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    Pull up your socks: Prepare for rapidly changing healthcare environment

    Alice G. Gosfield
    The dynamics of the healthcare environment are changing rapidly. Small primary care practices are confronting a host of challenges. The looming advent of value-based physician payment in Medicare ought to motivate physicians to change their behavior today, especially since commercial payers surely will follow suit.

    Medicare's Physician Quality Reporting System is voluntary today. Reporting can garner your practice extra money. In 2 years, however, you will be penalized for failing to report data, and the data reported will be made public.

    This moment of transition is a critical one and unique. It offers you an opportunity to reorder the way you practice, to become more ingenious, resourceful, and effective to achieve better patient outcomes. Key to this type of change is clinical integration. Clinical integration entails physicians working together systematically, with or without other organizations and professionals, to improve their collective ability to deliver high-quality, safe, and valued care to their patients and communities.

    Preparing for the immediate future requires a careful examination of those aspects of your practice that can influence your ability to provide high-quality, safe, and valued care. To begin, one technique to use is a new self-assessment tool I codeveloped (http://uft-a.com/CISAT.pdf), which speaks to 17 attributes of a clinically integrated entity. This self-assessment tool can point to those aspects of your practice that could be changed to improve value. Thinking about what the envisioned goal for each attribute might be can lead you to make changes for better results. The extent to which your practice standardizes such aspects of care as documentation, equipping examination rooms, use of midlevel practitioners, to whom to give referrals, the optimal moment of referral, and more, can improve the likelihood of success in the new environment.

    For small groups, finding other similarly motivated small groups in the community can provide a basis on which to proceed. This effort would not violate antitrust laws and would be beneficial to all parties.

    As part of any change, collecting data will be essential to improvement, because you cannot improve what you do not measure. Without data you will not know you have changed. If you integrate clinically with other groups and share the data you generate with payers, you can even bargain together with payers for higher fees.

    This current moment of ambiguity is one that has stymied many doctors. It should not. Doctors can improve their financial margins and their quality outcomes by focusing on both the administrative and clinical processes that impede their ability to have more time with their patients and more efficiency in their work. The real mandate is to get going. Talk to your colleagues within your group and beyond. If you pull up your socks now and take advantage of the clinical integration opportunities today, your own practice environment will improve, your results for patients will be better, and you will stand a far better chance of success in 2 years.

    The author is a health law attorney with Alice G. Gosfield and Associates in Philadelphia, Pennsylvania, and an editorial consultant to Medical Economics. Send your feedback to

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