2009 was a rough year for many in health care.   Like almost all industries we were hard hit by the poor economy.

Many people put off non-urgent care.  Health care costs increased for those who are lucky enough to have insurance, and many lost insurance benefits as they lost jobs.

Health care reform is moving through Congress. It doesn’t look like it is going to improve  how many of us make a living (or allow us to make a better living).

What will 2010 bring for private practice? What will it bring for YOUR practice?

I’m no economist, and no one will mistake me for a CPA, but by my calculations maintaining a small private practice that relies mainly on managed care reimbursement will be difficult in 2010. As the public’s health care out-of-pocket expenses rise, there is going to be more competition for those dollars.  Competition from all health care providers, not just those in your particular specialty.

Reimbursement rates will remain stagnent, or decrease. Costs will rise. It will be more and more difficult to remain profitable.

Eventually, the “hours for dollars” business model will become unsustainable.  In this model we only get paid for each hour we work. My rationale is this: if we get paid a stagnant hourly rate, but our costs continue to increase the only way to make economic gain is to work more hours. But at some point there are not enough hours in the day, or you become burned out and ineffective, unhealthy, frustrated.

As you think about the next year in your business, it will be important that you take these realities into consideration.  As a profession and as individual business people we need to ask ourselves the following questions as we adjust our business plans:

• Without increases in reimbursement rates, but increasing costs of doing business, at what point is our practice on financially unstable ground?
• How do we diversity our income streams so we are not solely dependent on the “hours for dollars” models?
• Can we partner with like-mined professionals in the same or different specialties  to build comprehensive group practices that offer unique approaches to health care?
• In a world of increasing competition for health care dollars, how does your practice stand out? How does the care you offer meet or surpass expectations of treatment and service?
• Can part of your services or products be sold outside of managed care reimbursement streams?
• If you want to free yourself from managed care, how will you do this? (hint: start with a strong specialty niche and excellent marketing).

2010 will be another year of difficult decisions for those of us in health care.  We want what is best for our patients, but need to hold on to the reality that we have a financial bottom line.  It is a delicate balance.

If your clinical hours quiet down around the holidays, I suggest you take a few hours to write down your business and career goals for the next year.  I’ve done this exercise and I can tell you my practice of child and family behavioral health will look very different this time next year. It has to. The same old ways of doing business don’t look sustainable for the long haul. But that’s ok. Change happens and those who take time to brainstorm, plan, collaborate and innovate will find ways to succeed, no matter what the economic conditions.

If you want some support in goal setting, feel free to leave comments here on the blog. No need to go it alone!

So what does your practice look like in 2010?