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 the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.