The numbers vary quite a bit depending on who is asking and how the questions are asked. But, when you dig into the data it appears that about half of physicians are employed by large enterprises and half say they are in a private practice.
The majority of those who have remained independent are looking for ways to stay that way. In fact one survey found that more than 70 percent would prefer not to sell their practice. In addition, many providers believe that this employment trend may start to turn around. This isn’t surprising considering that an independent practice offers more autonomy and flexibility along with higher levels of overall job satisfaction.
Most physicians seem to agree that staying independent isn’t easy. For three years in a row, doctors have reported that their biggest challenge is too much third-party interference. ICD-10, HIPAA and Meaningful Use are just the tip of the iceberg. Many payers, including CMS and United Healthcare, are significantly increasing their value-based payment programs. And on top of all that, patient expectations have drastically changed in recent years. Practices need to find better ways to engage patients and improve satisfaction or risk losing them to other providers who will.
There isn’t a single strategy to staying independent. The key is to be flexible and open to many different approaches. This includes changing or adding new technology, outsourcing business processes and being open to alternate payment models.
The 2015 Black Book survey suggests that the majority of smaller practices are looking to upgrade technology and/or outsource processes like medical billing as one step to avoid acquisition.
While there may be an initial outlay to upgrade, the long term benefits are worth it. “We wanted to be able to meet any coming changes in the industry,” said Dr. Josh Bock of AFC Physical Medicine and Chiropractic, a 24-provider practice, when asked why they opted to upgrade their technology. “We wanted an integrated practice management, billing, and EHR system. We’ve seen great results, such as improved efficiency in documenting, scheduling, records requests and billing.”
Technology not only makes practices more efficient, it can help providers focus more on patient care, which is one reason physicians want to stay independent. “I wanted the opportunity to have more personal and lasting relationships with patients and customize the practice to my style,” explained Dr. James Libecco who left employment at a large hospital for private practice. “The technology we have now allows me to manage my practice and staff and see about 50 patients a day.” He adds that he has been successful at building the practice he wants because of a combination of: “taking good care of patients, taking care of providers and staff, and providing really good service.”
Outsourcing provides some of the same benefits, but it can actually remove some of the headaches by pushing them onto someone else entirely, allowing practice staff to focus more on patients. Dr. Lester Hands also left employment with a larger facility and purchased an existing practice. According to his practice manager, outsourcing medical billing makes the most sense for a small practice. “The amount of money it costs to have a full time billing staff along with the time it takes to manage them is problematic. It’s better to be able to outsource the billing to someone else who can manage the claims and handle denials. Then we can go in and check the reports to see where we are each day and use that information to make decisions about our business, like whether or not we can or should add more staff,” he added.
While technology and services help lay the platform for a more efficient practice, the rest is really about the practice model and culture. And, achieving the culture you want means being open to looking at alternate models of care and payment. Fee-for-service isn’t the only game in town, and for providers who really want to separate from the payer system or at least reduce some of the regulatory headaches, alternative models might make more sense.
Using alternative, private pay models isn’t all or nothing. Recently, the American Academy of Private Physicians and Kareo conducted the largest industry survey on physician perspectives on practice models. It showed that about 24 percent of providers have already fully changed, or incorporated, a concierge, direct pay or membership model into their practice. The reasons weren’t surprising—more time with patients, better work/life balance and separating from the payer system. The main thing to note here is that many didn’t change their practice entirely. The largest percentage had only 25 percent or fewer patients on a direct pay or membership program.
They are finding success and staying independent by testing out different approaches and finding what works for them and their patients. That might be a combination of traditional fee-for-service, a concierge program for executives and some expanded offerings like a weight loss program.
Remaining independent is a balancing act. Being flexible and open to many options is one of the most important factors. With the right combination of technology, services, and reimbursement models, any practice has the potential to thrive.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker’s Hospital Review/Becker’s Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.
