Sharing services: A survival tactic for small physician practices

A stethoscope on a computer keyboard
By sharing services, more physician practices may be able to stay independent. (Getty/anyaberkut)

Sharing services may be one way that small physician practices can keep from going the way of the dinosaur.

It’s not easy for small practices to survive in the current healthcare environment, but some are experimenting with ways to pool resources across groups while maintaining their independence, according to a viewpoint piece in JAMA.

Those practices are forming “pods,” or networks of practices that contract with “shared service providers” to pool and manage resources, wrote Dhruv Khullar, M.D., and Lawrence P. Casalino, M.D., of the Department of Healthcare Policy & Research at Weill Cornell Medical College in New York, along with Gregory C. Burke, of the United Hospital Fund.

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Shared service providers can take several forms, including those organized by local hospitals, independent practice associations, payers or private companies, and can help small practices to compete in value-based contracts and a policy atmosphere that favors consolidation, they said.

Where do small practices need the most help? When the United Hospital Fund conducted a series of surveys, interviews and focus groups with clinicians in small practices, they identified several priorities where they need assistance, including care management support, data analytics, quality reporting infrastructure and electronic health record maintenance and optimization.

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A variety of organizations have begun offering these services and allow practices to share personnel such as care managers, pharmacists, social workers and behavioral health specialists. The authors describe how the different forms of shared service providers work, along with examples.

For instance, there are independent practice associations, which go beyond the traditional role of negotiating fee-for-service contracts with health insurers to act as a platform for sharing resources. One such association is the Greater Rochester IPA in New York, which offers its members—350 primary care physicians in 162 practices—data analytics services to help manage patients, care management support, pharmacists, visiting home nurses and diabetes educators. The IPA is financed from revenue from quality incentives and accountable care organization contracts.

A 2016 study, in fact, found 49% of respondents said being a part of an IPA was attractive for the increased scale it would provide in negotiating with payers and larger organized systems of care.

While questions remain about how shared services will work in the long run, they are an option to help keep small practice viable at a time when more than 5,000 independent practices were bought up by hospitals in just one year.

“In a healthcare environment shifting rapidly toward physician employment and practice consolidation—without clear evidence of benefit—shared service organizations may offer small practices a path to sustainability, and offer patients and physicians the flexibility to engage in an endangered form of medicine should they choose,” the authors wrote.

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