Decline of the Small Practice Might Make Plans’ Job Easier

By John Marcille

Change is difficult for many people. They fear it, and sometimes with good reason. The changes we observe in the organization of the physician workforce — changes that our cover story, starting on Page 14, is about — are certainly disconcerting to some physicians.

Simply put, the long erosion of small practice is picking up steam, and changes in payment methodology being eyed by Medicare and by private payers will surely encourage small practices to sell out to hospitals or to merge among themselves.

While physicians and hospitals are supposed to be joining and pushing ahead together, it’s hard to ignore the tension that these new relationships can engender. As is well known, doctors — especially older ones — fear loss of autonomy, and they fear loss of income. The autonomy question is difficult; readers who work in health plans know why the emphasis on evidence-based medicine, protocols, step therapy, and the like is necessary, and actually in patients’ interest.

But working in larger groups will bring benefits: less need to worry about administrative details, a more regular workweek for many, and a way to keep up with technological changes that Medicare and others are insisting on.

These are among the many upsides for health plans: Doctors spending more time at doctoring, paying more attention to the whole patient, as more plans and practices figure out the patient-centered medical home and — who knows? — set up the vaunted accountable care organizations.

Just about all of this should be viewed positively by the health plans’ clinical executives. And whether plans actually take a big contractual hit when there are fewer, but much larger practices — that remains to be seen. At the moment, I’m looking at the upside.

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