I completely disagree.. I think the smaller billing companies will be the last men standing. I have a very strong instinct that EHR and cloud computing or both will suffer a big failure down the road putting the larger companies in a quandary. I think with the way this business changes doctors want to pick up the phone and get an answer, advice and education w/out having to wonder who's picking up the phone and to what country they are in.
I believe the next decade is the decade of the small business. Digital marketing.. Pfff.. I can't remember the last time I even sent out a brochure. I get better responses and like GOING to the doctors, educating them, meeting their staff and personalizing my services. I leave digital marketing to the HP's of the world. I never want to be so big that I can't pick up my phone for a client every time they call. That was my goal starting out and that has never changed.
I'm in middle of finding another accounting firm because mine just joined a huge conglomerate, I want to talk to ONE person. I want to know MY best interests are on his mind and I don't want to have to provide an account number to someone on the phone to "look me up". I have enough of that with utility companies, mortgage companies, etc.
Decade of the small business
I wouldn't trade with the kareo's of the world. I really wouldn't. I believe in quantity and value of the client not volume. I've seen billing companies once they get big begin to drown, the medium fish sinks or swims.