I used to think of it as black or white. Physicians were either employed or independent. While this is directionally true, there are some nuances to physician occupational status today, particularly when considering independent physicians. The rhetoric we used to recruit as a startup in 2010 is a distant memory. You will not hear me or anyone at Beacon say anything about “easy in, easy out”. That was a mantra of yesteryear, and it is gone forever.
Small independent physician groups are quickly becoming an endangered species. Being completely independent is simply not possible for small groups (<4 physicians) and becoming increasingly challenging for mid-size groups (4-8 physicians). Why is this the case? Here are a few reasons:
- Inability to contract with managed care payors on own
- Inability to (meaningfully) negotiate with vendors to keep expenses down
- Insufficient care management and care coordination infrastructure
- Inability to compete on convenience or patient experience
- Challenges relating to reporting and regulatory requirements
- Expense of technology
Complete independence for a small practice today is objectively unwise. Some could conceivably argue that it is bordering on negligence. How can a solo practitioner for instance responsibly compete with sophisticated, well-funded, integrated systems in delivering the high quality, comprehensive patient care that is expected today? What about customer service? How loyal will their patients remain? Can the small independents stave off the convenience and access the retail clinics are offering? Single provider practices and small independents who are continuing to hold on to hope that they will survive and healthcare reform will not affect them do so at their peril.
Beacon Health Partners is an Accountable Care Organization and an Independent Practice Association. We are made up of more than 200 independent practices. But are they really, truly independent? In many ways, yes. Our practices are in charge of their own billing; they set their own compensation and benefit packages; have autonomy with human resources; flexibility around strategic practice decisions; and can more easily leave us than under an employed model. But, there are no free lunches. Independent practices that have chosen to join our network must accept the movement towards value based care. Each of our contracts requires physicians to improve quality, enhance the patient experience and eliminate unnecessary cost from the system. There are reporting requirements related to quality measures and closing clinical care gaps as well as baseline IT connectivity so we can share data.
Physicians who believe they can opt into our contracts in order to realize value to their practice, without more significant alignment with our mission and simply fly under the radar are sadly mistaken. This is a misconception that cannot and will not be tolerated.
As an ACO we are accountable and accountability is one of our core values. We are accountable to the patients we serve; we are accountable to our payor partners; we are accountable to our network of providers; and we need our network of providers to understand that they are all accountable to each other. We cannot accept poor performers, naysayers or laggards who under-perform if we are to be successful. We will continue to do everything possible to educate and assist in facilitating successful behavioral and operational changes that yield positive results towards our collective best interest… but, in the end it is up to the individual physician practice to make a choice.
Teamwork is another core value for us at Beacon and it is increasingly evident that healthcare is a team sport. The time has come for independent practices to pick a partner and join a team. Beacon offers a great value proposition for independent practices that are realistic with their expectations. While we believe physicians may no longer be able to achieve complete independence, as a sensible, viable path, we are firmly committed to helping physicians achieve healthier practices and remain Almost Independent.