Compliance plans, privacy, HIPAA, FIPA, HITECH, ICD-10, Stark, Anti-Kickback, fee-splitting, unbundling, coding, ZPIC audits, whistleblowers, qui tam, NLRB, exempt or non-exempt employees, EHR, and ACOs.  Compliance. Compliance. Compliance.

And all with decreasing reimbursement for services rendered.

How do I comply with all of this AND still provide quality patient care, with a smile?  Because if I don’t smile, just the right way, Twittersphere goes wild with my lack of sensitivity for the patients because I only care about money.

So, should I cave in and sell-out to the local hospital?

For many physicians, selling-out to the local hospital seems like the only alternative to deal with government intrusion into the private practice of medicine.  However, if you value your freedom (both in how you practice medicine and when and where you practice), if you value your entrepreneurial spirit, if you value the ability to generate income on anything but face-to-face patient visits, if you want to decide whether or not to take certain insurance payors or participate in Medicaid, or if you value your right to determine your office hours and what time you go home, then consider the following alternatives to your current practice environment.

  1. Integrated Group Practice. Size matters. There is strength in numbers. An integrated group practice joins multiple practices together under one tax identification number. The physicians use their cumulative size and strength to negotiate together with insurance companies, suppliers, vendors, etc. Most modern integrated group practices utilize a divisional accounting approach, which allows the practices to self-govern while taking advantage of being part of a large entity. Integrated group practices have proven to be successful for thousands of physicians taking part in large single specialty organizations and in multispecialty organizations. Integrated group practices use the power of numbers to negotiate on equal footing with insurance companies, hospitals and ACOs. Integrated group practices also allow the physicians to jointly share in ancillary services, such as diagnostic imaging, laboratory, physical therapy and others.
  2. Independent Physician Association (IPA). This is a “scaled down” version of the integrated group practice. With an IPA, each practice maintains its independence (and maintains its unique tax identification number). The IPA provides a list of services to the member practices for a fee. These services typically include contractual negotiations, billing, payroll, employee benefits, IT, consulting services and legal and accounting services. By grouping together, these costs can be spread out amongst multiple practices and many physicians, lowering the overall cost to each physician/practice. Successful IPAs can provide the foundation for participation in ACOs or risk contracts. The limitation with an IPA (as compared to an integrated group practice) is that the physicians of the multiple practices cannot combine to negotiate with the payors. Rather, the IPA negotiates a contract and goes to each participant of the IPA to either accept or reject the contract. This negotiation technique has proven less successful than all of the physicians joining together as a single economic entity and either accepting or rejecting the contracts at once. Notwithstanding the inability to negotiate together, IPAs have been successful in improving the leverage and benefits of its physician members.
  3. Concierge. Concierge practices historically have been available to primary care physicians, but there is no reason that the concierge model cannot work for other specialties, including cardiology, neurology and others. The concept behind a concierge plan is to decrease patient volume and increase the time spent with each patient, all while maintaining or increasing the practice revenue. Patients prefer the high-touch, high-contact approach provided by the concierge physician. The patient feels important, not 1 of 25 or more patients that must be seen in a day by the physician. In exchange for this high level of service, the patient pays an annual fee to the physician.

Some concierge practices go complete concierge.  This means that they take no insurance.  They rely on the annual fee plus fees charged to patients for services provided throughout the year.  Other practices maintain use of insurance.  The patients pay the annual fee, but insurance pays for services rendered throughout the year.

There are options to selling your practice to the local hospital.  The above are three options to consider, although other options are available, depending on your location and specialty.  For more information regarding this article, please contact Rick Reznicsek at (904) 567-1061 or