A feasibility study yielded positive results. Each practice was financially sound and supported by a large patient volume. And the physician-leaders involved shared similar values – all were willing to investigate new ways of doing business and each wanted to remain independent.

In the end, though, only seven of the nearly two dozen practices decided to merge as PediaTrust, LLC. Why? The answer, suggests PediaTrust’s chairwoman Dr. Susan Sirota, hints at the level of commitment required for forming a successful independent pediatric group.

“You can cover all the steps and see that everything can look good on paper, but still say, ‘Why do this? I’m doing just fine now as an independent physician. Who knows what will happen?,’ Dr. Sirota says. “That final decision requires a leap of faith.”

Getting Bigger to Stay Small

Incorporated in October 2012, PediaTrust integrates the operations, as well as the patient care philosophies and treatment models, of its seven member practices. Billing is centralized, the practices are clinically integrated through shared electronic health record (EHR) systems, and overall group decisions are made by a board of directors. Day-to-day decisions on workflow and finances, however, are made at the practice level.

The 39 pediatricians who took the leap of faith and joined PediaTrust are seeing clinical and financial benefits individual practices would be hard-pressed to achieve on their own, says Dr. Sirota. The LLC uses its shared investment in staff and equipment to offer lactation services that were eliminated by area hospitals. This service, which includes breastfeeding classes for expecting mothers, operates out of three centrally-located PediaTrust practices in suburban Chicago.

PediaTrust also offers 365-day-a-year after-hours care, now available to patients outside the seven practice group. The service is a higher quality, less expensive alternative for patients who would otherwise have to visit a retail-based clinic or the local emergency room.

The after-hours clinic has also been a financial success. “Our business model suggested it might take up to three years to make a profit, but we knew it was worth it,” Dr. Sirota says. “We opened July 1, 2013, and have already begun profiting.”

The merger has also yielded at least one unexpected financial benefit. PediaTrust’s central billing operation, comprised of the most talented staff from each of the seven practices, has since become its own company, having taken on two clients in the past year.

“Where else is it possible to bring in revenue without seeing patients?” Dr. Sirota says. While merging practices may seem counterintuitive to some independent-minded physicians, the group-without-walls model, if well-executed, can take independence to the next level, says Dr. Sirota.

“We like to say ‘we got bigger to stay small,’ to maintain our independence,” Dr. Sirota says.