Lancaster Physician Winter 2020 - 19

WINTER 2020

will address such interactions. Engage legal
counsel to ensure a sound contracting strategy.
Remember that good tactics rarely compensate
for an unsound strategy.
It is possible that terms and conditions other
than a straightforward demand for more money
may be a better overall outcome. Concepts such
as how payment is made; reduction in required
prior authorizations or denials; lack of financial
offsets; or other administrative pain points can
also add value to the medical practice.
* Acquiring the relevant operational, cost,
productivity, and plan reimbursement data
and comparing it to available external or
historical data
Run the numbers and compare the payer's
historical, contracted, and actual payments to
your costs and volume.
* Identifying one or more plan providers to
contact-and when to contact them

* Developing your value equation or proposition
Model your position(s), developing zones of
acceptability. Develop outcomes data, proven
patient satisfaction, and reduced ECU visits.
* K n o w i n g y o u r B AT N A ( b e s t
alternative to a negotiated agreement) and walkaway positions
Identify scenarios for compromise, determine
deal-killers, and be aware of counteroffer
opportunities. It is unwise to keep a contract
with a vendor that pays you below costs or
whose administrative burden is too costly to
justify the continued relationship.
* Initiating the contract notice to negotiate
* Agreeing on a schedule and sticking to it
Physicians must be heavily engaged at this
point, and they should resist the temptation
to set deadlines.

The new environment for private practice physicians is fraught with increasing complexity in
payment systems. It includes the proliferation
of value-based models that require size, money,
and sophistication. Challenges also come via
the increasing cost and complexity of health
care IT infrastructure and health insurers with
market dominance or state laws on their side.
Only by employing skilled managers, having
astute legal counsel, and approaching each
payer with a sound strategy, refined data, and
effective tactics will the physician stand a chance
of success negotiating with a payer.
Change is the one constant in the delivery of
health care. Decide if you believe it is time to
question your assumptions and models and to
dispense with traditional notions concerning
the relationships between payers and physicians.
In a future article, I will focus on optimizing
the revenue cycle, patient (and employee)
engagement, and more details on negotiating.

Solutions for Physicians'
Legal & Consulting Needs
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Full-service law firm providing risk solution strategies
Support for transitions/retirement/office closure
Personal counsel during litigation
Conduct practice sales and purchases
Review and draft shareholder agreements or disputes
Counsel on asset protection
Provide reimbursement enhancement tools
Conduct human resources audits of practices,
procedures and policies
Employee training on human resources issues

To learn more, contact Brandon R. Conrad, Esq.
at (717) 556-1008 or brc@saxtonstump.com
A DIFFERENT APPROACH | saxtonstump.com

L A N C A S T E R | H A R R I S B U R G | M A LV E R N

LANCASTER

PHYSICIAN

http://www.saxtonstump.com

Lancaster Physician Winter 2020

Table of Contents for the Digital Edition of Lancaster Physician Winter 2020