In recent months, independent physicians practicing in Texas have seen an influx in attainable services that have primarily been available only to their hospital system-affiliated counterparts.
It’s now possible to partake in an accountable care organization and to get help with data analytics. So, too, is group purchasing among practices in rural communities and administrative support. One of the largest medical associations in the country and some of the state’s largest insurers are trying to help these independent physicians feel less like they’ve been cast away on an island, clutching their autonomy tightly as the world around them changes.
It’s a sizable population, too. In Texas, 60 percent of practicing physicians operate independently, this despite shrinking reimbursements and increased governmental oversight and a heavier administrative burden. Stretch that demographic to the entire country and you’ll see the percentage of physicians who practice outside a hospital, clinic, or large group plunged to 35 percent in 2014, according to the most recent Physicians Foundation survey.
“We want our members to be able to practice in the setting that they feel is best for them with the tools that they need to be successful,” says Sue Bornstein, the executive director of the Texas Medical Association’s Medical Home Initiative. “This is not anti-hospital or anti-big practice or anything like that.”
Bornstein was on the steering committee for the TMA’s PracticeEdge, a first-of-its-kind services company that launched in in February. It pairs the association with the state’s largest insurer: Blue Cross Blue Shield of Texas, which is a minority partner. It hopes to attract other health plans as it grows. For independent physicians among the TMA’s 48,000 members, PracticeEdge offers a voluntary assessment of each practice to determine which services—from HIPAA-compliant data analysis to payroll help to group purchasing agreements and many things in between—would benefit them.
“We’re meeting people where they are, and there is a huge range,” Bornstein says. “Some really need help keeping the doors open, and others are at the end of the continuum and they’re ready to do things like accept shared risk.”
On a more specific scale, Dr. Christopher Crow, the founder of the successful Collin County independent family practice Village Health Partners, has launched an accountable care organization known as Catalyst Health Network. To further supplement the mindset of the independent participants, Crow has kept the ACO “100 percent physician governed,” from the board down to the committee members.
Large hospital systems and clinical chains (like Houston’s trailblazing Kelsey-Sebold) along with their affiliated physician groups have typically been behind accountable care organizations. It’s a resources and numbers game—the large systems can afford to take on such an initiative, and have the volume to exhibit cost savings. For instance, in 2013, when Baylor Scott & White Health’s Quality Alliance was then in its infancy, CEO Joel Allison said it was actually hurting the bottom line. Fast forward to 2015, and the BSWQA is one of two (with the aforementioned Kelsey-Seybold) that has been awarded a Level 2 accreditation by the nonprofit National Committee for Quality Assurance.
Independent physicians who were interested in such services often didn’t have the staff or the time or the money or the volume to coordinate care, Crow says. Now, facing declining reimbursements and a shift to value-based care, independent physicians are increasingly interested in teaming together and sharing the savings.
“It’s a generally assumed truth that independent physicians have a more reasonable cost footprint and are as high quality as even those in large health systems, but they’re all fragmented,” Crow says. “The idea was: what if you could network up all of those little pockets of independence? What would the possibilities be?”
Cigna saw that opportunity and asked Crow—whose Village Health Partners now includes 32 providers that see about 80,000 patients at its two Collin County locations—to help coordinate the network into such a system. That’s now Catalyst, an ACO of about 100 independent primary care physicians that, Crow says, has attracted about 75 percent of all major insurance plans in the Dallas area. Aetna is a holdout, he adds.
“The other ACOs have one contract, maybe two, but nobody has the penetration that we have,” he says. “That really speaks to the payers and providers wanting to partner with us.”
PracticeEdge is something broader, something that could provide services for rural independents that they can’t get. Kaufman-based pediatrician Turner Lewis is an example of the type of physician the Texas Medical Association hopes to get on board. His practice, Total Care Pediatric, is independent and has four nurse practitioners on staff. He says he sees the possibilities for data analysis among patients seen by physicians like him.
“The physician’s goal is obviously to improve population health,” he says, “but from a practical standpoint, that is a huge obstacle to get over as an independent physician. How do you get someone to do a statistical analysis of all of my patients?”
There’s also a huge potential for administrative support, he says, especially as new coding demands become law once ICD-10 is passed, which is expected to happen later this year. He feels such a program would be beneficial for doctors who practice in the wide open spaces of Texas, far from the sprawling and monolithic reaches of the state’s largest hospital systems.
“I love the fact that the TMA recognized that we have this heavy preponderance of rural counties and we have access to care issues and we have one of the largest makeups in the state of independent physicians,” he says. “How do we help them? How do we help our patients? That’s been their focus—how do we help physicians retain autonomy?”