Sustaining the Solo Medical Practice


Maintaining a solo physician practice in today’s economic environment can be challenging — and perhaps that’s summing up the situation too mildly. Faced with rising overhead costs and lower reimbursement, many solo physicians are closing their practices. Those who are weathering the storm have their work cut out for them.

“One of the top challenges that physicians are facing is preparing for the new reimbursement models that are going to place a greater share of financial risk on a practice,” says Ron Finkelstein, CPA/ABV, principal in charge of the health care services group at the accounting firm Morrison, Brown, Argiz & Farra LLC. “Primary care physicians need to realize that the reimbursement paradigm shift is taking place.”


Information is key

Finkelstein explains that the medical community’s current fee-for-service methodology is going to be replaced by a bundled payment program where physicians will be paid based on overall quality outcome measurements and savings. Access to information, he says, will be the key to achieving those outcomes.

“There’s an old saying that if you can’t measure it, you can’t manage it,” says Finkelstein, noting that a second a related challenge for physicians will be selecting an implementing an electronic health records system. “That is a critical investment, a required capital investment, which a solo practice will have to make because that information will essentially help them measure and collaborate with referral sources and hospitals.”

Finkelstein says that one of the benefits of having health-related patient information is the ability for solo practitioners to implement a patient-centered medical home strategy, where the primary care provider, nurses, social workers, nutritionists and the like all work together to coordinate the care of the patients.

“It’s going to lead, hopefully, to a more patient-centric focus, more efficiency and improved quality outcomes,” he says.


Thinking outside the box

Eighteen months ago, Nisha Chellam, MD, left the confines of the John Dingell VA Medical Center in Detroit, Michigan, and set out to start her own practice. Today she says that she would not go back to a job and explains that thinking beyond the four walls of her practice has been the key to successfully getting the practice off the ground.

“I could not sit in an office and wait for people to come and see me,” Chellam says. “I had to go and get people.”

She began frequenting assisted living facilities and rehabilitation centers to take on new patients, and now calls her practice “a diversified portfolio.”

“If one part of my practice is not very sustainable during a particular season, like winter, because no one wants to travel out in the snow unless they’re really sick, then I’m able to go to the assisted living facility and the patients are there,” Chellam says. “It provides a little more variety, and it’s my way of surviving in this economy.”

Time management and organization skills have also helped. Chellam explains that every night she reviews her schedule for the following day, regularly spending an hour to organize her time and her communication with patients.

“I cannot go home, sleep, get up the next morning, and take the day as it comes. I really have to organize my day.” The electronic health records system she uses, Amazing Charts, has been a big help. “It is totally amazing. I love it.”


Enlisting support

Finkelstein says that under the Patient Protection and Affordable Care Act, there are going to be more insured patients, therefore more patients for physicians to see. A strategy that some solo physicians are implementing to leverage the number of patients they see is increasing the usage of mid-level providers.

“They’re hiring nurse practitioners and physician assistants to help them triage patients, and handle some of the basic office visits,” he says.

Chellam has also enlisted support by training her staff to tackle many of the phone calls and communication received through the patient portal she established. Since her staff is with her when she sees a patient they can respond to any emails, and through the portal she can see emails going back and forth without having to get involved. She also trained the staff at the assisted living facility.

“If there’s an emergency, they need to call me,” she says. “But if it’s routine, the patient needs to wait until the day I come to the facility. So, it’s important to train the people you work with, because when you go electronic, you really need very well-trained staff. It’s not something a practitioner can do by themselves.”

In order for solo practitioners to survive, they really need to make an investment in technology for the practice, says Finkelstein. Otherwise a solo practitioner would have to “retire, merge or sell his or her practice.”

“And right now, there’s not much value in solo practices,” he says.

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