GARNER — Since it opened 33 years ago, Garner Family Practice has grown from a small medical office with a lone doctor to one of the largest practices in the Triangle, with nine physicians and 50,000 patients. But despite the growth, some things have been slow to change – patients’ charts are still filed in thick folders, a far cry from sophisticated electronic records.

In March, the practice joined Triangle Physician Network, a nonprofit set up by UNC Health Care and Rex Healthcare. Garner Family Practice wanted to gain access to the network’s electronic records system and to increase its bargaining power with insurance companies, said Dr. Johnny Bagwell, who started the practice.

“It was very obvious to me that the day of small stand-alone private offices are over,” Bagwell said.

He’s not the only one. More and more medical offices are aligning with hospitals in hopes of gaining security amid the uncertainty of health-care reform. Some doctors see the move as a way to get higher reimbursement rates from insurance companies, and they welcome the help networks provide for office duties such as billing.

Hospitals benefit from the relationship, too, because the network doctors send new patients their way.

Morrisville-based Triangle Physician Network formed in 2009 with 15 practices and more than 60 doctors. Today, the group includes 36 practices and 156 doctors in eight counties.

“I think they’re looking for stability as they look forward to health-care reform,” Bob Ricker, executive director of operations for Triangle Physician Network, said of doctors.

WakeMed’s doctor network, WakeMed Physician Practices, is made up of 220 doctors. The number has doubled in the last two years, said Dr. Susan Weaver, executive vice president for medical affairs for the hospital.

WakeMed also has less-formal relationships with doctors, Weaver said, including a new program in which the hospital pays some of the cost to switch to electronic records.

Duke’s network, Private Diagnostic Clinic, has more than 1,200 faculty doctors.

Bagwell said it would have cost his practice more than $1 million to switch to electronic records if it hadn’t joined a hospital network. Triangle Physician Network is providing computers, software and IT professionals, he said.

Beyond technology, Bagwell hopes his practice can join forces with others in the network to negotiate higher reimbursement rates from insurance companies. It’s tough for individual practices to haggle, he said.

“They look at you and say, ‘Go on back home; we don’t need you,’” Bagwell said.

But some doctors worry they will be forced to give up some autonomy when they join a network.

“I think the biggest concern is just losing independence,” said Dr. Erin Ennis of Garner Family Practice. “Time will tell how much that happens.”

Networks can also mean fewer options for patients. WakeMed Physician Practices urges doctors to refer patients to WakeMed, but it can’t require them to do so.

“We encourage them because we believe it improves the quality of care,” Weaver said, adding that specialists within the network have easy access to patient records.

Triangle Physician Network also prefers its doctors send patients to UNC or Rex. Bagwell said he lets his patients decide which hospital they use, and he doesn’t plan to change his referral process now that he’s aligned with Triangle Physician Network.

UNC and Rex don’t have a contract with health-insurance provider Aetna, so those patients who seek services there pay higher out-of-pocket rates. Garner Family Practice has fewer than 500 patients with Aetna insurance. If they want to remain at Garner Family Practice, they will likely have to shell out more money.

Dr. Randy Crumpler of Garner Family Practice said it just made sense to join a hospital network.

“Changes are happening so fast, so we’re back in a period of being uncertain about what’s going to happen,” he said.

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