Maintaining Independence in a Changing Healthcare Environment: Four Keys to Success

Updated on December 18, 2017

Screen Shot 2017 12 18 at 5.34.29 AMBy Scott Fowler, MD, FACOG

Given the financial, regulatory and market pressures today’s medical groups and physician practices face, running an independent multi-specialty practice isn’t easy; in fact, the number of independent physician practices has decreased 28 percent in the past decade. However, there is great value in participating in an independent physician-owned and physician-driven multi-specialty practice, especially in an era of value.

Physician-owned practices and medical groups have the ability to respond quickly to changes in the market. They are capable of testing new ideas and apply successful innovations more broadly to meet the needs of patients. And with the right infrastructure, they can offer personalized, responsive care and service which engages patients in a way that large systems would struggle to replicate.

What is the secret to maintaining independence in the face of competition from large systems or newly merged competitors? Our experience points to four keys to sustainability.

Invest in innovation. One key differentiator of independent multi-specialty practices is the potential to act confidently upon the creative ideas their physicians. The ability to sit at a table with one’s peers and contemplate ways to take patient care to another level excites and rejuvenates physicians. Some of the physician-led innovations we’ve seen come out of these discussions include:

  • An extensivist clinic—staffed by a hospitalist and nurses with emergency and intensive care training—that helps patients with complex care needs avoid a trip to the emergency department and a potential inpatient stay.
  • A clinical research department that helps patients become enrolled in clinical trials, improving care and advancing the service of medicine.
  • Developing best practices for precision medicine in a clinical setting (for example, using pharmacogenetics to better match patients who are sick with medications likely to elicit the best response).

Maintain data autonomy. In today’s healthcare environment, data is currency of exchange. Data is used to measure value, and it is proof that a provider has created value. Often, when a local hospital system merges with another entity, one of the newly merged organization’s first steps is to attempt central access and management of the data market by offering its IT services to independent physician groups. This enables the organization to gain access to all of the healthcare data sources in the community.

Our advice to medical groups is to maintain data access: Make sure you have access to your most critical data—patient data—at all times. Share patient data with other organizations for improving care while maintaining complete access for yourself.

Know your costs. For the Merit-based Incentive Payment System (MIPS), Advanced Alternative Payment models (APMs), accountable care organizations (ACOs) and clinically integrated networks (CINs) alike, cost will be the discriminating factor between success and failure. MIPS measures costs of care for Medicare Part A and Part B patients. In 2018, cost will carry a weight of 10 percent under MIPS, with performance based on total per capita costs per beneficiary, total per capita costs across four chronic conditions (chronic obstructive pulmonary disease, coronary artery disease, diabetes and heart failure) and Medicare spending per beneficiary. This will increase to 30 percent, and APMs and ACOs will be at risk for even more.

Success requires that physician practices ramp up the level of care they provide and elevate care management for high-risk and at-risk patients. Ensure that the right care is provided at the right time in the right location, and look for creative ways to provide care for complex, high-needs patients outside the hospital setting. For example, an extensivist clinic could help reduce readmissions.

Connect providers to real-time access to care information. The most successful physician practices are those that are viewed as trusted models of care. Physician-owned practices hold an advantage over hospital-affiliated practices in that they do not have an economic obligation to steer service to a specific facility. One of the ways we establish trust with providers throughout the community is by providing them access to a cloud-based health information exchange. No matter which member of our community a provider sees, that provider has access to his or her medical records through the community health information exchange. It’s a system that strengthens care coordination and communication across the continuum of care, with the ultimate goal of improving care and outcomes.

We also provide patients with access to their medical history and test results through our patient portal and offer home-based, nurse-facing technologies that capture vital healthcare data, such as cardiac and blood pressure data, from patients with complex healthcare needs. The more you can connect patients with real-time feedback on their health within the physician-patient relationship, the greater their level of trust.

A New Model for Independence

In an ever-changing healthcare environment, independent physician-owned practices are well positioned to transform from a traditional fee-for-service model to one that engages both physicians and patients in improving value. By providing the right care, communication and tools from the point of service across the continuum of care, independent physician-owned practices will be better able to sustain their position as trusted healthcare advisers.

Dr. Scott Fowler is the president and CEO of Holston Medical Group.

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1 thought on “Maintaining Independence in a Changing Healthcare Environment: Four Keys to Success”

  1. Excellent summary of critical success factors to enable the delivery of high performance health by an leading independent group. Honored to count Holston Medical Group as a member of AMGA.

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