PRIVATE & GROUP PRACTICES

Private practice normally refers to a single, self-employed physician practice. Group Practice generally refers to a practice that is owned and operated by a group of physicians. Private and group practices are commonly referred to as clinics. Many primary care and specialist physicians practice as part of private or group practices, so there are probably various primary care and specialty clinics in your area. The variety of private and group practice models that exist is vast and beyond the scope of this discussion. The important thing is to gain a general understanding of private and group practices, which can then be used to research the types of practices that exist in your community.

The cost of care at private and group practices can vary depending on the specialty and the ownership structure of the practice, which can determine the Medicare reimbursement rates. In general, primary care practices offer the lowest costs and costs then rise as care gets more and more specialized. Physician-owned private and group practices bill under the Medicare Physician Fee Schedule (MPFS), and thus in most cases are more affordable than hospital outpatient departments that bill under the Outpatient Prospective Payment System (OPPS). Hospital acquisition of private and group practices has been a recent trend in healthcare, and when this happens, hospitals will generally change the reimbursement schedule from MPFS to OPPS, which can cause prices to increase significantly for patients visiting the same doctors they've seen for years.

Because their model is generally built on lower reimbursements, private and group practices often are forced to become efficient and differentiate themselves by offering superior customer service. This can be a good thing for patients as it can lead to new and innovative practice models that emphasize patient convenience, timely access to care, and other service-oriented concepts. Again, the types of clinics in each community vary, so some homework will need to be done.

Quality can be harder to assess for private and group practices, especially smaller clinics. Many do seek accreditation in their particular specialty, and this can be used to assess quality. However, some small practices may not have the resources to accomplish this and cannot justify the cost unless it affects their reimbursement. This does not necessarily mean that these practices are low-quality, it's just harder to know. A good way to form an opinion in these cases may be to check out consumer reviews on the individual physician(s) and the practice itself, although these can be misleading at times. Your PCP can often be a great resource for advice on provider options and the quality of physicians.

Medicare offers a fairly good resource to find physicians and group practices called Physician Compare.

Essential QSA Knowledge

Private and group practices can be good, affordable options for patients depending on the circumstances. These practices often offer superior customer service to stay competitive, so things like timely access to care may be better than other options. Quality can sometimes be harder to assess, especially with smaller practices, so some further investigation may be necessary if this becomes a concern.

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