Managing Your Practice. Answers to your questions about. . .

March 1, 2007

Increasing managed-care reimbursements

Q The income I receive from my practice has been declining, especially because my managed-care reimbursements have not increased in years. How can I increase those reimbursements?

A Handling the relationship with managed care is crucial to the success of any practice and requires a comprehensive approach that combines internal and external considerations. The fundamental concept is that you must maximize your value in the health-care marketplace, and then capitalize on that value.

TO MAXIMIZE YOUR VALUE in the health-care marketplace, you have to first evaluate your practice dispassionately, and that can be difficult. To a large extent, your practice's value is determined by your patients' perception of it-and, therefore, how desirable you are-and by its adherence to various more objective and measurable criteria of medical quality and fiscal prudence.

ON THE FISCAL SIDE, you need to be able to demonstrate to insurers that you are providing care of the highest quality in accordance with the soundest fiscal principles. Managed-care companies use various parameters and outcome analyses to assess practices; learn what are the criteria and procedures used by the insurers important to you, and perform your own internal assessment on that basis. For example:

Managed-care companies survive by minimizing expenditures, so you will be valuable to insurers if you show that you are keeping your patients healthy through prudent use of resources.

NEXT, LOOK OUTSIDE YOUR PRACTICE to your community, knowing that in dealing with insurers, you need to be as formidable as possible.

Should you decide to do the latter, obtain legal counsel to ensure that your plan will comply with applicable trade laws. Either way, make sure that whomever you join forces with is as committed to quality and efficiency as you are.

ONCE YOU'VE TAKEN ADVANTAGE of any strategies to maximize the value and market potency of your practice, you can approach the insurers themselves to take action on your reimbursements. Be systematic about this: