How physicians can stay independent

The challenges to being an independent physician were already many, but COVID has made things even worse. Cancelled appointments, declining revenue, and an unknown future left many physicians scrambling for answers. Some turned to telehealth while others furloughed staff and did what they could to get patients into the office, hoping they could financially hang on until the pandemic passed.

But what will the post-pandemic future look like for America’s independent physicians? Medical Economics spoke with Scott LaRoque, founder and CEO of MPOWERHealth, about how physicians can remain independent in a rapidly changing health care environment.

(Editor’s note: The transcript has been edited for clarity and brevity.)

Medical Economics: How has the COVID pandemic made it more difficult for physicians to remain independent?

Scott LaRoque: I think there are several things that have created challenges for independent physicians: the shut down or lockdown of several states, in addition to patients’ fears about being in places with lots of other sick people or being in crowded waiting rooms, put stresses on patient volumes for the doctors. And then furthermore, a moratorium on elective procedures across the country further reduced physician volumes and that's really created a down year for most of the practices across the country. So those that don't have the financial liquidity or backing or support in terms of infrastructure or financial support, I think are having a tough go of it.

Medical Economics: Post pandemic, do you see permanent changes in medicine that will make it even more difficult for physicians to remain independent?

LaRoque: Yes, unfortunately, I think that there are some continued trends that will persist even post pandemic. I think there's a lack of influence in the contracting process that that small groups can have, and so looking for ways to have some impact on what they're paid for the work that they're doing will become increasingly important. There's an ever increasing landscape of regulatory and compliance requirements around record keeping and reporting. I think all of these things will continue to provide stresses on independent practices.

Medical Economics: How will physicians need to approach payer contracts to increase their chances of staying independent?

LaRoque: I think there's a real opportunity moving forward with the right infrastructure for independent physicians to tell their story to the marketplace and improving their value to the marketplace. Its value is a concept that is made up of both cost and quality. They need to put the right infrastructure in place within these independent practices to collect the data, and then to review the data to gain insights and then to execute on changes in care delivery that produce different outcomes. The ability to execute on all of that will have a big impact on whether they're able to retain their independence or whether they're forced into a situation to choose a different alternative.

Medical Economics: How can independent physicians improve their quality scores to boost reimbursement from payers?

LaRoque: By taking a look at and really understanding that moving forward, large data is being collected and reviewed currently by the payers. By understanding that and recognizing there is an opportunity to review this data to understand how it's impacting outcomes and make changes in care paradigms and therapy models so that the outcomes align with some of the incentives and rewards that are being administered by different payers and even employers at this point.

Medical Economics: Physicians and payers can have a somewhat adversarial relationship at times. Do physicians need to change how they think about payers and maybe see them more as a partner?

LaRoque: We're at a crossroads right now. Health care is very local in its delivery and health care within local markets has been consolidated to the point where there's not really sustainable competition to the large health care systems. These health systems have negotiated 5% to 10% pay increases year over year for some time now. And so there is a statistically significant gap between where independent practices sit and where their hospital-owned counterparts sit in terms of payment for the same work. This creates a real opportunity and telling the story of how they deliver the cheapest total cost of care without impacting quality. This gives them a huge leg up and an opportunity moving forward. And several conversations I've had with the major payers is that this is becoming a pain point in numerous markets across the country, and they recognize that there is a need for sustainable competition in the marketplace.

Medical Economics: What does the future of fee-for-serivce look like for independent physicians?

LaRoque: I think that fee-for-service is being transitioned toward value based care. Most all of the major payers in this country are doing that. The Blues now report that they have 20% of all plans transitioned to a value-based model. Cigna and United both state 50% of their payment models have been converted to a value-based care model. I think that trend will only continue as we move forward. And I think it's important to note that health care is one of those last industries that payment has no real tie to quality. So that transition to tie the quality of outcomes to the cost, ultimately is what creates real value in the system for the consumers and those paying for medical bills.

Medical Economics: As technology continues to become a bigger part of medicine, how can independent physicians keep up?

LaRoque: Over the past decade, there haven't been a whole lot of options for independent physicians. As a result, you have seen a trend of independent physicians either going to work inside a hospital employed model, or potentially selling their practice to a private equity type model. I think there are some new structures coming out now that give physicians the opportunity to remain autonomous to retain financial control of their practice, but integrate on a clinical level and really focus their time and efforts where they've spent the most of their training: improving outcomes, analyzing data sets, and figuring out how we can continuously refine that process and deliver better outcomes for less cost.

Medical Economics: How is the independent physician of the future going to be different than the physician of today?

LaRoque: I think the focus on a data-driven systematic refinement of care models and patient workflows will be much more important moving forward into the future. Evidence-based insights that lead to changes in care paradigms I think will really drive health care in the future, and you'll see less anecdotal-based judgments and personal experience get support from those paying medical bills.