviving.

"IPNs are a way for independent physicians to decrease cost and increase quality, while improving access in their communities," Dr. Shapiro says. "It comes down to strategic partnerships to accomplish those goals."

Dr. Shapiro adds that IPNs can be a win-win situation for patients who prefer independent physicians as well as for independent physicians who are not interested in selling their practices to a larger entity.

"Essentially, IPNs give patients and physicians choices," he says.

Another factor may also be driving more independent physicians to come together to form IPNs, Dr. Shapiro adds.

According to Dr. Shapiro, the Medicare Access and CHIP Reauthorization Act of 2015, also known as MACRA, is a quality performance measurement system that can boost or cut physician reimbursement. Small physician practices are predicted to get hit hard, not because of a lack of quality. Instead, small practices have greater difficulty obtaining information technology and data needed to demonstrate quality.

MACRA goes live in 2019, but initial baselines will be established starting in 2017 during a performance period that begins on January 1.

"Realistically, you may have a well-qualified, top-notch physician practicing in a solo or small practice, who unfortunately will find it more difficult because of MACRA," says Dr. Shapiro.  "Without IPNs in place, patients will slowly lose access to those types of practices."

This news release is brought to you by the Pennsylvania Health News Service Project, consisting of 21 Pennsylvania-based medical and specialty associations and societies. Members of PHNS include Pennsylvania Allergy & Asthma Association, Pennsylvania Dental Association, Pennsylvania Academy of Dermatology & Dermatologic Surgery, Pennsylvania Academy of Ophthalmology, Pennsylvania Academy of Otolaryngology, Pennsylvania Academy of Family Physicians, Pennsylvania American Congress of Obstetricians and Gynecologists, Pennsylvania Chapter of the American College of Cardiology, Pennsylvania Chapter of the American College of Emergency Physicians, Pennsylvania Chapter of the American College of Physicians, Pennsylvania Chapter of the American Academy of Pediatrics, Pennsylvania Medical Society Alliance, Pennsylvania Medical Society, Pennsylvania Neurosurgical Society, Pennsylvania Orthopaedic Society, Pennsylvania Psychiatric Society, Pennsylvania Society of Anesthesiologists, Pennsylvania Society of Gastroenterology, Pennsylvania Society of Oncology & Hematology, Robert H. Ivy Society of Plastic Surgeons, and Urological Association of Pennsylvania. Inquiries about PHNS can be directed to Chuck Moran via the Pennsylvania Medical Society at (717) 558-7820,, or via Twitter @ChuckMoran7.

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