A Q&A with Physician and Entrepreneur Dr. Adam Tabriz on the Challenges Facing Doctors Who Practice Outside the Managed Care System

Survey Question #6: Challenges

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Q: What are the main differences between practicing medicine as a member of the managed care system and practicing as an independent physician?

The concept of managed care comes down to: “You be the physician and take care of the patient, we’ll take care of the fiscal and administrative side of things.”

By definition, managed care is a healthcare delivery system designed to manage cost, utilization, and quality. By contracting with various types of MCOs to deliver care to Medicaid beneficiaries, states can reduce program costs and better manage healthcare utilization.

Physicians in independent practice deliver care without the influence of other entities and organizations. They do their own billing, clinical decision-making and marketing and develop their own protocols for treating patients.

Patients who seek care from independent doctors can choose whatever provider they want, but in the managed-care system patients can only visit physicians or providers within their own network. Physicians have to stick to a set of standards created by the designees of the organization, whether or not they agree with them.

One of the advantages of working within the managed care system is that you don’t worry about business fluctuations or matters of liability. But not every decision related to patient care rests with you.

And you won’t experience the same doctor-patient relationship, because many patients have been assigned to you by other people and there is a constant pressure to shorten face-to-face visits in order to fit in more patients.

Q: Why is it so difficult today for physicians to remain independent? What challenges do they face?

Government regulations — state regulations and the Affordable Care Act — are a constant pressure on independent doctors, who are already struggling financially. There are 15 distinct challenges that make independent practice difficult, Including

  • Collecting Co-pays
  • Meaningful use of Electronic Medical Records
  • ICD-10 administrative burden
  • Keeping pace with technology
  • Being reimbursed by payers
  • Fee-for-performance payment model
  • Avoiding liability
  • Rising operational costs
  • Staff retention
  • Maintaining certifications
  • HIPAA compliance
  • Decreasing Revenue

Under the fee-for-service model, practices can be penalized based on negative feedback from patients. This is just one example among the many challenges that independent doctors face. The government passes policies that favor larger health networks, because monitoring thousands of independent clinics that each do things their own way consumes more time and resources.

For these and many other reasons, a growing number of independent practices are closing their doors. Physicians simply find it too difficult to do it alone, and are more and more frequently joining the larger health networks.

Q: Why do many patients prefer to see independent physicians, rather than managed-care doctors?

We are a consumer-driven society, and many people have the mentality that they should be able to shop for healthcare with the same freedom as when buying a car or a house. Every doctor has heard patients request a certain treatment based on something they saw in a TV advertisement.

If a patient presents with knee pain and states that they want an MRI like the one they saw in an infomercial, the independent physician will likely order the test. A managed care doctor might have to skip it because it’s not covered by the patient’s insurance plan. Today’s patients are empowered consumers, and they might not like that.

This is one reason why patients have a better experience seeing an independent physician.

Q: What will it take to help physicians maintain their independence?

The survival of the independent physician practice is crucial for the healthcare industry, especially for the underserved and underprivileged areas. Individual choice is important not only for the community but also for quality of the care that each individual patient deserves. Healthcare should be in the hands of individual patients and individual physicians. Teamwork, interoperability, and centralization of healthcare is a necessity for efficient healthcare delivery across the nation and the world.

A strong independent physician practice model begins with embracing technology, accessing hands-on help from experts, and improving the point-of-care service model. Many doctors mistrust the software products that are supposed to help them manage their practices. Maybe it’s because physicians haven’t been the ones to build these products. Most current software solutions or EMR -based systems are not able to address the real challenges that physicians are facing today. Instead of rejecting these technologies, physicians should get involved, and make them better.

Q: What will happen to the country’s healthcare system if there are no more independent physicians?

Independent practices should not die away because physicians by nature and professional life want to be independent. Independent physicians are able to form real bonds with patients. Underserved areas need independent physician practices. To create a healthcare system without borders, we need to recharge the doctor-patient. relationship and empower individuals.

The corporate model of healthcare offers many advantages, but in the end it will never serve al patients’ needs.

It will take a new system of healthcare, with the individual doctor and patient at the center to provide care cost-effectively for patients all over the world. And it will take a new, hands-on system of practice management and an improved point-of-care model to enable this.

It’s difficult for physicians to remain independent, but it’s better for our healthcare system if many doctors can resist the pull into managed care. Consumers need choice, it’s what keeps our economy — and patients-healthy.

Dr. Adam Tabriz is a physician, entrepreneur and the founder of VirtuMed 360. Read more of his stories here.

What challenges are you facing as you manage your medical practice? VirtuMed360 wants to hear from you. Please respond to our survey here.

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