Author: Scott E. Fleming

Reading Time: 3 minutesYour last payer contract renewal went the same way every renewal goes. Someone on the payer’s side ran the numbers on your specialty across their entire network, calculated what the average provider in that pool costs them, and set a rate accordingly.

Reading Time: 3 minutesImagine seeing ten patients today instead of twenty-two. And having more time per patient. And making more profit. Then at 4pm, having an hour to call all ten, six minutes each, to ask how they are doing. It isn’t a fairy tale.

Reading Time: 4 minutesThe responses most practices use when revenue falls short are not wrong.
They are correct inside a model that does not include the variable causing the problem.

Reading Time: 4 minutesYour income statement shows what you collected. It does not show what collections cost you, what you were prevented from collecting, or what you would have collected if the price had been set by a market instead of by a contract.

Reading Time: 3 minutesEvery game has rules. Medical reimbursement is no different. If you accept insurance, you need to know who wrote yours. Because what separates a fair game from a rigged one is who writes the rules.

Reading Time: 3 minutesThe insurance companies hired the experts. Did the math. Built the models. And discovered they could take from you, take from your patients, reduce economic welfare, and pocket the arbitrage of the deadweight loss they created.