Should Doctors Join Managed Care Plans?

Many doctors are discouraged by the fee schedules of managed care. This prevents them from even joining any Managed Care Plans ( MCP). Often, doctors are accepting sliding scale managed care fees! In California the average managed care fee for a psychotherapy assessment session is $120.00 and for a counseling session is $90.00. In New York those numbers are even lower: it is $98. 00 and 68.00 respectively. Yes, you need to figure in extra time for case management and report writing, so your hourly pay gets lower the more time you put in outside of the session. But remember, these are things you should be doing for your clients anyway. You also need to keep in mind that you are investing in your business.

It's used to be a thought that this way you are building a practice. Another word: You need referrals more than you need higher fees, when you're building your practice. Referrals are the way to build your practice. More referrals bring more negotiating leverage for you down the road. You need to sacrifice some time and money now for the payoff later. Investing in managed care will pay off for you in the long run because it is the way of the future and will only become a stronger force with time.

I am not sure it is workable now days. In essence, practitioner put itself in the closed circle: in order to cover ever increasing practice expenses and get income to bring home, he/she needs to see more and more patients (since the capitation payments is minimal). Increasing number of patients put practitioners in front of dilemma: it is virtually impossible to provide high quality medical service for such low payment. Here starts the struggle: physician loves medicine, loves to treat patients, loves to learn something new and improve skills, and on the other hand: medical practice has overwhelming number of patients, expenses to run practice constantly increasing and MCP payments not getting any higher. In any case by the end of the day: very little time to read any professional or educational material, or going to seminars, for that matter, constant straggle to some how forecast the cash flow, fulfill the audit requests, keep up with daily changes in government rules and regulations, decreasing time for rest and relaxation,(or any quality time for that matter).

Well, you have to work this way for at least 3 to 5 years before you would have the freedom and experience to negotiate anything with any health insurance company. Based on the above, I would consider twice the participation with MCP's. However, I counted not all of the downsides of the MCP's, there is some light by the end of the tunnel: The next thing you need to know that the managed care fee schedule is often just "the first offer." Accepting this offer will get you in the door. They need you as much as you need them! They would much rather keep the good doctors they have than start over with ones they don't know. In perfect world, MCP's want a small provider pool, as this is supposedly much more efficient for them. They've invested a lot in you, too. They had to spend a great deal of time evaluating your application, checking your references, taking a liability risk by accepting you, training you their way, sending you clients, getting to know you, etc. If you're giving them what they want, they're not going to want to let you get away. I've never been turned down for a raise from an MCP, there is a way to do that.

Elena Newman president of Maximus Technology Inc-Medical Billing and Professional Services for Healthcare Specialists. You can ask me medical billing related question on our forum http://www.mtmedicalbilling.com/forum/ or visit our corporate website at http://mtmedicalbilling.com/