After years of rapid purchasing of physician practices by health systems, there are some signs this trend may be slowing. Providers are finding the benefits of working for a healthcare system, such as a fixed salary and fewer administrative tasks, do not outweigh the disadvantages, such as less autonomy, less time with patients, and more quotas.
A recent study of nearly 800 providers at independent practices by Kareo Inc., of Irvine, California, found that, although 13% of respondents were considering joining a hospital, 8% were planning to break from one, resulting in a net gain of only 5%. Kareo, which offers a technology platform for independent practices, conducted the study to understand the challenges these providers face and the priorities for their practices.
In the study, providers listed a range of concerns facing practices. Streamlining care delivery topped the list. Security, diagnostics, prescription and lab management, and treatment adherence also emerged as areas of concern.
Aaron Perreira, Director of Integrated Marketing at Kareo, said they see medical groups struggling with the complexities that come with independence in healthcare.
“They are not just delivering care and staying on top of their specialty and caring for patients, but they are being asked to manage a multitude of regulatory burdens … all while managing a small business with staff and facilities,” he said.
Keeping up with the regulatory environment is a definite challenge for providers, said Marni Jameson Carey, Executive Director of the Association of Independent Doctors (AID) in Winter Park, Florida. Doctors also want to simplify their practices and spend more time with patients and less time with computers.
The increasing use of technology may feel like a burden, but some in the Kareo study were optimistic about its potential to improve a practice.
“Newer providers are more likely to be optimistic about how technology can be an aid to addressing challenges around burnout,” Perreira said. “While more established doctors are often averse to technology and change.”
One way technology can help providers is by streamlining workflow and handoffs, Perreira said. Even before a patient enters a practice and engages with the front office, data can be collected and used to assist the provider. An example of this is by employing online patient intake and automated insurance eligibility verifications. This can save time for patients and front office staff. While delivering care, providers can use SALT (same as last time) notes for commonly used procedures and voice-to-text technology to improve charting speed.
Sharing the responsibility of patient outcomes between hospitals and independent practices will be increasingly important as the healthcare industry continues to move towards a quality care model. Independent providers who can efficiently share the required data for referred patients will benefit from a preferred relationship with referring hospitals.
“If you have a provider that is like-minded and has lots of metric-based foundations to drive shared outcomes, hospital systems will be more likely to refer patients to that provider,” he said.
Technology that removes steps, like automated appointment reminders and web-based scheduling and patient intake forms, frees up staff time to help with other tasks. Technology also should be used to target where resources can best be used, said Andy Snyder, MD, principal and chief medical officer for Cope Health Solutions, a healthcare consulting practice based in New York and Los Angeles. Not every patient needs extra support, but technology can help improve outcomes for those that do.
Risk stratification and patient identification can be used to find groups of patients that need population health management. Staff has taken the time to put data into health records, so providers should use that information wisely, Dr Snyder said. Electronic records can help providers identify patients’ prescription and medication adherence patterns and alert providers to patients who arrive at visits with unmanaged chronic conditions such as hypertension or diabetes.
“Technology has to be a tool that enables efficiency and better quality of care,” Dr Snyder said. “You can’t boil the ocean; use it smartly and only for what you have to.”
Making helpful use of data can also ingratiate specialists with primary care doctors, Dr Snyder said. For example, primary care providers value highly those specialists who alert them to patients who fail to fill prescriptions or are otherwise non-adherent with therapy, he said.
“If someone had actually called me and said, ‘Mrs. Jones doesn’t take her meds, will you help us with this?’ I would have been floored,” he said.
The Kareo study also found that 14% of practices surveyed said they were planning to merge with other practices. Working well with others is among Dr Snyder’s top tips for those going it alone.
“An independent practice cannot mean being an island,” he said. “They should still be part of a greater network for contracting and infrastructure supports that help with care coordination.”
Dr Snyder, a former chief medical officer for an independent practice association (IPA), said IPAs and clinically integrated networks should not be thought of as the “evil empire.”
“IPAs and CINs are traditionally physician-colleague managed organizations that provide infrastructure for independent practices and are there to represent the physician enterprise,” he said.
Another non-tech way to strengthen a practice is to eschew insurance and move at least part of a practice into direct patient care, said Jameson Carey of AID. Her organization surveyed about 1,000 members and found that one-third were already taking cash payments, working directly with employers, doing concierge medicine, or working in a hybrid situation. Another third of respondents said it was going to be critical to move in that direction and the final third wanted the status quo.
A growing number of employers are contracting with physicians who are paid a monthly per-member fee to treat employees and family members, she said. Her organization works closely with healthcare providers to figure out how to do more direct care work without limiting their practice to cash-pay only or switching their entire practice to a direct-care model.
“Doctors can practice better medicine while employers can save a lot on healthcare costs,” she said. “Doctors can choose to do this with some of their patients but not all of them.”