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6 keys to small practice survival


With expenses increasing and revenues dropping, how can small practices remain viable? If you like caring for patients in a solo or small practice and want to continue doing so, you won't want to miss this advice.

New Orleans-John H. O’Neill Jr., DO, FACP, interacts with many physicians in his roles as vice chairman of the American College of Physicians (ACP) Medical Practice and Quality Committee and governor of the ACP Delaware chapter. Most doctors he encounters tell him they are passionate about what they do and want to remain in private practice, he says.

Physicians who prefer working in solo or small-practice arrangements appreciate the increased autonomy and control over the work environment that they have, as well as close doctor-patient relationships, compared with those in larger groups, O’Neill told those attending a session at the ACP's annual meeting here.

And the healthcare system has a place for small practices, he adds. “This is America. A lot of our communities are served well by small practices, and by default, many of our communities have no other providers.”

But in an era of increasing malpractice insurance premiums, higher practice expenses, and reimbursement from payers not covering those expenses, how can smaller practices remain viable? Based on his ACP involvement and his experience practicing with Bayview Internal Medicine Inc., in Middletown, Delaware, O’Neill offers the following advice:

Analyze your top 10 charges/reimbursements by payer, including immunizations, then approach and negotiate with payers for better reimbursement. “As internists, our bread and butter is really evaluation/management codes,” he says. Physicians can use their payer program participation as leverage, he says.

Identify and micromanage your overhead using accounting software. “If you’re going to manage your overhead, you have to know what it is,” O’Neill adds. Track expenses and determine which reports to generate and read.

Pinpoint the procedures that best fit your practice, then track and optimize their use.

Implement an electronic health record/practice management system to help you improve the care you provide and to optimize your billing and reporting. He recommends using the same vendor for both systems to ensure compatibility.

Consider developing or becoming part of a Patient-Centered Medical Home (PCMH). “That’s where we’re heading,” O’Neill says. One major difference between current practices and PCMHs is that the latter includes one or more care coordinators who follow the patient inside and outside the practice.

Think about using midlevel providers in your practice; they can generate additional revenue.

Go back to current issue of eConsult

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