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What about Me? Print E-mail
Written by Lawrence Schimmel, M.D., FACS   
Tuesday, 03 January 2012 00:00

As 2012 begins the independent physician practice is under attack from a number of directions and to survive it must be smart enough to understand what is taking place and how to work around it. In the past few years, large single specialty groups have formed with the philosophy that there is strength in numbers. If you are part of this type of organization you have been protected to a degree. Those that are not part of these large single specialty groups have been left to fend for themselves. The independent physician has no strength in numbers, no economy of scale as it relates to purchasing power, and does not control enough market share to demand a higher level of reimbursement from managed care organizations. Understanding the problem is critical for you to make the necessary adjustments in your practice to compete in this environment.
A new threat is just around the corner. It is called the hospital and its physician owned groups. Hospital owned physician groups are a major threat to both independent physicians as well as those in smaller single specialty groups. How did this happen? In the 90s, the emphasis of the new healthcare world was going to be the family practitioner. The primary care doctor was going to be the manager of patient care.  Under the assumption that primary care doctors would provide care, managed care organizations attempted to capitate them to reduce the cost of care. Unfortunately, the result in many instances was that the primary care giver became a triage officer and handed out referral slips rather than caring for their patients.  Additionally, many primary care doctors stopped going to the hospital to admit or coordinate care for their patients. Historically, this shift is important because as primary care physicians went less and less to the hospital the question arose:  Who was going to coordinate the care of there hospitalized patients? A new specialty was born out of the capitation of primary care physicians, the Hospitalist. Initially some entrepreneurial physicians created hosptialist companies, but it was only a matter of time before the hospital saw the benefit of owning their own hospital-based caregivers. Now hospitals are acquiring specialty care physicians and we are faced with the growing reality that it is likely that hospital owned hospitalists will refer consultations to hospital owned specialists. 
The hospital has closed the loop on the delivery of care with its approach to owning and managing the urgent care center, the outpatient center, the hospital, the primary care physician, the hospitalist, and now the specialist. There are those who will say that this integrated delivery system is the best way to provide care to the patients surrounding hospital campuses.  However, this creates a dilemma for the independent physician in our community. Whether a planned strategy or something that just happened, many feel that the hospital is just a license away from being a managed care organization or under the new health care reform act very close to forming an ACO.
This is the new reality in many locations throughout Florida, so what is the majority of physicians who remain independent going to do about it to survive? Perhaps this will be the impetus for multi-specialty groups to organize? Perhaps this will force more specialists into larger single specialty groups? Perhaps the small independent needs to adjust their practice to the new realities and make more out of less?  Every business needs to adjust to market conditions and a medical practice is no exception. This is a very fluid environment and the decisions that are made by independent physician groups in the next year will have long-term consequences on their specific practice.
Dr. Schimmel is a Principal at Marcum Healthcare.  You may contact the author at or 305.995.9801.
Last Updated on Friday, 27 January 2012 13:19

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