HB1347

I am a Primary Care Provider in Rochester, NH. I cannot emphasize enough how many barriers to care that patients face in this area. This bill would help relieve some of this burden as we currently have to tell patients, this service is closer by, but "closed to outsiders". You could switch to their primary care group which could take up to 1 year to get in, then hope to get into a specialist within the following 6 months. The health issues precipitating these needs don't wait on such timelines.

Written Testimony in Support of HB 1347 I am Dr. Bridget Marvinsmith, MD and I am writing in strong support of HB 1347. HB 1347 is a simple and patient centered bill. It ensures that no health care facility in New Hampshire can block referrals from independent primary care providers as long as the specialist and the PCP both accept the patient’s insurance. In plain language: If a specialist takes a patient’s insurance, they must take the patient—regardless of whether that patient’s primary care doctor works for the hospital system or is independent. Why does this matter? Because across the country and here at home, large health systems are increasingly refusing specialty appointments unless the patient switches their primary care to someone employed by the system. This is deeply harmful. It disrupts long standing relationships between patients and the primary care physicians they trust—relationships that we know improve outcomes, reduce hospitalizations, and lower overall healthcare costs. I have personally watched many patients be negatively affected by these practices. First, as a physician employed by HCA/Appledore in Portsmouth for seven years, starting in 2016. We had multiple specialists in the HCA system, but did not have an Endocrinologist. I routinely had patients refused by CORE and WDH Endocrinology because I, as their PCP, was not in that system. As an MD, I take pride in my comprehensive management of patients, and only refer to specialists when needed. However, a type 1 diabetic with multiple endocrine issues like hypothyroidism and osteoporosis should absolutely have an endocrinologist as part of their care team- it is a disservice to the patient to do otherwise. At my next clinic, ConvenientMD Primary Care, where I worked from 2022-2024, I felt this more acutely. As an independent health system of urgent care and primary care, we had no direct relationship with specialists. I was stunned with the number of patients who were refused care by large health systems in the Seacoast area and beyond because I, as their PCP, was not employed by the same system. A patient with multiple auto-immune conditions would not be accepted by Rheumatology, who typically oversees these complex medications, because I did not work for WDH/MGB. In early 2025, I opened my own Direct Primary Care practice. I am now a fully independent PCP and I am grateful that my business and patient care are flourishing. However, I continue to feel the burden of large systems refusing care to my patients. Although my patients pay me directly, they use their insurance for specialists’ care. Just last month, one of my patients on a discounted payment plan with me, who has WellSense, was refused an evaluation by the Neuropsychiatry providers at WDH because she does not have a PCP in their system (we made certain they take her insurance, because the eval is far too costly for her to pay out of pocket). This is a woman with a complex psycho-social history, who I have come to know and whose trust I have earned after caring for her for 10 years, from the ages of twenty, when she was hospitalized extensively to, at long last, becoming a more thriving thirty year old with a career, hobbies, and goals. To leave my care now would almost certainly be detrimental to her health; but so too is the refusal of an appropriate evaluation for her complex issues, simply because of the PCP she sees. The American Medical Association has spoken clearly: Requiring patients to switch PCPs to access specialty care is ethically unacceptable, harms patients, and undermines the patient physician relationship. This is not about clinical appropriateness. It’s not about insurance coverage. It is purely about corporate control. This kind of discrimination has no place in a healthcare system that claims to serve its community. Now, systems will tell you that specialists are a limited resource. And they’re right—specialists are in short supply. But that scarcity makes it even more important to allocate care fairly, not according to employment relationships. We already have a model for this. Our community mental health centers—also operating under scarcity—serve every patient in their geographic area regardless of who their primary care doctor is. They treat the community as a community. Hospitals and medical groups should be held to the same basic standard. Importantly, HB 1347 does not force specialists to take out of network patients. It does not interfere with clinical judgment. It does not mandate referrals or override medical decision making. It simply says that patients should not lose access to specialty care because of who they choose as their primary care doctor. HB 1347 protects patient choice. It protects continuity of care. It protects independent practices in New Hampshire. And most importantly, it protects patients during a time when access is already strained. This bill is fair, reasonable, and urgently needed. I respectfully urge you to vote Ought to Pass on HB 1347. Thank you for your time. Sincerely, Bridget Marvinsmith, MD Tidepool Family Medicine Rye, NH drb@tidepoolfm.com

To whom it will concern, I am a physician in New Hampshire for the past 16 years. It has been very difficult to be able to refer many of my patients to specialists that work at different hospitals. My current hospital does not have every specialty that my patients need. The current practice of many hospitals in the state of New Hampshire is to require patients to see a primary care provider at that hospital to access care to their specialists. The patient should be free to choose any PCP they wish to see, as long as their insurance covers the specialist, they should be able to see any specialists they would like to see as well. This practice of poaching patient's away from independent PCPs or doctors that work for other hospitals is morally and ethically wrong. This is the Live Free or Die State. The current practice is antithetical to our state's motto and to good patient care. I implore you to pass this bill to stop this discrimination of patient care. Regards, Dr. Ray Wilt DO

As a primary care physician practicing in the local area it has been very challenging for my patients to schedule with certain specialists that are not available in our system. This causes undue burden for patients and the practice to arrange for these appointments outside of the local area and often with prolonged wait times.

Dear Committee members, HB 1347 protects patient choice. It protects continuity of care. It protects independent practices in New Hampshire. And most importantly, it protects patients during a time when access is already strained. This bill is fair, reasonable, and urgently needed. I respectfully urge you to vote Ought to Pass on HB 1347. Sincerely, Phenton Harker

Dear Chairman Hunt and committee members, I am writing as a Bow resident and an independent family physician practicing in Concord in strong support of HB 1347. A health system should not deny a patient access to a specialist on the sole basis that their PCP is not employed by that system. This bill provides for equitable access to specialty care without imposing new financial obligations on specialists or insurers. In the last several years, appropriate and necessary specialist referrals have at times been refused solely because I, as an independent Primary Care Physician, was not employed by the same healthcare organization. With the consolidation and acquisitions of specialty practices by healthcare corporations in New Hampshire, there were no equivalent in-state alternatives, and my patients were forced to travel to Maine or Massachusetts for rheumatology and dermatology care. This was not about clinical appropriateness or insurance coverage; the specialists accepted the patients’ insurance. Patients were being coerced into changing their primary care provider to one within the health system in order to access specialty care. The American Medical Association recently adopted a policy directly addressing this issue, stating that health systems should not require patients to switch PCPs in order to access specialty care and that these practices are ethically unacceptable and harmful to patient welfare. This undermines patient autonomy, disrupts continuity of care, and limits access to healthcare. It prevents primary care practices (specifically independent practices) from collaborating with our specialist peers for optimal patient care. In rural areas especially, limiting referral access effectively eliminates specialty care for many patients. This kind of discrimination harms healthcare delivery and erodes patient trust in New Hampshire’s healthcare systems. In some cases, it drives patients out of the state for specialty care. HB 1347 protects patient choice, supports independent practice, and ensures equitable access to specialty care without imposing new costs on healthcare systems or insurers. It is urgently needed, and I hope that you will vote to pass HB 1347. Thank you for your kind consideration. Please feel free to contact me should you have any questions. Sincerely, Eric Kropp, MD

This is common sense. Apparently there are some folks who don’t understand that it is wrong and dangerous to share someone else’s personal information on the internet. This should be a no-brainer for anyone in elected office. But apparently, there are some brainless folks who do this so they need a little help remembering how to conduct themselves in a manner consistent with their role in civil society. Vote OTP

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