For some physician practices, the demands of the Affordable Care Act have brought with them administrative and technical burdens, and an increasing number of providers are responding to that trend by consolidating with fellow practitioners.
Consumer advocates warn of the possibility of increased costs because of less competition due to consolidation, while others say it can advance the type of collaborative care that will improve patient outcomes.
In many cases, said URAC Vice President Deborah Smith, it could be a method of survival for an industry in flux.
“The way physicians have been compensated, and the current proposals for yet more changes, has altered reimbursement for physician practices. Forming networks or multi-specialty groups is one way to stay in practice.”
A recent study published in the September issue of Health Affairs documented that trend toward consolidation.
Using data gleaned between 2013 and 2015 from the Medicare Physician Compare tool, researchers from consulting firm Leavitt Partners found that the proportion of physicians in groups of nine or fewer dropped from 40.1 percent to 35.3 percent in that time span. Meanwhile, the proportion of providers in groups of 100 or more expanded from 29.6 percent to 35.1 percent. That shift was more dramatic in primary care than in specialty practices.
It’s tempting to debate whether the trend of physician consolidation might be good or bad for clinical outcomes and patient experience. For providers unlikely to face acquisition or consolidation due to size or geography, becoming a patient-centered medical home (PCMH) becomes another option for surviving under the current environment.
URAC’s PCMH Certification process focuses on development over time as an approach to a more sustainable transformation of primary care practices. The small practice with one or two doctors would benefit from becoming a PCMH through improved delivery of preventative services, reduced ER visits and hospitalizations, and better disease management.
“It never fails. High cost care is almost always low quality care,” said Smith. “Our PCMH certification enables small independent practices to improve care and lower costs, ultimately helping them stay independent and financially viable.”
Smith states that URAC’s position, in the face of the merger and consolidation trend, is be flexible, allowing for continuous improvement for physician practices of all sizes.
“Consolidation that pushes people together can achieve the quality outcomes we want and reduce errors that are preventable,” she said. “However, that small practice in rural America can see the same improvements if they take the path toward becoming a URAC certified patient-centered medical home.”
Officially recognized by CMS, the standards of URAC’s PCMH certification emphasize patient-centeredness, coordination of care and a commitment to quality and safety.
“We support real change and tangible outcomes for all physician practices,” added Smith. “Ultimately, we better position organizations for value-based payment.”