Individually and in groups, South Florida doctors are trying new business models for their practices that can reduce costs but may increase their risk.
Palm Beach County neurologist James Goldenberg says his practice is weighing a "risk" model where government or managed-care providers pay doctors a flat sum to care for patients. The doctors make money if they control their costs.
In Broward County, Dr. Brian Polner reduced the cost of business operations 20 percent after forming HealthwoRx, a group of cardiovascular, internal medicine and family practice physicians who share a testing lab and other expenses.
"We're seeing more doctors forming groups, or they're going to work for the hospitals," said Cynthia Peterson, executive vice president for the Broward County Medical Association. Nearly half of doctors who responded to a recent survey by the Florida Medical Association said they would pursue alternatives that included trimming their hours, retiring early, providing "concierge" care to a limited number of well-heeled patients, seeking hospital employment, or cutting back on the patients they see.
The trend "bears watching because it could negatively affect Florida patients' access to health care," the state group said.
Goldenberg said physicians are frustrated with ever-changing regulations, lower reimbursements for their services, and bureaucracy that often gets in the way of patient care.
To diagnose a diabetic for nerve damage, for example, he conducts a common test. But insurers and Medicare are reimbursing doctors at a rate 30 percent lower today than in previous years.
Goldenberg said his 75-doctor group, Medical Specialists of the Palm Beaches, is considering "all options" to offset declining reimbursements while maintaining quality care. That includes a model that would encourage doctors to think twice about ordering an expensive test — or assume the financial responsibility if they proceed.
"I think that's going to be a very important model in the future," he said.
Polner, chief executive of HealthwoRx, helped found the 20-doctor Broward County practice in 2005. The goal: to improve patient care through collaboration, which also helps lower costs for the doctors.
"You reduce the redundancy of testing, improve patient compliance by following up with doctors in the group, and have better control of medical records," he said.
By year-end, HealthworRx's number of doctors will double after it forms a new multispecialty model, he said.
But even a larger practice isn't enough to curb spiraling health care costs. A year ago, Polner launched PremierMD, an independent physicians association that contracts with major insurers to reduce costs. If the cost-cutting is a success, the group shares profits with the insurer. The physicians remain independent but benefit from the power of group purchasing for medical and office equipment and supplies.
So far, 80 local doctors have joined the association.
In January, PremierMD will introduce a group that will collect data with the goal of reducing Medicare costs.
"Doctors, especially in South Florida, are afraid of being in a group practice because they're afraid of losing their autonomy. But they want to collaborate with other doctors," Polner said.
Dr. Octavio "Tony" Prieto, who has been practicing family medicine for more than 30 years, is feeling the pinch as a solo practitioner. The Plantation doctor said insurance companies pay less — or nothing at all in some case — while patients cut back on visits to save on co-pays.
At one point, he considered selling his practice to a corporation, but "they couldn't come up with the money to buy my practice," he said.
So Prieto presses on, but has reduced his practice from 14 workers to six. He's also considering eliminating in-office X-rays because they cost more than insurers will pay.
South Florida patients, many who've lost jobs and employer insurance, try to talk their doctors into reducing their bills. "People arm-wrestle you for the $10 co-pay," he said.
Meanwhile, Prieto, 65, said he loves his work too much to give it up.
But someday, "If I can afford it, I will cut down my hours," he said.
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