As doctors weigh whether to stay in their practices or become employed in a group practice or at a hospital, they’re increasingly looking to alternative business models in order to remain – and thrive.

“Especially as the industry evolves, physicians and practice staff may be looking at alternative business models,” said Todd Evenson, data solutions director for the Medical Group Management Association.

“For example, this could … mean that practices are adding ancillary services, evaluating remote monitoring of patients, considering making test reporting available online or changing access models by adding mid-level providers if needed, or the capability to email your provider, just to name a few,” he said.

Adding ancillary services is the route Craig Pope, a Missouri-based primary care physician decided on. After working for a medical group for six years, he chose to go independent.

“They didn’t want me to do things differently than their way,” he said of his time with the medical group. “They wanted me to just be a good cog in the wheel.” He chaffed at the inefficiencies of the medical group’s business model, seeing that he could run his own practice and add ancillary services that he believed would be useful to his patients and bring money into the practice.

He bought out his contract, purchased equipment and his patient charts and gradually started adding ancillary services like an allergy lab, a pulmonary lab and ultrasound screening.

“We’re doing all those services on site, which is not only a great service to the patient, providing good integrated care, but those are all reimbursable services, which from a business model standpoint is vital to the success of our practice,” he said.

The practice’s ancillary services are so successful, he said, that revenue from them far exceeds his primary care services revenue. “I am not viable as a referring primary care doctor who just sees patients and bills office visits,” he said.

While ancillary services have helped Pope thrive, for Peter Anderson, a former primary care physician in Virginia, it was redesigning workflow in his office that allowed him to stay in practice and turn around a desperate financial situation.

“By the end of 2003, I was $80,000 in the red and knew things just couldn’t keep on like that,” Anderson said. “I was working 10, 12, 14 hours a day. I realized the only way I could fix this was to see more patients. I was in desperate need of a major transformation. I just couldn’t do something little and expect any significant change to happen.”

The big change he made was to change the process in the exam room. He determined which functions could be done by non-physician professionals and he assigned those folks those tasks, which allowed him to focus on his patients.

But re-establishing relationships with his patients was not the only success. In the first full year of his new workflow process, his collections rose by $100,000 because of the improvement in access. Additionally, he said, patient satisfaction and staff morale increased and care quality improved.

The success of his workflow process eventually allowed Anderson to give up practicing medicine. He has transformed his process into a new business, called the Team Care Model. To date, he has used his model to train six civilian health systems and the U.S. Army.

“There’s only one reason why I did this: it was because I was drowning,” he said. “It wasn’t because I’m smart. It’s not because I like to do innovation. It’s not because I like to do something different. It’s just – I was drowning.”

Anderson encourages primary care doctors not to give up, saying that now, more than any other time in the United States, is the best time to be in primary care.

“You don’t have to lose money (in primary care). It can become an extremely profitable business,” he said. “When you see what’s coming and how primary care can become the backbone of healthcare again (it’s) not an overstatement to say this is the best time in America to be a primary care physician. There’s never been a better time.”


By Stephanie Bouchard
February 6, 2013