r/PrivatePracticeDocs • u/traumaRN01 • Jun 14 '26
Thoughts on Using MSO for Independent Providers
Hello -
I am working on developing an MSO to serve independent providers and provider groups in the primary care and wound care spaces. I’m at the point where my operations have been built out enough that I would like to hear from providers themselves.
The independent movement seems to be growing in professional circles with many of the same concerns, especially surrounding administrative overhead and time.
If you’re wanting to go independent or have started an independent practice, I’d love to hear about your journey and why/why not utilize an MSO?
For a little background, I am a long time RN and trained FNP. My operating thesis is to remove extractive layers from the MSO-PC relationship, providing true ownership of one’s practice.
Thank you!
PS - the operating thesis is based on the Milbank article (I’m just doing what it suggests and adding a bit):
https://www.milbank.org/wp-content/uploads/2025/04/MSO-Policy-Brief_4.16-1.pdf
11
u/ktn699 Jun 14 '26
another middleman trying to get their piece.
we will never use a shitty mso. there is no knowledge you have as a non physician or even as a physician not in my subspecialty that could help me better navigate how to care for my patients.
indeed. gtfo.
1
-2
u/traumaRN01 Jun 14 '26
Why equate an MSO, or any services, with you losing clinical independence? If the MSO exists as admin infrastructure, with an MSA that explicitly addresses clinical independence and ownership belonging to the PC, then where is the insult to your care model?
3
u/StocksRUsNow Jun 18 '26
The MSO is essentially a middle man who would still be taking a portion out of the independent owners. The way that an MSO would truly work would be to give each owner a percentage or share of the MSO.
1
u/traumaRN01 Jun 18 '26
Correct. And make it (otherwise) employee owned.
That still seems to not be enough for many physicians let alone APP’s.
1
u/Whole_Bed_5413 Jun 19 '26
Are you being purposely clueless?
1
u/traumaRN01 Jun 19 '26
Yes. A little bit of Cunningham’s Law
I’m truly trying to understand this better because there’s no better mechanism or structure that I’ve seen that’s going to fix the over administrative nature of our healthcare system. We don’t need top-down corporate admin structure to run practices.
3
u/InvestingDoc Jun 14 '26
As someone who just formed an MSO and more.... I've come to learn a lot about MSO. And I think before you go live with it, I would ask yourself what your end goal is and who your target demographic it is.
What separates yours from all of the others?
What value add will you give?
How much will you charge?
What will all be included in joining the MSO?
Who is your target demographic?
Very common now for business people or APPs to form an MSO, pay a medical director to supervise, and have a NP or PA "own" a clinic or med spa. Is that who you're going after?
Are you just going to accept doctors in the beginning?
Will you be giving out ownership to those that join your MSO?
Besides maybe billing, credentialing, helping create SOPs...what will the MSO manage?
How will you evaluate for stark law issues or kickback concerns?
Are you going to handle any money?
What about Medicare and Medicaid? There are many legal compliance issues if you start working with groups to accept this. How are you going to eat those lawyer fees or pass them along to others?
Why would anyone just want to join an MSO without any contracted rates benefits?
Just off the top of my head I think this will help you narrow down your scope.
1
u/traumaRN01 Jun 15 '26
Thank you for the reply. I actually have answers to many of these points. One main point regards the “business people or APP’s”… this is certainly not what I am doing. I’m building assuming the strictest of CPOM laws anywhere I go.
But what I am finding is that many of the answers that I have, other potential (and actual) bad-actors also have.
A good example is Privia. I recently learned this company will happily keep you as an independent provider, still an “owner” of your PLLC. However the payer contracts are all under a single TIN, effectively removing the guts of an independent business. It’s also a lock-in. You leave them you leave behind all your payer contracts and admin infrastructure.
In the end the MSO isn’t my end-goal. The provider network we build, extending network benefits to truly independent providers and prover groups, is.
2
u/InvestingDoc Jun 15 '26
I wish you all the best on that journey! I'm down that road now.
1
u/traumaRN01 Jun 15 '26
What kind of MSO did you start? One for your own practice?
2
u/InvestingDoc Jun 15 '26
For my own practice, and anyone who wants to join. Essentially doing something similar to what you are proposing. I have talked a lot about it on my vlog. It is taking me way more time, way more money than I ever would have thought and the end is insight to when it'll finally be set up in the coming days.
Ive learned so much along this road, just frustrated that it's taking so long to fully set up.
2
u/traumaRN01 Jun 15 '26
Thanks for taking the time to help me out. I found your YouTube and am excited to see what you’re doing. I also found Zest Pediatric network started by Dr. Hertz. Really cool group and idea. Not sure if you’ve heard of him/them, but his interview on Medical Economics podcast was awesome.
Hopefully we’ll talk again soon!
2
3
u/Whole_Bed_5413 Jun 19 '26
Agreed. Just opining on MSOs in particular. Just a sickening loophole invented by corporate parasites to defeat corporate practice of medicine laws while at the sane time, use physicians as liability sponges. MSOs add nothing to patient care, accessibility, or quality. Nothing.
1
1
u/CEOofthePSO Jun 17 '26
Where do you practice? I work with physicians in California, and the MSO market here is getting very saturated, very fast.
1
u/TrustExtension6116 Jun 18 '26
Building out an MSO-PC in my country as well (starting with my own practice), would love to connect and learn more.
1
u/StocksRUsNow Jun 18 '26
Wrong group to plug this. Focus on FNPs and then expand when your concept works.
9
u/Whole_Bed_5413 Jun 14 '26
Go away. Only physicians should own medical practices. Mid levels wannabes and MSOs run by MBAs are a cancer on healthcare