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Issue Date: April 2007

Going Solo Continues to be an Attractive Option
For well over 20 years, health care policy experts have advised physicians seeking to be successful in a changing market to practice in larger groups. The experts say solo practitioners will be a dying breed in markets in which managed care dominates. But recently, we have written about how physicians in solo and small-group practices have continued to succeed, despite the advice from experts. In speaking with physicians in these solo and small group practices we have learned that they cherish their independence. They also seek a deep personal relationship with their patients while working hard to reduce overhead and use information technology wisely.

Billing and Coding Strategies Crucial for Practice Success
Physicians can find it challenging to tend to practice management concerns while focusing on providing high-quality care to their patients. By spending some time each week on establishing processes to ensure careful billing, coding, and other practice management functions, however, physicians can ensure that their practices will run smoothly and successfully. “Physicians today face a number of external pressures, including declining reimbursement, increased government regulation, an increasingly savvy patient base, and increasing costs,” says Kenneth T. Hertz, CMPE, a senior consultant with the Medical Group Management Association (MGMA) Health Care Consulting Group who has worked with many medical practices to improve their business functions. “All of these factors together are resulting in significant economic pressures on medical practices across the country. Focusing on the performance of the practice is necessary to ensure that the practice remains viable and able to serve patients into the future.”

Physicians Urged to Get Involved
Efforts to measure and reward high quality have been gaining momentum in both primary and specialty care. Encouraged by this trend, the American College of Rheumatology (ACR) in Atlanta has embarked on an initiative to develop quality indicators for the specialty. While the effort is important to rheumatologists, it also has implications for other specialists interested in quality indicators. What’s more, it’s important for physicians from a variety of specialties to participate in developing quality measures because a multidisciplinary approach improves the accuracy of such measures, says Kenneth Saag, MD, MSc, professor of medicine and epidemiology and director of the Center for Education and Research on Therapeutics of Musculoskeletal Disorders at the University of Alabama at Birmingham.

EMRs Enhance Patient Care
Some physicians are unsure about whether electronic medical records (EMRs) will generate significant cost savings. Other physicians, however, have adopted EMRs with a different goal: improve care quality. Leveraging the efficiencies of EMR technology can improve the quality of care by enabling access to complete patient data at the moment it is needed. An important quality-related feature of EMRs is clinical decision support, which alerts physicians to provide appropriate care based on a patient’s condition.

Finding Success in Small Groups
Many physicians dissatisfied with working in large groups wonder about the viability of practicing in a smaller setting. A solo or small group practice can certainly afford opportunities for personal empowerment, but an independent setting also can be challenging. Successful practices of all sizes must balance patient care with rising insurance costs, complying with regulations, and managing administrative requirements. It stands to reason that such factors are exacerbated in a small or one-person practice. Can a small practice be successful under such circumstances?

Group Pursues Retail Strategy
ProHealth Physicians, Inc., in Farmington, Conn., is the largest group practice of primary care practitioners in Connecticut. The group includes approximately 165 physicians and about 45 mid-level practitioners in 75 offices throughout Hartford, New Haven, Litchfield, and Middlesex counties. Specializing in internal medicine, pediatrics, and family practice, the physicians have more than 725,000 patient encounters each year. In this interview, CEO Jack Reed spoke with Editor-in-Chief Richard L. Reece, MD, about the group’s growth strategies, including its efforts to open retail medical clinics.

Experts Suggest Keys to Compliance
Patients frequently fail to comply with medication therapies, and glaucoma medications are no exception. To enhance patient adherence to treatment recommendations, therefore, experts in medication compliance suggest that ophthalmologists develop thorough communication strategies and devise multidimensional solutions for each patient. “Compliance with glaucoma treatment is definitely suboptimal,” says Andrew Iwach, MD, associate clinical professor of ophthalmology at the University of California at San Francisco. “Studies have attempted to estimate glaucoma compliance over time, which is a difficult task. One method is to measure the percentage of patients who refill their medications. These studies have suggested that up to 50% of patients may not be compliant six months after therapy initiation.” Iwach is also the executive director of the Glaucoma Center of San Francisco, and a board member of the Glaucoma Research Foundation, in San Francisco.

Steps to Improve Part B Billing
Recent changes to Medicare Part B have had a significant effect on how ophthalmologists and other physicians buy and bill for medications. To ensure appropriate reimbursement and avoid an audit, ophthalmologists must ensure that they and their practice staff are aware of the new Medicare policies and coding rules. “Buying and billing for medications under Medicare Part B is fairly straightforward,” says L. Neal Freeman, MD, MBA, an ophthalmic surgeon and president of Coding and Physician Reimbursement Analysts, Inc., consultants in Melbourne, Fla. “The problem is that many practices do not understand the basic rules underlying the program. Once those rules are mastered, it is not complicated to report the use of drugs. All practices need to invest the time and energy to learn the rules of the game so they can be effective players.”