The session Small Fish in a Big Pond: Private Equity, Corporate Medicine and the Sustainability of Independent Rheumatology held at the inaugural Practice Innovation Summit focused on the challenges that come with surviving as an independent rheumatology practice in the current health environment.
Factors Behind the Sell
Dr. Feldman
Although rheumatologists typically want to focus on the doctor-patient relationship and clinical choices, they also must consider profit in today’s environment, said Madelaine Feldman, MD, FACR, The Rheumatology Group, New Orleans. “Unfortunately, we have to,” she said.
She brought up four business factors—the business itself, the patient, heart and soul, and doctor/patient relationships—and noted that if any one of these factors falters, it can affect the others. This is something that is happening more frequently in today’s health environment.
Other factors affecting today’s private practices include lower reimbursement rates, government regulation, personnel costs and issues, technology and higher overhead costs, Dr. Feldman said. “How long can we sustain that?” she asked.
Two other challenges physicians face are educational debt and a lack of business training, with business training more essential nowadays for independent practices, she added.
Pressure from insurers to follow care strategies, such as step therapy or prior authorization, put pressure on rheumatologists as well as patients.
Yet another factor eroding the stability of private practices is the role of insurance coverage when deciding which drug or drugs are available for a patient, Dr. Feldman said. Shared decision making used to refer to a discussion between the patient and doctor; nowadays, it seems more guided by insurance coverage.
