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Regardless of how great any innovation or new venture may seem when it comes to improving the healthcare system, physicians are key to the solution.
Removing the detrimental friction of challenges that manifest in impediments to physician practice, participation, and even solvency enables more diverse expressions of both provider care and medical sciences, ultimately generating. better healthcare.
Let’s dive in to a couple of specific examples.
The practice of healthcare has never been easy, but in too many circumstances it’s become unnecessarily hard. The pandemic, for example, intensified what was already a growing existential threat to independent physician practice. In December 2020, the nonprofit Physicians Foundation reported that roughly 8% of physician practices surveyed were forced to close because of the pandemic. With mounting administrative burdens and increasing trends toward consolidation of large hospital and medical groups, it’s no wonder employed physicians now outnumber self-employed physicians in the United States.
Independents were already grappling with daunting overhead costs and complicated reimbursement pressures, then COVID hit and patient visits dropped as much as 60%. Last year, 1 in 10 practitioners were worried about solvency. Many physicians simply didn’t take salaries for a while.
Our system should provide opportunity for both employed and independent physicians. Since vast swaths of our population live far from the nearest hospital or large medical center, the independents are particularly essential to the fabric of our system. They’re in all 50 states and cover family medicine, primary care, and internal medicine, as well as almost every specialty. About half of them are in small practices of 10 or fewer and we must find new and better ways to enable them to stay in business.
Independent physician practices today are like any other small business — but the “business” side of the equation has grown worrisome. The independent physician is not only seeing patients, they’re also often acting as the CPA, the IT administrator, and the person who fixes the copy machine among other operational necessities for their practice. Studies from the American Medical Association show that, on average, a physician spends 20% of his or her time on administrative tasks. That means they’re not practicing one full day each work week.
One of the biggest levers we have for improving healthcare is reducing the administrative burdens independent physicians face. Irrespective of specialty, it’s not sustainable for a physician to practice medicine and run his or her own business while also serving as the EHR administrator, the facility manager, HR, and payroll director, etc. There simply aren’t enough hours in the day.
Additionally, because independent practices tend to be small, they also don’t benefit from economies of scale like large healthcare systems. It’s harder for them to negotiate, whether that’s for reimbursement or medical supplies. In fact, in the early days of the pandemic, one of the biggest stressors on an independent practice was simple access to personal protective equipment (PPE), partly because they weren’t part of supply chains favoring large-volume contracts.
When the pandemic crisis spiked last year, independent physician practices had to immediately switch over to telehealth. Most practices had been doing a handful of telehealth visits in any given month, if at all. Then seemingly overnight, they had to rework their whole business, figure out what technology was best for their practice, and figure out all the new regulations and reimbursements around telehealth — and then find time for actually practicing medicine during a growing health crisis. That administrative and change-management expertise should be available as-a-service—to figure out the technology, regulation, new reimbursement codes, negotiate resources and rates, and make sure everything works.
That service should focus on two things: giving back time to physicians and reducing costs by leveraging economies of scale. The service takes on the entire back-office administrative burden and overhead, provides shared office space, shared front office staff, shared purchasing, all of the technology infrastructure, and manages all of the billing and collections and all of those administrative functions that a practice needs to do every day to function.
The goal is to provide turnkey operations for independent practice. The concept provides an alternative to existing practice consolidation models in that physicians don’t work for the service, it works for them.
Within existing smaller and community-based physician practices, there are also compelling avenues for medical innovation and healthcare improvement that remain underdeveloped due to high barriers to entry — the clinical trial ecosystem is a glaring case in point.
Opening physician access to different parts of the clinical trial ecosystem would drastically improve medical science and treatment development, and forge new paths for modernizing healthcare practice.
Consider the current American clinical research and clinical trial landscape, which is heavily centered on major academic medical centers. Over the past 30 years or so, concentration increased because these centers tended to have the physicians and key authorities that pharma desires to serve as primary investigators and to lead programs. Historically, these centers have had the patient populations to fill the target needs for research. Additionally, these institutions have heavily invested in the equipment, staff, and infrastructure needed to effectively deliver clinical studies.
Concurrently, we’ve seen increased research and development (R&D) investment in the pharmaceutical industry, improvements in data management and analytical approaches, as well as new technology and regulatory changes that have served to increase the flow of pipeline opportunities.
However, this evolution has also increased the complexity of the landscape. Along with new research across indications and across therapeutic areas comes the need for subsets of patient populations for precision medicine development and more targeted treatments. This has driven changes that outpace both capacity and efficacy in such a sequestered ecosystem.
There’s a bias toward de-risking clinical research and trial programs by replicating what’s worked before — relying on familiar centers and familiar collaborators with a history of delivery. That might seem reasonable; however, that bias has also created a saturated and restricted cycle of competing and duplicating opportunities with the same pool of institutions and investigators and the same pool of participating patients, often inaccurately reflecting the ultimate targets of treatment. At present, the aggregate statistics of this process result in less than three percent of physicians and patients that might be eligible actually taking part in applicable clinical research.
The pandemic crisis and ensuing acceleration in vaccine development uncovered the inherent weakness of the status quo. In September 2020, Moderna had to slow its phase 3 COVID-19 vaccine trial because it was having trouble recruiting enough minority participants to reflect efficacy in high-risk populations.
Trial landscape diversification and democratization is the solution, but smaller and community-based practices needed to make it work face challenges in even being considered for—much less sustaining—participation. Right now, there are large upfront costs for training, building in-house infrastructure, accumulating support staff, and managing the data and processes and oversight that’s needed to deliver at the level that industry demands. While copious practices may want to diversify and strengthen practice income while also giving patients new options for innovative care, they need a navigable path to engage in trials.
Enabling trial and research participation at point-of-care across the country will help ensure equitable representation in trials, at least equal to general population demographics, and ultimately aims to better match disease prevalence and patient burden as well.
To make it happen, a ready-made platform facilitating entry for small and community practices would deliver clinical research training, resources, support for data acquisition and management, research, and care coordination, and even a central Institutional Review Board. It will supply that bridge to participation.
Physicians are the essential enablers of the vision. The solution should give them the ability to expand their practice repertoire and stay on the leading edge of research and treatment paradigms. In addition, offering research as a care option will present physicians with the opportunity to diversify and augment practice revenue (it can also help their patients with out-of-pocket costs, as these can be covered by the trial). Fundamentally, developing better treatments requires greater participation from more physicians and more of their patients. An onboarding platform for smaller and community-based practices can make that possible.
Regardless of how great any innovation or new venture may seem when it comes to improving the healthcare system, physicians are key to the solution. New technology platforms and services can help increase access and make certain types of science, research, and treatment more effective, practical, and attractive. But technology alone is not sufficient. Business models don’t treat illness;; tools and processes don’t practice medicine—physicians do.