Managed Care and Professional Service Contracting Knowledge Center

From analysis to strategy development and negotiation assistance, McKesson Practice Consulting Solutions makes sure terms and conditions are fair, appropriate and sustainable for your practice.

INDUSTRY INSIGHT

New! - ACOs May Create Financial Opportunities for Specialty Practices (PDF 405KB)
A new healthcare paradigm built around the Accountable Care Organization (ACO) is steadily taking shape, but exactly what effect this new world will have on physician compensation remains far from clear. Even so, practices must be prepared to transition away from fee-for-service, commodity-based pricing or risk suffering in the long run. Why? Because the goal to reduce unnecessary healthcare services will, by definition, reduce volume for some specialties. Fortunately, there are several things that physicians can do to understand the nature and implications of the ACO model, and develop the flexibility necessary to thrive in a volume-constrained environment while delivering quality care.

Revenues Down? Examine Your Contract Prices!
Insufficient attention to commercial payer contracts may be causing significant revenue short-fall for many different types of practices. The good news is that practices can do something about it - and this article presents 12 key actions that practices can and should take to make sure they are getting what they should be paid. Read the full story.

How One Emergency Physician Group Improved Managed Care and Hospital Contracts (PDF 135KB)
Learn how one large medical group was able to improve their contract negotiations with managed care and hospital organizations.

The Power of Partnership: Doctors, Hospitals Benefit from MSOs (PDF 193KB)
As the day-to-day operation of physician practices and ancillary services becomes increasingly complex and costly, management services organizations (MSOs) are emerging as ideal vehicles for addressing the needs of physician groups, other service providers and hospitals alike.

Anesthesia Stipends – 2010: Performance Metrics Increasingly a Part of Stipend Agreements (PDF 445KB)
As stipend arrangements have become increasingly prevalent, they’ve continued to evolve and today, a growing number of agreements include provisions requiring practices to meet or exceed specific performance benchmarks to receive new or continued financial support. Anesthesia groups need to be aware of this trend and be prepared to play a proactive role in developing mutually agreed-upon performance metrics, should their hospital partner seek to impose them.

Managed Care Contracting: Knowledge is Key When it Comes to Managed Care Negotiations (PDF 149KB)
Astute managed care contracting is more important than ever for hospital-based physician practices as government reimbursements either decline or remain static and the number of patients enrolled in public payor programs continues to rise. For many physician groups, realizing gains from commercial payors represents an effective way to offset these adverse payor trends and promote long-term financial stability.

When Push Comes to Shove: Bowing out of a bad contract can often produce positive results (PDF 30KB)
Asserting control over practice revenues by rejecting unfair managed care contracts, although not without risk, can be a highly effective business strategy for physician groups in today’s market. Known as de-contracting, the tactic is being used with increasing frequency by small and large physician groups to gain leverage with carriers who refuse to negotiate.

CUSTOMER SUCCESSESS

NEW! - Diagnostic Imaging Associates Payer Contract Renegotiations Net $600,000 (PDF 202KB)
This new case study highlights how McKesson Healthcare Business Consulting Solutions partnered with Diagnostic Imaging ssociates (DIA) to address the challenges DIA faced with payer contracts. DIA is composed of 17 physicians and conducts over 240,000 procedures annually. The organization faced a decline in payer reimbursements, wavering payer mixes and a decrease in volume. McKesson Healthcare Business Consulting Solutions renegotiated all of DIA's payer agreements and as a result DIA will achieve approximately $600,000 in additional revenue over the course of three years.

NEW! - Stamford Pathology Group Calls on McKesson’s Managed Care Contracting Expertise and Wins (PDF 174KB)
With some of its biggest contracts about to expire – which just happened to occur right in the middle of an extremely perilous economic climate – Stamford Pathology Group was faced with losing a substantial portion of its group’s revenues. However, using the expertise and industry knowledge of McKesson Healthcare Business Consulting Solutions, the group not only maintained agreements with seven major payors but also secured across-the-board rate hikes of 15% over three years.

Practice Brief: Radiology Group Recovers Nearly $300,000 in Contract Underpayments Through Audits (PDF 148KB)
Although evaluating payor payments is considered by some to be a fruitless exercise, this Practice Brief demonstrates the positive impact that such a consistent effort can have on a Radiology Group's bottom line.

Anesthesia Medical Group of Riverside Boosts Physician Income through Improved Compensation Plan and Payor Contracts (PDF 103KB)
With 19 physicians covering three hospitals and two surgery centers, the anesthesia group was struggling with staffing issues. Physicians were leaving the practice because of longer working hours and lower compensation. One year after McKesson agreed to help, the practice had 9 contract increases that resulted in additional revenues of $580,000 for the physicians in the first year.

Riverside Radiology Medical Group Partners with McKesson to Resolve Undetected Billing Problems and Strengthen Cash Flow (PDF 103KB)
Although Riverside Radiology Medical Group had no discernable problems with its in-house billing processes, they took the opportunity to reassess its billing operations and decided to outsource with McKesson. In addition to expected cost savings resulting from gains in efficiencies, Riverside reaped tremendous benefits from the expertise McKesson brought by enabling electronic information transfer and claims processing, reducing days in A/R by half, renegotiating payor contracts for higher reimbursements, and ensuring that each physician was properly credentialed to avoid noncompliance penalties.

McKesson Wins Payor Rate Increases for Tennessee Practice (PDF 189KB)
In 2006, Nashville, Tenn.-based Neurosurgical Anesthesiologists, PLC, hired McKesson to provide a range of turn-key, startup services, including establishing compensation and retirement plans, health insurance, and overseeing and coordinating staff credentialing. McKesson also negotiated all managed care agreements on behalf of the practice and when the agreements were set to expire in 2009, McKesson was again called upon to renegotiate the deals. Despite the economic downturn of 2008 and the unwillingness of many payors to grant provider rate increases, McKesson was able to secure rate increases of about 3.5% per year for three years from each of the major managed care companies.

PODCASTS/VIDEOS

NEW! - Managed Care Contracting Wake-up Call Podcast

WEBINARS

New! - Era of Accountability: Shared risks, rewards, and responsibilities Webinar
This webinar will provide insights from our featured speakers on the following: How will ACOs affect physician practices and hospitals? Should your organization get involved? What financial risks will you face? What does the concept of shared rewards mean? How can you improve the quality of patient care and start to control costs?

New! - Era of Accountability: Shared risks, rewards, and responsibilities Power Point Presentation (PDF 2MB)

Top 10 Revenue Protection Strategies in 2010
• Learn the top financial trends affecting radiologists in 2010
• Learn how one group successfully managed a billing conversion transition

Unlock your Managed Care Contracts' Revenue Potential
• Gain a better understanding of how to increase the value of your managed care contracts