Is A Group Practice Without Walls Right For You?

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Kevin McDonald, DPM

   Insurance negotiations. It is frequently frustrating for small group podiatrists to compare the private insurance fees received by large group medical providers with the fees paid to small podiatry practices for the same CPT codes. However, private insurers will not be inclined to pay higher fees based on group size alone. The group practice without walls must provide additional information and come up with its own unique value proposition.

   Group discounts. You might be surprised that there are various vendors that are eager to do business with large podiatric practices. Consider joining or forming a managed service organization to handle these issues.

   Ancillary services. The pooling of resources and economies of scale present in a large group practice offer some potentially profitable sources of ancillary income. Ambulatory surgical centers, physical therapy centers and radiologic and diagnostic testing centers may be feasible for a large group practice. Pathology lab services, in which the practice does the technical component of the lab service and a licensed pathologist provides the professional component of the service, offer one of the most potentially profitable ancillary income opportunities.

   Clinical integration. The Internal Revenue Service and other regulatory agencies require a group medical practice to be “clinically integrated.” The group practice without walls model complies with these requirements via protocols, chart review and outcomes data. The development of research projects, particularly involving the care of patients with diabetes, is encouraged.

In Conclusion

The group practice without walls concept is a viable option for like-minded podiatrists to come together for their mutual benefit. This practice model is attractive to podiatrists who are willing to compromise, desire to maintain a high degree of independence, seek to remain part of the mainstream of medicine and want to play a role in emerging healthcare constructs.

   Dr. McDonald practices in Concord, N.C., and is one of the managers of the NC Podiatric Physicians and Surgeons Group, PLLC.


1. Leardi J. Mega-Group white paper. Available at .

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