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Independent Practice and Managed Care Employment: Journeys with an Uncertain Destiny

Originally Published on Medium


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There are many differences between practicing medicine as an independent physician and practicing as a member of a managed care system. I have done both in my career, and I have insights into why many doctors prefer to remain independent and why many patients prefer to see a doctor who operates outside of the managed care system.


In managed care, a physician is encouraged to focus on taking care of the patient, while administrators take care of things' fiscal and administrative side. It’s a healthcare delivery system designed to manage cost and assure quality. By contracting with various Managed Care Organizations (MCO) to deliver care to Medicaid beneficiaries, states can reduce program costs and better manage health care utilization.

On the other hand, physicians in independent practice deliver care without the influence of other entities and organizations. They do their billing, clinical decision-making, and marketing, developing their protocols for treating patients.

Patients who seek care from independent doctors can choose whatever provider they want, but patients can only visit physicians or providers within their network in the managed-care system. Physicians must stick to a set of standards created by the designees of the organization, whether or not they agree with them.

One of the advantages of working within the managed care system is that physicians don’t worry about business fluctuations or liability matters. But a disadvantage is that not every decision related to patient care rests with the doctor.

Physicians don’t experience the same doctor-patient relationship because many patients have been assigned to them by other people. There is constant pressure to shorten face-to-face visits to fit in more patients.

The Challenges in Remaining Independent

Independent doctors are under constant pressure from government regulations — state regulations and the Affordable Care Act — and these physicians are struggling financially. Fifteen other distinct challenges make independent practice difficult. These include:

  1. Collecting Co-pays

  2. Showing meaningful use of Electronic Medical Records

  3. ICD-10

  4. administrative burden

  5. Keeping pace with technology

  6. MACRA

  7. Being reimbursed by payers

  8. Adapting to the fee-for-performance payment model

  9. Avoiding liability

  10. Dealing with rising operational costs

  11. Retaining Staff

  12. Maintaining certifications

  13. Maintaining HIPAA compliance

  14. Coping with decreasing Revenue

  15. Value-based reimbursement

Under the fee-for-service model, practices can be penalized based on negative feedback from patients. This is just one of many challenges that independent doctors face. The government passes policies that favor more extensive health networks because monitoring thousands of independent clinics that each do things their way consumes more time and resources.

This is why a growing number of independent practices are closing their doors. Physicians find it too difficult to do it alone and are more and more frequently joining the more extensive health networks.

Many Patients Prefer an Independent Physician

We are a consumer-driven society, and many people feel they should shop for healthcare with the same freedom as when buying a car or a house. Every doctor has heard patients request a particular treatment based on something they saw in a TV advertisement.

If a patient presents with knee pain, for example, and states that they want an MRI like the one they saw in an infomercial, the independent physician will likely order the test. A managed care doctor might have to skip it because the patient’s insurance plan does not cover it. Today’s patients have empowered consumers, and they might not like that.

That is one reason why patients have a better experience seeing an independent physician.

The survival of the independent physician practice is crucial for the healthcare industry, especially for the underserved and underprivileged areas.

Individual choice is necessary not only for the sake of the community. It is also for the quality of the care that each patient deserves. Healthcare should be in the hands of individual patients and individual physicians. Teamwork, interoperability, and centralization of healthcare is necessity for efficient healthcare delivery across the nation and the world.

An Independent Physician Practice Model Begins with Embracing Technology

Independent doctors need to embrace new technologies and combine them with hands-on help from experts to improve the point-of-care service model. Many doctors mistrust the software products that are supposed to help them manage their practices. Maybe it’s because physicians haven’t been the ones to build these products. Most current software solutions or Electronic Health Record (EHR) systems cannot address the real challenges that physicians are facing today.

Instead of rejecting these technologies, physicians should get involved and make them better.

We cannot allow independent practices to close their doors because physicians want to be liberated by nature. Independent doctors are better able to form genuine bonds with patients. Underserved areas need independent physician practices.

The corporate model of healthcare offers many advantages, but in the end, it will never serve all patients’ needs.

It will take a new healthcare system, with the individual doctor and patient at the center, to provide care cost-effectively for patients worldwide. And it will take a unique, hands-on approach to practice management and an improved point-of-care model to enable this.

It’s difficult for physicians to remain independent, but it’s better for our healthcare system if many doctors can resist the pull into managed care. Consumers need choice. It’s what keeps our economy — and patients — healthy.

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