Has the small practice danced its last dance? Thanks to alternative practice models like clinically integrated networks (CINs)—and their subset, clinically integrated eye care networks (CIENs)—the answer is ‘no.’ Throughout my many years in eye care, I’ve worked with practices of all shapes and sizes. No matter how diverse their goals or operations are, there’s usually one question that’s on everyone’s mind: Is it still possible to have a successful independent practice?
My answer is ‘yes.’
4 Reasons Independent Practices Can Still Thrive
There is undeniably a place in the market for independent practitioners today. Why?
- Not every patient wants his or her care to be provided by a large institution.
- Many patients seek providers who are clearly part of their community, and dedicated to giving the customized, personalized, high-quality care that people are craving.
- Independent physicians will save the health system money. They can provide better care at a lower cost as compared to health systems and hospitals.
- Patients benefit from choices. Diversity and competition in the market help keep costs down.
But smaller, independent providers must work hard—much harder than employed physicians—to keep their practices afloat. So my answer is more accurately ‘yes, but…’ Yes, it is possible to be a successful independent ECP, but you must constantly be looking for ways to participate in the transition from volume to value. This includes knowing your strategic options for sustainability and growth. To do this successfully, you need the right optometric business solutions (including software), leadership, and capital. This is often a huge stumbling block for physicians who want to focus on patient care.
Clinically Integrated Eye Care Networks— an Alternative Practice Model
Alternative practice models (APMs) go beyond traditional physician-owner arrangements. They aim to help small providers meet the challenges of today’s healthcare market. There are many models, and all of them seek to improve quality and efficiency while reducing costs and increasing patient satisfaction, but each is organized and operates differently.
Clinically Integrated Eye Care Networks stand out in one major way: They help small practices join forces with other providers while allowing each individual provider to retain ownership of his or her practice.
CIEN Q & A
Clinically Integrated Eye Care Networks help to level the playing field between independent practices and institutional providers. Let’s dig a little deeper:
Q: What is a CIEN?
A: A CIEN consists of general ophthalmologists, optometrists, and subspecialists who work together to address and manage patient conditions. Each provider owns and manages his or her own practice. A CIEN incorporates clinical integration—data sharing among treating physicians to improve care and reduce inefficiencies (i.e. duplicate testing).
Clinically Integrated Eye Care Networks also include one or more of the following features:
- Methods for collecting and analyzing providers’ performance.
- The development and use of performance standards along with a system to enforce those standards.
- Use of ophthalmology EMR and EHR systems to facilitate the exchange of health information across the network of providers. A common ophthalmic EMR is easiest but not necessary—they just need to be interoperable.
- Use of evidence-based medicine to establish guidelines for support of clinical decision making and treatment.
Q: What’s so great about clinical integration?
A: Clinical integration can help providers overcome a number of hurdles:
- You can gain leverage with payers. Your reimbursement directly relates to your bargaining power. Clinical integration allows independently-owned practices to team up on payer negotiations without violating Stark and anti-trust laws.
- You can draw on a larger pool of patient data than would be available to your individual practice. This helps to better evaluate treatment options and track which of those options offers the highest quality at the lowest cost for your patients. Then, best practices are shared with the group so that all the providers benefit. To be a driver of best practices through the analysis of performance, your group could have a positive impact on a certain specialty or even a certain chronic condition.
- You can also more readily gain information about your patients that impacts the care you provide. In an individual practice, an optometrist’s patient may have gone to the ER or stopped or started taking a certain medication, but the optometrist may not find out for months. In a CIEN, you’d know much sooner and that would allow you to be proactive in treatment decisions.
- Clinically Integrated Eye Care Networks offer increased access for patients. Eye care providers often serve an aging population and many times one that is chronically ill. With a CIEN, patients are referred to the appropriate provider within the group so they get to the right physician with the right skills at the right time to screen for or treat their issues.
Q: What About the Numbers?
A: A CIEN is a legal structure, not a payment model. But its structure and operation can have significant financial benefits for your practice:
- Clinically Integrated Eye Care Networks are a way to participate and succeed in value-based care because there is an active and ongoing program to conduct, evaluate, and modify the providers’ clinical practice patterns to control costs and ensure quality.
- The group collects and analyzes each provider’s performance, quality, and resource utilization data through ophthalmology clinic software, in order to continuously improve their delivery of care. So there’s continuous improvement within that group. Why is that important? The QPP (MIPS/APMs) is not pass or fail—the program tiers bonuses and penalties based on performance. You get paid a little extra if you do “good,” much more if you’re doing “great.”
- Depending on the group, providers may receive shared savings or bonuses if they meet the CIEN’s goals. You can also reap the economies of scale with shared expenses and resources, group purchasing, and centralization of services like revenue cycle solutions, billing, or credentialing. Again, it all depends on the group.
Q: How do I know if a CIEN is right for my practice?
A: One of the biggest benefits of joining a Clinically Integrated Eye Care Network—the ability to retain ownership of your practice and run your day-to-day operations more or less how you want—is also its biggest drawback. Participants must share a commitment to engage in coordinated care. This requires constant communication and open exchange of information. You have shared control over patient care, and your success is based more on the group, and less on the individual. The group will monitor all providers’ performance. You are interdependent.
The CIEN will have a board of directors, and depending on the size, sometimes various committees. You must agree on the group’s goals, and you must collaborate with the other providers on the goals and methods to achieve those goals. When it comes to alignment of incentives to achieve true care coordination, maintaining a silo mentality just won’t work.
Q: I’m mid-career and thinking long term. How will joining a CIEN now affect my exit strategy later?
A: There are a lot of different options for exit strategies within a CIEN and they’re all win-win:
- Membership in a CIEN provides a tremendous value proposition around the sustainability and long-term viability of your practice. If you’re looking to bring on new, younger providers with ownership potential, they’d likely find elements of a CIEN—like patient access and relationships with other providers—very attractive.
- If you’re looking to go the private equity route, a CIEN would also be attractive. You’ve got a situation where there’s an opportunity for volume and organic growth, and also a platform for mergers and acquisitions.