Taking on risk, both individually and collectively, is necessary. “We have to ensure that the products and services we supply are reimbursed at appropriate rates that allow us to continue practicing,” Dr. Greer says. “For example, at our infusion center we have to make sure prior authorizations are complete and that copays, deductibles and co-insurances are met. If we don’t collect on just one infused product, we would have to see several hundred patients to break even.”
Given the challenges, Dr. Greer says it’s becoming increasing difficult to own your own practice, especially if you’re the lone practitioner. In fact, a 2015 report by Accenture suggested that only one in three doctors (33%) would remain in private practice by the end of 2016.1 By comparison, in 2000, 57% of doctors were independent.
Dr. Perkins says, “Reimbursement has not kept up with the times. Therefore, all of the joys of building a profitable business have been offset [by] concerns in how to cover rising expenses and stay viable in the marketplace. With the introduction of new healthcare benchmarks for quality and cost, owners will have to reinvent themselves in new payment models.”
Dr. DiGiovanni, who is also the program director of the rheumatology fellowship at Largo Medical Center at Nova Southeastern University College of Osteopathic Medicine, Largo, Fla., has found that you can never leave your work at the office.
Coping with Challenges
To handle challenges related to payments, administration at Dr. Greer’s practice monitors contracts and tracks monthly and quarterly reimbursement. “We look at every single profit and loss statement at every line, and make sure no discrepancies exist,” he says. “When one occurs, we find out why and make corrections. We constantly renegotiate contracts with various vendors to obtain the best rates possible. This includes insurers, pharmaceutical companies and even our landlords, if we are leasing property, or our utility companies.”
Dr. DiGiovanni has also found that expenses bring challenges. “If you don’t belong to a large group practice, you can’t spread out the costs of expensive equipment or submit a requisition for something,” he says. “You have to buy it yourself.”
Additionally, as healthcare enters an age of quality- and value-based reimbursement, clinicians will have to surround themselves with staff who have expertise in this area. “You need an office manager with a great deal of skill whom you can trust,” he says.
Another challenge is maintaining and keeping up with changing rules and regulations within the field and healthcare system.
