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letter
. 2015 Oct;5(5):366. doi: 10.1212/CPJ.0000000000000196

Defending the solo and small practice neurologist

James N Goldenberg 1
PMCID: PMC5762015  PMID: 29443125

I have great respect and concern for the solo and small practice neurologist in our shifting health care landscape. Jones and Evans1 offer a comprehensive overview of the options available to sustain a practice of any size. My concern is that the focus of the article is on the quantitative analysis of the business. Alhough important, these strategies are like patching holes in the bottom of a leaky bucket. The greater problem is that the fee-for-service spigot is running dry. With a mandate to shift to value-based medicine,2,3 the emphasis should be on opening new spigots that are well supplied. It is affiliation and alignment with a value-based entity that will allow neurologists to regain stable financial footing. I commend the authors for reviewing alignment strategies, although I don't think they should be discussed in the context of selling a practice. There are many ways to affiliate or align and remain an independent practitioner and business owner. As we educate ourselves, I look forward to a more elaborate discussion of these important strategies.

Disclosures:

The author reports no disclosures.

References

Neurol Clin Pract. 2015 Oct;5(5):366.

Author Responds:

Elaine C. Jones, MD: As the practice of health care changes more dramatically than when Medicare was established in 1965, solo and small neurology practices may be struggling more than ever. In our article1 we tried to outline ways to monitor and improve the “bottom line” in the current fee-for-service model of practice. As Dr. Goldenberg rightly points out, there are other ways to maintain an independent practice and not have to sell out. As health care reform moves forward and reimbursement is based on Merit-Based Incentive Payment Systems (MIPS) and alternative payment models (APMs), neurologists will need to focus on collaboration with other value-based entities to remain successful. It will be vital to share our experiences about successes and failures as we develop these collaborations. The American Academy of Neurology is working on many resources about these new models as well. As Ringel points out, “[i]ntegrated models of care have the potential to meet the needs of patients and will allow neurologists to focus their time more efficiently and effectively.”4 We look forward to the conversation.

Bristol, RI.

Disclosures: The author reports no disclosures.

Articles from Neurology: Clinical Practice are provided here courtesy of American Academy of Neurology

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