For all of the doomsday pronouncements about the end of the independent medical practice, one solo practitioner in Texas is bullish on his prospects.
Joseph Valenti, MD, is the founding senior partner for an independent OB/GYN practice that is growing instead of shrinking.
His strategy so far has been to grow by acquiring solo practices that are no longer financially viable. It contradicts the trend of hospitals buying up independent practices, and Valenti says his growth is intentional.
Joseph Valenti, MD
"I would like to help other doctors stay independent," Valenti says. "Right now, it's very difficult, but I believe that if physicians remained independent, it would probably mean better quality and cost less."
Valenti believes that maintaining an independent practice is sustainable with the right tools, such as technology, an organized approach to billing and collections, and negotiating with insurers. He says negotiating skills can save money, but they also cue insurers into business practices that are ready for a value-based environment.
"Physicians who are practicing cost-effective medicine aren't leveraging it," Valenti says. "You need to have data to report to insurers. For example, our midwives have a low C-section rate. When we take that to an insurer, that's a lot of savings: time-off saved, morbidity saved. Insurers are interested in that."
Failure to collect data that shows the quality and outcomes at an independent practice is a problem, but isn't surprising, says Lisa Enright, senior vice president and director of the healthcare practice banking group at Citizens Bank.
"Business acumen depends on the practice," Enright says.
Valenti's expertise did not come from an MBA. It came from on-the-job training when he opened his practice in 2001. Now, 15 years later, Valenti's practice has grown to include six physicians, three nurse practitioners, three certified nurse midwives, and three locations. The lessons he learned in the first year of business are ones he still practices today.
"You have to have be willing to negotiate," Valenti says. "A lot of things need to be shopped and negotiated: supplies, your lease, insurance contracts. And I didn't pay myself for the first four to six months."
Another vital component to managing an independent physician practice is cash flow management, says Enright.
Jacqueline Fellows is a contributing writer at HealthLeaders Media.