These days, small practices face a daunting trend. “They’re getting less money for what they’re doing and the administrative burden is costing more than it ever has,” says Jerry Callahan, a partner at the CPA firm of Kassouf & Co. in Birmingham.

Behind the clinical side of every practice, physicians run a business that includes coding, billing, collections, tech support, hiring, leases, equipment care, and contracting with payers, like Blue Cross Blue Shield. “They didn’t go to school for all that,” says Gerry Kassouf, partner at Kassouf & Co. Throw on top of that all the new electronic health record equipment, software and data handling demands, and Kassouf says, “The economic benefit no longer outweighs that burden.”

So practices, especially smaller ones, are selling out to hospitals or joining up with other practices. A 2013 survey by Jackson Healthcare on practice acquisition trends found nearly half of 118 hospitals surveyed were buying practices. And most of the acquisitions were initiated by the practice.

Kassouf says small practices do have another choice. Instead of selling or merging, they can hire an all-in-one practice management firm. This allows the physicians to retain all of the control they relish “without having to ride quarterback on all the administrative pieces or coordinate with all the vendors,” Callahan says.

“They don’t have to sign checks, approve vendor invoices, or know how much money is in the bank to meet payroll service,” continues Callahan. No more overseeing an office bookkeeper or a separate billing office for collections either. These comprehensive management companies even handle leasing and maintenance of the office space, hiring personnel, and all the IT needs.

The all-in-one approach can make a remarkable difference. Last year, Kassouf’s group saved a local practice around $300,000. “That’s more the exception than the rule, but depending on how large your practice is, the potential for really large savings is out there,” Callahan says.

One area Kassouf’s group has found to be rife with overlooked revenue is credentialing. “The bills are being sent to the payer, but the practice receives no payment because they’ve not signed up with the payer. So the practice writes that money off,” Kassouf says.

For each physician, a practice may need to get credentialed with 20 to 25 payers. “It’s not just filling out paperwork for Blue Cross or Medicare,” Callahan says. “There’s an arm’s length-long payer list inside each of the major payers. Medicare has plans inside its plan.”

An area for savings under the comprehensive practice management model that makes mergers so appealing lies in combined purchasing power. Currently Kassouf’s healthcare team manages 21 practices. “Because we’re serving as the inventory managers for many practices, we can see how the pricing for supplies to practices compares to one another. If we see one out of line, we can come back to that vendor to get those prices back in line with what others are paying,” Callahan says.

The collective power of getting more for your money applies to staffing as well. With the management of many practices under one roof, a comprehensive practice management firm can hire more qualified expertise than a small practice could afford. “So you get a much higher level of management while only paying for a fraction of it,” Callahan says.

Workflow also never wavers in any administrative area. Practices may have one or two coders on staff. That means a sick coding specialist can directly impact a practice’s revenue cycle. Not so when under the care of an all-in-one management firm. “There’s enough staff that if someone goes down with something unexpected, there’s no loss of flow of billing or work,” Kassouf says.

One practice Kassouf now manages said they had to replace their billing manager three times in one year. “You don’t really know the competence of your employees in those functions until you’ve hired them,” Callahan says. “But we’ve already vetted our staff and have processes and controls in place, so if performance is not being met, we know it.” And practices never feel the bump of staff turnover.

With HIPAA violations setting off audits by the Office for Civil Rights, and Medicare contractors scrutinizing coding and billing with new intensity, practices are undertaking more and more detailed administrative duties. “These are things that physicians did not have to deal with historically and have no infrastructure for dealing with if they occur. Likewise, there is no arrangement in place to prevent them from occurring,” Callahan says.

But the solution does not have to mean selling out. “With our model, physicians maintain the ownership in their practice,” Kassouf says. Also unlike selling to a hospital or joining with another practice, the decision to hire a comprehensive management firm can be reversed. “And since we know they can change their management company any time they want, we know we have to do the job at the peak of perfection.”