Dr. Jeffrey Harris is only one of three full-time doctors who work with three full-time physician assistants at Graham Medical Clinic in Newville. In the past, that staff number had been eight physicians.
Getting more physicians to fill those holes, however, isn’t an easy task.
Not only is there a shortage of those becoming primary care physicians, but Graham Medical Clinic and other independent practices also find themselves facing obstacles in getting the available physicians to their offices.
“We’re just a small practice in Newville,” Harris said. “Our practice is accepting new patients as other practices close. You compete with hospitals who are recruiting at medical schools and offering stipends.”
Harris said hospitals can offer incentives that independent practices can’t, and the practices affiliated with those hospitals can reap the rewards in gaining more staff.
For Harris and others, however, those rewards come at the cost of having their own independence in making decisions on how to handle patients and staff.
It’s part of the reason Graham Medical Clinic is one of a growing number of physician practices turning for help from an affordable care organization model.
Graham Medical Clinic recently joined the Pennsylvania ACO that was formed by Aledade, which is based out of Bethesda, Maryland. An ACO model helps physicians with paperwork and changes in health care while allowing them to take the lead in the care of their patients, according to Ahmed Haque, vice president of provider networks for Aledade and executive director of the Pennsylvania ACO.
“It helps (physicians) stay independent in the current situation,” he said. “What an ACO does is take a diverse set of independently-owned and great physician practices and have them come together in a group setting. We jointly work to help better understand the needs of patients.”
Haque said staff at the Pennsylvania ACO can help physician practices track the admissions and discharges at hospitals of their patients, which can be quicker than the practices doing it themselves, especially if they are not affiliated with a hospital. Aledade instead works on their behalf to make those connections with hospitals to ensure the information gets to physicians in a timely manner.
In doing so, the physicians can call their patients and help them transition from their hospital stay, which could help patients avoid readmission.
“We make sure patients receive appropriate care at the appropriate time,” Haque said. “There’s a tremendous amount of burden that has been placed on physicians, especially primary care physicians today. These are really good physicians who want to manage patients without having to worry about policy changes.”
The model is something that is attracting more independent practices.
Aledade now has 15 ACOs across the country, with organizations in West Virginia, Kansas, Mississippi, Maryland, Delaware and Florida. Aledade has two other ACOs in Pennsylvania, one in Chester County and the other in Delaware County. The Pennsylvania ACO primarily serves central Pennsylvania.
Haque said ACOs can incorporate all types of health care practices, but for the new ACO in this region, there are only primary care practices involved.
For the Medical Group of Pennsylvania, it has had two years to see its locations grow in the Midstate. The group, which has an ACO model, formed in 2015 with nine physicians. Today, it has 75 physician practices at 150 sites.
“We’ve been very humbled by the support the independent physician community has given to this idea,” said Dr. Safa Farzin, CEO of the medical group and provider at Pulmonary Critical Care Medicine Associates in Lemoyne. “We’re constantly adding members and geographic areas.”
Farzin said a third of the group’s physicians are primary care providers while the rest run the gamut of specialties.
“Our practices are those that have been around for 40 to 50 years,” he said. “The relationship we’ve built in the community is very strong.”
Both groups said their models help physicians instead of hindering them. Farzin said the medical group is an easy way for patients to figure out if a physician is in-network, and their range of services are offered to practices but not forced on them.
Haque likewise said the ACO’s work deals more with information and staff helping practices sort through data that insurance providers can provide about each patient. The ACO’s staff can help physicians determine better ways to help patients, while physicians can concentrate on seeing patients.
“Smaller practices are very, very busy providing patient care,” Haque said. “ACO has a team of experts that work very closely with practice staff.”
The Medical Group of Pennsylvania recently touted its partnership with Highmark that will help ensure its physicians are in-network for patients with Highmark plans. Farzin said this type of model, in addition to helping arrange for in-network status, also helps with general costs for health care.
“We have a strong focus on price transparency,” he said. “Some of our members are less expensive than many of the larger organizations.”
Farzin said, for example, a family looking at the cost of an MRI or CAT scan may face a sizable disparity in cost among health providers and often won’t realize it.
“Right now, there’s no cost transparency,” he said. “And the price for that service can range from $500 to $2,500.”
In addition to its other services, the medical group is developing a tool that will help patients determine where to go for the best price. Farzin said that tool will be announced later, and he hopes to have it in place in November.
Need for change
For Farzin and others taking part in ACOs and ACO-like organizations, the new model is needed at a time when health care has grown more complicated. He said he’s seen costs increase and choices decrease in areas where the majority of practices are a part of large health care systems and paying entities.
“That has happened in communities across the state and across the country. We want to make sure that doesn’t happen,” he said. “Over the past decade, the community of physicians has seen the decline in the number of independent physicians and primary care providers. I can’t emphasize enough how important it is to have independent primary care physicians in practice and to support the community.”
Haque said physicians joining Aledade also have a focus on staying independent.
“(Some practices) are very thirsty to remain independent, very thirsty to provide good quality care to patients,” he said.
It was independence that led Graham Medical Clinic to Aledade. It’s too early yet in the move for Harris to comment about whether it has worked for the Newville practice, but he said the help from the ACO is welcome.
“We like our independence. We’re more personally invested,” he said. “We want to be as efficient a practice as we can be.”