Deal of a lifetime came from cooperation with MCO
Deal of a lifetime came from cooperation with MCO
Why can't we be friends?
Who says managed care contract negotiation has to be about white knuckles and poker faces?
Kathy Hutcherson just signed the best managed care contract she's ever landed in her stint as managed care director of The Hughston Clinic, a Columbus, GA-based orthopedic practice with 45 physicians in 20 locations. What's impressive about Hutcherson's story is not only her results, which include the right to charge MCOs full price rather than a negotiated discount for any service not paid within 30 days. It's also the way she achieved them.
The old adage, "you'll catch more flies with honey than vinegar," could be applied to the Hughston Clinic. The group is signing longer-term contracts - three to five years is becoming the norm - and approaching discussions with payers as opportunities for partnerships, rather than as adversarial across-the-table negotiations to be dreaded.
"I've noticed that insurers are starting to want to work with physicians, and vice versa. Com mu nication lines are becoming a little bit better," explains Hutcherson. "I've taken more of a partnership approach for the last six months, and I've been surprised at how it has opened up negotiations."
Here is a rundown of Hughston Clinic's approach to managed care relationships:
A managed care contract committee meets monthly to evaluate existing and potential relationships with MCOs. The committee includes Hutcherson, coders, billing analysts, and three physicians from the practice, all of whom have one vote.Committee meetings are open to all staff physicians. "It really takes a team approach. Physicians are best at treating patients, while coders bring in a different perspective based on their experience," Hutcherson says.
Hutcherson acts as primary negotiator on managed care contracts, with occasional help from a consultant as needed. Before she makes a final decision on a contract, she presents the contract committee with a summary of the proposed contract, using a standard form listing acceptable criteria as a guideline. "If something strikes a physician's interest, he'll flag it and we'll discuss it," Hutcherson says.
Although each payer relationship is different, there are common points Hutcherson tries to look for, including:
· Look out for "silent PPOs." If Hughston Clinic contracts with a company, the clinic requires the payer to disclose a list of any affiliated companies that would be involved in the contract, such as a third-party administrator. "It's like a treasure map. You have to go through the jungles and look for rocks," she explains.
· Request copies of the payer's marketing materials. Look for promises the company makes to their clients regarding medical care and access. If your practice does not meet these standards - for example, the ability for patients to see a physician within 48 hours of calling you - your practice, not the insurer, will be held accountable for poor service in patients' eyes.
· Know how to access the network.
· Try to understand the payer's point of view. Hughston Clinic offered to put its employees through a training session held by an MCO executive to help clinic staff members understand the payer's standards for customer service excellence.
· Don't be afraid to tout your practice's strengths. Hughston Clinic touts its quality of care through statistics that show hospital length of stay and outcomes for procedures the practice performs frequently. Another selling point is to show studies from the clinic's research center as proof that the group constantly looks for ways to improve outcomes and save money.
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