New Lobbying Coalition Represents Physician Groups, IPAs

A new national coalition of physician groups and independent practice associations (IPAs) has been formed to lobby for an unfashionable vision of health care reform. Spearheaded by the California Association of Physician Groups (CAPG), Physician Groups for Coordinated Care (PGCC) is trying to make the case to Congress that coordinated care in large physician organizations is the best hope for saving the health care system. At the same time, the coalition aims to preserve at least some of the funds that are expected to be cut from the Medicare Advantage program.

Other organizations representing physician groups have a presence in Washington. But, according to Donald Crane, president and CEO of CAPG, PGCC is the only one that really is advocating on behalf of “capitated, coordinated care.”

He is quick to add, however, that PGCC does not exclude groups or IPAs that are primarily fee for service. “What we’re after is the result, which is integrated care and integrated incentives. That can be achieved in a number of ways. We’re not dogmatic about capitation. There’s a lot of talk about bundling, about shared savings programs, and about medical homes. We fit all of those bills.”

(For the uninitiated, “bundling” refers to proposals to bundle physician and hospital payments; “shared savings” means letting physicians keep some of the savings they generate by providing better preventive and chronic care; and “medical homes” is the tag for various proposals to reward primary-care physicians for better coordination of care. The Centers for Medicare and Medicaid Services [CMS] is investigating all three approaches.)

CAPG, which represents about 150 physician groups and IPAs with 59,000 physicians, decided to form the national coalition late last year. “We decided we needed to have a broader national footprint, better reach to more Congressional districts, and more credibility,” says Crane.

So far, 10 organizations have joined PGCC. Besides CAPG, they include Greater Rochester IPA (New York), Health First Network (Florida), Healthcare Partners (California, Florida, Nevada, Utah), Heritage Medical Groups (California, New York), North American Medical Management (California, Illinois), Physicians Care Network (Florida), Southeast Texas Medical Associates, LLP (Texas), WellMed Medical Group (Arizona, Florida, Texas), and Willy Pezzia MD & Associates (Texas).

IPAs definitely need some lobbying help in Washington. In the first draft of the health IT provisions of the economic stimulus package, CAPG discovered, there was no mention of IPAs. Physicians had to belong to integrated groups to get government funds to buy EHRs. That ruled out California IPAs that are trying to  help their members acquire information systems. CAPG prevailed on the bill-writers to refer the matter to the Secretary of Health and Human Services, who will address it in the regulatory process.

The biggest priority of both CAPG and PGCC is Medicare Advantage, because senior HMO payments are the lifeline that prepaid groups in California and other regions depend on. While Crane doesn’t believe that anybody can stop the movement to cut government subsidies to Medicare HMOs, CAPG is trying to persuade Congress to spread out the cuts over a multi-year period and/or reduce payments less for more efficient providers. When PGCC takes a position on Medicare Advantage, he believes it will be similar to CAPG’s.

Here’s a conundrum: It’s politically popular to cut subsidies to insurance companies. But if Congress does that, what will happen to the only physician groups in the U.S. that know how to manage care?