The business of private practice — Dr. Paul Slosar on physician independence

Megan Wood -   Print  |
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Immersed in a highly competitive and regulated industry, independent physicians must demonstrate expertise in business management. Paul Slosar, MD, of San Francisco-based SpineCare Medical Group, says independent physicians must dedicate themselves to both clinical care and the "back-office side of the equation."

"Obviously, many physicians, and certainly most surgeons, have personalities which could be characterized as 'independent,' so the issue of maintaining of control is the most important benefit of remaining independent," says Dr. Slosar.


Maintaining control carries a lot of responsibility, however, as independent physicians must be prepared to take on payers: "Large alignments in healthcare can make it challenging for smaller practices to navigate the large insurance companies changing physician panels," says Dr. Slosar.


Still, Dr. Slosar believes the healthcare industry needs independent physicians. Focused on cost containment, payers don't want hospitals to "own" every physician. A non-competition delivery model only increases costs, "The concern here is, it is an unsustainable rise in cost that's being driven by consolidation and monopolization of markets."


Instead, payers are beginning to seek out and engage independent physicians in evolving payment models as opposed to only doing business through hospital-owned medical groups, adds Dr. Slosar.


Navigating independence
The key to securing independence involves teaming up with strategic partners. Dr. Slosar suggests collaborating with partners who share similar interests in independence.


Dr. Slosar's practice works with Episode Solutions, a Nashville-based company that assumes risk alongside SpineCare Medical Group as they participate in the Medicare Bundled Payments for Care Improvement Initiative. Episodes Solutions partners with the physicians, helping to grow bundled payments and risk-sharing models as they solidify relationships with large hospital systems, CMS and big payers.


"Most practices are very good at fee-for-service, but don't have any infrastructure to navigate the evolving reimbursement landscape," says Dr. Slosar. "Remaining independent requires the practice administration to look at different partners than in the past."


For surgeons who practice in ambulatory surgery centers specifically, Dr. Slosar recommends teaming up with their management company, as they can help with reimbursement navigation and case transitions to the outpatient setting.


Medical student training
The difficulty with ingraining the independent mindset in young physicians lies in their training.


Dr. Slosar said about 90 percent of residents train in academic institutions or hospitals, so even if they have an understanding of private practice, it isn't a practical understanding. Although fellowships used to fill this role, fewer fellowships take place in private practice today.


"There are certain personalities that lend themselves to being independent and entrepreneurial," says Dr. Slosar. "And those doctors will often try to find access to these types of practices."


To enhance medical student and resident exposure to independent practice, Dr. Slosar thinks various device and ASC companies could host symposiums that lay out the differences between employed models and private practice.


Seeking employment
If considering making the switch to hospital employment from private practice, consider the business changes. Salary, benefits, staff and control will all change once a physician works for someone else.


"I think the doctors who make the transition really should be almost certain, that they are not going to want to bail back out," says Dr. Slosar. "Those transitions tend to be a very much one-way transition."


By joining a hospital, you're transferring all of your practice ownership and goodwill to the hospital system, he explains.


"There is growing evidence that a lot of these surgeons that made those transitions are looking to unwind them," Dr. Slosar says.


Ultimately, Dr. Slosar believes the healthcare industry will always offer a place for independent practices that have an eye toward the evolution in delivery of care.


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