Some of us are practicing medicine as an independent physician while others are working as part of the managed care system. Managed care systems put the responsibility of treating the patient on the physician while the fiscal and administrative aspects are run by third parties (At the expense of losing physicians independent clinical decision making capability). The model of healthcare delivery system is meant to be suitable for providing effective care in a cost effective way. States supposedly can cut down program costs and improve health care utilization based on population healthcare model by pairing with different managed care organizations (MCOs) to deliver care to Medicaid covered patients.
Independent physicians, on the other hand, are free from any third party influences and treat patients, take clinical decision, carry out billing process, do their marketing and establish patient treatment protocols independently. Both the systems have their advantages and drawbacks, but recently the independent practice is going through a challenging time. We will talk about the challenges but first, let’s explore why we need independent physicians in private practice.
The Importance of Independent Physicians
Ensuring Patient Safety
Doctors are generally prepared to face the long hours of duty after going through their education. But in recent times the healthcare system along with managed care “Reward” (More you work…more work you get…) has put immense pressure on the physicians forcing them to work even 18 hours at a stretch. This leads to physician burnout which is a major cause of avoidable medical mistakes.
83% medical organizations consider physical burnout to be a serious threat. Today a physician has to work 59.6 hours per week which has led to half of them reporting burnout issues.
Physicians need to be physically and mentally fit to ensure the success of their treatment. Only when they are fully functional the patient can expect a positive outcome and avoid some of the 250,000 deaths that occur every year in America due to avoidable medical errors.
Practicing privately enables physicians to take on as many patients as they can handle comfortably and prevent any burnout to ensure patient safety. They also don’t need to follow protocols and procedures drafted by people who understand nothing about medicine.
Effective Patient-Doctor Relationship for Better Treatment
Private practice helps the physicians form strong relationships with their patients which impact the treatment. In managed care, the patients don’t have the liberty to choose from a larger pool of doctors and have to be satisfied with what the system provides them with.
Patients can choose who they want to get treated from which helps in forming the first step of the relationship. The physician can give due time to each patient as there is no rush to fit in more patients. The direct relationship enables improved delivery of healthcare devoid of any third party profit motives and dictates.
Better Access to Options
Today the patient is more aware and knowledgeable about his options. He knows what he needs even though he may not be able to get it under managed care.
For instance, a doctor who is a part of the managed care system may not prescribe an MRI for knee pain as the procedure may not be covered under the insurance. But independent doctors are not under such obligations and can act for the patient’s best interests. They can prescribe procedures and medicines even without consideration of coverage.
Improved Access to Healthcare
Even today the rural areas of USA don’t have basic access to healthcare. Some counties are doing with only one hospital while there is none at other places. A study of 28 counties revealed that 2,227 residents had access to only one physician. For Gray County in Kansas, only one primary care physician is assigned to 6,000 residents!
Independent physicians can really make a big change in such underprivileged areas bringing necessary healthcare within the reach of the residents.
Surely we cannot do without independent physician who are facing a dire time in the present.
The Challenges Faced by Independent Physicians
The biggest challenge facing independent physicians is government regulations. The government policies invariably favor the large health networks and don’t apply for the clinics and independent doctors though they have to follow it.
The Affordable Care Act and state regulations put constant pressure on the independent physicians who already in a financially tight position. They are also liable to be penalized for any negative feedback from the patient under the value based reimbursement model. The other difficulties include-
- Managing co-pays
- Administrative responsibilities
- Keeping up to date with technology like EMR
- Reimbursement management
- Pay for performance reimbursement models
- Handling liabilities and claims
- Increased operational costs
- Managing certifications
- Employee management and retention
- HIPAA regulations
- Inconsistent revenues
“Many doctors are closing their clinics and selling out to the corporate in face of the challenges. But that is not at all desired!”
We need the Survival of Independent Physicians
Many might argue but healthcare is a consumer driven market, especially at the present time. Today’s empowered patients know what is best and where they can get it. This is one vital reason why patients prefer to consult a private physician; another reason is to provide the underprivileged areas with accessible healthcare.
We need to put doctors and patients in the center of the healthcare systems and decisions. Then we can have an effective interoperability, teamwork and “effective” centralization of healthcare for efficient global healthcare delivery.
Doctors should learn to embrace technology at the earliest. They can contribute to perfect digital systems like EMRs and billing software which can be effectively used to assist doctors in reducing their administrative burdens and ease burnout.
By nature and profession, physicians are meant to be independent to form better bonds with patients. We need independent practice to survive for the sake of healthcare and the patients!