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Accessing Patient Care in an Independent Delivery System



The Integrated Independent Physicians Network was formed in 2015 to align independent physician practices in a unified network to provide a vehicle for solo and small practices to compete in the ever-changing healthcare market, and provide a cost effective delivery system for central Florida patients.

Today the IP Network has over 1,000 Independent Physicians in eight counties and growing, and has also developed an ancillary network of providers, resulting in a complete independent healthcare delivery system. The result offers patients healthcare services without additional costs, called facility fees, charged by any healthcare faculty owned by a hospital system. These facility fees not only cost the healthcare system significant extra dollars, but also cost patients higher copays and out-of-pocket costs. This results in higher premiums for all payers and employers.

There will always be a need and place for hospital-based care, but why should patients spend more than necessary for care, whether it is paid by their insurance or out-of-pocket costs? One example is that in 2016 there were 9 million emergency room visits in Florida, and it is estimated that 71 percent of those ER visits could have been provided by a primary care physician or urgent care center resulting in hundreds of millions of dollars in savings to the system and patients. Independent urgent care centers charge significantly lower fees than hospital-owned urgent care or free standing hospital owned ER facilities.

One of the most significant impacts employers can have on their healthcare costs is to educate their employees and families to access care with independent physicians and independent ancillary providers. IHP manages and owns IPAs, MSOs, and ACOs throughout Florida. IHP's only mission is to preserve and protect the independent practice of medicine. Nothing happens in healthcare until a physician treats a patient, writes a prescription, or admits a patient to a healthcare facility, yet the imbalance of where our 3.6 trillion U.S. healthcare dollars go results in only 8 percent of those dollars going to physicians today.

The shift to value-based outcomes in the delivery of patient care and reimbursement is changing the landscape of healthcare with all stakeholders. Hospital systems continue to position themselves to acquire and build delivery systems and ancillary facilities well beyond the walls of the hospital. This strategy by large hospital systems is driving up healthcare costs, premiums, and out of pocket costs to consumers and patients, and many times results in a referral gateway to hospital ERs. Patients often don't even realize the difference in cost until they receive a bill for significantly more than expected.

Clinically Integrated Networks (CINs) have been developed in central Florida by both Florida Hospital and Orlando Health, along with the Integrated Independent Physicians Network's CIN. These narrow networks all provide complete healthcare delivery systems for patients, however, the IP Network represents independent physicians and ancillary providers, eliminating higher facility fees and costs.

Recently, Disney chose to contract directly with the two hospital CINs for their self-insured HMO plan, eliminating many independent physicians, both primary care and specialists, causing their employees to change physicians and convert to hospital-owned physicians for care. Disney's decision to direct contract with the hospitals may come back to haunt them over time, resulting in even higher costs to them and their employees.

Independent physicians continue to fend off hospital forces that eliminate their access to patient care, trying to control their payer- physician relationships and contracting, and moving patients seeing independent physicians to their hospital-owned practices. The patient is usually unaware of this strategy and finds themselves paying higher out-of-pocket costs for care.

Unfortunately, when a patient ends up in a hospital ER or is admitted, they usually have no choice in which physicians provide their care. One solution is to work through their primary care physician and hospitalist to access the physicians of their choice. Patients need to be more educated and in control of this process by asking for their doctors when in an acute care position. We have experienced numerous incidences where our patients are redirected to hospital-owned physicians.

If the large self-insured employers in central Florida like Disney are convinced by the hospital CINs to sign these direct to employer contracts, costs will only increase, and access to care will be limited to hospital-owned physicians.

Employers are continually seeing double digit rate increases in the fully-insured area, and self-insured employers continue to experience higher claims costs for their employees and families. Independent physicians and independent ancillaries are the solution to these continued rising costs.

Family of four premium costs are approaching $2,000 per month, and that can only represent 60 percent of total costs. It is estimated that up to 40 percent of costs are paid out-of-pocket by patients today. A significant saving to patients can be made if services are provided by an independent provider.

It would seem that employers and consumers would wake up and understand that healthcare costs can be reined in if transparency in pricing and quality are more evident. Our legislators need to continue to explore alternative delivery methods, just like we do in all other segments of our economy.

Buyer beware, consumer be educated, employer continue to educate. Central Florida has one of the finest healthcare delivery systems in the U.S. Let's just use our resources appropriately.

Larry Jones, is the Executive Director of the Integrated Independent Physicians Network and Chief Executive Officer of Independent Healthcare Partners (IHP), a Maitland-based healthcare company. He can be reached at

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