“TMA has done a great job over the years of encouraging physicians to learn more about the business side of their practices.”
managers, “TMA has done a great job over the years of encouraging physi- cians to learn more about the business side of their practices. They are really understanding the dynamics of what makes a practice successful and rec- ognizing, even small groups, that they have leverage if they use that to their advantage for the purpose of negotiat- ing,” Mr. Reiner said. Many doctors, he says, “will hear ‘no’ and walk away. But I’ve learned over the past 15 years, ‘no’ never means no. ‘No’ means maybe. It just depends how persistent you are.” Austin attorney Michael Stern
agrees the trend is likely due, in part, to physicians’ business savoir-faire, as well as other market forces pushing both parties to the brink. The man- aged care contract expert offers dis- counted services to TMA members. For more information, visit www.tex
med.org/NegotiationHelp. “Rates are sometimes so low that doctors may be feeling the pinch to either negotiate up or not take the contract. And it may be managed care companies are feeling the pinch, too, because doctors are opting out of not just Medicare and Medicaid, but man- aged care, when they realize some of these payers and contracts are not worth dealing with,” he said. TMA data show 20 percent of phy-
sicians terminated their health plan contracts over the past two years, most commonly because of payment problems like rate cuts and inade- quate payments.
WORKING JUST TO GET A CONTRACT TMA Council on Legislation Chair Ray Callas, MD, suspects with the advent of the Affordable Care Act, health plans may be feeling pressure after coming under increasing fire for shrinking their networks to in- adequate levels to save on costs. The Beaumont anesthesiologist is among those hospital-based, or indirect-ac- cess, physicians TMA’s survey found were most likely to attempt to nego- tiate health plan contract terms, com- pared with other specialties.
44 TEXAS MEDICINE March 2017
It took Dr. Callas two years of un- answered phone calls to get in net- work with one of Texas’ major payers. “I finally got a bur in my saddle be-
cause we don’t like having to collect money from our patients when we are out of network, and [health plans’] maximum allowable rates (how much of patients’ costs insurers decide to cover) are so low,” he said. “Health plans are never going to throw out their best offer first, so we kept say- ing, ‘No, no, and hell no.’ It takes a lot of time and commitment and rigor. But that’s what our patients deserve and what’s needed to hold insurance companies accountable so access is not compromised. We have to be per- sistent for our patients.”
EVERYBODY HAS LEVERAGE
Physicians and legal experts dispel the myth that size matters, saying every practice, large or small, has something to leverage. The key, says Dr. Curran, is doctors knowing their practices and local markets. Physicians must be knowledgeable, for instance, about what it costs to run their practices and make ends meet, data Dr. Curran took with him straight to the negotiating table. (See “Contract Negotiation Help From TMA,” opposite page.) “If you are genuine with insur-
ance companies about why a particu- lar payment won’t work, why it isn’t fair, and what you can live on, they are much more receptive to that. You can’t negotiate from a position of just saying, ‘I want to be paid more,’” he said.
Dr. Curran also took advantage of
the fact that his practice is in a small community where insurers do not have a lot of primary care options, adding that big systems don’t always win out.
“Insurance companies are sensi-
tive to the fact that if you are part of a large system, they are probably not going to be doing much negotiation without the system participating. And they are not real fond of all-or-none or our-way-or-the-highway scenari-
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