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Web Exclusives - Perspectives
Kyle C. Harner, MD
Managing Partner
Carolina Arthritis Center
Greenville, NC

If your rheumatology practice is physician owned, I am willing to bet that staying independent is very important to both the doctors and managers. In short, you do not want to “work for the man” that runs the health system, hospital, or multispecialty group down the street. You want to remain the boss even if that means extra headaches at times. In the current healthcare environment, remaining independent means being informed and staying proactive. In short, being your own boss is a lot of work and is becoming more work as the years go by.

The clinic where I work with my 2 partners is the only single-specialty rheumatology group in the city where we practice. There are other rheumatologists at a large multispecialty group and at an even larger hospital system. How do we stay independent in this environment? And believe me, we want to stay independent. The 3 partners in our practice control the destiny of our day-to-day operations, along with the managers and staff members that WE chose. We do not answer to anyone (other than the insurance companies and the federal government and…but that is another story).

As a group, we try to be very proactive and to keep our eye on the medical landscape in the area. What other groups are looking for new rheumatologists or adding physician extenders? Are we accepting patients from the best mix of insurance carriers? How are other practices advertising? Do we have the right ancillaries to offer our patients?

If a private practice rheumatology clinic is so busy that patients have to wait for months to be seen, those same patients are likely to see a competing rheumatologist. Your practice may need to recruit another physician or hire an extender to shorten wait times. Patients who are seen in a few weeks after a referral are much less likely to look for another doctor to address their problems.

Without a mix of accepted insurance carriers, it is hard to weather the frustrating fluctuations in the accounts receivable process. Managers need to constantly monitor for changes in reimbursement from all the accepted carriers. At times, poor-paying insurance providers may need to be dropped, or contracts may need to be renegotiated. A practice may need to add a carrier if such a carrier starts to cover a larger percentage of the patient population in a given area. At best, this aspect of practice management is a constantly moving target.

Advertising aggressively is the key to staying busy if the wait time for your practice is too short or if you have too many unbooked appointments. This advertising can take several forms—print (both newspapers and local magazines), radio, and TV. Advertising has to fit into your budget, and it has to reach the right audience. Another effective way to advertise is to give patient lectures or sponsor a booth at local health fairs. Both doctors and extenders can give interesting patient talks to recruit patients. Such gatherings put a face with a name, and I believe that most patients appreciate these educational opportunities.

Keeping patients happy is another key to staying independent. This means trying to minimize wait times, having a congenial staff, and offering a mix of ancillaries. Patients will start to walk across the street if they have to wait every time they come to see the rheumatologist. They also want to hear “please” and “thank you” and to see smiles, especially when they are having a bad day. Also, if patients have to drive around town for labs, x-rays, and other ancillaries, they might start looking for a rheumatologist with one-stop shopping all under the same roof.

The quest for ongoing independence is becoming more difficult over time. Being proactive is the key to keeping control of your practice. No one has knocked on our door and tried to buy us out…yet. And we plan to do everything we can to keep it that way.

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Last modified: March 7, 2019
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