Marcia L. Brauchler, of the Littleton, Colo.-based healthcare consulting firm, Physicians Ally, isn't afraid to speak candidly about payers.
"[Payers] care about keeping money. All this stuff about ‘Triple Aim’ and patients, I don't see that," said Brauchler, who works as an advocate for practices who are renegotiating reimbursement rates with insurers. "I see that as an excuse to not give money to the providers of care who are bearing the burden and actually taking care of sick patients."
Brauchler outlined 10 payer obstacles during contract negotiations, to attendees at this year's Medical Group Management Association (MGMA) Annual Conference, held in San Francisco. At the top of her session, "Experiences with Payor Tactics in Contract Negotiation and Management," she warned attendees that payers have no interest in giving out rate increases and practices will have to win "a war of attrition" to get one.
Here are the 10 obstacles Brauchler presented:
Obstacle 1: "You can't find me."
Brauchler said payers make it hard to find a single contact person to negotiate a rate increase. Instead, they'll pawn the practice administrator off on 800 numbers and their website. One payer even forced employees to leave a scripted voicemail that encourages practices to call the 800 number, rather than call the contact back directly.
Solution: Log an official complaint with the insurer's complaints department, forcing them to take action in 30 days. Once you do obtain names, she also suggested creating a database of contacts at a particular payer.
Obstacle 2: "I can't hear you."
"Even if you get someone at the health plan, they're going to act like they have no idea what you are asking for or they're going to be totally worthless," said Brauchler. Many payer representatives will simply ignore the request, cancel meetings, and generally avoid the topic altogether.
Solution: Document everything. This proves to higher ups in the insurance company that you've been treated poorly and will force them to take action in your favor.
Obstacle 3: You have to beg the right way.
One excuse from payers to not give a rate increase is claiming the practice administrator "didn't ask for one the right way," Brauchler said. Even worse, they'll sometimes claim providers didn't ask altogether.
Solution: Documentation, again; keep emails, send mail certified, and transcribe voicemails. Also give them a deadline where they have to do something, such as attend a face-to-face meeting with physicians in your practice for the negotiation. "They'll usually avoid and cancel the meeting, but in doing so will give you what you want," advised Brauchler.
Obstacle 4: "I'm powerless to help you."
"I wish I could help you, but that's just the way it is," is a popular excuse from payers, according to Brauchler. They'll come up with flimsy excuses to not work with you to negotiate a rate increase. In one example, she said a payer used the Super Bowl being in town and shutting down streets as a reason they couldn't give the practice the new contract they wanted. Solution: Use Google. Brauchler said it allows you to find out information that can be used against the payer, such as how much the CEO of the insurance company makes.