The most common worry I hear from practices considering dropping a plan is that they can't afford to "lose all those patients." The larger the portion those patients make of a practice, the scarier it gets. "BCBS/Aetna/Oxford/etc. is 25% of my practice! I can't lose 25% of my visits!" Ultimately, it's the greatest obstacle in the process of helping customers negotiate.

It's obvious to most practices that you can't - usually - simply drop a plan and rejoice. You need to do a lot of homework and follow-up, especially as it relates to patient recall. As one of our customers told me once, "I put my patient reminder letters in the same batch of letters telling patients we're dropping a plan." With some attention to well visits and chronic disease management, you can keep yourself quite busy and your patients quite healthy.

That's only part of the equation, though. Even after you drop a plan, quite a few of those patients will still come to your office. They know you, they like you, and that extra out-of-pocket expense is often well worth it. Even better, some of your patients will actually switch insurance (when they can) just to continue seeing you cheaply. The question, though, is how many of those patients will stay?

Just recently, I've checked on two East Coast groups who have used Partner to examine this very info. And, interestingly, the numbers were the same in both places: in the year (or less) since each practice dropped a plan, approximately 50% of the patients on the dropped insurance returned to the practice. Of those patients, more than half had switched insurance companies. Now, I haven't gone to see what the visit rate is normally for patients (i.e., not all of your patients are active and visit every year), so as a practical matter, that 50% return rate is actually higher than 50%!

I'll have some more data shortly and I'll post it. But how nice would it be to know that 25% (or more!) of the patients on your panel will drop the insurance company just to see you when you are sitting across the table from your rep? And half of them - or more! - will come see you anyway, costing the insco extra $$?