The front office of one of MaineGeneral’s family practices is buzzing with activity. The receptionist is checking in a child with a fever, and a medical assistant is calling a diabetic woman to remind her that she needs her periodic blood sugar test to help avoid complications.

This practice sees all patients, regardless of whether they have private insurance, Medicare or MaineCare, Maine’s Medicaid program. The only way we can afford to provide high-quality integrated health care to all our patients is because we are affiliated with the hospital.

Our ability to care properly for our patients is threatened by Gov. Paul LePage’s budget proposal that calls for millions of dollars in pay cuts to hospital-based physicians. The Department of Health and Human Services claims its goal is investing in primary care, but the sum of these initiatives is to strip hospitals, the leading providers of primary care to MaineCare patients, of almost $30 million a year.

Lots of people are nostalgic for the days when a single physician ran his practice out of his home and made house calls. And the knowledge of their patients that those doctors had remains important. But with modern medical advances, the practice of primary care has changed. One hundred years ago, patients with diabetes wasted away and succumbed to their disease. Care was little more than comfort. These days, diabetes is a disease that is managed with testing, dietary and lifestyle changes and medication.

That management requires the participation of both the practice and the patient. Our physicians might not be making as many home visits as the old-time doctors did, but our offices follow up with patients, helping them manage their conditions and maintain their health.

Being part of a larger hospital system with its broader infrastructure allows us to focus on patient-centeredness, population health, quality improvement and innovation. Doctors in private practice have to spend as much or more time managing their business as they do caring for their patients. They don’t always have a medical assistant or nurse call every patient who hasn’t had her yearly exam or regular cancer screening. It’s very hard to keep up with the regulatory burden of the Joint Commission or National Committee for Quality Assurance accreditation.

We have heard providers in private offices say, “I can’t accept any more Medicare patients,” or “We don’t have time to track care gaps.”

As a result, there are big differences between doctors in private practice and hospital-based physicians. A recent study by the American Hospital Association highlights the differences. Using national data, the study found that patients served by hospital-based outpatient practices were:

• 2.5 times more likely to be on Medicaid or eligible for charity care;

• Almost twice as likely to be eligible for both Medicare and Medicaid; and

• Almost twice as likely to be from high poverty areas.

Hospital outpatient patients are sicker and have more complex medical needs. Under Maine law, hospital-based doctors have to provide charity care. Private doctors don’t. And when the state picks up the tab through MaineCare, it reimburses only 83 percent of a hospital-based physician’s costs to provide that care.

Maine’s hospitals didn’t get into the primary care business because it was a big money maker. To the contrary, hospitals did it because of gaps in the private system to care for the poor, the sick and those in rural areas. By providing administrative support with things like centralized billing and purchasing, hospitals free up their physicians to spend their time caring for patients, not sending out invoices. Being part of a larger system means the hospital can take on the administrative burden seamlessly and allow for a more integrated, comprehensive model of healthcare delivery. And doctors can spend time being doctors.

The state budget proposes an increase in reimbursements for non-hospital based physicians who treat MaineCare patients. That is a good idea. Private doctors remain a vital part of the health care system and working in a hospital system is not the right thing for all doctors. MaineCare reimbursement rates are low and should be raised for those doctors who remain in private practice and who still see Medicaid patients.

But cutting reimbursement to hospital-based doctors is a mistake. Hospitals can’t sustain such cuts and continue to subsidize physician practices. Access to care will suffer and that will jeopardize the health and well-being of patients. That is bad medicine.

This column was submitted by Melanie Thompson, MD, MPH, medical director, MaineGeneral Primary CarePractices; Stephanie Calkins, MD, director of Clinical Medicine, Maine Dartmouth Family Practice Residency: Deborah Learson, MD, medical director, Elmwood Primary Care; and David Preston, MD, Internal Medicine, Mid Maine Medicine.

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