“One is the loneliest number … ” so the 1960s song says about relationships. But now more than ever, it can apply to solo practitioners, especially those in primary care.As the hospitals, MSOs, managed care companies and others spend big bucks wining and dining us to join their group practices as employees, it’s worth a look. But the cost of losing our independence and to be beholden to a large system, at the expense of our patients, can be high.
Solo practitioners are free to use the most efficacious imaging, labs, and other services for our patients and to admit them to the hospital that’s best for them (not for the hospital system). However, we face a great deal of uncertainty with the approach of Obamacare and do not have leverage with health insurance companies to receive the best reimbursement for our services.
Why not have it both ways? Independence with the security of a group practice.
There are alternatives for physicians to become hospital employees. Many of the specialties have already done it—formed large group practices to share information, contract with insurance companies, and streamline the business office.
There are about 1,500 primary care physicians in south Miami-Dade County who are wrestling with their decision to join a hospital-owned group practice, MSO, or to remain independent. The costs and benefits of each choice are significant.
Physicians who sell their practices to hospitals, MSOs, etc. will have a level salary and the security of being part of a group, but they may have to radically change the way they have practiced medicine for decades. They will be subject to rules and regulations on running their practices and limit where they can admit their patients when they need hospitalization and where to send their patients for imaging and other tests.
“No is the saddest experience you’ll ever know,” as that Three Dog Night song from the ‘60s continues.
Being told “no” about where to refer patients may not be the best for them—inconvenient and expensive if they do not have insurance or have high-deductible coverage. Insurance companies should be very concerned about increased costs when independent practitioners join a hospital group.
The alternative to working for a hospital group is to join a physician group that allows the physician to continue practicing independently while leaving business matters, such as negotiating contracts, to senior-level business managers. Group members continue referring their patients to specialists, imaging facilities, labs, and hospitals that are best for the patient and cost effective.
PrimeHealth Physicians, LLC is a new 40-member group in south Miami-Dade of primary care physicians who have banded together as an alternative to joining a hospital-owned practice. We hope to grow to 75 members by the end of the year, and there is a great deal of interest from our colleagues. Other groups are doing the same.
Medicine is changing, and we have choices. One doesn’t have to be a lonely number, when we’re able to keep our independence, especially when we don’t have to hear “no” when it comes to what’s best for our patients.
