Small, doc-owned practices key players in value-based care

By Aine Cryts

Small, physician-owned practices are an ideal environment to practice value-based care, writes Farzad Mostashari, M.D., former national coordinator for health information technology at the U.S. Department of Health and Human Services, in the Annals of Family Medicine.

That's because practices of this size are more responsive to patients, incur lower average costs per patient and have fewer preventable hospital admissions and lower readmission rates than larger, independent- and hospital-owned practices, he says.

Debunking the argument that healthcare consolidation leads to lower costs, better coordinated care and less duplication of tests and treatment, he notes that hospital ownership of a doctor's practice increases the chance that a patient will be referred to that hospital--even if the hospital delivers lower quality care at a higher cost.

"A paradox emerges for independent primary care physicians who, because of their relationships with patients, are uniquely positioned to lead the transition to value-based care and succeed in new payment arrangements; but because of the investment, and the regulatory, technological, and analytic expertise necessary to enter these arrangements, they are also least equipped to do so," writes Mostashari, currently CEO of Aledade, Inc.

He advises that practices of this size leverage the benefit of being small while linking up with similar-sized practices to enjoy economies of scale and to spread risk--so that, for example, a number of unavoidable hospitalizations don't doom an individual physician to financial failure. Further, joining a network of small practices can more easily enable access to data analytics, billing and regulatory knowledge that's required for success in value-based care arrangements.

Shared knowledge about population health models and being in a better negotiation position--because of economies of scale--will also serve the best interests of small practices in terms of value-based contacts, according to Mostashari.

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