Connecticut's system of primary healthcare still relies heavily on small, physician-owned practices. It's a quaint hangover in a world that's increasingly dominated by large multi-specialty groups, and hospital-owned practices. But as WNPR's Harriet Jones reports, Connecticut's small practice doctors are looking to wield just a bit more clout.
Dr Doug Gerard sees his last patient of the morning. He's an internist in New Hartford, the only primary care doctor in town.
"Knock on wood, I haven't missed a day in practice due to illness since the beginning."
And the beginning was in the mid-1980s, when he began in practice here with two partners. Now he's a solo practitioner.
"I cover myself 24 hours a day, 7 days a week, which it's not as bad as it sounds. After being in practice for a long time, you know your patients very well, your patients know you. You're their neighbors, and if they call you on the weekend or at night, there's a valid reason usually behind that."
He says this type of personalized care is starting to become rarer in the state, as doctors opt to join large corporate groups.
"Patients will lose things many times by going into a larger practice, that is not the Norman Rockwell type practice, with one doctor sitting there who kind of knows what's going on with the patient over years and years."
Gerard himself has sought a balance. Some years ago joined Collins Medical Associates out of Hartford, so while he's preserved the small town doctor feel of the office for his patients, his back office work, including importantly, negotiations with insurers, is handled for him. The number of small practices in Connecticut has been on a long-term decline for many reasons. Doctor John Foley, the president of the Connecticut State Medical Society, says one key factor is the changing balance of power between physicians and insurers.
"We're seeing that as there are fewer and fewer insurers, controlling more and more patient lives, they are less willing to actually involve physicians meaningfully in a dialogue."
Hence a piece of legislation that's currently making its way through the process this session, House Bill 6431, An Act Concerning Cooperative Health Care Arrangements. Provisions in the bill would make it possible for small practice physicians to talk to each other and form coops among themselves in order to negotiate rates with insurers, something that's currently illegal under anti-trust laws. Foley says it will allow doctors to improve patient care.
"This is a process that says, ok, now the cardiologists think that you're denying care for cardiac catheterizations or this EP procedure, or whatever. We're going to sit down with the cardiologists involved and we're going to sit down with the insurance companies and we're going to negotiate this fairly."
But George Jepsen, Connecticut's Attorney General says it's not about patient care -- these cooperative arrangements are all about doctor's reimbursement.
"They don't want to have the competition. I understand that. I understand they would like to see their rates increased. But this would add cost to consumers, this would raise insurance rates."
The AG has staunchly opposed this bill, as he did two years ago when a similar measure was considered but defeated. That year, the Federal Trade Commission weighed in, calling the legislation an anti-trust violation. And Jepsen isn't buying the Medical Society's contention that they've addressed those concerns in the rewrite.
"They've stirred the pot without changing the essential stew."
The legislation also calls for a review process, which would see state officials adjudicating each coop proposal individually to see if it meets a public interest standards. That, says Jepsen, would be very expensive. He's not alone in his opposition. The Connecticut Business and Industry Association has testified against the bill. CBIA's Jennifer Herz says it's bound to increase healthcare costs.
"If we exempt the providers from these anti-trust provisions, there's nothing driving competition in the market, which would unfortunately increase prices and then decrease access."
"We're not talking about let's get together and price fix. That's not what this is about."
John Foley at the Medical Society disagrees. He says unless small independent practices find a way to wield more power against large corporate insurers, they'll be forced to sell out or go under.
"If physician practices go out of business those are more patients who don't have doctors to take care of them, and we already have a shortage of physicians in the state. We are desperately trying to recruit."
But for Jepsen, if the problem is solved this way, it will be at the patient's and the taxpayer's expense.
"Legislatures should not be enacting a law that violates federal law, they shouldn't be out there raising prices on consumers and they shouldn't be adding to the governmental bureaucracy with close to a million dollars in new costs."
The bill has been successfully passed out of the Labor Committee and awaits action by the full legislature.