Independent physician associations are growing across the country as new regulations and pressure to consolidate make it more difficult for solo practitioners to keep their doors open. An independent physician association is a legal entity directed by private practice physicians primarily to contract with insurance companies on the members' behalf.
Physician members often pay for membership and the IPA typically can assume greater financial risk than individual physicians. The IPAs including both primary care physicians and specialists can form ACOs that track data and prove quality, cost-effective outcomes. According to Leavitt Partners Center for Accountable Care Intelligence, IPA-led ACOs grew from 30 in 2011 to 202 in the first quarter of 2013, overtaking the number of hospital-led ACOs at 189.
The 2015 Independent Physician Outlook Survey from ProCare Systems, "Physician Migratory Patterns: Threats to Independents and Implications for the Future," reports 88 percent of the physician respondents envision a future where reimbursement is driven by value, which could be a good thing for independent practices going forward.
Although consolidation is the current trend, and 44 percent of the survey respondents anticipate selling their practice in the future, 73 percent would prefer to remain independent. And as the healthcare system shifts away from fee-for-service and toward value-based payment, the independent physician groups "with their agility and natural inclination toward innovation and efficiency" will be more flexible to make the shift quickly. Thirty-six percent of the survey respondents envisioned a future where a significant number employed surgeons will migrate back into the independent practice settings with more progressive business models.
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About half of the physician respondents said becoming part of an independent practice association was an attractive way to increase scale and negotiate with payers as well as organized care systems. Physician groups are also collecting data and automating their patient information collection with electronic medical records, which are expensive. But larger groups can pool resources to ease the financial burden for the individual group.
Forty-one percent of the survey respondents said escalating costs and downward reimbursement pressure is the most challenging issue for independent practices today; recruitment, retirement and legacy issues was number two with 31 percent saying it was the most challenging issue. In fact, 20 percent said "retirement" was the most important factor influencing their decision to sell.
There are still young, entrepreneurial-minded physicians exiting medical school that want to join independent physician groups and specialists who fiercely desire independence. The ProCare Systems survey reports 49 percent of respondents feel aligning with like-minded specialists in an IPA is the most attractive avenue to maintaining independence; by comparison, 23 percent reported mergers and acquisitions while 28 percent said practice management and shared equity was the most desirable.
The IPA model outlined in the survey aligns physicians in a loose strategic alliance relationship without equity participation. The organization focuses on scale for negotiating with payers and large care systems. Typically the physicians are banded together by geographic proximity and dealing with the same major health systems and payers as others in the state.
The alignment between independent physicians will likely become even more valuable as accountable care organizations and other risk-sharing models emerge. The federal government is pushing ACOs, and hospital-run organizations could cut out non-network providers; but physician groups are able to manage ACOs and those with a strong foundation will be able to take on the challenge.
A 2011 American Medical Association report outlines the opportunity for IPAs in ACOs. At the time, there was around 500 IPAs in the United States including 120,329 primary care physicians and 144,080 specialists. That year four specialty groups in Maine formed an IPA while 10 IPAs in Tennessee consolidated and the Marin-Sonoma IPA in San Francisco grew from 300 to more than 500 members.
Independent physicians, especially specialists, cling to autonomy and won't let burdensome regulations drive them to employment. The larger IPAs make them strong players in the market and force hospitals and health systems to partner with them on community healthcare initiatives. Since a majority of surgeons — 94 percent of the survey respondents — think the marketplace should offer new practice models to ensure independence and sustainability for the healthcare economy, it's likely IPAs will continue to evolve and support physician independence in the future.