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The End of Private Practice?

I was reading an online article from CNNMoneythat discussed the trend of physicians in private practice selling to hospital groups. The article reports that this is happening at a much higher rate and the expectation is that it will continue. The main reasons being cited are just general frustration in dealing with insurance company rules and regulations as well as the overall decline in reimbursement. For many having a private practice just isn’t a viable option anymore and they are selling to hospitals and becoming employees again.

It made me think about all the reasons I have decided to have a private practice and whether or not I would be willing to trade those for the “stability” of being an employee again. When I started a private practice it wasn’t to “get rich”. I am a physical therapist so “getting rich” isn’t part of the job anyway…if you run a clean practice that is. I opened a private practice for autonomy. To do things my way. To offer a level of care that is better that what can be provided at the majority of hospital locations that I compete with. I have achieved that and continue to strive for new ways to improve our services and expand to be able to allow more patients to experience the level of care that can be expected in a private practice.

Unfortunately, being “the best” and offering “premium service” doesn’t come with better reimbursement…although being part of a large hospital that has more clout with the insurance companies sure does. It is no secret that services received in a hospital setting are both charged and reimbursed at a higher rate. It has been well publicized in the news and the Attorney General in Massachusetts has many tasks forces looking in to it…but it still happens.

Locally we have Partners Health Care poised to acquire South Shore Hospital “for the good of patient care”. That couldn’t be further from the truth…what Partners Health Care is interested in is expanding their foot print to enroll more patients in preparation for the continued development of ACO’s and for more clout with the insurance companies which will allow them to have more leverage in negotiations for reimbursement.

As a small private practice I have to compete with much larger groups with deeper pockets for advertising…groups that “own” their doctors and dictate where the patient can go, regardless if it is the best place for them to provide care.

I wish I could see the future, but reading this article made me think that the trends are not in my favor. It’s not that all hospitals and large institutions give bad care…it’s just sometimes you are just another number and not someone that they develop a relationship with. The small, local private practice that works hard to earn your business and even harder to keep it should be able to survive.

I know what has happened with the “Walmartization” of retail and how it has affected the “mom and pop” stores…the same is happening in healthcare. Big groups are forming that push the little guy out…join us or compete against us. You would think with superior service, cutting edge technology and top notch staff you could do it, but the odds are not in favor and the regulations are becoming more and more cumbersome everyday…so for those groups that are selling, I get it…maybe it will let you get back to just patient care again?

Keep in mind that as a patient you do have a choice…when you can, choose local private practices that really do have your best interests are heart…before they are all gone.

Michael Vacon, PT
Managing Partner
Proud private practioner (for as long as it lasts)