FiercePracticeManagement Special Report Part I: State of independence: How practices survive in a challenging healthcare climate

Published February 20, 2015


State of independence: How practices survive in a challenging healthcare climate

By: Leslie Small

It's no secret that doctors relish the ability to remain autonomous in their practices, choosing which patients to treat, when and how to treat them and fundamentally, acting as their own bosses.

A host of pressures--financial and otherwise--may make it difficult for providers to maintain their independence, but data from the American Medical Association indicate that while there has been a substantial increase in large-system affiliation among doctors, the majority still work for organizations owned by physicians.

But that doesn't mean the independent practice landscape isn't changing. Providers use a variety of administrative, technological and organizational tactics to increase their efficiency and keep up with the ever-shifting industry regulations while maintaining a high level of care quality.

In this special report, FiercePracticeManagement explores some of the ways independent practices innovate their business models in order to thrive in today's healthcare environment.

Strength in numbers

For some physicians, the financial and administrative burden of running a medical practice makes going it completely alone an untenable strategy.

Many of those high costs are associated with government regulations such as Meaningful Use, which mandates electronic health record use and interoperability standards, said Denny Tritinger, pictured left, executive director of the Centers for Advanced Orthopaedics, an organization that includes about 26 independent orthopedic practices in the Virgina-D.C.-Maryland region.

While the regulations "are not a bad idea in the long run," said Tritinger in an exclusive interview with FiercePracticeManagement, "in a small practice, it's really nearly impossible to satisfy the requirements of those types of laws."

That's one of the reasons Louis Levitt, M.D., pictured right, an orthopedic surgeon, chose to align his practice with the Centers, which is not categorized as an Independent Practice Association (IPA), though both models allow independent providers to reap the benefits associated with a group practice.

"The choices came down to staying autonomous … versus being absorbed by the hospital and starting to be an employee, someone who rules are made for," he said. 

By joining forces with a larger group of independent physicians, "we have the benefit of being able to negotiate as one large company, first and foremost with the insurance carriers," he said. "We believe we can partner with the insurance companies so [that] it's a win-win."

Not only has affiliating with the Centers helped Levitt and his colleagues increase their bargaining power with payers, it's also helped his practice cut its malpractice insurance rates by 25 to 30 percent as well as helped stem the rising costs of providing healthcare for his employees, he said.

Furthermore, sharing data between multiple practices has helped the participating physicians access a much broader array of clinical information, Levitt said, adding that he and his fellow orthopedists have also begun to form clinical specialty groups to share and evaluate best practices.

Indeed, "if you're a standalone doctor, you really don't have the amount of data to determine what is the best outcome," Tritinger said.

In spite of such collaborative efforts, Levitt said, the Centers' model is to eschew a large, centralized office in favor of allowing all 26 offices to function almost entirely independently. And even with a lot of voices coming to the table, a shared vision keeps the model working, according to Tritinger. 

"We're human beings, so there's going to be some disagreements and misunderstandings and communications," he said. But "the model is so strong … those things kind of melt away. We're still sticking together and we still know we're doing the right thing."

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