Independent physicians in the U.S. are declining as more and more physicians seek employment by health systems. According to a 2012 Accenture Consulting report, 57% of physicians were independent in 2000. By 2012 only 39% of physicians were in independent practices. Accenture estimates that number will decrease to 36% in 2013, a 5% annual decline after considering the increase in the total number of physicians.
A physician-led group in Kansas City is striving to offer physicians in the area an alternative to hospital employment in the form of an independent physician association. The Kansas City Metropolitan Physician Association (KCMPA) was formed in late 2011 with the goal of empowering independent physicians to be leaders in the Kansas City health care landscape. A little more than a year later the organization has more than 200 physician members in many different specialties dedicated to the creation of a clinically integrated, coordinated care system consisting solely of independent physicians. MSMA member Nathan Granger, MD, MBA, and his physician colleagues at Clay Platte Family Medicine Clinic, cultivated the broad physician involvement and commitment to the vision. According to Dr. Granger, a family physician and the President of KCMPA, the time for action is now.
“Of all of the health care delivery organizations in Kansas City, independent physicians are in the best position to make health care more affordable for our patients and community while focusing on patient-centered care and new reimbursement models,” Granger said. “It feels like the regulatory environment and market forces should favor independent physicians, but the sheer number of regulations, ever-changing local health care landscape, and the demands of operating a small business make it hard for independent physicians to see the mountains through the trees. With so many independent physicians in Kansas City choosing employment, our opportunity to be leaders in the Kansas City health care marketplace is beginning to dwindle.”
Barriers to Independent Practice
Just why do physicians seek employment in the first place? Physicians surveyed by Accenture cited business cost and expenses, prevalence of managed care, electronic medical record requirements, maintaining and managing staff, and the number of patients required to financially break-even as the chief reasons for seeking employment. All of these concerns, according to Granger, can be addressed with the formation of a strong, supportive independent physician association.
“Looking across the country, independent physician associations have become essential to a large number of independent physicians seeking to control costs while being innovative and working to act in the best interest of their patients and community. Like the KCMPA, they also seek to help physicians navigate new regulations and participate in the new reimbursement models.”
Kansas City Metropolitan Physician Association: Preserving Independent Practice
If recent announcements from CMS are any indication, the KCMPA is walking the walk when it comes to reform. On January 10 the KCMPA-ACO, the primary care subset of the KCMPA, was announced as one of the new Medicare Shared Savings Program Accountable Care Organizations – the first Medicare ACO based in the Kansas City metropolitan area. KCMPA-ACO was also named one of the Centers for Medicare and Medicaid Innovation’s 15 new Advance Payment ACOs, making them one of 35 such ACOs in the country. Essentially, Medicare placed a bet that KCMPA’s ideas about how to reduce costs will work, and the group will receive funds upfront from Medicare to enable the innovation described in the application. Within this program, KCMPA-ACO physicians are incentivized to reduce healthcare costs while improving the quality of care for nearly 12,000 Medicare patients.
The KCMPA views the ACO recognition as a beginning of a journey. “The KCMPA-ACO is an important step as we seek to prepare independent physicians for new reimbursement models in Kansas City,” Granger said. “We will look to engage other payers in similar models as we grow and learn from each step of this process.”
Dr. Granger and many other KCMPA physicians are career-long members of MSMA and Kansas City Metro Med. Dr. Granger served as Treasurer of Kansas City Metro Med for the past three years. A.J. Delaney, MD, MBA served as one of MSMA’s Alternate Delegates to the American Medical Association. Kansas City Metro Med has supported KCMPA-ACO’s from the beginning, making introductions to local CMS staff and offering its board room for KCMPA’s monthly board meetings. Jill Watson, Metro Med’s long-time Executive Director, left Kansas City Metro Med at the end of February to become KCMPA-ACO’s CEO, and first employee.
“I’ve spent my career understanding the health policy goals and best practices, where we’d like health care to go, and what keeps physicians from getting there,” Watson said. “I think the time is right, with aligned goals and resources in place to finally make it happen.”
Those interested in learning more about the Kansas City Metropolitan Physician Association may visit www.kcmetrophysicians.com or contact by emailing info@kcmetrophysicians.com.
Biography
Nathan Granger, MD, MBA, MSMA member since 1997, is the KCMPA-ACO President, and Nate Kelly, MBA, is the Director of Strategy and IT, KCMPA and Director of Population Health Strategy, Cerner Corporation.
Contact: info@kcmetrophysicians.com
