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Another Attack on Small Practices: Exclusion from Quality Rankings


When so-called “quality measures” don’t include small medical practices, patients lose out on finding great physicians.

I offer my blog this month as a rallying cry to fellow independent, one- to two-provider practices currently fighting the good fight to remain small and independent in an industry that seems to only respond to the large and loud.

Case in point: A group called Massachusetts Health Quality Partners (MHQP) recently launched an online tool patients can use to search for “quality” primary-care providers in our state. I know for a fact that MHQP has surveyed our patients in the past and that we have performed very well. So imagine my shock when I tried to find us using their online search tool and we weren’t there.  I couldn’t find us by zip code, provider, or practice name.

I contacted MHQP about this oversight only to learn that, due to our small size, we weren’t included.  I can almost understand that there is too little data to be statically significant for their rankings, but if that’s the case, they should still list us with an explanation that says we are too small to provide enough data. Instead, we don’t appear at all; it’s like we don’t even exist.

Whether MHQP endorses the belief or not, the message from them is clear: Solo doctors don’t provide “quality” care. It is an insult to leave us off this list. To quote Rodgers & Hammerstein, “I don't say I'm better than anybody else, but I'll be danged if I ain't just as good!”

We should appear on that list.

I experience discrimination against our small group in other areas as well. I have vendors who triage our needs after their larger customers. In addition, many insurance payers brush my appeals and EFT challenges off until larger groups are satisfied. Most days I hear nothing but Rodney Dangerfield in my head saying, “I don’t get no respect.”

I think, though, there are ways to fight back. As I’ve blogged about in the past, we are a small independent practice, but we are not alone. Our involvement with a strong independent physicians’ association (IPA) is critical to our success.  Through the IPA we have the needed size to negotiate fair contracts with payers and vendors. In addition to our IPA, I have faith in national organizations, like the Medical Group Management Association and the American Academy of Pediatrics, and their ability to influence both the government and the public for the betterment of patients and small independent providers.

Although we don’t need the MHQP “quality” site to drive new patient to our busy practice, I resent the fact that the online tool is perpetuating the myth that bigger is better. According to Blue Pearl Consulting, independent practices are critical for the improvement of healthcare and, in fact, doctors are once again, for the fourth time since 1975, moving from hospital employment to independence and smaller practices.

In primary healthcare, good things do come in small packages, and I want the world to know that when compared to larger practices, danged it, we are just as good (if not better)!

What are some ways your small medical practice experiences "discrimination"? Share your thoughts in the below comments section. 

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