Maintaining autonomy in private practice

[See also: Primary care practices to test service delivery and payment model]

The future of healthcare is changing and the implications of what that means for private practices remain uncertain at best. Maintaining practices' autonomy will require them to "shift and adjust to that change," according to Lawrence Braud, MD, executive committee member and chair of the Health Information Technology/ Quality Committee of The Physicians Foundation. 


"There is a lot of unknown right now with medical practice and healthcare in the future. We are going to see a lot more of the effects of the Affordable Care Act, and there are questions about how it is going to affect us and people are afraid," said Braud, who is an ear, nose and throat specialist with over 30 years of private practice experience. He is also worried about the threat of a 27 percent cut in Medicare, which although is not a new problem, is compounded by a "fiscal cliff that makes things unpredictable and has everyone concerned about what is going to happen."

"If the threat of Medicare cuts go into effect, there will be a number of providers who will have to opt out of Medicare," said Cyndy Walsh, CEO, at ProCare Systems, a West Michigan-based management service organization dedicated to medical practice management and legal practice management. "We don't know what we are going to get paid for services by the end of the year," Walsh explained. " We need a long-term fix to how healthcare providers are reimbursed by the system," she added.

But regardless of who is in office, the trends in healthcare will move forward, said Fred Davis, MD, president and co-founder,  at ProCare Systems.

"We have to look at what is happening: We [practices] are getting more overhead, and less and less reimbursement; we are coming to a point of diminishing returns," commented Braud. Practices will be looking at ways to increase their revenue, he said, by increasing their hours or days, or opening satellite offices or using mid-level providers to expand their practice. They may also look at joining another practice or an independent physician association, he added. "Everybody is going to handle the changes differently. Some will prosper, but some will have a tough time."

Despite all the uncertainties the future may hold for private practices, Davis believes "there will be every opportunity for [private] practices to be successful as they move toward more value-based care." He argues that whenever there is a trend in one direction  -  such as we are seeing in healthcare as it moves toward larger systems  -  there will likewise be a demand for more "private, personalized, patient-focused care."

"When there is coalition of market share in one or two entities, that can create some problems," added Walsh. However, Davis noted that practices are well positioned to take advantage of these problems because they are already "extremely motivated to work hard and can more easily adapt because they are not encumbered by administrative overhead."

In order for private practices to maintain their autonomy, "the main thing from a clinical perspective is to provide quality services and keep your prices reasonable," Davis said. This is where firms such as ProCare Systems can help, said Walsh. Because IT investment is such a huge hurdle for doctors, "[ProCare] has tried to let physicians take advantage of the economy of scale and only pay for tapping into the IT world," she said.

"We offer applications that can be imbedded into practices to measure the quality of care provided," she explained. Our systems allow [providers] to capture the clinical outcomes of the work they are doing, which is "very powerful information," said Walsh. Not only can providers benchmark their results against physicians in other parts of the country, but they can use the data to "help advocate for value-based reimbursement," added Davis.

With so much change on the horizon for private practices, Braud is certain of one thing: "The status quo and what has been is not what we are going to see in the future." [See also: Medicaid payment parity would improve access to primary care, says AAFP president]