As a medical director and practicing physician, I count myself fortunate to meet and engage in meaningful conversations with many health care professionals throughout the state of Pennsylvania. Recently I was both humbled and inspired when I visited with a group of primary care physicians who operate their private practice in a rural community. These doctors are not only staunchly committed to serving a community that so desperately needs them, but they are also convinced that the best way to do so is to remain in full ownership of their practice. I have been traveling and meeting a lot of these passionately independent physicians, and their heartfelt stories are, not surprisingly, very similar.
Regrettably, there are many examples of published research indicating how physicians in rural communities across the United States are under strong economic pressure. As the health care industry moves towards risk-based payments, reimbursements that reward value, quality, and cost reduction are replacing fee-for-service payments. Unfortunately, the stark reality for many rural and remote communities is that a large number of physicians serving these areas are being left behind in reimbursements because they lack the human and technological resources necessary to access the quality and value rewards typically offered to larger health care systems. In addition, many newer “value-based contracts” include increased administrative burdens and additional overhead costs, which are often insurmountable to small independent practices.
These hard-working and high-performing clinicians, whom I have met in their trenches of daily dedication, deserve to be fairly compensated for the high-quality of clinical care they provide to their communities. Pay for Performance is an important component of total compensation in virtually every industry, including health care.
These physicians have long recognized and embraced what published research clearly supports: Independent, physician-owned practices provide high-quality care to their patients. The data shows that these practices have lower readmission rates than larger independent and hospital-owned practices, fewer preventable hospital admissions, and lower average cost per patient. These doctors should be rewarded for such admirable service to their communities.
Small rural physician practices are a beacon of hope in their communities, where the staff has often withstood for many years, surviving the effects of both a struggling economy and the consequential loss of high-paying jobs on their patients’ well-being. Day to day, the care these types of practices provide is frequently administered in the face of difficult, real-world situations. Currently described as “social determinants of health,” zip codes can strongly influence health and life expectancy. Physicians who choose to practice in rural areas have routinely confronted such realities long before the terminology of social determinants was woven into our lexicon. The primary reason for this level of understanding is these doctors, and their dedicated support staff, truly know the communities they serve.
Consequently, the care received by patients is personalized and provides continuity, which engenders trust, improves health outcomes, and contributes to greater physician satisfaction. The physicians with whom I work value and personally protect their status as independent practices. Despite the many long hours, demanding call schedules, and often unrecognized diligence and sacrifice, it is the strength of their compassion for the community, conviction in what they are doing and a high level of autonomy that protects them against burnout.
The good news is that independent practices across the state are not alone. Thankfully, they can pool their talent and experience, through network integration, to further enable and enhance the high-quality care they provide. This type of integration is accomplished using innovative data analytics tracking health outcomes at a county level, as well as state-of-the-art case management that can mobilize community-based resources down to the level of the zip code. When these efforts are combined with the collective wisdom of community-based doctors, the well-being of their patients will increase, insurers will benefit from higher health care quality, and value-based contracting will reward the successes of participating physicians. I firmly believe that integrated networks of independent, devoted doctors will possess the necessary strength and proven performance to lead the way in the quest for high value, high touch, and low-cost medical care. It is clear to me that our rural communities will remain better served by these remarkable physicians, whom I am honored and privileged to work with.
Johanna Vidal Phelan is a pediatrician.
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