Eight ways the physicians can increase their pay
• Get educated: Find out the basis for your MCO’s physician payment policies. Speak to the plan administrator with prepared questions regarding the contract, its provisions for ensuring an equitable fee schedule, and how the group can forge better rates.
• Network: Identify the physician leaders within the organization and work with them to evaluate existing payment levels and to set more equitable terms.
• Take a global or case rate: But also try to operate more efficiently as a clinician without sacrificing your high standards of patient-care quality and effectiveness. Be prepared to balance standards of cost and caring.
• Be flexible and creative: When negotiating case rates or global fees, develop bundled fees that include routine services but that won’t put you in the poor house. For example, bundle your lab work in one fixed fee but leave yourself enough room for some profit. That may take flexible, creative accounting.
• Anticipate profiling: It’s how payers will set rates. Do your own profiling and negotiate from an informed position of strength.
• Insist on extra dollars: Carveouts and risk corridors that set volume thresholds on expensive procedures have been touted for years. But they work. Check with your accounting department and determine where to draw the line before you ask the payer or medical group for more money.
• Know your case mix: About 15% of emergency department revenues come for full-pay sources such as automobile casualty and homeowners’ insurance claims. Medicare fee-for-services cases also pay better than managed care. Be aware of these patient volumes when calculating your optimum payments. They’ll help offset the effects of heavy discounts and shortfalls from outliers when renegotiating your other contracts.
• Understand your vulnerabilities: Determine your hospital’s level of uncompensated care, including shortfall from Medicaid and charity cases. They’ll help you to determine how bad your hit is from low commercial payers. You’ll also know whether you’re wasting your time working at that hospital or medical group.
Source: These suggestions were offered by the sources quoted in this issue’s cover story.
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