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Is independence a viable option for physicians today?

Practicing independently is becoming increasingly challenging for physicians, as operating margins grow slimmer and reimbursement per case trends lower. Despite the growing list of obstacles taking hold, many physicians are maintaining their independence and have employed strategies to move forward in the tumultuous landscape.

With 15 years of experience under her belt, Belinda Muench, vice president of strategic services for Louisville, Ky.-based Advantum Health, a company that works with independent groups and hospital-based groups to implement best practices within their revenue cycle, has seen the many changes occurring in healthcare. When Ms. Muench was at Columbus-based Ohio State University pursuing her master's degree in health administration, a summer internship in Las Vegas gave her insight into the malpractice crisis and the need for tort reform with Level 3 trauma centers shutting down due to physicians walking out. Many challenges physicians faced in years past remain prevalent in 2017 — a copious amount of data entry, rising overhead costs and a seemingly endless list of regulatory requirements. For the first time ever, more physicians were employed than independent in 2016. An American Medical Association survey found 47.1 percent of physicians held ownership stakes in a medical practice that year.  

Can providers hold onto their independence in a time of massive consolidation? Ms. Muench believes they can and draws on her experience at Advantum Health to share insight into steps physicians can take today to remain autonomous.

Here are four strategies Ms. Muench recommends:

1. Ensure physician leaders are motivated. Physicians often set a precedent for a practice's culture, which can fare either in or out of the practice's favor. A physician with a positive attitude will likely translate to a happier, more motivated staff. However, physicians who are burned out by the accumulating daily administrative tasks may find it challenging to maintain optimism, and this may trickle down to staff members' overall attitudes and productivity.

"Often, people leave practices because of leadership. It all starts with your physicians," Ms. Muench says. "They are often the CEOs and owners [of a practice] and they develop the culture."

Physicians want to focus on medicine and a practice's capability in allowing a provider to do just that will result in a more satisfied stakeholder. Practices can give more time back to physicians by having administrators equipped with the essential data to drive decision making. This individual should stay updated on the changing regulations to ensure a practice is compliant with any state and federal regulations, as a compliance issue may impede a practice's ability to stay float. Administrators and physician leaders who work in tandem will help ensure a center is operating at its optimal efficiency.

2. Implement technologies that help physicians work 'smarter.' Technology is driving growth in the healthcare sector and there is a surplus of technological platforms available for a practice to boost its operations. Investing in technology often requires a fair amount of capital and physicians should meticulously look over their options to ensure an investment aligns with their organization's overall strategy at that point in time.

"Some practices have missed out on opportunities to leverage technologies [effectively]. They were working harder, [when they should be] working smarter," Ms. Muench says. She recommends physicians look at third-party vendors who can assess a practice's operations and weigh which technological investment would be worth their while and help the practice turn a profit.

3. Be wary of overcoding and undercoding. Coding accurately is pertinent to a practice's survival. If a provider undercodes, he/she may be leaving a substantial amount of money on the table and this loss in revenue may put a physician's independence in jeopardy. However, overcoding could have hefty consequences for physicians, as well.

"Often when we talk about coding, it has a negative connotation," Ms. Muench explains. "[With overcoding] the last thing a provider wants is to have payers auditing them and recouping funds." To avoid losing revenue, physicians should consider employing a certified coder who is well versed in the appropriate level of coding and conducting coding audits every quarter with each provider.

4. Make the healthcare experience seamless for consumers. Independent providers cannot forgo the importance of the patient experience. Simply put, patients are paying more for their care, and with more capital comes higher expectations. When a patient is asked the same set of questions multiple times or they are on hold for more than 10 minutes, this could lead to an agitated customer who could leave a poor review and taint a provider's reputation.

"There has been a shift in the marketplace to it being consumer-driven. Patient satisfaction is driven by making things easier for the patient," Ms. Muench says. A provider can nix the complexities within a practice through simple measures. Rather than reaching an automated system that may have difficulty understanding a patient, a practice can directly connect a patient to a staff member. Physicians should also set a patient's expectations from when they first walk into the door. If the wait time exceeds 10 minutes, Ms. Muench advises staff to inform patients of the projected wait time and keep them updated.

Although the degree of consolidation varies market by market, Ms. Muench says consolidation is likely here to stay for the time being. Thus, physicians seeking to stay independent should consider employing the aforementioned strategies moving forward.  

"The dip in [independent practice] won't be as significant as years past, but it will continue," Ms. Muench says.

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