The Network Effect
People handle adversity differently; some break down sooner than others. When a team focused on a common goal faces adverse conditions, dissent among some team members precludes them from reaching a shared goal. Under extreme conditions, a mutiny isn’t just mission-critical—it can leave everybody dead. The famous explorer Ernest Shackleton, best remembered for his Antarctic expedition of 1914–1916 in the ship Endurance, managed such risks by assigning the whiny, complaining crew members to sleep in his own tent and share the chores with him. Clustering the “complainers” with him minimized their negative influence on others, and this helped his team survive and accomplish their goals. Medicare Vs. Private Payers It’s essential to acknowledge the contrasting dynamics between Medicare and private payers. Medicare, as a government-backed program, follows distinct regulations and reimbursement structures, while private payers operate in a competitive market with more flexible terms. The negotiation strategies and considerations may differ significantly when dealing with these two payer types. Payment negotiations Actively negotiating with payers is crucial for independent medical practices. However, many providers lack experience or haven’t been successful in past negotiations due to inadequate preparation. To ensure a fruitful negotiation, it’s vital to: Know Your Data: Understand your practice-specific data, including patient volume, charges, reimbursement history, and more. Know the Terms of Each Contract: Familiarize yourself with your current payer-specific contract terms, especially the reimbursement schedule and the claims filing data. (Babcock, 2021) According to a KFF analysis, as seen in the image below, private insurers often pay nearly double the Medicare rates for hospital services. Specifically, for outpatient hospital services, private insurance rates were found to be significantly higher than Medicare rates, averaging 264% of the latter. This difference underscores the varying dynamics and market powers between Medicare and private insurers. Policymakers and analysts continue to debate the necessity of high payments from private payers to compensate for the lower Medicare payments. (How Much More Than Medicare Do Private Insurers Pay? A Review of the Literature | KFF, 2020) Classification of Payment Models Payment models dictate how healthcare providers, including physicians and hospitals, are remunerated for their services. Each model inherently carries incentives and disincentives that can influence the balance between cost reduction and improving care quality. These two objectives often stand at odds. This report delves into the implications of Alternative Payment Models (APMs) in either mitigating or intensifying health disparities. However, before exploring these implications, it’s essential to understand the incentives and disincentives embedded within the prevailing payment models. These incentives play a pivotal role in fostering cost-efficient, high-quality care. The primary distinction among these payment methods lies in the unit of payment. This determines how financial risk is distributed between the payer and the provider. The nature of this risk can significantly influence the behavior of healthcare providers and the overall efficiency and effectiveness of the healthcare system (Quinn, 2015). Factors affecting payment negotiations According to AMA, it’s not just about the rates but also about the terms and conditions that can impact payment. For instance, some contracts might have clauses that allow payers to change rates without notice, or they might have stringent requirements for prior authorizations. Providers should be wary of “most favored nation” clauses, which can restrict them from offering better rates to other payers. It’s also crucial to be aware of the dispute resolution process outlined in the contract, should any disagreements arise. By being well-prepared and understanding the intricacies of payer contracts, providers can position themselves for more favorable negotiations and better financial outcomes. (American Medical Association & American Medical Association, 2022) Payer-provider conflict In the payer-provider conflict, the providers who accept lower reimbursement and who don’t challenge underpayments or delayed payments make it easier for the payers to maintain their market control (oligopsony). Recent research supports this notion, indicating that payers with larger market shares have more negotiating power in contract negotiations (HealthPayer Intelligence). ClinicMind’s network helps providers maintain their payment schedules and motivation by establishing a shared discipline for clients and billers alike in terms of both thought and action. Payers with Larger Market Share and Their Negotiating Power Payers that have a dominant presence in the local market have a distinct advantage when it comes to negotiating lower prices for physician office visits. A study conducted by researchers from Harvard Medical School found that health insurance companies with a market share of 15% or more negotiated visit prices that were 21% lower than those set by payers with a market share of 5% or less. For instance, payers with less than 5% of the market negotiated prices of $88 per office visit. In contrast, those with 5 to 15% of the market share settled for a price of $72, and those with more than 15% of the market share negotiated even lower at $70 per visit. The graph below shows this analysis. From Policy Changes to Physician Consolidation In 2010, President Barack Obama signed the Affordable Care Act (ACA) into law, a move that expanded Medicare’s reach by adding millions to its coverage. This expansion meant that more physicians had to accept Medicare rates, which have been systematically reduced over time. The ACA not only aimed to extend healthcare access to uninsured Americans but also set in motion a wave of consolidation in healthcare services. As Medicare adjusted its rates, private insurance companies followed suit. While they still paid above Medicare rates, they too began to reduce their payouts. This trend forced physicians to grapple with a challenging reality: working more hours for less pay. The Power of the Network Effect In response to these financial pressures, physicians began to see the value in consolidating their practices. By joining larger organizations, they could harness the network effect, gaining more significant negotiating leverage with insurance companies. This consolidation is not just about survival; it’s about strength in numbers. Large groups, especially those with revenues exceeding $1 million annually, have more room to negotiate than smaller entities. The Rise of Management Service Organizations (MSO) Amidst these challenges,
Building Empires of Health
In the ever-evolving landscape of healthcare, few stories are as compelling as that of Dr. Jeff Danielson, a chiropractor, visionary entrepreneur, and the mastermind behind Big Fish Enterprises. In an exclusive podcast episode, Dr. Danielson shares the intricate details of his journey, offering listeners a glimpse into the unique blend of chiropractic expertise and business acumen that has propelled him to success. The Genesis of a Visionary: Dr. Jeff Danielson’s story begins in Minneapolis, Minnesota, where he not only thrived as a chiropractor but also cultivated a keen entrepreneurial spirit. It was during his interactions with students at a chiropractic school that he recognized a recurring pattern: young, talented chiropractors eager to make a difference, but often left unsupported after a brief stint in his practice. This realization led to the birth of an innovative coaching program. “Pay It Forward” Philosophy: The heart of Dr. Danielson’s coaching philosophy lies in the concept of “Pay It Forward.” He sought to break the cycle of talented chiropractors leaving after gaining experience and knowledge. Instead, he envisioned a system where associates would be mentored, trained, and ultimately become partners in the journey of acquiring and transforming chiropractic practices. This unique approach has not only benefited Dr. Danielson’s clinics but has created a ripple effect of success through the chiropractic community. Big Fish Training: Transforming Practices: The coaching program, aptly named Big Fish Training, was designed to turn ordinary practices into thriving enterprises. Dr. Danielson emphasizes a hands-on approach, pairing associates with him in his own practice, imparting not just clinical knowledge but the critical skills needed to run a successful chiropractic business. The goal is to transform practices from mere “Ford Taurus” models to high-performance “Lexus” clinics. Team Doc: Revolutionizing Community Engagement: One of Dr. Danielson’s game-changing innovations is Team Doc, a program that redefines community engagement and patient acquisition. By sponsoring local sports teams, especially those in unexpected niches like trap shooting, Dr. Danielson creates opportunities for meaningful connections. This unconventional marketing strategy has proven wildly successful, with dozens of new patients generated from each event, further solidifying the impact of chiropractic care in the community. Chiro Life: A Platform for Transformation: Dr. Jeff Danielson’s commitment to sharing knowledge and fostering collaboration reaches its zenith with the Chiro Life seminar. This annual event is a testament to his vision of building a community of chiropractors who not only excel in their practices but also inspire and support one another. The upcoming seminar, themed “Build Your Army,” promises to be a transformative experience, featuring speakers like Brian Capra, Jeff Langmaid, and Roberto Monaco. Conclusion: Dr. Jeff Danielson’s podcast episode is a masterclass in combining passion, purpose, and business savvy to create a lasting impact in the chiropractic world. His journey, from a chiropractic clinician to a mentor shaping the future of the profession, is an inspiration to aspiring chiropractors and entrepreneurs alike. As the chiropractic community eagerly anticipates the Cairo Life seminar, Dr. Danielson continues to shape the narrative of success in chiropractic care and business. To watch the full episode, you may view it via: https://bit.ly/3TK2qoS
Maximizing Chiropractic Practice Success
In today’s exclusive discussion, we have Michelle Corrigan, Director of Operations at Genesis Chiropractic Software, joining us. Michelle, a seasoned professional in the field, shares her extensive experience and valuable insights. Get ready for a deep dive into optimizing your practice management. Unlocking the Potential of Technology: In the chiropractic realm, Michelle highlights a common concern—practitioners may not be giving due attention to their bottom line. Genesis Nation aims to change this narrative by leveraging technology to streamline and enhance every aspect of your practice. Michelle is not just a Director of Operations; she’s a certified coder and compliance officer. With a wealth of experience, Michelle has witnessed the evolution of chiropractic practices, from manual HICFA forms to the seamless automation we enjoy today. Her insights are invaluable for those seeking to navigate the complexities of practice management. Bottom-Line Focus: Chiropractors often neglect their bottom line. Michelle emphasizes the importance of understanding the financial health of your practice. Genesis Nation encourages practitioners to use technology for robust financial management. Staff Training and Knowledge: The success of any practice relies on well-trained and knowledgeable staff. Michelle underscores the significance of hiring individuals who align with your practice’s values. Training staff effectively ensures that money doesn’t slip through the cracks. Underpaid and Rejected Claims: Every underpaid or rejected claim represents potential revenue loss. Michelle urges practitioners to intelligently combat these issues, preventing insurance companies from taking advantage. Genesis provides robust tools to fight for every dollar owed. Coding Accuracy: Coding is a critical aspect of chiropractic practice. Michelle stresses the need for a deep understanding of the relationship between procedure codes and diagnosis codes. Accurate and bulletproof notes are essential to support medical necessity. Network Effect in Billing: Michelle introduces the concept of a network effect in billing. Changes in one region may affect others. Genesis actively incorporates these changes into its system, creating a collective advantage for all practitioners in the network. Patient Payment Collection: Michelle addresses the challenge of collecting patient payments. While chiropractors are focused on healing, it’s crucial to ensure timely payments to keep the practice running smoothly. Innovative solutions like Chusa offer legal ways to provide discounts and facilitate payments. Avoiding Pitfalls in Contracts: Michelle shares a cautionary tale about contracts that promise quicker payments in exchange for reduced amounts. Practitioners need to scrutinize such agreements, ensuring they don’t inadvertently sign away substantial revenue. Conclusion: As we conclude this insightful discussion with Michelle Corrigan, Genesis Nation stands as a beacon for chiropractors seeking to revolutionize their practices. By embracing technology, focusing on financial health, and staying vigilant in billing practices, chiropractors can elevate their success. Join us on this journey of transformation, and stay tuned for more enriching discussions from Genesis Nation. To watch the full episode, you may view it via https://bit.ly/3S4ylPS.
How Practice Automation is Redefining Chiropractic Care
In an era where technology continually reshapes the landscape of healthcare, chiropractic practices are not left behind. The integration of practice automation into chiropractic care, as exemplified in discussions like the insightful interview with Dr. Aaron Gum of Blueprint to Practice Automation, is a testament to this evolution. This blog delves into the transformative impact of practice automation on chiropractic care, exploring how it enhances patient experience, streamlines operations, and opens new horizons for practitioners. The Rise of Practice Automation in Chiropractic Care: The concept of practice automation, as discussed by Dr. Gum, revolves around the integration of advanced technological systems into the day-to-day operations of chiropractic practices. This includes everything from patient management systems, electronic health records (EHRs), to automated patient education tools. The goal is to streamline administrative tasks, improve patient care, and ultimately, enhance the overall efficiency of chiropractic practices. Key Components of Practice Automation: Automated Patient Management Systems: These systems manage appointments, reminders, and follow-ups, significantly reducing the administrative workload and enhancing patient engagement. Electronic Health Records (EHR): EHRs provide a digital platform for storing patient data, facilitating easier access to treatment histories, and enabling better coordination of care. Digital Patient Education: Automating patient education ensures consistent and comprehensive information delivery, crucial for patient understanding and adherence to treatment plans. Remote Monitoring and Treatment: With advancements in technology, some aspects of chiropractic care can be monitored or even administered remotely, increasing accessibility and convenience for patients. The Benefits of Automation in Chiropractic Practices: Enhanced Efficiency: Automation reduces the time spent on repetitive tasks, allowing chiropractors to focus more on patient care and less on administrative duties. Improved Patient Experience: Automated systems contribute to reduced wait times and more efficient communication, leading to higher patient satisfaction. Scalability of Services: With automation, chiropractic practices can manage a larger patient load without compromising the quality of care, facilitating growth and expansion. Data-Driven Insights: The use of technology in practice management provides valuable data that can be used to make informed decisions about patient care and business strategies. Challenges and Considerations: While the advantages are significant, the transition to an automated practice requires careful consideration. Issues such as data security, the cost of technology, and the potential impact on the patient-practitioner relationship must be addressed. Additionally, there is a learning curve associated with new technologies that both staff and practitioners must navigate. Conclusion: The integration of practice automation in chiropractic care, as highlighted in discussions like Dr. Aaron Gum’s interview, is not just a trend but a necessary evolution. It offers a pathway to more efficient, patient-centered care, and a more sustainable business model for chiropractic practices. As we continue to witness technological advancements, embracing practice automation becomes not just an option, but a crucial step towards the future of chiropractic care. To learn more about Blueprint To Practice Automation you can visit them here https://bit.ly/bpa-genesis
