Is Joining an IPA for You?

Lea Chatham October 2nd, 2014

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Tweet This Kareo StoryAs physicians look at whether to stay independent (or start an independent private practice), there are many options to consider and questions to ask. One of these is whether or not to join a group like an Independent Physician Association (IPA).

Also known as an Independent Practice Association, these groups can often take some of the risk off your shoulders while also providing costs savings and even some care coordination opportunities.

Typically, IPAs serve to negotiate contracts with insurance companies on the behalf of their members. Participating physicians are usually paid on a capitated or modified fee-for-service basis but may also care for patients outside of the insurers contracted through the IPA.

As the industry moves towards more of a value-based model and away from fee-for-service, these groups can be better positioned to make the shift since they are often set up this way already. Their structure also makes them more readily in a position to shift to an ACO model.

Often, the IPA has a staff who do the contract negotiations, disburse payments to participating physicians, and manage other tasks based on the structure of the group. By centralizing many of the administrative costs, using the group’s bargaining power in contract negotiations, and offering other benefits like group purchasing, an IPA can help smaller practices reduce overhead.

In her recent webinar, Taking the Leap: Best Practices to Start Your Own Medical Practice, practice management expert Audrey McLaughlin talked a bit about IPAs. “Determining if you should join one depends on many factors. Often, small practices find IPAs advantageous in achieving savings, support, structure, and networking.”

While your practice remains independent, an IPA is a legal entity and you do sign a contract to join.Tweet this Kareo story
So it is important to be clear on the ins and outs. IPAs can vary widely so read the fine print.

Here are some things to consider before you sign on the dotted line:

  1. Does the IPA have a solid organizational structure? There needs to be an effective Board of Directors, an experienced leadership team, and a well-qualified staff. There also needs to be a large enough staff to manage the aspects of the IPA. Some groups grow too fast without the infrastructure to support that growth. As a result, they may fail—or flail—both of which can hurt the physician members and their patients.
  2. Is there sound fiscal management? You don’t want to join a group that doesn’t manage its money well or spends more than it earns. You should ask to see the financials and have someone walk you through the budget, profit and loss, and long term plans for financial success.
  3. Are the business operations and service style a match? You want to be part of an organization that reflects your values. Don’t get into bed with a group that has a radically different approach to customer service or management than what you are comfortable with.
  4. Information Technology: Does everyone in the IPA use the same practice management and EHR technology? How is that paid for? What is involved in making the switch? What is the cost to your practice? Ask all these questions and gets a hands on demonstration of any software you’ll have to use.

One last piece to think about before you join an IPA is whether or not you are comfortable giving up some control to reduce some of your risk and management responsibilities. There are always pros and cons. If you are more comfortable having a lot of control over which payers you contract with, negotiating those contracts, and being involved in the details of your billing and administrative tasks, an IPA might not be for you. However, if your most interested in providing care and would prefer to hand off more of those tasks to someone else than an IPA might be the right fit. Because an IPA functions like a larger medical group, it can also help you to grow a small or new practice faster.

An IPA could be a great fit to help you manage and grow your practice, but always invest the necessary time to look at every angle before you commit yourself.

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3 Good Reasons to Conduct Patient Surveys

Lea Chatham October 1st, 2014

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Tweet this Kareo storyBy Lisa A. Eramo

Customer satisfaction is important in any business, and healthcare is certainly no exception. In order to be a contender in today’s competitive healthcare market, physicians need ongoing feedback from their patients. Not only can this feedback help improve processes, but it can also enhance patient retention. Surveying patients directly is one way in which practices can glean this important information.

Surveying patients about the quality of care they receive—including what they like and more importantly, what they don’t like—is definitely a smart business move, says Tom Jeffrey, president of the SullivanLuallin Group, which helps administer patient surveys and establish patient satisfaction improvement plans for practices of all sizes, including solo practitioners and groups of a hundred or more physicians.

“Right now, in the industry, 70% of new patients are word-of-mouth referrals,” says Jeffrey. Tweet this Kareo story
“When patients have good things to say about your practice, that’s generally where you get new business.”

A well-constructed survey can also help physicians understand how they can connect with patients. This connection can actually improve the efficacy of the care they provide, says Jeffrey. “When patients connect with their physician and feel that the physician listens to them and communicates well, the likelihood that the patient will follow and complete the treatment regimen is higher. This leads to better outcomes.”

Consumers want to voice their opinions, and they also want to know the opinions of others. According to USA Today, one in four consumers checked the online ratings for their physician when choosing a primary care doctor in 2012. If physicians don’t know what these ratings say or imply, they could be missing out on opportunities.

Surveying patients internally gives physicians a first-hand glimpse into how their patients feel about them. Many public websites have been publishing this information for quite some time. Healthgrades®, for example, is a website that allows patients to take an online survey to give feedback about a provider’s ability to listen, ease of scheduling appointments, office cleanliness, and more. Other sites, such as Vitals, Consumer Reports, Yelp, and even Angie’s List have similar purposes.

Most physicians today are becoming more interested in patient satisfaction because it’s such an important driver in healthcare reform, says Jeffrey. Not only is patient engagement and satisfaction important in terms of Meaningful Use, but surveying patients using the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey is also a requirement for providers in an Accountable Care Organization (ACO) or a Medicare Shared Savings Program, according to CMS.

It behooves providers to survey patients now so they can gauge overall satisfaction before these ratings and scores continue to become publicized via Physician Compare and other sites. Some providers are already banding together to make scores public.

For example, the Maine Quality Forum launched an initiative to encourage the use and public reporting of patient experience survey data to improve quality. Each practice site that participates in the initiative will partner with a vendor to administer either the six or 12-month version of the CG-CAHPS PCMH survey or CG-CAHPS core survey instrument. The Maine Quality Form will pay $8.65 per completed survey or 90% of actual survey costs (whichever is less). Survey results will be publically reported at the practice level at

Prevea Health, a 200-physician multi-specialty group in Green Bay, WI has been using the Press Ganey survey at each of its sites since 2006, according to a white paper developed by Physicians Practice and sponsored by Press Ganey. Not only does the specialty group provide reports to individual physicians, but it also posts survey results internally for all physicians to see.

Even if your practice isn’t part of a larger initiative, it can still solicit feedback from patients using something as simple as a comment box at the receptionist desk, says Jeffrey. If physicians want to administer a more formal survey, they can do so using one of several surveys available, such as the one provided by SullivanLuallin Group at

Providers may also want to partner with a vendor to administer the survey. Doing so allows physicians to compare their data with practices nationwide. SullivanLuallin Group, for example, has compiled more than 300,000 patient responses in just the last 12 months, allowing practices to benchmark their data by specialty, says Jeffrey.

Jeffrey provides the following tips for practices that want to try doing it themselves:

  • Administer the survey to a random and representative sample of your practice’s population.
  • Include as many questions as you feel necessary; however, try not to exceed 40 questions.
  • Ask about access to care (ease of scheduling appointments), communication with physicians and other staff members, thoroughness of the exam, ability of the provider to listen thoroughly, and ease of obtaining answers to billing questions.
  • Survey patients at least once per year or on an ongoing basis. Use the first survey as a baseline. Take steps to improve the patient experience and then re-survey to compare results.
  • Provide patients with options for completion, such as email, telephone, mail, or point-of-service (at the office via a tablet or paper).

The bottom line is to do something—anything—to evaluate performance and solicit feedback from patients because it will help you achieve three key goals—improving satisfaction, retention, and outcomes. “You need feedback from your patients at regular intervals,” says Jeffrey. “Surveying is just the first step. Without it, it’s just business as usual, and this could be problematic when competition heats up.”

For more tips and best practices watch, Nothing but the Facts: Find Out What Your Patients Really Think, a free webinar sponsored by Kareo and presented by Judy Capko.

About the Author

LisaEramofreelanceLisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.

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