How practices can stay independent

It's a question that's loomed since well before the Affordable Care Act or even before anybody had heard about an ACO: Can independent practices continue to survive? And in today's ever-consolidating marketplace, how?

At today's session at the Medical Group Management Association's Annual Conference in San Antonio, it was the audience members who took center stage in sharing their insights into the challenges of maintaining their independence and what it will take to survive and thrive in the future.

The physicians and administrators in the audience directed questions to Patrick Lencioni, consultant of the Table Group firm in Lafayette, Calif. The following are some of the most salient ideas offered during the discussion, which was moderated by Stephen Dickens, a risk management specialist with Brentwood, Tenn.-based State Volunteer Mutual Insurance Co.:


"Avoid distraction from the things you can't control. The only thing you can control is making your practice really awesome."

Don't assume physician owners are leading practices the way they want to.
This was Lencioni's feedback to several administrators' questions about leading practices in which the doctors are truly the boss. This dynamic, administrators said, can make it difficult for them to persuade physicians to adopt a more business-oriented mindset.

Lencioni said to consider the physician's perspective--that he or she probably became a doctor to care for patients and may very well be open to new ideas for how to better operate the business. Approaching docs with these ideas takes a good balance of respect, as well as courage, but it's a mistake to believe they won't listen, he explained.

Practices don't have to choose just "A" or "B."
Many physicians today believe that their only two options going into the future are to stay totally independent or to become acquired, an audience member commented and then called out as a myth. Other models such as independent practice organizations (IPO), physician-hospital organizations (PHO) and clinical integration, many agreed, allow practices to maintain most of their independence while getting the benefits of banding together.

One administrator asked his colleagues, "Who do you trust? Hospitals and health plans--or your colleagues?" His advice: "If you're going to integrate, do so with doctors, in an IPA or similar approach. Look at what we can do together."

Physicians shouldn't undersell their power.
More than one attendee spoke out against the notion that physicians won't be able to survive without becoming part of hospitals. Rather, some said the power structure is actually the reverse. "Other than the gift shop, a hospital can't make any money without a physician's signature," said one audience member.

Calm leadership is critical.
Don't get bogged down in fear, Lencioni advised, but concentrate on running the very best practice you can.

"Avoid distraction from the things you can't control," he said. "The only thing you can control is making your practice really awesome."

And with the call to rise to that challenge, this is a time for practice administrators to really shine, an audience member noted.

"This is a time of tremendous opportunity for the people in this room," she said. "We have never been more important than we are right now to our physicians."

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