Thinking of leaving independent practice? 7 questions to consider before making the leap

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Private practices face increasing pressure to give up their independence, partly because of the growing complexity of running the business. Practices need a strong infrastructure to effectively handle the mounting demands around quality reporting, risk adjustment, care management, billing and more. Creating and maintaining this infrastructure is becoming more time-consuming and costly, and physician practices are struggling to prioritize patient care while managing a business without help. They must seek other options to get the resources and support they need to compete in today’s environment –– whether that means joining a hospital or health system, aligning with another independent physician group or selling their practice to a larger organization.

So how does a physician practice decide on the best approach to get the help they need? Not all potential partners or arrangements can provide the assistance physicians want while giving them the autonomy they are accustomed to or the work-life balance they may seek. Following are a few questions to consider as you think through your options.

Who leads the potential partner organization?

If you prioritize having autonomy in how you practice medicine, look for an entity that has engaged physician leadership with a clear voice in how the organization operates. When physicians are at the helm, it ensures the clinical perspective is firmly represented in decision-making, structure and long-term vision –– and this perspective is offered by those practicing every day.

According to a recent report from Bain & Company’s Frontline of Healthcare survey, physicians are more satisfied when they work in physician-led organizations versus non-physician-led ones. This is partly due to greater alignment around compensation, staffing, workload and autonomy.

Strong physician leadership is especially valuable if you are considering different care and reimbursement models that prioritize population health management, quality performance, and any risk, both upside and downside.

Physician leaders also understand what it means to practice medicine in today’s environment. They see the challenges and opportunities in improving care quality while reducing costs, especially as patient populations’ health conditions become more complex. Moreover, they genuinely appreciate a physician’s desire to remain autonomous while getting the needed infrastructure.

How transparent are the financials?

As you consider a potential arrangement, make sure you have clarity about when, what and how you will get paid and the associated tax implications. In addition, transparency around how the larger entity’s leaders get paid, and where the money to fund the organization comes from in the short- and long-term, can help you understand what motivates decisions at the leadership level. It is important to parse out the details as much as possible to get clarity and avoid misalignment in the future. For example, some entities will offer enticing up-front payments, but these may not be as lucrative as they appear. Therefore, it is critical to “do the math,” looking past the initial payout to calculate the financial picture five and 10 years down the road.

Contracting is another topic to broach. Does the entity support alternative payment models, as well as fee-for-service? Are there options for upside and downside risk? Can it help establish favorable contracts with multiple payers? Can it help establish favorable contracts with payers who provide better service levels? The more you can rely on a partner to help navigate the complex and evolving contracting process, the more it reduces your load while opening up financial opportunities for broader reimbursement and potentially a lower administrative burden.

What resources can the entity provide?

Every physician practice has unique strengths and areas for improvement. Seek a partner that can provide people, processes and technology to enable better performance — but not in a cookie-cutter way. An organization that has a wide repertoire of services but is flexible in how it provides those options can complement and amplify your existing resources, meeting your needs effectively and efficiently. For example, if you already have a care coordinator, you may not need additional staff to support care coordination. You may be more interested in data analytics tools that help you efficiently spot improvement opportunities. Or perhaps a social determinants of health team would be beneficial in helping you address social and economic barriers to care for at-risk populations. In addition, you should find out if changes to existing resources will be required. Will you be able to continue using your electronic health record or other established technology, and if not, what support will be provided to help you transition?

Does the entity provide actionable data?

Data in and of itself is not overly beneficial. A partner should provide information you can actually use, as well as insights based on best practices. For example, giving you a report that indicates your practice has a higher rate of readmissions than similar practices is interesting but does not give guidance on what you should do with that information. By working with an organization that not only offers data but provides practical, evidence-based suggestions on how to respond to that data, you can increase the chances of making meaningful improvements to practice performance.

How experienced is the organization?

Care and payment models are constantly evolving, so you want to work with an organization with deep experience in understanding new models and a proven track record in serving physicians and patients. To gauge the organization’s priorities, look at what it has done to date and ask the people involved where they see it in five years. You want a partner committed to long-term relationships built on honesty and trust. They should have a sustainable approach to supporting patient care that prioritizes patient and provider interests. In addition, they should be continuously looking to the future to ensure the organization evolves appropriately, continues to live up to its mission and remains financially strong over time. Ask about their track record with compliance as well as their growth rate. Growth rates far outside the norm may be a flag for asking about scalability or potential for a sale. You want to understand who your partner is and will be.

How much time will I get with my patients?

One of the biggest concerns physicians have when thinking about a new arrangement is how it will impact where they spend their time. Although you want more time with patients, that doesn’t mean increasing the number of patients you see each day, which can quickly become overwhelming and lead to less quality time per patient. The right partner should put any concerns about this to rest. By assuming many of the business aspects of running a practice, the right entity can free physicians’ time so they can focus more on patient care and, simultaneously, allow them to decide how they spend their time –– not the business partner.

Know what you want and what to look for

Giving up your independence is a big step. Taking time to think about what you want out of a new arrangement can help ensure you select an option that aligns with what you value most. If you seek autonomy, choose a partner that gives you a degree of freedom while still providing the support and infrastructure you need to be financially, clinically and operationally successful over time. Think about connecting with physicians who already work with the entity you are considering joining. Ask them how long they have partnered with the organization and what they like about it. Don’t be afraid to ask tough questions to get a true sense of whether the arrangement will give you what you want and need.

Noreen Nageotte is vice president of business development at CareAllies.