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Physician Practice Perspectives

The number of solo and small practices continues to dwindle in the U.S., and the pace of consolidation is expected to quicken in the next few years as uncertainty and change continue to pressure independent practices. A number of factors are impacting the bottom line of small practices and physicians, including the high cost of medical malpractice insurance, the demands of health information technology, flat reimbursement rates from Medicare and Medicaid, and the potential for those flat rates to be reduced if a practice doesn’t meet quality reporting benchmarks.


Concierge medicine is still a niche industry, but in an era of decreasing reimbursements and increasing government regulation, it has become a more attractive option for some physicians running a small practice. The concierge business model, which operates under several names including “direct pay,” has been around for 20 years and once catered to wealthy clients in affluent urban and suburban areas. But changes in the way small practices operate—and the proliferation of high-deductible health plans—is prompting physicians and consumers to give the model a second look. 


Physician practices are working with a new set of rules when it comes to engaging patients online and encouraging them to view their medical records, and the new Advancing Care Information (ACI) program has made some standards easier to reach than those under the meaningful use program that it replaced.
Under the revised rules for the Merit-based Incentive Payment System (MIPS), many minimum reporting thresholds under ACI are lower than those imposed under modified Stage 2 and Stage 3 meaningful use, and physicians are required to report on fewer measures using a more streamlined scoring system.


Physicians say communicating with patients online is still a challenge but that patients are becoming more comfortable with making appointments, refilling prescriptions, and asking follow-up questions through patient portals after appointments. Yet physicians are also discovering that having patients review their medical records—and try to decipher the clinical terms and codes within—can open up a whole new line of questioning.


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