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05/09/2016 Lawrence M. Rubin, DPM
Solo Practice is Doomed (Jeffrey Worman, DPM)
Preparing for our changing reimbursement model ideally means you are among the first podiatrists in your locale who are ready to step into providing value based care. Nobody is absolutely certain about all the definitions of "value" that will emerge, but it is possible to prepare for any definition and requirement once you know what it is. If you Google search articles on value based medical care using keywords, you will find a lot out about it.
Whether we like it or not, the emerging foot health care marketplace will be dominated by those groups of podiatrists already transitioning into it. I bet some podiatrists reading this are already making appointments with the medical directors of ACOs to get their "foot in the door" for their groups as we are already doing in Las Vegas. One thing is certain. The solo and small, single location practice or even a practice with a satellite office or two has no power to negotiate with ACOs, Medical Homes, and new organizational versions of HMOs -- yet they are major players in value based health care delivery. Unprepared, solo and small group podiatrists will get what is left over when the negotiating podiatrists have taken their share of business.
I have been recommending the same thing for a long time through our ability to post in PM News (thank you Dr. Block) about what I believe will be needed for a podiatrist to prepare for the future. Here it is, oversimplified, but hopefully a "how to" place to start.
If you are in solo practice or in a small group podiatry practice, look at your community geographically and determine how many podiatrists are needed to create a marketable network capable of providing reasonably easy access for "comprehensive foot care" services to patients who live and/or work throughout your area. Then, get together with just a few other business minded podiatrists who have well managed offices and successful practices with locations not very close to your locations(s). It is essential that every podiatrist in your group have a great reputation, an entrepreneurial bent, access to startup funding, and an understanding of the power of numbers strong enough to bypass personality differences and biases.
A few words of caution: Do not comprise your group to be a network of podiatrists who are only happy when they are performing major elective foot surgery, but, depending upon how large your geographical territory is, at least one of the group should be capable of providing the complex, major foot surgery procedures that are on the menu of packaged serves marketed by your group. In a very large metropolitan area, highly credentialed foot and ankle surgeons can become a sub-network within the larger negotiating network.
Discuss this network formation initially as a very small group, then slowly bring in other like-minded podiatrists to fill predetermined, needed locations and provide specialized skills.
Next, find an accomplished medical network formation consultant who can integrate you and your now "preferred provider" colleagues into one of several business models in which you maintain your present practice ownership but collaborate on the workings of the group. You will need a savvy health care attorney to make this work, and also a medical marketing consultant who has networked physician groups successfully. Don't forget, you want to market the network to the public as well as managed care.
And, of course, you have to figure out how consulting and other business startup fees are going to be paid. There is no free lunch in value based provider network organization. Sometimes it is better to get the consultant before the attorney as it can save loads of legal fees by his or her explaining and giving you the ability to opt into simpler networking arrangements rather than complex ones. But you will always need a healthcare attorney.
Podiatry specific negotiating networks have worked successfully in my old home town of Chicago, and they have been structured as successful "supergroups" in other areas as well. Maybe some of the podiatrists who are forming or already affiliated with podiatry networks can chime into this post and make it a conversation? What more important conversation can there be than sharing information about how we will all be making our livelihoods just a few years from now?
Lawrence M. Rubin, DPM. Las Vegas, NV
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