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Issue Date: July 2007

Is There a Viable Alternative to Fee for Service?
Health policy experts, academics, and many physicians themselves believe fee for service payment is a leading cause of rising costs, inconsistent quality, duplicative service, lack of care coordination, and fraud.

Medicare and other patients bounce among doctors, most of whom are unaffiliated with one another and as a result, few patients have a single doctor central to the care they receive, says Peter Bach, MD, a physician at Memorial Sloan-Kettering who recently served as senior advisor to the federal Centers for Medicare & Medicaid Services (CMS). The problem is fee for service payment, Bach added. In fact, fee for service offers an incentive to physicians to provide more services and more expensive services, he said in a recent article in The Wall Street Journal.

Tactics for Improving Operations
Highly efficient physicians are continually exploring ways to improve the operational efficiencies of their practices. While many medical practices focus on expense reduction, highly productive physicians focus on ways to gain economies of scale through various consolidation or centralization opportunities. These practices also explore other initiatives such as group purchasing contracts and changing the mix of personnel in an attempt to do more with less.

Typically, the most efficient physicians have more support staff than physicians in average practices have. Having more staff means these practices view personnel as an investment, much the way large corporations do.

Make Choices That Match Your Goals
Once they finish their first full-time position in medicine, most younger physicians face a wide range of choices about career direction. The challenge they face involves selecting the alternative that lays the foundation for a stable, growing, and satisfying professional career.

For these physicians, the most popular options include working in an established private practice, forming a group practice, starting a solo practice, buying into an existing group, or working in a private or public setting. Since each of these options has advantages and disadvantages, experts offer guidance on how to choose among them.

Consider the Value of Decision Support
Advances in science and technology have led to remarkable changes in health care and in the delivery of patient care. New diagnostic tests, medical devices, and treatments enable clinicians to treat patients more quickly and more effectively than they could in the past. Despite these extraordinary advancements, a fundamental problem continues to hinder the quality of patient care.

As an increasing amount of medical knowledge becomes available, physicians and other providers are expected to recall and synthesize a staggering amount of information surrounding clinical features, differential diagnoses, investigations, treatments, and complications for thousands of disease entities. For any given set of clinical features, it is difficult to construct, on every occasion, a complete and safe differential diagnosis, no matter how well trained, well read, or well practiced a physician may be. This failure can lead to delays in diagnosis and misdiagnosis.

Investment Opportunities to Review
Many physicians and other professionals want to know more about the wide variety of investment opportunities that are available. These physicians and other professionals should know enough so that they can work intelligently with a professional investment adviser. To learn the basics about some of the various investment opportunities, these physicians should review a brief description of some of the most common investment vehicles.

It is best for physicians to leave portfolio monitoring to an investment professional and use this professional as an adviser. Physicians also should be aware of the factors that can affect the performance of an investment vehicle. (See “Managing an Investment Portfolio,” Practice Options, June, for a description of the role of the investment adviser and a discussion about the factors that affect performance.)

Physician Demand Drives Buy-Ins
Daniel M. Bernick, JD, MBA, is a principal with The Health Care Group and Health Care Law Associates in Plymouth Meeting, Pa. He advises physician groups on the financial and legal aspects of medical practice operations, buy-ins, buy-outs, sales, mergers, and other transactions. He has extensive experience in valuation of medical practices and he has lectured widely to such organizations as the MGMA, American College of Rheumatology, American Society of Ophthalmic Administrators, Medical Society of Delaware, and other groups. He discussed medical practice valuations with editor-in-chief Richard L. Reece, MD. This interview is the second of two-parts.