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Independent Physician Practices: Sell, Consolidate, or Stay Put?

Independent Physician Practices: Sell, Consolidate, or Stay Put?

Eide Bailly

Independent Physician Practices: Sell, Consolidate, or Stay Put?

With more than 40 years of working in the healthcare industry, I have seen health systems buy practices and divest of them over two or three cycles. Private equity firms come in and consolidation happens. This is often touted as the end of the private practice. Currently, these transactions seem to be even more intense due to the high cost of technology, staffing and other general operating costs. There are also concerns about contracting with the payers at acceptable rates if you’re not rolled up into a health system. The pundits might be right, but if they are, then why do we see very successful groups and some individuals faring better than average, and some of them working less?

Let’s examine each option, starting with working as an employee of a health system. You get paid to see patients, with some administrative pay for various activities due to Stark Laws, etc. As a result, the main way to make more money in this system is keep increasing your patient volumes. The benefit is, if you’re a good doctor, the health system might be willing to lose some money on your practice for the greater good. In a private equity group setting the entity must make money, which leaves only two basic options: see more patients or get paid less in anticipation of a big payout when the private equity group potentially flips the business years later.

The successful independent practices are good entrepreneurs who enjoy running a business of their own. They have control over their own schedule, how many patients they want to see and how they want to treat their staff. They often have investments in many different services, and their income is not solely based on how many patients they see per day. As with any good business, they also surround themselves with good staff and outside assistance to be successful. Owning your own business is not for everyone, but it can be very rewarding.

Your fit might be in a health system or private equity roll up, but don’t discount the ability to still own and run your own practice. There are examples in many markets where independent practices are not just surviving but thriving. Often, it comes down to business basics, supply and demand for your specialty and quality of service—why would a patient come to your practice over the other options?


Critical Access Hospital Assessment and Business Intelligence

Critical Access Hospital Assessment and Business Intelligence


March 22, 2019

Health care reform continues to reshape the landscape of how critical access hospitals will be paid in the future. Value-based reimbursement continues to expand, and forward-thinking critical access hospitals are acting now to prepare their facilities to receive maximum reimbursement once changes are implemented. Changes come with new challenges. One of the challenges we are striving to meet is the opportunity to leverage facility system data in combination with our assessment process to understand opportunities across the organization or within various departments.

Business Intelligence (BI) offers data pulls that are closer to real-time, improved visuals, and navigation functionality. The difference between spreadsheets and BI has been compared to the difference between a photo and a movie.


Operational Analysis Coupled with Business Intelligence

To help maximize future revenue, critical access hospitals can conduct an analysis of their operational efficiency and productivity by department. Recently, we have added the inclusion of BI processes pulling data from relevant systems and creating “real-time” views that keep the assessment fresh long after the final report.

Our analysis embeds benchmarks comparing productivity to other critical access hospitals. Benchmarks create “the mark” that helps you determine how your facility stacks up against local, regional and national peers. Even though they are not new, and some critical access hospitals have used them to help measure their financial performance, the process of conducting the analysis department by department and visually presenting the standard in BI may be new to some organizations. We can now pull current data from your facility and correlate that with reviews and observations to uncover inefficiencies and waste, improving operations for each department for the months to come.

Measuring productivity by statistical calculation shows where you stand now and helps you set operational goals. These goals, in turn, guide workflow and processes that improve staff efficiency, reduce costs and, when coupled with a holistic viewpoint to patient care, create a better patient experience. Benchmarks are not just about operational efficiency; they help you put the processes and practices in place that can generate improved patient satisfaction scores—another future determinant of revenue.


Benchmarking for Efficiency

When benchmarking, many factors come into play such as patient mix, technology investment, staff training, staff experience level, facility layout, physician practice patterns and volumes. All are important aspects of operations and can be difficult to assess and re-assess for movement toward a goal without conducting another assessment. Benchmarking was something once thought of as out of reach and cost prohibitive for critical access hospitals, but Eide Bailly continues to face challenges with new solutions and ideas with better tools or processes.


An Innovative Culture

The BI tool and assessment we work with establish a known current state and a future state which produces a delta (difference)—goals. Not having a consistent real-time data flow into these equations can lead to some frustration as variables change. What is the result of our ideas to change? How much further do we need to go? Are we seeing some cause and effect in the departments as one change possibly impacts others? Seeing the measures change after ideas are implemented helps reduce frustration and can help with innovation. This cause and effect learning process is key to help staff stay engaged and is what data-driven organizations can accomplish with the proper tools and set up.


Mobilizing Benchmark Data from Assessments

There are four primary components to mobilizing benchmark data from assessments: gathering the organization’s information, assessing the values and work flows, visualizing the information in BI and mobilizing the information into the organization.

Mobilizing the data is linking, or hardwiring, the information to pertinent points within the facility with a focus on aligning it to the strategy. Data without communication is relatively useless, so we work with you to help build a structure for communication, learning and growing. We use the assessment data as a baseline to the structure and the BI tool as the connector of data to daily work.

Benchmarks give you data to work against. Once an organization knows the benchmarks per department, they can start to ask questions: Why are we different than top performers? Is it our volumes? Is it staffing, training, processes, procedures? In the past, any sort of issue was typically dealt with by throwing more staff at it. This will no longer work as the Centers for Medicare and Medicaid (CMS) is not going to pay for inefficiency.


Start Benchmarking Today

The benchmarking process starts with learning. When you discover where you have been and where you are now, you can lay down the path to where you want to be in the future. The advent of better technologies has created a huge opportunity for critical access hospitals to begin to access this information and use it to make better and more informed decisions that impact an organization’s efficiency. This type of data will also enable you to meet patients’ growing demand for more information and better communication up front.

Changes to the reimbursement model are coming, and there has never been a better time to begin the journey to the operationally intelligent critical access hospital!


For more information, contact:

Bruce Kirkpatrick, CPA
Healthcare Tax Manager
Eide Bailly