Bigger Isn't Always Better

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Bare bones micropractices can help physicians trim costs and spend more time with their patients.

Pamela Wible, MD, has no support staff. She rents a tiny 280-square-foot office inside a wellness center. She works only part time. And she wouldn't have it any other way.

"For the first time in my career, I am not only practicing medicine in alignment with my values but in alignment with the values of my patients and community," she says.

Wible, a family physician in Eugene, OR, is one of a growing number of doctors who are abandoning the traditional production-driven medical practice in favor of a more patient-centered approach to medicine in the form of a "micropractice." The micropractice model stresses same-day access for patients, more accessible physicians, and low overhead. Physicians wear all of the hats: They answer the phone, make appointments, haggle with insurers, treat patients. Proponents of the model say the reward is freedom and autonomy.

"I used to get sticky notes posted on my door that would say you haven't seen enough patients today after seeing 28 patients," says Wible, who opened her micropractice in 2005. Now Wible can give her patients the time and attention that they want in office visits as long as an hour. What's more, Wible has reduced her overhead expenses, saving roughly $360,000 annually. And she only needs to see 88 patients annually to cover her overhead costs.

Operating a micropractice isn't for everyone, however. Before taking the plunge, physicians should:

Do the math. Doctors should evaluate the local cost of owning a practice by researching overhead expenses, average payer payments, and malpractice rates to make sure their personal income needs can be met. Even with the best intentions and a seemingly perfect setup, these practices can fail in parts of the country known as dead zones, says L. Gordon Moore, MD, a Seattle physician and a leading researcher of the micropractice model.

"These are places where the average reimbursement falls below the cost of doing business and no practice survives without subsidies."

Evaluate what they really need. Moore says practices fail because physicians rent space they can't afford or buy an expensive electronic medical record that drags them under. "It is easy to grow, but very hard to pull back when you have sunk money into equipment, space, and supplies," he says.

Know their own strengths. Although not every micropractice is just one doctor, physicians who choose this model must be well-organized and willing to work independently, says Rosemarie Nelson, a principal at MGMA Health Care Consulting Group Physicians. Doctors will also need to multitask. "You can't be squeamish about taking out the trash and arguing with clerks so that insurance people will pay you," says Moore. At the same time, physicians shouldn't assume they know everything; for example, some may need to take a coding class, Moore says. "You can make a lot of mistakes in billing, and the last thing you want to do is make a mistake and look like you are committing fraud."

—Carrie Vaughan

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