One practice model doesn’t fit all

Tom Giannulli, MD, MS, Chief Medical Information Officer, Kareo
Tom Giannulli, MD, MS, Chief Medical Information Officer, Kareo

There was a time when most medical practices looked much the same. Many were solo or small independent practices that served their local community. Insurance covered much of the cost and patients paid a reasonable premium and a copay. Most patients stayed with their provider unless they moved or changed insurance.

It was all pretty vanilla, as they say. But then premiums began rising more and more every year, and copays and deductibles increased. From 2004 to 2014 the number of patients with a high deductible plan increased 31 percent. Regulations around medical billing, use of technology, and patient privacy and security have increased, too.

Over the past few years the number of providers saying that their biggest frustration is too much third-party interference in their practice has been on a steady increase in the annual Great American Physician Survey. For some, this has been a leading reason to consider leaving private practice for employment.

However, in recent years more providers are saying they want to stay in private practice and they see the employment trend slowing. To maintain their independence many are looking at alternate practice models, new technologies like telemedicine, and expanded practice marketing and patient engagement. In a survey conducted by the American Academy of Private Physicians (AAPP) and Kareo, 46 percent of providers said they were considering a switch to direct primary care (DPC), concierge, or other membership model in the next three years.

These practices, which are truly agile medical practices, are bucking the system and trying a variety of ways to be successful. Many are combining fee-for-service with DPC, ACO participation, and other tactics.

The Kareo and AAPP survey showed that many of the practices that are using DPC or concierge type memberships in their practices aren’t using them for all of their patients. Most have a portion of their patients on a membership and still have other patients on fee-for-service or other models.

According to Douglas Hansen, MD, a primary care physician in Colorado, his practice is trying DPC because they see it as a growing trend and something that some patients with high deductibles are looking for in a practice today. “We wanted to provide the option to patients who are interested,” he adds.

Dr. Hansen’s practice is one of the 375 practices that belong to an ACO. This allows him to access financial incentives and participate in programs designed to improve care coordination and patient outcomes. Lee Peter Bee, DO, who is also part of an ACO says it provides a lot of opportunities to cut costs and improve reimbursement for his practice. In return he was able to bring a lower rate for labs to the group that he had negotiated on his own. So the benefits swing both ways.

Both Dr. Bee and Dr. Hansen have tried other options to build and strengthen their practices as well. Dr. Bee has offered extended hours through telemedicine to rural patients. “Reimbursement is still challenging for telemedicine services but there is a demand,” he says. He hopes to be able to grow this part of his practice as they nail down getting paid.

Dr. Hansen is implementing comprehensive marketing automation in his practice this year. His goal is to add a couple more providers in 2016 and he knows that practice marketing and online reputation will play a role in building the practice. “We have to keep growing if we want to stay independent,” he explains. “I think the right technology plays a big role in that.”

The status quo simply won’t cut it anymore. Practices need to be open to trying new things. Not every practice or payment model is the right fit for every practice. But in today’s competitive marketplace, using many different approaches may be the best path to success and independence for smaller practices.

AAPP, American Academy of Private Physicians, comprehensive marketing automation, Direct Primary Care, Douglas Hansen, DPC, fee-for-service, Great American Physician Survey, Kareo


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