MDNews - Mid Hudson

���I think during the next ���ve to 10 years, you���ll see the death of solo practice,��� he says. ���I don���t see solo practice as a viable business model or care provision model in the near future.��� A combination of factors ��� from ACOs to medical record and patient management technology ��� is driving the trend, says Dr. Boutros. ���Nationally, we are moving toward standardized outcome measurements,��� he observes. ���Such measurements call for technology-enhanced diagnosis and treatment of patients. That means pulling the best data to analyze performance, in addition to utilizing the best evidence-based medicine to guide patient care. Today, large variations in care exist even between different ZIP codes in the same city. In the future, that will no longer be acceptable. Doctors will have to demonstrate they���re living up to the best practice patterns.��� Dr. Boutros adds that large numbers of patients are needed to invest in the technology required to make that happen. ���You need reminders for testing and technology to alert patients to have blood tests,��� he illustrates. ���It will no longer be acceptable to say, ���I told her three months ago to get a hemoglobin A1c, and she didn���t do it.������ Increased accountability and a higher level of standardization, according to Dr. Boutros, are best achieved across large practices, where outcomes can be measured and interventions implemented en masse. Small and Nimble Delicia Haynes, M.D., a family physician in Daytona Beach, FL, disagrees. She runs her own small practice, where she is looking at setting up some form of hybrid concierge-style care. But as Dr. Haynes told American Medical News, ���If someone needs the safety of a guaranteed paycheck, then [a solo practice is] not for you.��� Most people, of course, do need predictable income. And medicine isn���t something that can be practiced ���on the side��� or ���until you get started,��� like more uncertain careers. Few physicians would want to support their medical practices with supplemental work. Staying solo without going under takes an extra dose of creativity, such as Dr. Haynes��� move toward concierge medicine, or a helping hand. In many cases, physicians are partnering with larger groups while still maintaining majority control over their own practices. These groups provide just the population health resources Dr. Boutros describes. Joint Ventures the New Normal Joint ventures are becoming more common, with numbers rising nationwide during the last decade. For physicians, entering a joint venture can represent a compromise between the increasingly costly private ownership model and the loss of autonomy that comes with hiring on with a hospital. This model can be appealing to hospitals, too, write Jeff Simmons and Vivek Taparia of Regent Surgical Health in an April 2011 Becker���s Hospital Review article. Hospitals want to recruit and retain choice physicians, and with a joint venture practice, they can offer more incentives in the form of independence and shared rewards. Simmons and Taparia focus on ambulatory surgical centers, but the same holds true for other forms of medical practice that were once independently owned, such as OB/GYN practices. In one joint venture model, a physician practice may sell stock to a hospital, giving the hospital minority ownership. This works only in some states, points out Dr. Boutros, but where it does, it gives doctors equity in the hospital, as well as access to resources. Simmons and Taparia agree, noting this model gives physicians majority control over their practices, while making additional resources available to them. Strategies for Success Deciding on the best way to stabilize a struggling practice begins with taking a hard look at the current options and situation. Robert Carrera of Pinnacle III, an ambulatory surgical center management company, notes that practices all along the spectrum ��� from physician-owned to joint ventures between physicians, management companies and hospitals ��� can see high levels of success. The key to prosperity, he writes in a June 2012 SurgiStrategies article, is due diligence founded on a basic heuristic. ���What is the strategic and economic rationale behind the particular ownership/management structure being considered? ��� In other words, does the project or change in ownership structure make sense?��� Dr. Boutros agrees that the bottom line is awareness. ���The time for procrastination is gone,��� he says. ���Even if doctors make a decision not to join someone right now, they need to make a clear assessment of where their practices stand, create a strategic plan for the future and have a timeline by which to measure their progress. ���You can���t run from it. Nobody runs a business worth hundreds of thousands of dollars without a business plan. For physicians, the time is running out to do that.��� To share your experience, join the discussion at MDNews.com. I MDNEWS.COM I MD NEWS Mid Hudson | 15

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