Some physician specialties are feeling financial pressure as healthcare insurers narrow provider networks and renegotiate smaller physician reimbursements, caused in part by healthcare reform under the Affordable Care Act and Medicare payment cuts. But rheumatology practices seem to have skirted the eye of the storm, at least for now.
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“We haven’t really seen much of that affect us yet,” says Lynette Byrnes, practice administrator for the past 11 years with Rheumatology Associates of Long Island, N.Y., which employs eight full-time rheumatologists and serves 200 patients per day at three offices in Suffolk County.
But Ms. Byrnes, who chairs the education committee for the National Organization of Rheumatology Managers, says it won’t be long before rheumatology will be asked to take the same financial haircut.
“Absolutely, there is no doubt in my mind,” she says. “The payment model is changing with [Centers for Medicare and Medicaid Services] CMS, and the commercial payers probably will fall into line. I see that coming.”
That’s the same feeling Chris Morris, MD, and Erin Arnold, MD, say they have when it comes to insurers squeezing rheumatology. Dr. Arnold, in private practice in Skokie, Ill., says she didn’t “come up against any difficulty” when transitioning to her new practice 11 years ago, but she and her three partners also chose not to participate in managed networks, in turn setting up an artisan-style practice.
Dr. Morris, a 20-year veteran of Arthritis Associates in Kingsport, Tenn., says she thinks the lack of rheumatologic care in smaller communities has helped insulate the specialty from the initial rounds of cost controls.
“The people who are going to have more problems with this are those in the large cities. We are not getting hit with this limitation because of competition,” Dr. Morris says. “Rheumatologists are safer [than surgeons] because there aren’t that many alternatives.”
Ms. Byrnes says patient choice is a long-term concern for her practice, especially as hospitals and healthcare systems gobble up smaller rheumatology practices. She is also concerned with the emergence of accountable care organizations, which she says don’t work well for patients who need a lifelong continuum of care.
“The commercial payers have not jumped on that wagon yet,” she says, “but CMS sets the pace and tone, and eventually, I am sure the commercial payers will jump on.” (posted 9/2/14)
Richard Quinn is a freelance writer in New Jersey.