Providing high quality care at the lowest cost is a tough double play for doctors to turn.

Yet a small Twin Cities practice is getting national notice for the feat, even while going up against competitors with, well, bigger payrolls.

A Stanford Medicine think tank recently examined 15,000 primary care groups across the country, stripping away clinics that didn't finish in the top 25 percent for quality, and also in the top 25 percent for low cost.

About 750 were left. Researchers with the Peterson Center on Healthcare then looked for the best of the best and came up with 11 "most valuable" groups.

One was Northwest Family Physicians, a primary care group in Crystal, Plymouth and Rogers.

Defying stereotypes that only large groups can provide affordable care in modern medicine, the 16-doctor practice made the cut for a variety of innovations, including "up-skilling" their doctors so they can provide procedures such as colonoscopies and allergy tests in-house.

"The cost is significantly lower than doing these things in a hospital," said Dr. James Welters, Northwest's president and chief medical officer.

Good fortune allowed the practice to stay independent. Others have found new requirements such as electronic medical records so expensive that they have had little choice but to merge or get bought out.

Northwest invested in e-records a decade ago, when the cost was more manageable. Now, e-records are integral to the clinic strategy of keeping patients caught up with care.

"A cold is never just a cold in our office," Welters said.

Not that Northwest is perfect. MN Community Measurement ranks Northwest highly for diabetes and depression care, but ho-hum for asthma management and cancer screenings. Welters said that is one limit of being small: the practice can't improve in all areas at once. But the recognition is still worth celebrating while his group keeps working at improvement.

"It's not just for us," he said. "It's for people like us — smaller, independent primary care clinics. Unfortunately, the health care system is stacked against us."