Strategy Surprise Medical Bills

The Problem Is the Cure

June 29, 2020

Many medical group leaders come to me for help when they’ve got a “problem” and they’re looking for a solution.

Oftentimes, they think that the solution lies outside of the problem.

But I want you to think about things a different way: Most problems, maybe even all problems, are themselves the kernel of the solution.

Let’s take an example. Currently, many medical group leaders are looking for the cure for the “cure” for surprise medical billing. It’s a big issue for many hospital-based physician group clients.

They’re facing threats of being thrown out-of-network and relegated to new out-of-network payment schemes. Those schemes are, in essence, cram-down rules imposed by the bureaucratic “cures” for surprise medical billing.

They’re also being forced to feel the pressure of reduced “offers” of reimbursement from those payors still willing to contract. The implied, and sometimes vociferously stated, threat is that unless the group agrees to work for peanuts, their only other choice is to work out-of-network pursuant to a sham payment methodology in which they’ll be paid in metaphorical peanut shells.

It’s win-win for the payors. Higher reimbursed groups are either pressured to work for less or are tossed out-of-network. And, by reducing their average in-network rates, they’ll eventually lower what they are forced to pay the groups pushed out-of-network under the arbitration system mandated by surprise medical billing statutes or regulations.

Faced with those problems, many medical group leaders seek to know how to deal with that arbitration system.

But query whether the problem isn’t something different. Instead of seeing it as in-network versus out-of-network, perhaps the problem is the lack of control over patients and the ultimate means of funding patient care. With that mindset, perhaps there are other ways (there are!) to bypass carriers, or to turn the legislation and regulations inside out to make what was a problem for physicians, a problem for payors.

Think about problems a different way. Think about solutions from other industries to similar problems and how they’ve played out. Think about whether you want to “game the system.”

There are ways to accomplish far more than you think. But that means you’ve got to look at things differently and invest in yourself by obtaining help.

If you’re not willing to do those things, consider shutting down your business, it might be cheaper.

If you are willing to do those things, get in touch now.

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

www.weisspc.com

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