Private Practice is Dead: Long Live Private Practice

The future of private practice

A few months ago I wrote a short blog post titled The End of Private Practice. It was a whopping two paragraphs and contained no images or outbound links. It was based on ideas presented at a Behavioral Health Leadership Academy presentation I had recently attended. I didn’t expect much of a response to the post but to my surprise, the article received more comments on LinkedIn and generated more traffic to my website than any other post I’ve written.

In short, I posed the question, “will private practice survive the Affordable Care Act and Mental Health Parity laws?” Based on the number and nature of the responses, I seem to have struck a nerve . One person commented that they not only disagreed with the premise, she thought it was “dangerous” for us to even discuss it.

 

Of course I didn’t invent the idea. I started thinking about the subject when I heard an interview on NPR with the author of KevinMD.com, the nation’s most popular physician’s blog. In the interview, he briefly discussed a trend in medicine where doctors are closing or foregoing private practices in exchange for the consistency and stability of working directly for a hospital.

With the continued implementation of the Affordable Care Act and the passage of the Mental Health Parity Act, it appears behavioral health is becoming more like traditional medical care that ever before…like it or not. The consensus among most professionals who commented on the blog post is that private practice will indeed survive but those who want to continue independently will have to adapt. One of the adaptations talked about was to focus on a niche in the market or cater to a particular type of client who can afford services not covered by insurance.

Some of the best information from the discussion came from a series of newsletters published in the first quarter of 2013 from the New York State Psychological Association (NYSPA). The February 2013 newsletter listed several items in an article by Lubna Somjee, PhD, one of the co-chairs of the Health Care Reform task force of the NYSPA. In the article, Dr. Somjee listed the following important items to consider:

  • There is a push to consolidate practices into larger entities
  • Performance metrics, models of payment and EHR all place pressures on small or private practices
  • The future of private practice may depend on whether patient care organizations hire their own therapists or contract with those in private practice
  • Well established private practices are likely to survive the if they are able to adapt
  • Those that survive may need to diversify into non-insurance dependent services
  • Those in later stages of their career may be able to continue until retirement without much change in practice or focus.

The changes and need for adaptation aren’t limited to those in private practice. I expect small organizations will face as many if not more challenges than those in private practice.

 

Another great source of information came from the Addiction Technology Transfer Center (ATTC) Network in a series of three publications on Health Care Reform and Behavioral Health. The publications can be accessed at the following links:

There don’t seem to be any clear answers to exactly what is coming but it is clear that change is on the horizon. Except for those approaching the end of their career, success will likely depend on the ability to anticipate change and adapt to whatever comes. These changes won’t come overnight but they are coming. We probably won’t see the full effect for a number of months or even years. However, if we wait for the change to happen before moving to adapt, it will likely be too late.