By Mary Carpenter | Photo by Ty Kretser
Issue: March 2022
According to a 2018 American Medical Association survey, 47.4% of U.S. physicians were employed by group, hospital-owned or corporate-affiliated practices, while 45.9% owned their own practices. The allure of independence is strong in the medical community, but it brings challenges with it. As an alternative to going it alone there is a growing movement that is having an impact on both patients and care providers. Independent Practice Associations (IPA), business organizations owned and operated by member networks, are designed to connect physicians, identify best practices, provide data analytics, and share information, all of which ultimately improve patient care. An IPA allows physicians to enjoy the benefits of a larger organization without having a legal relationship with other members. There are currently more than 687 member organizations representing approximately 317,000 medical doctors in 36 state chapters in the United States.
The Northern New York Physicians’ IPA was founded in 1986 by neurosurgeon Dr. Soham Patel. What started as a small group of doctors has grown to include primary care physicians as well as specialists in the 7,400 square miles of Clinton, Franklin and St. Lawrence Counties. The association offers the best of both worlds – connecting physicians to an organized system of care while allowing them to maintain their independence. Current officers are President Dr. Kris Ambler (Internal Medicine), Vice President Dr. Craig Hurwitz (Nephrology), Treasurer Dr. Anita Bodrogi (General Adult Care), and Secretary Dr. Harold Chaskey (Pediatrics). Stacey Ambler is the Association’s Project Administrator. The diversity of the board allows for input from many perspectives.
I recently sat down with Kris and Stacey Ambler to learn what the NNYPIPA offers private physicians and their patients. “In order to best serve our patients, we need to be able to look at quality measurements,” Kris began. “Our member primary care practices have integrated their Electronic Health Records (EHR) with our data warehouse. This allows for many things which ultimately deliver providers and health plans positive outcomes by improving risk assessment accuracy, the quality of care and reducing medical expenses”
Asked how the approach works, Stacey posited, “How valuable would it be for a physician to know with one click, which of their patients had their annual mammogram or which diabetic patients were maintaining their ideal blood glucose levels? Information like that can reduce gaps in care and help to better manage chronic conditions. The payoff is a healthier population.”
Kris explained that each participating practice has access to data that can, as he put it, “be sliced anyway that helps the physician.” He further offered, “Having access to data on a practice level is invaluable to a provider. Some practices have EHRs that make report generation challenging. Our IPA can write any report a practice may need.”
At a time of increasing healthcare regulations and COVID’s chaotic impact, it is critical that independent physicians have access to the latest information and are able to make their voices heard. The IPA meets that need through education and heightened communication.
“When the pandemic hit there was no road map for how to react,” Kris offered. “Having the organization’s structure was invaluable. We were able to connect, share ideas and develop best practices.”
The IPA organized Zoom meetings that allowed physician members to collaborate. “That ability, to work in partnership, was instrumental as the pandemic swept across the country,” he observed. Now, two years into the epidemic, the virtual meetings continue as physicians look for ways to keep staff safe, deal with the new variants as they emerge and serve patients.
Kris and Stacey believe their complimentary skill sets are part of the reason the IPA has been a success. “The group is, in large part, a success because of Stacey’s skills and dedication,” Kris emphasized. Stacey added, “We are not a large bureaucratic organization. We are nimble and able to make changes and implement new ideas quickly, which is a big help.”
Stacey continued, “Kris is the big idea guy. Our diabetic eye exam program is a perfect example.” She went on the explain how she wrote a grant, based on Kris’ clinical knowledge, to purchase portable eye exam equipment that screens diabetic patients for damage to the blood vessels in the tissue at the back of the eye. Kris clarified, “Undiagnosed or untreated diabetic retinopathy can lead to blindness. Early detection is important.” The machines, purchased by the IPA, are used for annual exams that are saving patients’ sight.
Another example Stacey shared, “Kris read a study about automated blood pressure cuffs and their accuracy. Within a month we had purchased and distributed monitors for all the primary care practices. He has the clinical knowledge and I implement the ideas. It works.”
In addition to the health care benefits provided by the IPA, the association also offers advice on care management services, office procedures, billing, marketing, and educational resources. “Everything we do now is data driven,” Kris emphasized. “We are on a constant search for how to expedite procedures and improve patient outcomes.” As proof of the success of this approach he explained private physicians in St. Lawrence County had not had data analytic as robust as the IPA’s data. With the new information they were able to better analyze practice trends, bolster pre-visit planning efforts and address patient issues quickly. Within their first year the rates for specific preventative measures doubled.
All services of the IPA are available to members at no cost. “How is that possible,” I asked. In much of health care, physicians and hospitals are paid by the number of procedures/services they perform. In an IPA, payment is awarded on a value-based care arrangement which compensates providers based on the quality of care delivered versus the quantity of services performed. Rather than physicians focusing on volume, IPA members focus on high-quality care which yields better health outcomes.
“We have a long-standing relationship with Excellus BlueCross BlueShield,” Kris explained. “They have supported our efforts since 1998. This invaluable partnership has created a vehicle for us to better manage chronic conditions and measure domains in primary care, mental health, substance use disorders, and children’s measures. This arrangement incentivizes all of us to be more efficient.”
To achieve success, the IPA is committed to providing the newest information and data analytics that will give physicians the tools to track patient progress and recommend ways to improve care through more preventative screenings, better medication monitoring, improved communication between patients and physicians, better health education, and improved management of chronic conditions. These add up to better patient experiences and improved health.
With a structure such as the IPA, everyone gains something. Delivery of care is more efficient, patient outcomes improve and health care costs are lowered. It is a win for everyone. “And having colleagues to interact with makes the practice of medicine more rewarding and more fun,” the Amblers concluded.
Northern New York Physicians’ Individual Practice Association, Inc.
128 Boynton Avenue
Plattsburgh, NY 12901