When the practice looks at network offers, there are a number of alternatives to consider. Some take pretty much any contract they are offered that meets their requirement for payment. Others are more selective, limiting the number of networks they join, with the intent of concentrating their business with those who pay more quickly and have fewer rejected claims and an acceptable payment level.
Explore This IssueFebruary 2016
Practices need to base these decisions on the needs of their specific area. If there are more otolaryngology practices, a practice may have less bargaining power than if there are only one or two. The same goes for the insurance market, where your options may be limited if there is one large employer controlling healthcare dollars through its health plan.
Mergers, ACOs as Options
Depending on the financial balance of power in a given area, another response for smaller practices may be to merge with others or be bought out by a hospital or multispecialty group. “If you can become the dominant practice in a market, and one that patients overwhelmingly want to go to, you certainly will have more negotiating power,” said Watson.
ACOs can also impact your ability to win referrals. This model groups together physicians across specialties that share financial and medical responsibilities. It is hoped that coordination of care will lower costs and maintain a high quality of care. As in narrow networks, patients are largely referred to group-affiliated physicians.
“Otolaryngology is not a big slice of the healthcare pie, so there isn’t a significant financial incentive to invite our specialty to join,” said Watson. “We belong to an integrated network similar to an ACO, but we are just the ENT group they work with. There are no requirements for us to meet, and we aren’t tied to any of the ACO’s contracts.”
Yet, the impact on otolaryngology practices is not yet well established. “Perhaps the biggest problem we are facing is that none of these models have coalesced yet, and even those that are organized don’t have a lot of history,” said Watson. “This means we don’t have a very good handle on most of the implications of these changes.”
Kurt Ullman is a freelance medical writer based in Indiana.