"There is nothing wrong with staying small. You can do big things with a small team."
-- Jason Fried, software entrepreneur
For decades, medicine -- especially primary care -- was delivered by a cohort of independent physicians who dedicated themselves to their patients and their communities. These physicians delivered their services and compassion through a network of solo and small group practices that were largely isolated from each other and other physicians. There was connectivity to the local hospital because family physicians, not hospitalists, took care of their patients who were admitted. They also worked the emergency room, delivered a few babies along the way, performed school physicals, and made weekly trips to the nursing home. This scenario was the prototypical family medicine practice in countless communities across the nation, large and small.
I know this model well because I grew up with one of these family physicians, and I witnessed first-hand the relationship that he had with his patients and our rural Oklahoma community.
One thing that has long been a concern for the AAFP is ensuring that solo and small group practices are able to sustain their business model and continue providing care to their patients. Yes, many physicians have chosen to pursue other practice settings and financial arrangements. We support these practice choices fully in our education and advocacy activities, but we have added emphasis to the future of the solo and small group independent practice. We are not alone in this work, and several people have begun to invest thought and energy into the importance of maintaining diversity in physician practice types and arrangements. In a May 26 blog posting, David Blumenthal, M.D., and David Squires from the Commonwealth Fund posed an interesting question: "Do Small Practices Have a Future?"
This question has taken on renewed interest and importance as we approach the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA) and became highly emotional thanks to the now infamous "Table 64," which CMS published as part of proposed MACRA regulations that inaccurately predicted that more than 80 percent of solo and small practices would take a penalty under the MACRA payment pathways. CMS published a follow up fact sheet explaining how solo and small practices can achieve success under the new payment programs.
The Commonwealth Fund article noted some interesting facts:
It likely is no surprise to any of you that the solo, independent practice model has been in decline for several decades. There are multiple reasons (population shifts, economics, costs of education) why this shift has occurred, and I am quite confident that the comments associated with this article will provide some colorful clarity on this subject. However, before you throw in the proverbial towel, let me remind you of a few additional facts about the strengths of solo and small practices:
These studies and many others demonstrate that there are significant public policy justifications for why the preservation of solo and small practices should be a priority. Setting aside the simple fact that consolidation in health care escalates costs for patients and decreases payments for physicians professional services, the fundamental reason that community-based primary care should be preserved is that it actually benefits patients.
The AAFP is dedicated to ensuring that family physicians, regardless of practice type or location, have the tools and resources needed to be successful. We strive to ensure that each of you can find and maintain a practice that enables you to provide high quality care to your patients and allows you to realize your professional and personal goals. We recognize that many solo and small group practices feel that the current trends in health policy are moving away from them, or as some put it, destroying them. We understand why this anxiety exists and we prioritize the development and distribution of resources that can assist our members in these practice settings. The following is a sampling of the tools and services the AAFP has created for members:
In addition, the AAFP is working closely with CMS to prepare physicians for value-based payment models through two programs, the Transforming Clinical Practices Initiative (TCPI) and the recently announced Comprehensive Primary Care Plus program.
You can learn more about the practice transformation opportunities available through the TCPI program on our resource page. I also encourage you to join our TCPI member interest group.
The AAFP also is actively engaged in identifying and recruiting physicians to participate in the CPC+ program, which will be launched later this summer. While the exact regions are not yet known, we are seeking to identify family physicians who have an interest in participating in this program in advance of the enrollment period, which opens July 15. We are especially interested in identifying solo and small group practices so that we can begin assisting you prior to the open enrollment period. If you are interested in participating in the CPC+ program, please email us at CPCPLUS@aafp.org.
As noted in this posting, the AAFP continues to place an emphasis on solo and small group practices. We see these practice settings as contributory to the betterment of our health care system. However, we fully recognize that much has changed during the past 30 years. We feel it is important to hear directly from our members on how these changes in care delivery and physician payment may impact your practices.
If you practice in a solo or small independent practice and you are interested in learning more about MACRA and its opportunities for solo and small practices, we will be hosting a webinar on Thursday, June 16 at 7:30 pm Eastern. We will be posting registration information on the Solo and Small Group Member Interest Group listserve and directly emailing to our CPC Plus community. To ensure you receive the registration information, please email us at CPCPLUS@aafp.org or join the solo and small practice group member interest group.
Stephanie Quinn, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy. Read author bio »