Becker's Spine Review

19 ASC Private practice isn't going anywhere By Riz Hatton Despite current trends, some physicians say private practice isn't going anywhere. Physicians are less likely to work in private practice now than they were 10 years ago, according to an analysis of physician practice agreements from the American Medical Association. However, physicians who continue to practice privately still see the value in doing so. "I'm a direct primary care family physician, and our future looks great," James Tinsley, MD, family physician at Lighthouse Direct Primary Care in Newport News, Va., told Becker's. "I opened my practice in 2019, six months before COVID-19. We were the first direct primary care practice in our area. There are four now. Even with the laws against free market medicine … we are still growing and thriving as are other practices. My patients get same/next day 30- to 60-minute visits and unlimited visits without a copay. We also shop for medical care and make it affordable for them. As a reward, I get to be the physician I always wanted to be. I truly love my job." One big draw to private practice is the level of autonomy physicians have. This allows them the flexibility to practice in the way they best see fit. "I have this flexibility to do what I think is right," Calvin Wong, MD, a cardiologist at Pacific Cardiology in Honolulu, told Becker's. "I'm not obligated to send the patient to the hospital that employs me. I can send who I think is the best doctor for that particular patient … so therefore it's a question of patient fit. The cornerstone of independent practice is the doctor-patient relationship. In Hawaii, which is very multicultural, if I have a Chinese-speaking patient from China, I'm gonna send him to this Chinese- speaking doctor in Chinatown. I can match the patient to the background." There are several opportunities for private practices to be successful regardless of the current trend of physicians moving toward the employment model. One of those opportunities is partnering with insurance companies directly. "The growing discourse between hospitals and insurance companies has provided a sizable opportunity for private practice groups across the country," Taif Mukhdomi, MD, interventional pain physician at Pain Zero in Columbus, Ohio, told Becker's. "Private practice has the chance to partner with insurance companies directly. Through competitive rates and specialized care, private practice groups can be an asset to health insurance companies by contracting together, building on each other's needs and providing dedicated care to health insurance members at a fraction of the cost in a hospital setting." n Some leaders have been able to ensure practice growth in 2023 with these partnerships. Grant Booher, MD, neurosurgeon at Fort Worth, Texas-based Longhorn Brain and Spine, told Becker's he was able to build out an ASC by partnering with a management group and several local surgeons. "e days of in-house billing, long-term relationships with one's team, the independence to run your own outfit, are sadly gone," Dr. Dayal said. "It was fun while it lasted, but it's time to bring in the suits — like the hospital days of yore. " 4. Focusing on payer contracts ASCs are also focusing on reevaluating payer contracts to stay ahead of potential reimbursement declines. "With the inflationary curve on the rise and another looming cut to the physician fee schedule, it is imperative that we reexamine our payer contracts with all other payers in our market," Mr. Lovewell said. "Many of the Medicare Advantage plans in our market are trying to pay below the Medicare physician fee schedule, and none of them are accounting for the implant costs associated with doing surgery in our ASC." Leaders also are focusing on providing risk-based contracts to reduce costs for ASCs and patients. Reuben Gobezie, MD, director of the Gobezie Shoulder Institute in Cleveland, told Becker's his growth strategy includes incorporating ASCs to his organization's "overall practice strategy to provide risk- based contracts to payers and employers in order to reduce their total cost of musculoskeletal spend." 5. Investing in technology Because ASCs are largely independent, leaders in many markets do not operate on high enough margins to invest in costly technology. In 2024, however, ASC leaders are sure to keep an eye on the technology they need to grow. For some ASCs, this comes into fruition with EHRs and EMRs. "My priority is building our new EMR system to ensure more efficient workflows within the system to better care for our patients and to be able to communicate more efficiently with other healthcare systems," Heather Liester, RN, director of pain management at York, Pa.-based OSS Health Pain Center, told Becker's. Other ASC leaders and physicians are eyeing artificial intelligence and how it can affect care provision. "My priority for 2024 is to see the impact of AI in the field of gastroenterology," Pankaj Vashi, MD, department head of gastroenterology and nutrition at City of Hope Chicago in Zion, Ill., told Becker's. "Artificial intelligence is in its infancy, and we are already seeing it being used for screening for colon cancer and surveillance for Barrett's esophagus. New applications of AI will change how we practice in the near future." n

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