An old wooden desk, a telephone and an office manager handling the schedule while a physician examines a patient. That’s how movies and TV shows used to depict a physician private practice—before the growth of new rules, procedures and technologies.
In today’s fast-moving health system, it takes astute clinical judgment as well as a commitment to collaboration and solving challenging problems to succeed in independent settings that are often fluid, and the AMA offers the resources and support physicians need to both start and sustain success in private practice.
The episodes are co-hosted by Taylor Johnson, the AMA’s manager of physician practice development, and Meghan Kwiatkowski, program manager of private practice sustainability at the AMA. Together, they share information and resources to help physicians navigate medical practice business operations and efficiency solutions to create and support a thriving business.
Practice management thrives on efficiency, but as physician private practices struggle to build up and train to achieve full staffing, they need guidance. In the episode “Private Practice Efficiencies,” Johnson and Kwiatkowski recommend Lean, a collection of principles that help practices run more efficiently and improve outcomes.
The focus of Lean is to minimize waste in every process, which then adds value for the patient, for the physician, and the entire care team. Johnson and Kwiatkowski recommend that private practices engage all employees in identifying procedures that they consider wasteful and allow them to propose solutions. Success can be measured in terms of hours saved.
Another tool that physicians can use is called PDSA—which stands for “plan, do, study, act.” The PDSA method provides a straightforward, but iterative, approach to quality improvement in a private practice, and the framework is easy to adopt. It can be done regardless of practice size or resources.
Where can you start? One place is with the EHR. Start looking at all of your EHR policies and procedures. Can you work with your EHR vendor to reduce signatures, verification, or number of logins required? All of those suggestions are very quick changes that could end up saving physicians and staff ample amounts of time during the day. Learn more with the AMA de-implementation checklist (PDF).
One of the areas changing most rapidly is how private physician practices get paid for the care they deliver under new payment models. Knowing these models is critical to thriving in a private practice as change is being driven by the growth of payment models other than fee-for-service, as well as by regulatory changes, technology and consumer demands.
In the “Private Practice Payment Models” episode, Johnson and Kwiatkowski said there are four key steps to take to understand the current payment landscape. The first is to define the terminology used in the payment models. Then, identify common contractual provisions within the payment agreements. Next would be to ask key questions about the payment model design and accountability. Finally, strategies for alternative payment model engagement and evaluation.
The most common models fall into three main categories, which are core payment models, supplementary payment models, and organizational models.
Doctors can learn more from subject-matter experts in the AMA’s free, two-hour webinar series that guides private practice physicians through the complexities of the health-plan payment landscape. “Payor Contracting 101” and “Payor Contracting 201” cover basic contract provisions, basic legal rules governing contracts, commonly negotiated provisions, common disputes, and innovative and nontraditional opportunities.
The AMA also has developed a comprehensive private practice toolkit on payor contracting that covers these elements:
- Payor Contracting 101 (PDF).
- Payor Contract Review Checklist (PDF).
- Payor Contract–Sample Contract Language (PDF).
- Examples of Significant Payor Unilateral Policy Changes (PDF).
Since the COVID-19 pandemic, telehealth has become an essential part of health care delivery in private practice, Johnson and Kwiatkowski noted in the episode “Telehealth Services for Private Practice.”
Telehealth can include real-time audio-video communication that connects physicians and patients in different locations. It also can include real-time audio and telephone communications, store-and-forward technologies that collect images and data to be transmitted and interpreted at a later date, as well as interprofessional internet consultations between care teams.
The AMA has developed several resources for implementing telehealth programs, including the AMA Telehealth Implementation Playbook.
Johnson—who managed an ophthalmology practice prior to joining the AMA—said that developing a telehealth plan begins by identifying and defining a need within the practice “which we obviously had due to the pandemic because we could not see a lot of our patients in the office.
“Some of the things that we needed to consider were: Who in the practice needs to be involved and when? When should we involve the staff? And then when should we involve the front desk staff?” she said.
“We evaluated our current workflow, and we tried to keep things as close to in-person visits as possible when we were designing our digital workflow,” Johnson added. “So, we pulled in the clinical and administrative staff for their input on the proposed workflow and made adjustments based off of their recommendations.”
The “Private Practice: Attending to Business” episodes are part of the AMA Ed Hub™ and the associated CME activities are each designated by the AMA for a maximum of 0.25 AMA PRA Category 1 Credit™. Learn more about AMA CME accreditation.
Also, learn about the AMA Private Practice Physicians Section, which seeks to preserve the freedom, independence and integrity of private practice.