The Executive Suite: How to thrive in independent practice

There has never been a more challenging time to practice primary care: long hours, more metrics, increasingly sicker patients and low financial incentive compared to other specialties. Nonetheless, independent primary care doctors continue to be an integral component of the health care system.Staying independent allows us to improve even further on what we do best by enabling us to be nimble and innovative while focusing on satisfaction of patients and staff.

Nimbleness

The health care environment is constantly changing – and independent practice allows providers to adjust quickly. When COVID-19 limited in person visits, independent practices could pivot to telehealth without needing multiple committee approvals and complex workflows. When payor and Medicare incentive programs change, we can modify our approach quickly to focus on the new metrics.While we may not have as much input directly with Medicare into these changes as large corporate practices do, our advantage is the ability to adjust quickly and start initiatives early to meet annual patient goals. We continue to be early adopters of trial platforms to make health care better. For instance, I was part of an early effort in Pennsylvania to transform primary care using the Patient Centered Medical Home (PCMH) model. I watched independent practices become some of the earliest to achieve NCQA PCMH certification in the state, resulting in additional revenue for these practices from participating payors.

Innovation

Independent primary care doctors are innovating and adapting to ever-changing demands of patient needs, technological advancements, and the greater health care landscape. Many of the earliest Meaningful Use certified practices in my geographical practice area were independent. In my own independent primary care practice, making the Meaningful Use criteria part of regular everyday activities required multiple iterations of new workflows with trial, error, and adjustment. For example, it took us just three months to experiment with trying three different approaches to find the most successful way for patients to receive post-visit summaries. In a corporate practice, the process of implementing change is considerably more arduous.

One study published in The American Journal of Managed Care showed small practices reduced patient spend greater than large practices. The AJMA found that over 80% of solo primary care practices were privately owned as were over 35% of practices comprised of two to five physicians. Therefore, it is likely that privately-owned primary care physicians represent a significant portion of better performers in lowering preventable patient costs. In a primary care ACO of independent practices that I co-founded, practices innovated around open scheduling, pre-session huddles, care management outreach, and adjusting visit frequency for high-risk patients. While many of these activities seem routine today, at the time they were new and innovative.

Satisfaction

When Meaningful Use was introduced and Accountable Care Organizations were first being explored, the concept of the Triple Aim was gaining momentum. Most considered the components of Triple Aim to be patient care, cost, and outcomes. Today, most experts have shifted to the Quadruple Aim which also includes physician satisfaction. In the privately owned primary care practice, ensuring that physicians and staff are satisfied is key to success. Physicians feel valued when their input and contributions are recognized. In an era marked by heightened burnout in the health care industry, it’s crucial to prioritize the satisfaction of physicians. Working in an independent practice can have a team-like feel where everyone can provide input on leadership decisions. Having worked as both an independent and employed physician, I found it much more difficult to have this sense of belonging and control over the direction of the employer organization compared to private practice.

Today, providers of all types are facing new and increasing pressures and many would say that primary care physicians are experiencing a greater share than their peers. Independent practice provides primary care physicians with advantages that are essential to surviving and thriving in this today’s healthcare environment.