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What happens when you take the Medical Director for one of South Florida’s larger medical centers, a resident supervisor at a community hospital, the CEO of HealthNet, one of Florida’s first board certified health lawyers and a member of CareCloud’s best and brightest?

A jam-packed roundtable teeming with quotables and profound insight hosted by Florida Health Industry/FHIcommunications on Tuesday morning at Aventura’s Imperial Club. The event, titled “Practice Formation/Reformation 2014,” featured prominent players of the South Florida healthcare circuit waxing poetic on the future of private practice.

Sponsored by CareCloud and moderated by Director of Client Solutions Brian Foster, the group discussed what options smaller practices have in light of increased regulation, as well as the pros and cons of joining larger medical groups or accountable care organizations.

“It’s to the small practice’s advantage to join a large group,” started Lanny Pauley, COO of Neuroscience Consultants. “That way, you can have a place at the table and share what you have and what you’ve done.”

Healthcare lawyer Sandra Greenblatt built upon the view, claiming it may make sense for some doctors to “throw [their] practices into a group and get equity.” Later, Greenblatt outlined additional reasons for doctors to consolidate, including more data about costs, professional management and fear of government regulations, e.g., the ICD-10 transition and the Stark law, which restricts physician referrals of designated health services for Medicare and Medicaid patients if the physician has a financial relationship with that entity.

Another option, said Greenblatt, could be switching your practice over to a concierge model.

On the topic of ACOs, the very vocal HealthNet CEO Richard Lucibella defined the organization as “a loose association of like-minded practices” that provides a “pool of expertise for moving your practice into the future.”

According to Lucibella, physicians turning their heads away from ACOs are normally fee-for-service physicians perpetuating a “70s era care concept,” and they’d rather not give up control of their practices.

On the issue of retaining control, Antonio Wong, MD, Medical Director for Doctors Plus Medical Center, explained that “in business, you don’t get what you deserve, you get what you negotiate.”

According to Wong, physicians are a step away from going bankrupt at any point, and it’s imperative they understand that whether they remain small or join a larger group, medicine cannot be a one-size-fits-all kind of practice.

On that note, it didn’t take long for the panelists to expose a troubling conflict between the urge to consolidate and the need for quality imposed by government regulatory measures.

“There should actually be more responsibility for outcomes,” said Ira Agatstein, MD, Resident Supervisor at Larkin Community Hospital. “Reimbursements could be tied to these measures.”

Agatstein alluded to an interesting point, noting the language used between the “quality people,” or regulatory agencies, and the “clinical people,” or the practicing healthcare community, has not been streamlined. And this lack of communication puts into question the issue of productivity.

Foster, steering the conversation to its climax, took a second to define productivity, asking the panelists if joining an ACO would fix the communication issue Agatstein brought up.

In response, Lucibella made the most colorful point of the morning: “Say you’re a short order cook at a small restaurant and your small restaurant was acquired by Denny’s. Will Denny’s make you more productive? No. Rearranging your kitchen will make you more productive.” 

To further illustrate this, Lucibella alluded to what the healthcare community often forgets in light of strenuous regulations and value-based care models – practices need to go back to the basics of business, meaning it’s all about creating and maintaining patients.

What do you think? Will joining an ACO make your practice more productive? Check out some food for thought by Brian Foster.