Managed Care Contract Negotiations
Aug 07

Consider these four factors in negotiating talks

Case mix index: This metric takes into account how sick patients are when they come in to your physician office and it can have a dramatic effect on your costs. The cost to treat those patients is higher, so you need to make sure your contracts effectively address this higher level of costs.

Quality: I’ve preached this for years – this is your most important form of leverage with managed care payers. Why are you getting paid the same as your high cost driven competitors? Positive clinical outcomes are extremely important and are becoming more so. Also remember that many consumers are demanding that positive quality measures be available to help select their healthcare providers.

Complexity of services offered: Do you offer complex services not typically offered by your competitors?

Number of adult and pediatric subspecialists: Treating the sickest of the sick deserves higher reimbursement in my opinion.

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →