As small group practices and independent physicians everywhere struggle to stay afloat in the choppy waters of modern healthcare, at least one organization in Virginia has settled on a long-term strategy for success.

In recent years, the primary care practice PMA Health has changed its name, undergone a major rebrand, and significantly expanded its service line. What started in 1961 as Pulmonary and Medical Associates of Northern Virginia, a single community clinic in the city of Falls Church, Va. has since expanded to three offices with 30 physicians, and has become a member of Privia Medical Group, the multi-specialty branch of the administrative services network Privia Health.

“We do still see patients for pulmonary medicine, and that’s a major part of the practice,” says Elizabeth Bramham, PMA's chief operating officer. “But we’re focused on other things as well, so the original name was kind of misleading.” Hence the new, truncated moniker. Today PMA Health includes internal medicine, sleep medicine, sports medicine, and allergy and immunology services among its offerings. Two years ago, the organization also opened an immediate care center to support population health management in its community.

“With population health, obviously, we’re incentivized to keep patients healthier and keep costs down,” Bramham explains. “So we decided we could achieve both of those things if patients had a place to go for same-day sick care and for after-hours visits that wasn’t your typical ‘urgent care USA’.” PMA Health patients can reserve an appointment online and even video conference with a doctor during an online visit, and urgent care visits are almost always less expensive than a trip to the emergency room. “And we like to think the care we can provide will be significantly better,” Bramham adds. “Because most of the time we already know the patients — we have their charts, we know their medical history.”

From surviving to thriving

There was a time when such market maneuvering might have seemed out of place in primary care, but today, it’s simply a matter of survival. Many practices are scaling up to achieve financial sustainability and stability — and they’re often building partnerships in the process.

In the case of PMA Health, joining the Privia network has allowed them to streamline their administrative processes, especially when it comes to revenue-cycle management. The organization is able to leverage Privia’s group purchasing clout to reduce the cost of medical supplies, and Privia also helps with physician recruiting, which is key to their ability to offer additional services. But according to Bramham, the most important aspect of the partnership has been the access the network provides to shared savings and reimbursement programs. “Primary care providers have been undercompensated for so long compared to specialists, but with population health we have ‘quality’ money coming in, which for us, has been kind of wildly successful.”

What other business strategies and care delivery models are practices using to thrive in the current healthcare climate? Here’s a look at a few of the more common approaches and how each can help drive financial performance.

Management services organizations

Similar to administrative services networks, management service organizations (MSOs) offer practice management and administrative support services to healthcare providers. MSOs have a straight-forward business proposition for independent physicians and small group practices: If it’s non-clinical, we’ll take it off your hands so you can focus on what you do best. (It’s worth nothing that MSOs also serve hospitals and other organizations, too.)

Among the tools an MSO might add to any given practice’s management-administrative toolbox are technological support in the form of electronic health records (EHRs) and medical equipment, HR and payroll services, and coding, billing, and collections expertise. MSOs can also negotiate contracts with insurers, provide regulatory compliance oversight and services, and leverage group purchasing power to help practices get lower prices on medical supplies.

Clinically integrated networks

Clinically integrated networks, or CINs, are another option for practices facing pressure to reduce costs while improving patient care. CINs consist of primary care doctors, specialists, and other providers who team up with hospitals in the name of advancing population health. Across-the-board access to a patient’s electronic health record facilitates collaboration between providers, empowering them to make better decisions with cost savings and quality metrics in mind.

According to Lloyd Darlow, M.D., Vice President of Clinical Integration at Cayuga Medical Center in Ithaca, NY, the CIN approach is one proven way for physicians to succeed in value-based care, and it’s a path to continued independence. “If you’re an independent physician working in a community that isn’t clinically integrated, it’s really hard for you to do your job well,” Darlow told athenaInsight in a 2018 interview. “But with the tools, practice support, and quality data of a CIN, it isn’t.” 

Private equity investment

Another strategy used by some physicians involves accepting cash infusions from one or more third-party investors. How such an arrangement might unfold depends on the entities on either side of the deal, but at least one expert on the subject, Dr. Halee Fischer-Wright, president and CEO of the Medical Group Management Association, advises providers to proceed with caution. “I have yet to hear of an exit from such a primary-care deal considered successful by both investors and physicians,” wrote Fischer-Wright in a recent editorial in Modern Healthcare. “The truth is there’s a big gap between the fantasy and reality of private equity involvement when it comes to primary care.”

The issue, Fischer-Wright noted, has to do with the demands some private equity firms make on the organizations in which they invest. The money may allow a primary care practice to avoid acquisition by a large health system, but the trade-off could involve excessive pressure to grow and profit — expectations that can be difficult to meet.

Not all private equity is equal, however, and a well-aimed investment can spell the difference between failure and success in certain cases. For example, if a practice can steer the money toward revenue cycle management and technologies that improve care quality and efficiency, it may find that the benefits of the private funding outweigh the potential risks.

Minding the details

Back at PMA Health, Elizabeth Bramham says she spends much of her time shoring up day-to-day operations at the practice. Belonging to a network like Privia, she explains, allows them to achieve economies of scale they wouldn’t otherwise achieve as an independent organization. But they still have to mind the details, which includes things like minimizing patient no-shows and working to ensure their physicians are satisfied.

“It’s things like building templates in the EMR to help our doctors spend less time on documentation so they’re not going home with work to do. And trying to stay on top of cancellations, and going to the waitlist when we need to fill spots last minute.” Even as members of a bigger network, Bramham stresses that details like this still matter very much when it comes to the bottom line. “Every open slot is money flushed down the drain,” she says.

Chris Hayhurst is a frequent contributor to athenahealth's Knowledge Hub.