President's Letter

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Private practice: Are we approaching the end of the road?

By Rebecca Hart, MD
TAFP President

Is private practice obsolete? Can it be saved, and if so, who will save it?

Such questions dog many of our colleagues in family medicine. We struggle to keep small businesses thriving amid ever-increasing administrative hassles and expenses. All the while, disruptive new market entrants threaten to upend the mores and norms we’ve always known.

Is the EHR to blame for the demise of private practice as we know it? Is it burnout? Or is it a flawed payment system that fails to appropriately value what family doctors do?

We are witnessing a tectonic shift in the business of health care and the changes just keep coming. 

In the face of such upheaval, many family physicians have chosen to be employed by health systems and insurance companies. For some, employment offers the stability and favorable work-life balance they seek. But too many of our colleagues have succumbed to market pressures, and believing they were out of options, they’ve sold their private practices to large hospital groups or insurance companies that feed on a growing primary care base.

So, another question: How can small, independent practices compete for insurance contracts with large hospital-led groups that can amass huge numbers of doctors for payers and employers?

To find an answer — to find people and organizations leveraging independent practices and building networks of primary care doctors that can collectively compete for fee-for-service and value-based contracts — we need look no further than here at home in Texas.

Over the past four years, Christopher Crow, MD, MBA, has built an ever-growing network of more than 650 primary care physicians in North and East Texas through the Catalyst Health Network, leveraging their value with insurers and employers to secure better contracts than they could have won on their own. As part of a network, these physicians retain their independent practices but they work with and through Catalyst on contract negotiations to better align payment structures and offer more freedom of choice in how they best care for their patients in their communities.

Catalyst also uses care teams to extend the reach of primary care physicians, putting them at the center of the care process and providing data-driven feedback so physicians know how their patients are doing. It gives patients and physicians more choice, ensuring they can access the best care a community has to offer—not just what a hospital system tells them to use.

Now employers of all sizes are approaching Catalyst to improve the care they can offer their employees — and to lower costs in the process. Everybody wins. Physicians keep their practices and earn better reimbursement rates; employers pay lower premiums and benefit from a healthier workforce; patients get to keep their relationships with their primary care physicians without sacrificing flexibility and freedom; and insurers share risk through Catalyst’s value-based contracts that assure high quality and lower costs.

Likewise, family physicians across the state have built similar enterprises designed for doctors who want to maintain their private practices while providing excellent care to their patients. Physician leaders like Sheila Magoon, MD, at Buena Vida y Salud, an accountable care organization in Harlingen, and Clive Fields, MD, who co-founded Village MD, in Houston. Then there is Lloyd Van Winkle, MD, with United Physicians of San Antonio ACO, and Martin Franklin, DO, with Alliance ACO, and Norm Chenven, MD, with Austin Regional Clinic in Austin. And the list goes on.

Can models like these work for the rest of the state? Absolutely. These kinds of solutions become more important as Texas grows and the health care market evolves.

Here is the key: Physicians who want to remain independent need to come together with like-minded colleagues to organize in a way that allows them to pool financial resources, aggregate data, and share clinical tools to provide high-quality care.

Physician leaders are already in the process of implementing these organizations around the state. They are blazing a trail that could help save private practice in Texas.

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