HMSA’s misguided payment change sets pediatrics back 50 years

HMSA is in the midst of enrolling all primary care physicians (PCPs) in its new Payment Transformation (PT), and pediatricians are the last group required to start participating by the July 1 deadline (or face serious financial consequences). This is despite numerous concerns we have expressed about the negative effects the PT will have on our ability to care for families covered by HMSA in the future.

The basic idea of this system is that instead of paying PCPs “fee for service,” HMSA will pay a flat monthly fee per patient in each PCP’s practice, regardless of any office procedures or treatments provided, or how often the patient needs to see the doctor.

HMSA has proclaimed that the new PT will result in “improved access to care,” although it essentially forces pediatricians to spend less time with each family in the office. HMSA seems to believe that our availability by phone, text or email is more important than having a trusting patient-doctor relationship.

We look at it quite differently. When we accept the challenge of caring for a child, we invest time and effort to build a relationship of trust with each child and family. This can only be achieved with face-to-face interaction, sincere open communication, hands-on contact and ongoing dialogue. We work to build a lasting, listening framework from which to understand the context of the child’s illnesses, psychosocial development, successes and failures. We use national guidelines (e.g. Bright Futures) that also recommend frequent face-to-face visits for all children from birth until young adulthood to address prevention, parenting, immunizations, screening for mental health problems and adoption of healthy lifestyles.

HMSA has stated that the PT will enable PCPs to “spend more time with patients who need extra care,” and “invest in their practice’s infrastructure.” Despite these claims, the PT in reality removes all compensation for extra time and effort spent with families having a child with a chronic medical condition or complex problem, who truly need guidance to navigate our complicated medical system and find the appropriate health care resources.

Clearly, our families also want us to keep up to date with the latest medical developments in pediatrics, and implement new office technologies to benefit their children, but the associated cost of such innovations will not be covered in HMSA’s new system. We suspect this issue will eventually drive up overall health care costs as patients have to be sent elsewhere (including the emergency room) for tests and services we no longer can afford to provide ourselves.

HMSA furthermore insists that the PT will allow PCPs to “practice medicine the way they believe is best” — yet it increases our administrative demands, taking more time away from us to care for our patients. Most of all, we worry that the PT will undermine the unique relationship we have with our children and families and keep us from our passion and purpose, caring for our future.

Now is the time to advocate for your child’s and family’s relationship with your pediatrician to stay unbroken. Talk to your doctor, your employer and your legislator. Please help us in our efforts to continue caring for your children and our future together in the best way we know.