Practice Othercare not Obamacare

NOVEMBER 13, 2014
Arlen Meyers, MD, MBA
Independent practitioners are facing significant challenges to their survival. Radical changes in the healthcare delivery system have forced private practitioners to reassess their business models and create new ways to practice.

Some will ignore the threats and fail. Others will jump ship and join the increasing ranks of employed physicians. Others with practice Othercare and thrive.

The alternative to Obamacare is Othercare. In other words, you can struggle using old models of care and chase your tail every time the government and payers issue new rules, or, you can be innovative and proactive. In other words, to repeat hockey great Wayne Gretzky, stop skating with the puck and, instead, skate to where the puck will be. You need to adapt to several major trends like fee for service migrating to payment for value, improving the patient experience, the demand for care outstripping supply, and many more. 

To thrive in private practice, you must practice the 10 rules of Othercare:

1. Practice state-of-the-art medicine

One thing has not changed and that is the necessity to pursue life-long learning and incorporate state-of-the-art technologies, best practices, evidence-based standards, and new validated methods into your practice. The challenge is significant given the explosion in daily medical information and barriers that exist to the adoption and penetration of new medical technologies and findings.

2. Consolidate to garner market power

Physicians are consolidating to garner market power, benefit from economies of scale and reduce costs for back-end business process platforms. Some are forming IPOs. Others are merging practices and still others are becoming franchisors or franchisees.

3. Use innovative care delivery models incorporating validated digital health technologies

Care delivered solely in brick and mortar facilities, like offices, hospitals, and clinics,  is rapidly being supplemented with eCare technologies, creating digical (digital and physical) care delivery channels. The retail industry adopted eCommerce many years ago, to the point where 6.4% of all retail sales are done online. Healthcare has been slow to do the same. To thrive, practitioners need to familiarize themselves and adopt validated eCare methods that improve outcomes, enhance the patient experience, and reduce per-capita costs. Examples include telemedicine, social media, patient portals, remote sensing, and wearables. Some practices have gone “micro,” minimizing staff and infrastructure, and using enhanced information and communications technologies to deliver care at reduced costs. Others have abandoned brick and mortar totally, creating virtual care clinics in the cloud. Others have embraced the retainer or concierge direct payment model.
 
4. Improve patient communication portals and create transparency

Transparency is driving a physician-dominated model to a patient-centered model, stressing shared decision making, particularly for preference-sensitive conditions. Examples include posting package prices for services, sharing data with patients in the electronic medical record and sharing outcomes data for given procedures and treatments. At its core, removing the opaqueness over healthcare information will provide payers and patients with the information they need to make market-driven, valued-based healthcare decisions.

5. Dominate on service and experience, not quality

As healthcare becomes more and more commoditized, patients will expect quality and demand quality of care as a minimum standard and will no longer see it as a major competitive differentiator. Instead, they will increasingly value service, experience, convenience, cost, and speed as dominating value factors and will be willing to pay a premium to those who provide it.

6. Measure everything

Data will drive value. The more you can measure, the more you can demonstrate value. You get what you measure.

7. Adopt an entrepreneurial mindset

That mindset means the pursuit of opportunity with the goal of creating stakeholder defined value using scarce, uncontrolled resources through the design, development and deployment of innovative biomedical and health ideas, inventions discoveries and processes. Start thinking more about the new and less about the now.

8. Maximize practice management efficiencies and efficacies

Keep your eyes on the numbers. Your net income will derive from how to generate and collect revenue, manage costs, and reduce overhead. Learn how to keep score better and carefully manage your profit and loss. Cash flow should be the biggest dial on your dashboard.

9. Le​ad

Care has changed from one doctor taking care of one patient to care teams taking care of patient teams consisting of relatives, surrogates and advocates. You will need to further refine your leadership skills and avoid the common dysfunctions of teams.

10. Fail early, cheaply, and often with new product line offerings

Entrepreneurs fail early, often, and at least cost as possible. Test a little and learn a lot. Experiment, measure, analyze, and refine in a cycle of continuous improvement until you validate a profitable business model that can be scaled.

The attractiveness of private practice for any given specialty swings from one generation to the next. Some predict that the demise of private practice is premature and that, given multiple factors, it will be a more favorable alternative to working for someone else in the future. Only time will tell. One thing, however, is certain and that is that the successful private practices of the future will faintly resemble old models of the past. You can take that to the bank.



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