From the Consultant’s Corner 9/7/12

Collaboration: The Key to Future Success for Independent Practices

For the last few years, there’s been a lot of talk about healthcare’s transition to collaborative care. But all that stuff about a “paradigm shift” goes in one ear and out the other if there’s no financial incentive to get on board.

If you’re part of an independent physician practice, that day has arrived. There are plenty of sound financial reasons for jumping on the collaborative care bandwagon—and a distinct financial downside for not doing so.

In short, small independent practices can’t do it alone any more. While Marcus Welby could afford to be a maverick, I believe all practices now need to work closely with other physicians and hospitals to be able to document the quality care that leads to higher reimbursements.

For independent physicians, this requires a completely new mindset: moving from individual episodes of care to a focus on improved outcomes for entire populations. It also requires electronic medical record data to document quality improvements as well as greater teamwork with other area physicians and hospitals.

You have to demonstrate that you’re helping improve care for, say, all of your diabetic patients and helping to lower the number of avoidable hospital readmissions. Your practice’s financial health will be directly tied to how well you meet these metrics.

Now’s the time for small independent practices to begin leveraging data to prove that they can hit the quality and financial benchmarks that will land them a share of the reimbursement pie. Here are four strategies that can help independent practices access the systems that can help them enjoy the financial benefits of quality-based care:

• Take the EMR plunge. Access to an EMR is critical to future viability as a practice. There are affordable EMRs many practices can implement right now.
• Get help from a Health Information Exchange (HIE). This strategy works well in some localities like Rochester, New York, where the HIE is already selling information technology services to independent practice associations (IPAs) in the region.
• Start or join an IPA in your area. This is arguably the best choice because you get more negotiating leverage when you join forces with other independent practices. You can band together to get the best pricing on EMRs, risk contracting, and incentives from commercial payers. Better yet, focus on clinical integration – providing the right care for your patients at the right time.
• Work closely with your hospital’s medical staff.  Many forward-looking medical staffs are actively reaching out to independent practices, offering to share strategies and the hospital’s formidable IT resources.

In recent years, we’ve seen countless articles about how cooperation and care coordination are the pathways to a brighter healthcare future. But now those aren’t clichés—they’re the key to your practice’s financial performance.

In the state of Massachusetts, for example, there’s already been a sea change due to Blue Cross/Blue Shield’s Alternative Quality Contract (AQC) program, which provides incentives for large physician groups to meet quality care metrics. Physicians who meet those metrics get a sizeable bonus—up to 20 percent of total reimbursement.

Working closely with other physicians and your hospital isn’t optional any more. It’s the only way to gather the quality data that leads to higher reimbursements.

Jeff Wasserman is vice president of strategic and executive leadership services for Culbert Healthcare Solutions.