Independent Practices: Staying Strong

Independent Practices: Staying Strong


As an owner and managing partner of my pediatric practice, I’m tired of hearing that the end of the independent practice is close at hand. Those of us who have been in private practice for a few decades have heard it before, and we are still here. In fact, with collaboration and more data, many of us are thriving. So while everyone is screaming “the sky is falling”, I’m not buying it.  I think we are uniquely poised to thrive in the current environment.  Why?  Because pediatricians
  • have a lower overhead without huge administrative burdens
  • are more flexible
  • are more in tune with what our patient population needs and expects
  • have data
  • understand pediatrics!


I lived through a few phases of the “buy up private practices” trends in the past. When capitation first came into vogue, many practices were worried they would have no negotiating clout as small entities. Some sold out to bigger systems and networks. But most of those systems had NO understanding of how pediatrics works and how different it is than the adult-care world. They wanted to add on an administrative overhead fee of 5-10% to pay their systems costs. For many of us that’s our bonus check. And what exactly am I getting for it? Their fee schedules didn’t pay attention to vaccine and vaccine administration costs which is a huge part of our profit/loss calculations.


If something isn’t working well in a big health system, exactly how long does it take them to change? About 18 months. Need some transformative change in your independent practice? How about a lunch meeting and let’s try a pilot next Monday. Steering the Titanic isn’t easy, especially when it’s headed for the iceberg. I’ll take my sleek power boat and leave you behind.


Independent practices know their patients and communities, and are more equipped to develop a true patient-centered medical home. Do you think the person in a big tower understands what the dynamics of the individual family needs are? Yes, we need to move toward managing our “patient population” better, but patients have superior outcomes and satisfaction when they have a relationship with a provider and a practice, not a health system. (This may be true for adults with chronic diseases who are in and out of the hospital and emergency department, but that’s not the majority of our patients!)


In the world of data, and data exchange, it will become even MORE possible for us to navigate the medical landscape. The Meaningful Use 2 requirements require that different systems play better together and exchange information. No longer will hospitals be able to say to us, “we can’t give you patient information because you aren’t on our preferred EHR.” They won’t be able to take that position and play bully with the information for much longer. We can run quality reports to show how much better and cost-effective we are at providing great care for our patients! And more than once I have used that data to negotiate better rates from insurers. Here’s the biggest reason that we have a bright future:  WE KNOW PEDIATRICS! Most of the multi-disciplinary systems have no clue what we do every day. When is the last time your hospital gave you equal footing at the decision table with the CT surgeons and the interventional radiologists? Do you really expect this to change? We don’t have huge monetary considerations to the big systems, so we’re lucky if we are considered an afterthought.


Another advantage: pediatricians have a unique collaborative community. We naturally share our best practices and successes and we work together to tackle our challenges. I’d much rather be working with my experienced colleagues facing the same issues to ensure that we are all doing the best that we can to keep our independent medical homes thriving. Our patients value what we have built, and we should also!