Who will save the independent physicians?

The Wall Street Journal is my favorite newspaper, but its Op-Ed page is not the place to turn to for sober, non-partisan analysis. So I was only a little bit surprised to read The Doctor’s Office as Union Shop, which blames the Affordable Care Act (ACA) for ushering in “a potentially radical factor in the transformation of health care –the doctor as union worker.” The author, Dr. David Leffell from Yale Medical School, asserts that the ACA’s reimbursement schemes are forcing doctors to abandon their practices, although he doesn’t get into specifics. But reading between the lines it’s clear that Leffell understands that the shift of physicians from independent practice to hospital employment pre-dates ObamaCare and has other powerful causes.

Actually, I am at least as concerned as Leffell about the rapid switch of physicians away from independent practice. I’m cited in InformationWeek’s 2013 crystal ball article as predicting that doctors will continue to abandon independent practices. However, I added a hopeful caveat that I’ll explore further in this post:

“On the other hand we will see more independent physician practices adopt technologies that enable them to retain their autonomy, improve their financial performance, and serve patients better,” Williams said. “Staying independent will again feel like a viable option, and we may even see new physicians hanging up their own shingles again.”

I’ll admit that’s on the optimistic side, and its coming from someone who prefers to be a patient in a small practice rather than a large institutional one. But I truly believe that the small practice model can be viable. After all, other professionals with advanced training –including accountants, lawyers, and management consultants like me– have been able to leverage various tools to practice in smaller, more flexible settings than was possible a decade or two ago. These arrangements are rewarding to work in and better for clients (at least in my biased view). Granted, the dynamics of medicine are different, but many of the same lessons apply.

So, what needs to happen, and who can help?

First and foremost, physicians need to be able to get paid for their services in a timely fashion. For  better  or worse that still means dealing with third-party payment from health plans and the government. Athenahealth is the leader in the so-called “revenue cycle management” arena, offering a cloud-based infrastructure that ensures a steadier and more predictable cash flow than traditional billing services. Others, including electronic medical record vendors with integrated practice management systems like eClinicalWorks, help achieve similar results.