A customer called me yesterday to ask, “[Evil Empire HMO] has finally come to the table and is offering me 100% of Medicare on my E&Ms…should I take it?”
Normally, I’d say, “100%? That’s a joke.” But this client was calling from a part of the country where pediatric practices average 65-75% of Medicare. I know of at least three groups (of 5-20 practices each) within 70 miles of of this practice who are trying to merge for the stated purpose of negotiation. So, here we have a small practice getting one of the worst HMOs to the table on their own. I figured I’d better check to see what the deal would be worth.
We spent a few minutes in Partner. If just their 99211s through 99215s are raised to 100% of Medicare, the practice will bring in an extra…$175,000. Every year. For for just this one payor.
We quickly agreed to ask for 100% of all codes (you always have to ask), but take 100% for a one-year contract. And ask for 105% or 110% next year.
Next time you think you need to be big to negotiate, remember this, Example #754.