For many small and solo practices, collaboration is the key to survival in today's health care world. Whether joining an independent practice association or accountable care organization or entering into an informal, handshake agreement with other practices, physicians have been able to lower their costs and improve their quality of life by banding together. ...
Colin McCulloch, an associate in the health care and life sciences practices with the Washington, D.C., office of the Epstein Becker Green law firm, said there are several other potential problems that need to be considered when practices collaborate.
McCulloch gave the example of two physicians located two doors from each other in the same building who decide to share costs and offices. He said sharing costs could violate Stark rules, particularly if one physician is picking up a large share of the costs and is getting referrals from the other physician.
The Stark law, which limits physician referrals to health entities with which they have a financial relationship, especially comes into effect when a hospital-owned practice enters the mix. Physicians in the group could be accused of having incentives to make more referrals to that hospital, McCulloch said.
McCulloch said patients may start to see the two doctors as operating under one practice, which could open the practices up to the same legal liabilities.
"Depending on your personalities, this could also lead to labor issues. If you're laid back and I'm high-strung, your long-time receptionist may really hate me, and that's a problem for both of us," he said.
McCulloch said IPAs also are at risk for cherry-picking doctors, especially if hospitals are included. "The key is to go in with your eyes wide open. You may not want to go into a full-merged partnership," he said. ...
McCulloch predicted that more physicians will move to a more formal structure, such as an ACO, which doesn't run the same risks as an IPA. In ACOs, doctors come together voluntarily to give coordinated high-quality care to Medicare patients while avoiding unnecessary duplication of services and preventing medical errors. Wild said physicians can't negotiate prices with Medicare, eliminating any price-fixing worries.