MDNews - Cleveland-Akron-Canton

University of Akron School of Law. Glessner is included in The Best Lawyers in America, 19th Edition, 2012–2014. Haupt is a Director of Krugliak, Wilkins, Griffiths & Dougherty Co., LPA. He also currently chairs the firm's Healthcare Section and the firm's Marketing Committee. His practice is focused in the areas of healthcare law, business/corporate law, mergers and acquisitions, business planning, and real estate law. He represents healthcare providers, health-related entities, physicians and physician groups and has been recognized as a "Rising Star" in Ohio's Super Lawyers (top lawyers under 40). Feltes is Canton Office Partner in Charge of Buckingham, Doolittle & Burroughs. His areas of practice include Health & Medicine, Employment & Labor, and Litigation. He represents acute care and rehabilitation hospitals, physicians, nurses and other healthcare professionals, managed care plans, and other healthcare providers and suppliers. Feltes has been selected seven times for inclusion in Ohio's Super Lawyers, six times for The Best Lawyers in America. He also received Martindale-Hubbell's highest Peer Review Rating of AV Preeminent. When all three attorneys peer into what Feltes describes as "that foggy crystal ball," they predict the future of health care will be challenging for physicians who want to remain in private practice. But they also predict that many can and will succeed. Here are their suggested strategies for success. The Challenges Recent laws have resu lted in decreased revenues and increased costs for private practitioners. This combination, along with higher overhead expenses, threatens the financial stability of small group, and especially solo, practices. "Even prior to the passage of the Affordable Care Act (ACA), sources of revenue for physicians were under attack by federal regulatory agencies, including, and in particular, diagnostic and other ancillary income sources viewed as being drivers of healthcare costs in this country," says Haupt. "The passage of the ACA and projected cuts in reimbursement pose even greater threats to the financial viability of private practices. This financial strain, and the fear associated therewith, has and will continue to drive physicians who want to maximize their income in the short-term . . . to choose hospital employment over private practice." "For all of its flaws, Obamacare may be hastening change, but even in its absence, change would have been inevitable," adds Feltes. "Economic pressures, resulting from increased operating expenses, including the financial burden of implementing HITECH requirements associated with EHRs, coupled with declining reimbursement, have hit traditional solo and small private practices particularly hard, causing many physicians to sell their practices and accept employment from healthcare systems. Some prognosticators predict that, within just a few years, as many as 75 percent of physicians could be hospital employees." "While many physicians have become, or are considering becoming, salaried hospital employees, other physicians are realizing that hospital employment may not make sense," says Glessner. "Some physician practices are not well suited to the hospital employment model. Other physicians are reluctant to give up the autonomy and flexibility that private practice often offers. In an ever-changing health care landscape, though, how do physicians hold on to the benefits of private practice while continuing to provide first-rate patient care and earn a living?" All three attorneys agree that there is no easy answer to this question. In fact, they say, physicians who want to retain at least some of their autonomy may need to consider a number of strategies, including: + physician extenders + practice mergers and acquisitions + physician health organizations (PHOs) + professional service agreements (PSAs) + accountable care organizations (ACOs) + group purchasing organizations (GPOs) There are other options, as well. Basic Treatments Feltes advises private practitioners to start with a "rudimentary approach" and re-evaluate both the revenue and expense side of their practice and formulate an economic "treatment plan" to give themselves the best prognosis for survival. "To boost reimbursement (or, at least, retard erosion), independent physicians may want to consider contracting with PHOs that may offer a greater opportunity to receive better negotiated rates with payers that may include value-based payment models," he says. "Another option is to explore co-management and gain-sharing contracts with hospitals to manage service lines, provided these arrangements meet legal safe harbor requirements to avoid implicating the Stark and anti-kickback laws." He points out that contracting with a GPO that uses market power to negotiate volume discounts from vendors can help minimize expenses and help bolster the practice's bottom line. "Employing advanced practice practitioners, including certified nurse practitioners and physician assistants, may be a way to provide services more cost-effectively, as well," Feltes says. "Also, opportunity still exists for independent physician practices to become patientcentered medical homes and participate in co-management, gain-sharing, jointventuring, group purchasing, and other contractual arrangements. "Clearly, the shift from fee-forservice to bundled payment and shared 2014 JANUARY/FEBRUARY ■ MDNEWS.COM ■ MD NEWS Cleveland/Akron/Canton |9

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