February 02, 2018 08:48 am News Staff – Family physicians focus on providing necessary care to patients, but ongoing consolidation in health care is limiting basic access, a point the AAFP recently reiterated to HHS.
In a detailed letter to Acting Assistant Secretary for Planning and Evaluation John Graham, the AAFP outlined policy changes that could boost competition in the health care marketplace and enhance patient choice. The Academy sent the letter, which was signed by AAFP Board Chair John Meigs, M.D., of Centreville, Ala., in response to the agency's request for "information about barriers to choice and competition ... and proposed solutions that could facilitate the development and operation of a health care system that provides high‐quality care at affordable prices."
Independent physician practices need an environment that allows them to thrive, the Academy has long contended, but the continuing consolidation of insurers and large health systems threatens their viability. To counter this trend, the AAFP called on HHS to support value-based payment models that bolster independent practice, including physician-led accountable care organizations. Physicians, especially those in independent practices, are well able to accelerate the move toward payment for performance.
"They have repeatedly demonstrated their superior ability to generate positive results in value-based care arrangements, both in improved health outcomes and reduced costs," stated the letter. "They are the most powerful tool we have to foster an affordable, accessible system that puts patients first."
Federal officials should promote payment methods that boost competition in the marketplace and create greater choice for patients. Mergers among hospitals in a single market increase costs for patients and drive up prices for low-value medical services.
"We strongly believe that this is an area where greater competition would benefit patients, physicians, and other health care providers," the letter stated. "Allowing hospitals and health systems to expand their stranglehold on the marketplace is harmful for patients, physicians, employers, and federal and state health care programs."
When a small number of commercial carriers dominate specific geographic markets, they exert inordinate power over consumer choice and payment. For example, Medicare Advantage plans now cover 19 million beneficiaries, yet just two insurers account for 41 percent of this market. On a similar note, Blue Cross Blue Shield accounts for 85 percent of the individual market and 93 percent of the large group market in Alabama.
When large health systems merge, they often shrink their networks, meaning patients may be forced to go out of network to maintain a relationship with their physician. For physicians, greater consolidation means they are often pressured to accept lower payment levels to stay within a particular network.
"The AAFP is deeply troubled by the explosion of mergers between hospitals and health systems," said the letter. "These mergers, in our opinion, are driving up costs, decreasing competition, and creating an escalating arms race in medical technology and costly, low-value medical services. No evidence exists that these mergers are decreasing prices in those marketplaces where they occur."
Another trend that limits access is the rapid rise in high-deductible health plans that dominate the employer-sponsored insurance market. Individuals with these plans often have annual deductibles of $2,000 or more and, as a result, may delay or forgo care rather than pay for a primary care visit out-of-pocket.
"Higher deductibles create a financial disconnect between individuals, their primary care physician, and the broader health care system," the letter noted.
The AAFP has proposed a primary care benefit that would be standard for all commercial policies under which visits to a primary care physician or medical team would not be subject to a deductible or copayment.
Finally, the letter presses the agency to remove legal barriers for patients who want to use their health savings accounts to pay for direct primary care (DPC) arrangements. Current tax law prevents patients from doing so because the IRS considers DPC to be insurance. The AAFP has supported legislation previously introduced in Congress that would change that designation.