HOW DISPARITIES AND INEQUITIES PLAY OUT IN THE DOCTOR’S OFFICE
Across America, thousands are marching against institutionalized racism and inequality. At the same time, a pandemic continues to rage. In many cases, the people marching shoulder-to-shoulder in our streets are those most at risk for death and disability from coronavirus. We cannot ignore the existence of healthcare disparities and the role they play in a society with deeply ingrained inequities.
In fact, the sweeping healthcare reform program that was designed to make healthcare more affordable and accessible to all Americans may be inadvertently contributing to the problem. The Affordable Care Act became law in 2010. While the current administration remains focused on its attempts to roll back most of provisions of the act, providers continue to grapple with complex changes to healthcare financing that are among the many levers embedded in this massive and ambitious legislation. Just as our nation’s most prominent public health threats – Covid-19, coronary artery disease, cancer, asthma and diabetes, to name a few – disproportionately affect communities of color, so too do the mandates of healthcare reform.
A key tenet of reform is the implementation of incentive programs designed to shift the focus of the American healthcare system from disease management to population health management. While the underlying theories driving this shift are based on sound principles, implementation of these programs has created unmanageable layers of complexity for community-based physicians. Herein lies the problem: small, private, independent practices are among those that struggle the most to participate in the alphabet soup of incentive programs promulgated by both Federal and State government.
Unfortunately, physicians have few options.
Practices must either invest significant resources in the technology and human resources required to participate in MACRA, MIPS, PCMH, VBP/QIP and a host of other incentive programs; sell their practices to large, corporate health systems which have the infrastructure to handle the data collection and reporting required to participate; or close shop and become employees of large practices or health networks.
It comes as no surprise that the infrastructure cost to fully participate in these programs is prohibitive for most small, independent primary care practices. As a result, local pediatricians, internists and family practitioners, particularly those in historically underserved and minority communities, are vanishing. This leaves many patients without access to neighborhood-based healthcare providers who know them, understand and share their culture and language preferences, and may have taken care of generations of their family members.
In their place are large, corporate practices, often owned by monolithic health systems headquartered far from the communities they serve. As a result, this model may actually reduce access to much needed care by disenfranchised individuals.
As our nation confronts a new generation’s frustration with institutionalized racism and socioeconomic inequality, we cannot ignore the healthcare divide that often leaves people of color more at risk for chronic disease, sicker than their white counterparts, and less able to access the high quality care they need.
To help address this inequity, now more than ever, small, independent primary care practices need relief, assistance and support to meet the healthcare needs of the communities they serve. Many private primary care physicians struggled to remain independent before Covid-19 impacted their practices. Now they must juggle the logistical, financial and medical issues imposed by the pandemic, while attempting to meet stringent data collection and reporting requirements of incentivized payment systems.
We call upon our elected officials in Albany to effect policy changes to protect community-based physician offices that are providing culturally sensitive care in their local communities. Their livelihood and their patients’ lives depend on it.