FEDERAL AND STATE POLITICIANS have raised a lot of concerns about Steward Health Care’s plan to sell its physician group to Optum, but no one has asked the physicians how they feel about the deal. To that end, I contacted Dr. David Weinstock, who leads a primary care practice in Auburn called Grove Medical Associates. The practice was formed in 1988 and he joined in 2003, right after completing his internal medicine training at Saint Vincent’s Hospital in Worcester. Weinstock also holds a leadership role in the central Massachusetts chapter of the Steward Medical Group. What follows is an email Q & A with Weinstock that I conducted with him in recent days.
PAUL A. HATTIS: How did you get involved with the Steward physician group?
DAVID WEINSTOCK: When I joined Grove Medical Associates, it was part of an association of independent physicians that contracted directly with health insurance companies on behalf of its member physicians. When Blue Cross Blue Shield of Massachusetts developed its Alternative Quality Contract, it offered providers a per patient per month rate plus incentives if certain health measures were met. Our association was interested, but Blue Cross required practices to have a minimum of 10,000 patients. To reach that level, our association aligned with Steward as an affiliate and became part of Steward’s Central Massachusetts Chapter. The original contract with Steward was signed in 2017 for five years. It was renewed in 2022, with one-year renewable terms, requiring a six-month window to withdraw from the contract. However, physicians face serious financial risks leaving the contracts, and Steward has not negotiated changes to the contract to reflect inflation or other expenses we encounter in our practices.
HATTIS: If the Steward-Optum deal goes through, what will it mean for your practice?
WEINSTOCK: If the Optum purchase moves forward, Steward will directly transfer the previous provider agreements to Optum without an opportunity for physicians to negotiate a new deal, despite an entirely new corporate change-over. We also worry if there will be pressure to join Optum. Will Optum demand in-network referrals to Reliant or Atrius providers, or impose penalties if we don’t? Will Optum mandate use of its electronic health record system, a cost most private practices cannot afford? We’re also concerned about how a sale would affect patient care. As independent providers, we make care and referral decisions based on what’s best for our patients. If the best care is met out of network, we want that choice for our patients.
HATTIS: What would be the financial impact for you of the Steward sale to Optum.
WEINSTOCK: The Steward affiliates who choose not to move forward with Optum will likely be forced to forfeit their contractually earned dollars for achieving health quality measures or reducing overall health care spending from years past. Steward has written the contracts in a way that allows the company to keep the money owed to physicians if the physicians leave Steward before payments are made. By delaying those payments until after the deadline to leave, Steward forces the doctors to go with Optum or face losing their money. Steward currently owes Grove payments dating back to 2021 for care provided to approximately 6,000 patients under Medicare, Medicaid, and commercial insurance. We estimate the amount Steward owes Grove for the care we’ve provided is around $200,000. While Steward is telling us now that “payments will be made” in early May 2024 for monies owed for commercially insured contracts (we have been told this in the past and months have passed before getting the money), we will still be waiting on 2021 Medicaid distributions and 2022 Medicare distributions.
HATTIS: How can Steward get away with withholding your money?
WEINSTOCK: Steward knows they aren’t held accountable for failing to distribute provider payments by a fixed date, even if those payments are federal dollars paid by the Centers for Medicare and Medicaid Services. Steward has held on to tens of millions of dollars over time that we were owed for our services and our earned performance incentives. The expenses of doctors like us keep going up for rent, utilities, employee salaries, health insurance, medical supplies, computers, electronic health records, and on and on. Our income, meanwhile, is decreasing — skimmed or restricted beyond our control. If payments were made directly to practices like they used to be instead of becoming profit for entities like Steward, primary care physicians could afford to remain independent and add the staff, resources, and services patients need.
HATTIS: What are your options?
WEINSTOCK: If we don’t sign with Optum, we’ll need to negotiate individually with commercial insurers. In theory, getting rid of a contracting middleman would be a positive. But in my experience, insurers like Blue Cross and United Healthcare refuse to discuss possible contract terms with us unless we first leave Steward. Over the past 20 years in private practice, the gross lack of transparency, lack of help, support, or just answers from commercial insurers is mind boggling. I’ve written numerous times to the insurance commissioner raising concerns, but there’s been no response.
HATTIS: That doesn’t seem fair.
WEINSTOCK: Nowhere else in business are you refused the ability to make an informed decision before committing to a contract. Without transparency, we risk worse contracts whether we stay or leave Steward/Optum. If insurers would simply contract and pay independent providers directly, the money they pay Steward for contract management would be available to improve patient care.
HATTIS: What are you and your colleagues doing about this?
WEINSTOCK: Given the increasing difficulties facing health care providers, more and more independent physicians are coming together. It’s encouraging. Most of us want the opportunity to contract directly with insurers. We’d do better managing the infrastructure dollars that should be going to primary care physicians to improve patient care. We’re coordinating our efforts and we’re doing our best to be educated on what’s happening behind the scenes to primary care.
HATTIS: Is there a lesson in all of this?
WEINSTOCK: Numerous entities claim they’ll improve healthcare and save dollars within the system. Yet what we typically see is increased costs, fragmentation, and erosion of patient care. Insurers make billions of dollars from premiums and deductibles and costs just keep increasing. Entities like Steward take money out of the system and further complicate our healthcare. The declining payments, withholding of money earned, and the lack of transparency with contracts, mergers, and distribution payments make providers question why we continue to battle the system. We strive to keep our patients healthy and out of the hospital. We navigate every aspect of their care from analyzing lab results to dispensing medications to ordering diagnostic tests. Primary care physicians are the 24/7 backbone of our healthcare system. If we don’t invest in the backbone, we’ll continue to see the collapse of our healthcare system.
HATTIS: It sounds like the future is bleak.
WEINSTOCK: Fewer practitioners are going into primary care, and too many are retiring or leaving the field because of how warped healthcare has become. Without the financial support needed to provide quality patient care, more and more primary care providers will run out of options to stay in practice. Ultimately, it’s the patients who suffer. It’s their money, foregone wages, and taxes that support our healthcare system. Patients need to demand more from insurers and the system to support primary care to keep themselves healthy, on their feet, out of the hospital, and out of bankruptcy.
Paul A. Hattis is a senior fellow at the Lown Institute and regular participant on CommonWealth Beacon’s Codcast.