MDNews - San Antonio

T HERE IS SO much talk about physi- cians not being able to maintain their independent medical practices because of greatly increased admin- istrative burdens, higher expenses, lower reimbursements and the like. That same talk goes on to say that physicians leaving residency will not open new practices, but rather join hospital systems. These predictions, while certainly true to a point, are not what many of us consultants in the medical field are seeing entirely. It is very much underestimated how physicians value their autonomy and independence. There is no doubt that it is now much more difficult to maintain or open a new medical practice. So for those independent physi- cians who want to remain their own boss, what advice can we give them? Physicians read nationally published articles that emphasize joining ACOs, IPAs, PHOs and other associations in an effort to band together to enhance business strategies, negotiate better reimbursement rates with insurers and reduce costs through larger purchasing power. While it is not entirely appropriate to include in a single discussion the benefits and issues of these types of associations, there are a few points to be made about affiliating with a larger medical group. Certainly there are some benefits to gain from joining an association. What needs to be reviewed carefully before joining are: 1. The degree of financial and contractual commitments — What fees are required? What set of criteria/measures must be met as if the physician were an employee? 2. Does the particular group lean heavily towards PCPs or does it favor specialists? 3. What are the financial bonuses/rewards possible for the physician in light of +++++++++++++++++++ +++ + +++ + +++++++++++++++++++ ACCOUNTING to Stay Independent the large amount of quality reporting measures that must be provided? For primary care physicians, the direct pay model that is commonly referred to as concierge or personalized medicine has some merit and has worked for some PCPs. Setting the correct fee structure and retaining and recruiting patients are key, as well as maintaining a loyal patient base and a solid reputation in the community. Transition can take three to six months and contractual obligations must be addressed. Still, the initial results seem to indicate an overall satisfaction with many of the PCPs who have transitioned to a direct pay model. For most of our independent physician practices, the bottom line is to work smarter, develop ancillary income streams, spend wisely and work with a medical consultant to achieve all of this. Along these lines, here are a few of the more current comments being made across this country: 1. Some of the more successful practices have 15 to 20 percent of their revenue coming from ancillary services. 2. Screen patient scheduling to include eas- ily treatable problems between already scheduled appointments, as those "fast track" appointments will only take a few minutes. 3. The front-desk person can make a lifelong patient or a one-time patient. Evaluate that position carefully and train that person well. 4. Cut waiting room time. See if patients can download and complete intake forms ahead of time. 5. Pay attention to what patients are saying about your practice on review sites. I could go on about fine-tuning operations, re-evaluating recurring costs, reconnecting with dormant patients, motivating better performance from employees, prioritizing collection of patient receivables, renegotiat- ing contracts with insurance companies and building a marketing brand for your practice, but we'll leave that for a meeting with a medical consultant. New, innovative associations are sure to be developed over time. We will have to wait and see how those new associations/systems can benefit our independent physicians. In the meantime, hang in there. Jim Rice, CPA, is a shareholder at Sol Schwartz & Associates, P.C. He has 36 years of experience in public accounting, and he works with a high concentration of physician practices and high-net-worth individuals. Contact Rice at jprice@ssacpa.com or 210-384-8000, ext. 112. ■ By Jim Rice, CPA The Fight M D N E W S . CO M ■ MD NEWS San Antonio | 1 1 M D N E W S . CO M ■ MD NEWS San Antonio | 1 1

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