10 Critical Strategies for Primary Care Practice Survival

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Owning a primary care practice is tougher than ever — nearly 4,000 primary care practices had to close their doors during covid. That means about 8% of all physicians shuttered their business at least on an interim basis in just the last 12 months, many pertinently.

This trend poses a threat to the future of healthcare. Primary care physicians (PCPs) play a critical role in maintaining the health and wellbeing of their communities. The annual check-ups, initial diagnoses, and preventive care provided by PCPs are our first line of defense against both the burden of disease and high healthcare costs. 

What should PCPs do to make sure they can continue their patient care mission? Adopt an operating model that is both patient-centric and business-focused. The following ten strategies will help primary care practices ensure their future survival while continuing to offer high-quality patient care. 

1. Be Strategic But Nimble

No one could have planned for 2020, but it has taught every primary care practice owner a valuable lesson: expect the unexpected and plan for the worst. While the COVID pandemic may be winding down, new challenges are cropping up, such as increasing competition from primary care disruptors like Walmart and Amazon. Going forward, PCPs need airtight business plans that allow them to make quick yet informed decisions. Priorities include:

  • Having a plan for adopting value-based healthcare 
  • Compiling metrics from payers, hospitals and other credible data sources to measure success
  • Choosing hospital and physician partners with long-term relationships in mind
  • Looking for practice and professional association alliances that will generate immediate and future business


2. Tighten Operations and Workflows

A successful primary care practice has strong operations and clear workflows. Unfortunately, far too many practices today have physicians who try to do everything, from facility management to procurement to IT to compliance to marketing. The best way to sustain today’s medical practice is to allocate responsibilities to the right people to keep the practice profitable and running smoothly. 

Additionally, PCPs must work with staff to integrate evidence-based care and automation into workflows. A team-based model is the future of health care. Every team-based practice needs a high-performing leader who can separate and delegate acute care and care management responsibilities, allowing physicians to work at the top of their license. 

3. Understand Financial Data

There was a time when primary care practices could “try” new services and care programs to see if they worked. If the service fell flat with patients or created problems for the practice, there was not much consequence. Those days are long past us. 

Investing time, staff attention, and patient goodwill in an unsuccessful initiative can hurt your practice. Before you launch a new service or program, you must identify its value and determine its potential ROI as they relate to your practice goals and patient population.

To do this, assess each care program and your practice’s operational structure to determine:

  • Per capita cost or cost per patient
  • Total spending per member per month
  • Reimbursement by contract and overall reimbursement 

Have your financial expert perform a full analysis to identify the services that will have the most impact on your practice. Determine which are best suited for acute or ambulatory care and which services will yield the most value and best outcomes. 

Ideally, perform these analyses for your practice’s existing care programs as well. Ultimately, your goal is to create a model that pairs investment with outcomes and can help you predict future success. 

4. Align Your Compensation Models

If you are employing physicians or other providers, review your compensation model to identify any disconnect between how the practice is paid and how providers are paid. Both drive behavior. If payment models are not aligned, you could be setting physicians up to work against your practice goals.

Let’s say your practice uses a capitation payment model. Under this model, physicians’ main focus should be on providing appropriate disease prevention and chronic disease management services. But if you compensate your physicians using a fee-for-service model, their focus could be on service volume. You can see the disconnect already. 

When you consider that patients today tend to be more astute and informed about their care, the disconnect starts to impact more than just numbers. Physicians who are focused on maximizing visit volume tend to spend less time checking in with their patients about how they feel about their care. In today’s healthcare environment, patient satisfaction can make or break a practice. That is why quality and cost of care are now measurements of patient experience. Patient satisfaction increasingly drives practice performance and profitability.

Create staff incentives that focus on the patient experience and outcomes. In addition, make sure your team members know how important they are to the success of your practice. Their emotional health and personal investment in their work will help reduce turnover.

5. Review Quality and Patient Satisfaction Ratings 

Another new reality for PCPs is the importance of publicly reported ratings. Patients can now look up your practice on various websites, including Medicare Care Compare, to find out what you charge for services and how you rank on a 5-star scale compared to other physicians and practices.

This means that practice owners need to be aware of every patient interaction, from annual checkups to ambulatory services to prescriptions to acute care. Physicians should track their patient satisfaction surveys and review their performance regularly. It is especially important to pay attention to any negative patient experience as it may provide insight on how patients are rating you. 

6. Connect Clinical Variation and Evidence-Based Care

One of the most powerful strategies for ensuring quality care and patient satisfaction is to reduce clinical variation. Of course, there can be several right ways to treat a disease, but the key is to identify the evidence-based care plan that offers the patient the best chance of a good outcome. 

Start by analyzing existing clinical data — how are you delivering care in your practice and is it consistent? From there you can identify opportunities for improvement, create physician scorecards, and develop training to promote the desired clinical behavior. Reinforce your clinical protocols with regular group check-ins and one-on-one evaluation and education sessions to assess physician scorecards and clinical outcomes. 

7. Prioritize Clinical Coding

We all know coding is important. Hopefully you have a practice automation system that helps your team code consistently to ensure fast claims submission and reimbursement. Be aware, however, that coding impacts more than just income.

Increasingly, accurate coding drives quality metrics. The ICD-10 diagnosis codes you use inform payers about population health and severity of illness, and they are also being used more and more to assess patient complications, morbidity, and mortality. The overall result is that these codes are being examined to determine how well physicians treat their patients — again, quality of care. 

Make sure to delegate coding oversight to an experienced staff member who (a) stays up to date on coding changes and (b) understands how to accurately submit claims for reimbursement and the best quality assessment of your practice.

8. Optimize Convenient Care 

Telehealth is here to stay. According to experts at the 2021 AMA State Advocacy Summit, telehealth services delivered to Medicare, Medicaid, and CHIP patients during the first seven months of the pandemic increased 3,000% over the prior year. 

But telehealth is just one aspect of a commitment to convenient care. Today’s primary care practices must take patient-centered care to a new level by giving patients unprecedented access to care, including urgent care. People have come to expect that their care providers will meet them where and how it’s convenient for them, the patient — and you can be sure that your ability to do so will impact patient experience and quality rankings.

Services that every primary care practice should investigate and implement include telehealth and telemedicine, remote monitoring, extended hours, emergency care alternatives, and responsive phone support. 

One note: Not every access expansion has to be provided by your practice as a direct service. PCPs can explore opportunities to expand patient access through affiliations with other organizations.

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9. Remember That Referrals Impact Patient Satisfaction

Your referral partners are an extension of your primary care practice and should be treated that way. Before you send your patients to another provider, think about how that physician’s care of your patient will reflect on your practice, because your patient will make this connection.

Keep referrals “in the family” as much as possible — whether it’s in the practice, in-network, or within the same hospital/system affiliation. Your goal is to make referrals that are in the best interest of your patients without damaging the reputation of your practice.

And don’t forget to factor medical costs into your referral decisions. For your patients, likability and trustworthiness are not the only issues. They also pay attention to the quality of care they receive from referred physicians, their personal health outcomes, and how much they end up paying out of pocket. Insurers are also watching healthcare costs; and ultimately, as value-based contracts and risk contracts become more prominent, the total cost of care is often assigned to the PCP for the purpose of calculating bonuses and incentive payments.

10. Keep Physicians Engaged   

For primary care practices, lasting success depends on physician engagement, physician leadership, and preventing burnout. The physicians you bring into your practice should be a good fit for the long term. Train them well and give them a reason to commit to the success of your practice. Engaged physicians provide better patient care and foster a more successful, happier work environment.

Work with your physicians to determine their goals, including training, certifications, and leadership aspirations. Then give them the opportunity to develop those skills. This approach will not only contribute to their job satisfaction, but it will also improve your practice.

Most important, pay careful attention to burnout. The fact is that primary care physicians experience one of the highest levels of burnout in the medical profession. Practice owners can counter this risk through individual coaching, open communication, careful training, and ongoing leadership support.

Strategy for success

Your success as a primary practice owner is directly related to how strategic you are in every aspect of your operations. By adopting a patient-centric, business-focused operating model, primary care practices can position themselves as a vital component of the rapidly evolving healthcare landscape. 

George Mayzell, MD, MBA

By George Mayzell, MD, MBA

Dr. George Mayzell is a physician executive who specializes in helping healthcare organizations transform their delivery of care through population health strategies, care management redesign, and physician leadership programs. His extensive career spans more than two decades in healthcare and includes direct experience with hospitals, health plans, integrated delivery systems, and clinical practice.