Introduction

MSSNY’s Task Force on Survival of Independent Practice presents these recommendations on options physicians can consider in order to practice successfully in an independent environment.  

The Task Force was charged with exploring options for independent physicians to collaborate and create practice models to achieve the goals of diversity of service, economy of scale and collective negotiations. We present real practice models that have been creative in exploring what can be done and that have worked for independent practices, making them successful financially and freeing them from many administrative frustrations. These models are offered as options for members to consider, modify or build on. 

The Task Force recognizes that one size does not fit all. We therefore present both collaborative models of care as well as ideas to help those who wish to remain completely independent. Some general recommendations are applicable to all physicians. Other recommendations may be more applicable either to solo or small group practices, while others are more suited to a larger single or multi-specialty setup.  

Please note that the practice models presented here are not specifically endorsed by the Task Force or by MSSNY, and they have not been subject to legal review. Members interested in these concepts are advised to perform their own due diligence. Physicians should never enter any form of practice without legal guidance. MSSNY’s General Counsel, the law firm of Kern Augustine, PC, offers MSSNY members a free consult and reduced hourly rates. 


Members of the Task Force on Survival of Independent Practice

Thomas T. Lee, MD, (NS) Co-Chair
Paul Lograno, MD, (OBG) Co-Chair
Rose Berkun, MD, (AN) Erie
Ellen Braunstein, MD, (NEUROL) Nassau
Henry Chen, MD, (IM) Kings
James Chmiel, MD, (OTO) Erie
Eli Einbinder, MD, (PSYCH) New York
John Franco, MD, (FP) Suffolk
Scot Glasberg, MD, (PS) New York
Michael Goldstein, MD, JD, (OPH) New York
Bing Lu, MD (IM), Kings
Donald Moore, MD, (GP) Kings
Hannah Ortiz, MD, (OBG) Suffolk
David Page, MD, (FM) Onondaga
Jack Resnick, MD, (IM) New York
Sumir Sahgal, MD, (IM) Bronx
Stephanie Siegrist, MD, (ORS) Monroe
Saulius Skeivys, MD, (FM) Queens


PRACTICE MODELS

Hybrid Practice Model - Donald E. Moore, MD and Associates dmoore@drmooreandassoc.com

Dr. Moore has stopped taking all commercial insurances, accepting only Medicare and Medicaid, and has adopted a hybrid practice model that many now refer to as a form of “direct pay”. 
Read more here.  

Independence at Home Shared Savings Initiative - Jack Resnick, MD JackResnick@gmail.com

Dual eligibles (individuals covered by both Medicare and Medicaid) are the sickest and costliest to care for. A federal/state program, Fully Integrated Duals Advantage (FIDA), was initiated in 2015 to address these beneficiaries, but it failed miserably across the country. Dr. Resnick has been working with senior administrators in Albany and Washington on this issue. Read about his Pilot Statewide IPA for Dual Eligibles. Read more here.  

Practice Without Walls – Henry Chen, MD HChen@jennanmedical.com

Excelsior Integrated Medical Group PLLC (EIMG), a New York professional limited liability company, is a clinically and financially integrated medical group that qualifies as a group practice for purposes of the federal anti-referral prohibition, known as the Stark law. It is governed by a centralized board, yet provides a meaningful level of autonomy to its operating divisions to operate efficiently and harmoniously. Read more here.  

Certificate of Public Advantage – James Chmiel, MD jfchmiel@aol.com

This group of ENTs has explored mechanisms to integrate and improve both patient care and physician professional lives for more than a decade. They are currently awaiting a response from the NYS Department of Health on their application for a Certificate of Pubic Advantage, which would allow independent doctors with their own tax ID numbers to negotiate collectively, under very close scrutiny and strict rules for clinical integration, with immunity from state and federal civil and criminal action. This “supergroup” model allows for all groups to maintain private finances while benefiting from economies of scale. Read more here.  


OUT OF NETWORK
Out of Network practice does have potential benefits. If you are interested in pursuing this practice alternative, view the testimonies of these MSSNY members.   
 

Independent Doctors of New York is a group of 120 completely Out of Network physicians supportive of one another and of the idea of expanding traditional medical practice. Eli Einbinder, MD einbinder@aol.com Read more here.  

Out of Network The Challenge To Educate: D.A.R.E. Define, Alert, Reject, Educate. Hannah Ortiz, MD drortiz@soundgynonc.com

Read more here.


 IPAs in NYS 

MSSNY will update this list as additional information is received. Please direct any suggestions for listings to eskelly@mssny.orgClick here for the list.  


PRACTICE MANAGEMENT RESOURCES  to assist you with the business side of your practice. 
  

THE E-MYTH PHYSICIAN Michael E. Gerber

Michael E. Gerber, bestselling author of The E-Myth Revisited, shares his powerful insights to lead independent physicians to successful practices and enriched lives. Read more here.  

HEALTHCARE TRANSITIONS MANAGEMENT John Riche

HTM provides services to physicians on three different levels: Outsourced Billing, Consulting and Practice Management. Read more here.  

PRACTICEMAX Michael Johnson, VP of Marketing and Research

Brought to the Task Force by Tom Lee, MD thomastleemd@aol.com

Two primary lines of services include practice/facility revenue cycle management and marketing/patient engagement, including some innovative concepts regarding patient satisfaction and online feedback. Read more here.


ENTREPRENEURIAL BUSINESS COACHING Krista Bleich, Certified EMyth Business Coach

Brought to the Task Force by Stephanie Siegrist, MD ssiegrist@knowyourbones.com.

You can preserve your independent medical practice. Dr. Stephanie Siegrist is an excellent example of what’s possible when you remain independent – and EMyth coaching helped get her where she is today. Read more here.