AT THE NEGOTIATING TABLE
Fewer physicians are taking “no” for an answer when it comes to negotiating health plan contracts with the five major payers in Texas.*
Health Plan Contract
100% 90% 80% 70% 60% 50% 40% 30% 20% 10%
Negotiation A majority of practices attempt to negotiate contract terms.
52% 36% 13% Yes No No contracts
100% 90% 80% 70% 60% 50% 40% 30% 20% 10%
Physician Role in
Contract Negotiations But physicians themselves aren’t always involved in the process.
52% 20% 12% Primary decisionmaker
One of a group of decision- makers
12%
Aware and might give input but do not par- ticipate in process
40%
100% Aetna 90%
80% 70% 60% 50% 40% 30% 20% 10%
37% 23% No changes 26% 13%
Payment and term changes
100% Cigna 90%
80% 70% 60% 50% 40% 30% 20% 10%
Contract term
changes
Payment changes
32% 23% 15% No changes
Payment and term changes
Contract term
changes
100% UnitedHealthcare 90%
80% 70% 60% 50%
40% 30% 20% 10%
33% 29% 10% No changes
Payment and term changes
Contract term
changes
Payment changes
29%
Source: Texas Medical Association 2016 Survey of Texas Physicians,
www.texmed.org/surveys
46 TEXAS MEDICINE March 2017
*Numbers may not add up to 100 percent due to rounding.
Payment changes
31% Not involved
Other 4%
•
• •
Prepare to speak about market is- sues affecting the practice;
Know their competitors’ offerings;
Make note of Medicare’s fee sched- ule for common services and pro- cedures performed in the practice; and
• Be reasonable — not excessive — with requests, and be willing to compromise.
Success in Negotiation
Contract Changes Of those who attempted negotiations, 40% on average reported some success in getting changes, mostly on payments.
100% 90% 80% 70% 60% 50% 40% 30% 20% 10%
Blue Cross and Blue Shield of Texas
DO’S AND DON’TS Physicians need to know what — and what not — to ask for, adds Mr. Stern. Payment is usually at the top of physicians’ list. “But payment is actu- ally the easiest thing because it’s just dollars and cents, and nobody puts out their best offer fi rst. So you can usually assume when managed care companies throw out their initial fee schedule, there’s room to maneuver,” he said. Dr. Callas also worked with his at-
torney to make sure payment terms are not set in stone for perpetuity when practice costs are constantly evolving. Instead, he negotiated in- cremental increases every so often. But physicians’ due diligence
37% 27% No changes 26% 10%
Payment and term changes
100% Humana 90%
80% 70% 60% 50% 40% 30% 20% 10%
Contract term
changes
Payment changes
should not stop at payment. As far as other legal terms go, Mr. Stern gives practices a full written analysis of the contract to review and to identify what they consider to be the most sig- nifi cant changes they desire. He cautions, for instance, against
39% 23% 13% No changes
Payment and term changes
Contract term
changes
Payment changes
25%
asking for modifi cations that would affect what he described as managed care companies’ daily business prac- tices. Examples might be terms that would require a plan to alter its soft- ware programs, such as requesting 90 days to submit bills when a program is hardwired for 30 days. On the other hand, legal provi-
sions for liability, arbitration, termi- nation, or noncompliance penalties are usually open for negotiation, and Mr. Stern strongly recommends phy- sicians pay close attention to those terms in a contract. He points to egregious provisions, for instance, that could require a doc-
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