ACP: What’s a small group practice to do?

A guest column by the American College of Physicians, exclusive to

In 1998 I started a period of national service to the American College of Physicians leading to my term as President for 2010-2011. During that time I kept an almost full time private practice in Fayetteville, Tennessee. Moving between the worlds of health policy and “the trenches,” I understand better than many the tremendous challenges we face in changing health care delivery.

Our practice includes internists, family physicians, pediatricians, and a nurse practitioner. We adopted an electronic health record (EHR) in 2004 and are in the process of moving from a Level I Patient-Centered Medical Home toward a Level 3.

We have seen consultants over the years with slick presentations touting one or more innovations that promise to change everything. These new ideas have come and gone and our practice expenses go up while revenue is flat. Fortunately, six of us are native to the area with strong roots, but our 102 year old practice is facing the greatest challenges in a history that includes two world wars, a flu pandemic, and at least one depression depending on your perspective.

In 1983 our expenses were under 40% of revenue and we had the option of raising our historically low charges to meet new needs. Currently, the opposite is true. Expenses are over 60% without good options to increase revenue. In our particular market, hospital ownership would be complicated and not our best option. In any case, a true “system” of health care should allow a financing mechanism where a core of primary care doctors can maintain a viable practice.

Like many physicians, my partners and I worry about the future. We worry about leaving the community with limited care if we moved away to take any of the many salaried jobs available these days. We may ultimately join larger regional groups if that is the right thing to do but currently we want to survive in the transition.

When we looked for our EHR, we visited a number of practices to see the records in action. In each visit we learned something about practice operations that helped us in ours. Hopefully, we were able to pass along similar tips that were helpful to others.

ACP understands that we have members in many different practice situations and is working to find ways to help all our members adapt to the changing world of health care.

A significant tool has been developed by ACP to help practices starting or contemplating transformation to a Patient-Centered Medical Home. Medical Home Builder 2.0 is an online program that helps an office team improve patient care and support ongoing practice improvement.

ACP has also joined with others to offer AmericanEHR Partners, an online community dedicated to supporting adoption, use, and optimization of EHRs.  AmericanEHR Partners is free and access to the satisfaction data is available to all registered users.

Do any of the readers of this column have ideas about how smaller groups can begin to help each other survive in these difficult times? Are there examples to cite of purchasing power, shared employees, or other ways to help with overhead?

Fred Ralston practices internal medicine in Fayetteville, Tennessee, and is the Immediate Past President of the American College of Physicians. His statements do not necessarily reflect official policies of ACP.

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