The Emerging Role of the Independent Provider

Episode Overview:

Employment has become a viable option and a trend, and more physicians have become employed over the past decade or two. However, we’re starting to see another trend with specialists who are deciding against employment, and starting their own practice or joining groups or large systems. Many see this an opportunity to stand out in the market and want to embrace the entrepreneurial spirit to have more control of their business and their work-life balance. Definitely having a strong business acumen has contributed to their success.

In this episode of Value-Based Care Insights, Daniel J. Marino speaks with Dr. Carlos Torre, founder of Sleep, Snoring & Sinus Center of Florida and triple board-certified sleep specialist, to discuss becoming independent and growing his practice.

Episode Discussion Areas:

1. Reasons and rationale for entering an independent practice.

1. Transitioning from a large group to an independent practice and the importance of strategic partners for growth.
2. Partnering with other specialists to support accountable care.

2. Vision of the new practice

1. Creating a solid business plan and vision over the next 3-5 years is critical.

3. Lessons learned

1. Setting up core services and a solid organizational structure
2. Finding a unique niche and
3. developing strong integrated services.
4. Challenges include enrollment and contracting with the payers

4. Advice for physicians considering starting their own practice or new physicians

1. The integration of services and being able to provide services specific to a specialty and type of care provides patients with better access.
2. Have a strong referral base coming from other physicians or partnerships with insurance companies and hospitals.
3. Offer services that are cost-effective,
4. Invest in a strategic planning process to understand what you can accomplish in the long run.
5. Planning before jumping in is important — have a good budget for equipment, staffing, etc.
6. Networking is a key component. Most physicians try to do it on their own, but Dr. Torre did the opposite and built relationships to build his practice.
   
   

7 Key Takeaways: The Emerging Role of the Independent Provider

1. It’s important to create differentiators within a practice.
   Independent providers have the opportunity to be more flexible and have more autonomy, which lets them provide the care they want. It also removes some limitations on growth potential. If a provider has great credentials and a market differentiator, they can more easily penetrate the market and grow their practice.
2. How can providers transition from an employed structure to independence?
   They must learn what they really want to do and then begin organizing their knowledge and services. Planning here is key to not lose sight of goals, to mitigate risks, and to identify the steps needed to move forward.
3. How can providers market themselves in the community?
    Strong referrals from other practitioners, existing patients and alignment with local hospitals. Patients need to feel they’re being taken care of and they’re getting the best quality care. It’s important to have differentiators in the market and provide care in an area without a lot of competition in terms of consults or patient referrals.
4. How can independent providers build their practices?
   Providers should offer different services without needing other partners or providers, expand their referral sources, and promote their brand. They must look at the data and see if the services they’re providing are actually helpful. Once they gauge what’s working, they can then partner with a larger network to provide quality care to more patients.
5. What’s the most difficult part about getting into an independent practice?
   Overcoming the fear of doing things independently and losing the security of being in a known position. Negotiating with contracts can become more difficult because when a provider is part of a larger group, they have a lot more leverage to negotiate contracts with the insurance companies.
   
   Providers must show insurance companies they have a cohesive program and provide a unique quality of care. Data is the best way to demonstrate this differential — leading to better rates and more profit.
6. Keep costs low to focus on growth.
   A common mistake is wanting to grow too fast and starting off with a lot of expenses that make it difficult to grow. If providers can improve efficiencies and provide care at a lower cost, they’ll have some capital on their side to invest in things that will help bring value to the program.

Resource Mentioned

• Lumina podcast ep. 35: Challenges and Opportunities of Independent Providers

About Value-Based Care Insights Podcast

Value-Based Care Insights is a podcast that explores how to optimize the performance of programs to meet the demands of an increasing value-based care payment environment. Hosted by Daniel J. Marino, the VBCI podcast highlights recognized experts in the field and within Lumina Health Partners.