Economics BY AMY LYNN SORREL


If at first you don’t succeed …


PASSION AND PERSISTENCE PAY OFF FOR PHYSICIANS AT THE NEGOTIATING TABLE


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ike many physicians, Doug Curran, MD, assumed for many years the contracts health plans slid across the proverbial negotiating table were take-it-or-leave-it offers. It’s no wonder when managed care represen-


tatives’ typical responses to any physician pushback are an automatic “No, we can’t make any changes” or “This is our standard contract.” But when the payment offers pitched to the Athens family physician and


chair of the Texas Medical Association Board of Trustees kept sinking to levels that would barely keep his practice afloat, he decided he wouldn’t take “no” for an answer. “As they ratcheted down our payment, we came back pretty quickly saying,


‘If you want us to continue to work with you, you need to work with us, and we need adequate payment for our services,’” Dr. Curran said. Having gotten to know his plan representatives over the years, he tenacious-


ly called until he climbed up the chain of command to get the right dealmak- ers back to the table, where Dr. Curran stood his ground, and actually gained ground, after getting insurers to hear his side of the story. “Doctors tend to give up because they feel alone in the deal, or they got


turned down a few times and can’t make it happen. And we are busy seeing pa- tients, putting out fires, and looking over our shoulder, so who wants to spend time negotiating?” he asked. “We just want to take care of our patients. But we forget that if we want to take care of our patients, we have to be sure that we can. And the more proactive you are, the less likely you are to get into a take-it- or-leave-it situation.” New TMA data show physicians’ passion and persistence are paying off as


they attempt to negotiate the terms of their health plan contracts. And when they do, physicians often are successful at getting some of the changes they ask for, according to TMA’s 2016 Survey of Texas Physicians. (See “At the Negotiat- ing Table,” page 46.) This is the first of TMA’s biennial surveys to delve into physician negotiation


success rates with each of the five major health plans in Texas. Read the full results at www.texmed.org/surveys. The research shows over the past two years a majority of Texas doctors, 52


percent, attempted to hammer out payment and other contract terms with the plans. On average, about 40 percent of those physicians were successful in their negotiations. For the most part, those physicians who shied away from dealmaking did


so because they assumed their contracts were nonnegotiable, or they had been unsuccessful in the past. Former TMA payer relations expert Bradley Reiner says over the past de-


cade or so, insurers have become slightly less reluctant to make changes. More importantly, physicians are getting more business savvy. His firm specializes in payment and practice management issues. From contracting, billing, and coding to hiring the right consultants and office


March 2017 TEXAS MEDICINE 43


“The more proactive you are, the less likely you are to get into a take- it-or-leave-it situation.”


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