Register / Log In

RomneyCare: Canary in the coal mine not looking very healthy


If so-called RomneyCare in Massachusetts is a harbinger for national healthcare reform, as some critics have claimed, then the continuing pressure on the primary care system will be significant.

A recent survey by the Massachusetts Medical Society (MMS) found that more than half of primary care practices in the Commonwealth are closed to new patients. In addition, wait times to get appointments with both primary care doctors and specialists are increasing, and fewer practices are participating in key government healthcare programs, according to the survey, which is part of the MMS’s annual Physician Workforce Study.

In terms of primary care, the survey, based on 838 telephone interviews, found that 51% of internists and 53% of family physicians are not accepting new patients, similar to last year’s figures. According to MMS officials, those figures illustrate a continuing and serious shortage of primary caregivers. Other findings:

  • The average wait time for an appointment with a family medicine practitioner was 36 days, 7 days longer than in last year’s survey.
  • The wait time in internal medicine was 48 days, a slight drop from last year.
  • 73% of pediatric practices were accepting new patients, and the wait time was 24 days.

How have primary care practices in Massachusetts dealt with that state’s healthcare reform efforts? A substantial number of Massachusetts’ primary care doctors have responded to the healthcare reform efforts by opting out of at least some of the programs, according to the survey:

  • While 85% of internists and 87% of family physicians accept Medicare, only 53% of internists and 62% of family physicians accept MassHealth, the public health insurance program for eligible low- and medium-income residents of Massachusetts.
  • 43% of internists and 56% of family physicians accept Commonwealth Care, a health insurance program that provides uninsured low- and moderate-income Massachusetts adults with free or low-cost health services through managed care health plans.
  • 35% of internists and 44% of family physicians accept Commonwealth Choice, a nonsubsidized health insurance program for uninsured adult Massachusetts residents.
  • 89% of pediatricians accept MassHealth, but only 50% accept Commonwealth Care and only 45% accept Commonwealth Choice.

“Massachusetts has made great strides in securing insurance coverage for its citizens, but insurance coverage doesn’t equal access to care. We still have much work to do to reduce wait times and widen access,” Alice Coombs, MD, president of the Massachusetts Medical Society, said in a statement.

Go back to the current issue of eConsult.

Last week, the Centers for Medicare and Medicaid Services mailed the first Medicare checks to physicians who had attested that they had achieved meaningful use of their electronic health records (EHRs). What effect will these payments have on you and your colleagues? Will everyone rush out to buy EHRs now or will they let this opportunity pass them by? Read on to find out.

The new proposed rules for accountable care organizations haven't been well received, to say the least. All 10 of the clinics that participated in the prototype program, and 93% of American Medical Group Association members, said they would not participate in ACOs under the proposed rules.

For more than a decade, Congress and physicians have agreed that the Sustainable Growth Rate isn't sustainable. Noted at a recent hearing, the 29.4% cut in reimbursement scheduled for January 1, 2012, would have a "disastrous effect on access to care for Medicare beneficiaries," which in turn may cause 82% of physicians to "make significant changes in their practices that will affect access to care."

Medical informatics, long in a gray area between information technology and medicine, may soon be recognized as a full-fledged medical subspecialty. If this occurs, it will arrive just as many healthcare organizations and physician practices are beginning to view health IT as an essential tool for improving the quality and lowering the cost of healthcare. Our experts explain the thinking behind this proposal.