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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