MACRA doesn’t spell end of independent medical practices
“I think the question is, how far will the government allow it to go,” added Zetter. “My concern is that a small practice in a highly concentrated payer market may not have a lot of leverage in its contract negotiations.” *
The changing face of independent practices
Despite the challenges they face from MACRA and elsewhere, independent medical practices still have a future, the panelists said. Martin noted, for example, that many small towns and rural areas still need doctors, especially primary care practitioners. “They’ll build them a house or whatever, so they can practice medicine the way they want to. So I don’t think that’s going away,” she said.
In metropolitan areas, it’s more likely that independent practices will need some kind of affiliation with a hospital system, although it could be something other than outright ownership, Reiboldt said. “I feel there’s a role for both, although you have to be a little innovative sometimes,” he said.
He cited the example of North Side Hospital in Atlanta. “Their attitude has always been, ‘figure out ways to work with your physicians. Don’t necessarily say it’s employment or nothing.’” The system looks for ways to work with doctors through mechanisms such as clinically integrated networks and accountable care organizations. “I would like to think there are other systems out there thinking like that, and would allow physicians some level of independence and autonomy,” he said.
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Echoing Reiboldt, Zaenger said that some systems no longer have the money to acquire new practices or hire individual physicians. “They’re looking for alternative ways to partner with doctors that don’t cost them a lot of money,” he said. “I’m hopeful that in the long run you’re going to see there will still be a mix of providers, whether they’re independent or employed. So generally speaking, I think we’re alive and well.”
*Editor’s note: On July 21, the U.S. Department of Justice announced it had filed a lawsuit to block the planned mergers between Aetna and Humana and Anthem and Cigna.