Dec 4, 2015/By Kelly Luchini

The challenge of remaining a private practice in the era of IT transformation

Electronic Health Records
Quality Reporting
Value Based Purchasing

Can private practices upgrade systems, comply with the myriad programs pushing technology use forward, and still keep the doors open?

In today’s transformation of healthcare IT, between costs and complexities, many private practices are finding it more challenging than ever to remain private.  Private practices are somewhat unique.  They are private for a reason.  Many are family run, solo, or “Mom and Pop” types of settings, where it’s not unusual to have the same person you see at check-in, also be the person behind the scenes billing your insurance, and also be the person taking care of the IT systems.  Being ‘private’ means wanting to remain autonomous, as a provider of care and as a business.  They are not employed by a health system and therefore consider themselves ‘independent’.

Our nation’s healthcare IT transformation has been a challenge for everyone, but has been most challenging for those that choose to practice on their own. Some are banding together with others in an IPA, many are becoming employed by a larger health system, and some are making the hard choice to close their doors (forever). Having worked closely with many private providers over the past several years, I have personally seen their struggles and have a soft spot in my heart for the private practices.

The certainty is that use of health IT is now a core competency that all practices will have to stay on top of.

First there was the implementation of an EMR.  For some, this alone was cost prohibitive, especially if the practice needed to purchase or upgrade the technology in their offices. This means computers, printers, scanners, and internet connections. I’ve even seen private practices working out of old houses that need to have new wiring done. And what about for those practices still using a spiral bound appointment book? Think of how far they have to go.

With the STARK Exemption, local hospitals have been able to offer up to an 85% subsidy to local community providers for the purchase of e-prescribing and EMR software. Often this means the hospital is offering private practices the opportunity to become part of the health system’s EMR. I’ve seen health systems offer access to a recommended third party billing company to help the practices out on the revenue cycle management side.  This can be a big advantage to those standing on their own, as the billing company is already trained on the EMR, will bill the insurance on their behalf, and will even produce patient statements. Some health systems have offered to perform hardware assessments, make vendor recommendations for purchasing necessary equipment, and identify the best service providers to use for installation and maintenance of the chosen EMR. This means the private practices get to leverage the health system’s purchasing power and get better deals and lower costs.

Sounds good, right? It can be, but the first questions I’m always asked are: “Will the hospital have access to my patient list? Who will own the data? Will the health system see my billing?”  Hmmm…skepticism?  Perhaps.  They don’t want to lose their autonomy (their ‘independence’) by signing on to become part of a health system’s EMR.  Simply stated: They don’t want to feel “owned.”

For those who were able to swallow the costs of an EMR investment, now comes joining an HIE, reporting on clinical quality measures, sending and receiving electronic care summaries, and a new way of supporting inter-organizational care coordination. In the beginning there were incentives for all of this transformation. Now providers are coming up against penalties for non-compliance. So when will small private practice providers say “enough is enough?”

On the bright side, many private practices have dug their heels in to remain private and are doing so successfully.  That said, there is no doubt it is a big decision and commitment to succeed.  They need to be honest in assessing the ‘climate’ of their practice, both financially and their willingness to stay current in the ever evolving era of healthcare transformation.  They need to be realistic on the amount of time and effort this will take and accept that their productivity will waiver throughout the changes, while keeping an eye on the end goal of increased efficiencies and improved patient care.   

Those that are making it have accepted both the initial financial outlay and sacrifices required, i.e. having to reduce patient visits by 50% during the initial two weeks of an EMR Go Live.  They have embraced the investment to update their technology to support care coordination, have protected clinical autonomy as best they can, and have been scrappy in pulling together all the help and resources they can find to make it work on the business side. The flow of Federal and state funds and help has slowed over the years since ARRA was passed but there is still plenty of help to be found.  But, if after considering these challenges, if a practice is still compelled to remain private, then I’d say go for it!

We’ll have to wait and see how the private practices fare. Health reform laws will continue to change and we know that technology will be ever-evolving. The certainty is that use of health IT is now a core competency that all practices (regardless of size and affiliation) will have to stay on top of. As for me, I’ll be rooting for the Mom and Pops and hope they continue to have the option to stay private as they carefully navigate the help offered by the health systems consolidating on all sides.