You’ve likely noticed that the practice of medicine is changing. The traditional physician practice model is increasingly unsustainable, yet most doctors would prefer to practice independently. Many are even contemplating leaving the profession. If you’re one of them, it’s worth looking for ways to maintain at least some of your independence before abandoning ship. Here are 10 to consider:
1. Stay in private practice. This option may work for physicians in a few distinct situations: practices in rural areas, certain specialties (such as cosmetic surgery), thriving larger single-specialty groups, and large primary care or multispecialty groups with enough market power to win the support of payers and health care systems.
2. Grow an existing practice. Two of the greatest shortcomings of many physician practices — lack of market clout and access to investment capital — can be addressed by growth. By adding doctors to the current group or merging with another group, a practice may be in a better position to negotiate payer rates, invest in a new EHR system and other practice management technology, and demonstrate its commitment to quality of care.
3. Evolve into a large multispecialty group practice. An online article in the May 2010 Health Affairs reported that large multispecialty medical groups provide higher quality care at a lower cost compared with physicians in small group practices. This combination is especially attractive to health plans and integrated delivery systems. The greater volume of revenues generates enough capital to finance state-of-the-art clinical and management systems, quality enhancement initiatives, patient-focused programs, development of medical homes, and participation in accountable care organizations (ACOs). These expansions usually occur as a result of mergers with or acquisitions of other modest-size single-specialty practices.
4. Form an independent practice association (IPA). These organizations, which are a type of ACO, allow physicians to continue in their individual private practices while presenting a united front in negotiations with payers and delivery systems. The key to forming an IPA without violating antitrust laws is to clinically and financially integrate the participating practices. The physicians may remain at separate physical locations with considerable control over their practice operations, but there must be a sharing of significant risk. It’s common for IPAs to align with local hospital systems. Of course, a major hurdle is finding the necessary startup capital.
5. Transform into a concierge or direct-pay practice. A big headache for physicians is dealing with payers, both public and private. They can be avoided by only accepting payment directly from patients. A concierge practice may charge patients an annual fee ranging from $1,500 to $15,000. In return, patients receive amenities such as same day appointments, 24/7 access, e-mail consultations and longer appointment times. Under the direct pay model, the patient pays a $60 to $100 monthly fee for all primary care services needed. In either case, the physician benefits by spending more time with patients and less time with payers. Caution: If you participate in Medicare or other managed care programs, consult with your health care advisor before offering either of these services.
6. Practice in an employer-owned clinic. Many employers are setting up their own health care facilities, ranging from full-service, off-site clinics to in-house workers’ compensation clinics or wellness programs. In all cases, they employ doctors who work a reasonable schedule providing services to a population they get to know well.
7. Become an employee. In a quest to gain market share, hospitals have recently increased employment of physicians to support referral bases and capture admissions. The hospitals select doctors on the basis of their quality and service. And, rather than buy the assets of these physicians’ practices, hospitals often lease the office space and equipment. The physicians continue to work in their own offices, while the hospitals assume responsibility for administration and contracting. To enhance physician loyalty and clinical effectiveness, the hospitals are granting doctors larger roles in governance and management. In the end, physicians gain greater job security but give up complete control of their practice behaviors.
8. Be a strategic partner. You may be able to achieve some of the security of affiliating with a hospital by managing a specific service line within a hospital. Physicians often form management companies for this purpose. Similarly, a physician group can leverage its existing medical staff relationship with a hospital to jointly develop an ACO or integrated delivery system.
9. Join an ACO. Speaking of ACOs, creation of these organizations has accelerated with the passage of the Patient Protection and Affordable Care Act. Regardless of the practice structure (small or large, single or multispecialty, IPA or otherwise), doctors have much to gain by participating in an ACO. To succeed, these entities must invest in innovations (such as enhanced care coordination and disease management protocols). Physicians will have the satisfaction of practicing the most sophisticated medicine, fully serving the needs of a defined population and collaborating with peers.
10. Practice in a patient-centered medical home (PCMH). This type of facility goes hand in hand with the ACO. The PCMH concept is particularly appealing to primary care physicians, who oversee multidisciplinary medical “neighborhoods” in which patients dwell based on their medical needs. Doctors must assume much greater responsibility for management and coordination of care delivery. In return, they enjoy more equitable compensation and greater work satisfaction.
For more information on this topic, please contact Bill Clayton at [email protected].
