In July of 1994 I wrote an article for Sacramento Medicine entitled " Survival in Private Practice." This was basically the beginning of a new approach in the practice of medicine. The name of the organization in the article was called Quality Practice Alliance. The word Traditional has been substituted for Quality in order to project an image of the medical practice style involved. It was hoped that the Traditional Practice Alliance (TPA) would stem the erosion of private practice in Sacramento.

As TPA became formalized, our two primary goals were to preserve both quality medicine and independent private practice. The structure that allows us to achieve this, is that of a nonprofit medical care foundation. It is staffed only by volunteers, thus keeping our overhead negligible. In essence we are an independent, physician driven, professional standards review organization. There is no fiduciary control over the individual offices.

With such a simplistic structure, the makeup of the provider panel became critical. We did not wish to be percieved as an "Old Boys' Club", or as those fools who did not move fast enough to get the lucrative HMO contracts. Thus our version of a provider profile was formed.

Our members must be board certified and have a good malpractice and utilization history. They must believe in hands on medicine, where direct patient care is their primary concern. Members must be engaged in the private and independent practice of medicine, not subject to the direction or control of any other persons or entity. Finally, our members must be committed to reasonable cost containment.

It should be apparent from the tone of this article, that TPA does not believe that a physician can service both private pay patients and capitated HMO contracts. The two practice types cannot be melded. Each of us must choose the form that fits our goals. TPA can be a vehicle to help providers wishing to limit their exposure to discounted HMOs.

The manner in which this is accomplished is through networking. The physician panel works in several ways. It provides us with an established referral system and a built in patient base. With every new qualified physician, we all increase our penetration into the market. Because these referrals are from independent offices, they are rich in PPOs and indemnity plans.

Another way we are expanding is through joint marketing efforts with insurance plans that believe in our practice tenets. This will provide our patients with alternatives to discount HMOs. If we are to preserve our patient base, we must aid people in their insurance choices.

TPA has endorsed LifeGuard Insurance as an affordable, not-for-profit carrier that truly believes in quality patient care. They are consistently rated among the highest of California's thirty HMOs. LifeGuard is committed to preserving the patient- physician relationship and a modified fee- for-service reimbursement schedule.

The principle of networking is being applied to other areas as well. All aspects of medical practice have been impacted by discount HMOs. By selecting and interacting with only quality organizations, we will help preserve some of the original infrastructure that has made our medical system the best in the world. Not everything should be driven down to the lowest common denominator because of the bidding practices of some for-profit- HMOs.

If one doubts that an organization could grow merely through networking, peer review and internal marketing, they need only look at TPA. Since mid-1994 we have grown from seven board members to forty-two providers. We have helped remove some of the frustration our patients have experienced in finding independent practices. We have had a positive financial impact on several offices. We have networked with other organizations (such as LifeGuard, Unilab and the Independent Mental Health Practice Alliance) to service and preserve our patient base.

Currently, in Sacramento there is a paradigm shift away from IPAs towards other integrated systems. The IPAs of the past add too much cost to be tolerated in a maturing market place. TPA adds no cost while providing many of the same functions. However, one of the main differences is that we aid physicians in preserving their independence and standards of medical care.