The need for physicians to have focus on not only the delivery of care but also the ever-increasing complexity of running a practice has led to the consolidation of physician practices and increased employment of physicians. Recent legislative changes, including the Quality Payment Program and the drive towards value-based payment models, compound the reasons for the slow demise of the small practice model. Losing this opportunity to operate as an independent small practice deprives physicians of choice as they contemplate their mode of care delivery and location. Many doctors enjoy the autonomy and shared intimacy garnered by different practice configurations. Furthermore, the rural area needs are markedly different than those of the urban environment.
Even within the legislative realm, there have been attempts to ease the burden of small practices allowing them to work together towards improving patient care without consolidation. Two recent examples of such instances have been the increase in the minimum number of Medicare lives under the exclusion criteria from MIPS and the creation of “virtual” groups.
Along with these examples, there are numerous additional ways to provide the ability for small practices to thrive. Defining and clarifying the needs of these small practices are the driving factors that lead to consolidation, and these discoveries are paramount to creating viable solutions. Care management support, data analytics, quality reporting, and electronic health records have been identified as the primary needs of small practices. For instance, Independent Physician Associations have been in existence, allowing physicians to leverage their combined efforts towards the improvement of quality and cost. Though historically not a focus, medical societies have the capabilities of providing the services needed. Another solution may be the expansion of services offered by Physician owned malpractice companies that have been created to address specific needs.
There has also been an expansion of hospital systems, private companies and groups of independent physicians that have focused on service sharing arrangements in a “co-op” manner. Payor plans have focused on this dilemma by providing support to practices to enhance patient services. These business arrangements have been as varied in design, thereby increasing the probability of success.
Our goal should not be to drive towards consolidation or a small practice model, but instead, hone our focus towards how to allow for multiple delivery sources. Those we serve not only desire for us to be in different locations, they also wish for us to provide varied models. With both the supply and demand side wanting choice, and with there being advantages and disadvantages to all situations, let us not try to solve this as a simple 2 +2 equation. Let’s remind ourselves instead of the complexity of this work and thus focus on optimizing the desired states. There is innovation abound in all aspects of both the care model and delivery of services that we provide.