High-Performance Practice Series, Ep. 4: How to Renegotiate Payer Contracts (and When to Just Drop Them)

[00:00:02] Welcome to the Private Practice Owners Club. Your hosts and coaches, Nathan Shields scaled his practice and exited for millions, while Adam Robin went from working 60 hours a week in one clinic to scaling to multiple clinics while working less than four hours per week remotely. This podcast is meant to share with you exactly how they did it and how you can build a business that supports the lifestyle that you truly desire. And don't forget to

[00:00:27] join the Private Practice Owners Club community on Facebook, where we are obsessed with providing even more resources that help owners just like you win the game of private practice. Hey, it's Nathan. Quick heads up for all the private practice owners who are listening. If you've been listening to the podcast for a while, you know that it took me at least 10

[00:00:53] years of grinding in my own clinics before I finally figured out how to scale and sell my four practices for seven figures and about three times the national average. The biggest shift wasn't some secret marketing hack. It was how I thought about profit systems and actually my role as the owner. That's exactly what we're going to be working on together with you at the High

[00:01:17] Performance Practice Conference this fall in San Antonio, Texas. From October 15th through 17th, Adam, Robin, and I are hosting a three-day hands-on event for PT, OT, speech, mental health, peds, pelvic floor, and medical practice owners who want to build clinics that are profitable, scalable, and best of all, don't depend on them 24-7. We'll dig into simple profit and KPI frameworks,

[00:01:43] real leadership and culture work, and practical systems you can take home and plug in with your team. So if you're doing roughly six to seven low figures a year and you want your clinic to feel more like a real business and less like a job slash cage, I'd love to see you there. Frankly, I'd love to see you bring your leadership teams as well because we will have breakout sessions for them too. You can get all the details and grab your seat at the link in the show notes. All right,

[00:02:10] let's get into today's episode. Hello, and welcome to the Private Practice Owners Club. I'm your host, Nathan Shields. Got my partner, Adam Robin, with me today. How you doing, man? I'm doing good. Don't lie. That was the best cover-up I could come up with. It's a little sluggish today, right? Yeah, it's kind of one of those things where it's like physically I'm tired, but mentally I'm charged up, you know what I mean? So I'm trying to just, you know. Yeah, I don't think I have that

[00:02:39] disparity, that disconnect in my body. If I'm slow physically, I'm slow mentally too. Gotcha. We'll push through because we've got some cool stuff to talk about. For sure. When I brought it up, you're like, oh, hell yeah. Let's talk about that. Right? I love talking about a topic that I'm like actively studying. You know what I mean? Because it's like, now I got all the ideas. It's like- For sure. I feel like there's some value that I can add here. So like, that's exciting.

[00:03:05] Exactly. Well, this is episode four of the High Performing Practice series for our podcast, all leading up to our High Performing Practice conference for the Private Practice Owners Club in San Antonio, October 15th through 17th. Go to ppoclubevents.com to register, bring your leadership team. We're going to have multiple tracks so they can get value as well. You can divide and conquer, get a ton of value for your clinic, but that's going to be all about

[00:03:32] how to make things more efficient, how to be a better practice owner, how to run things more efficiently, how to make more profitable and gain freedom in your clinic. So for episode four, we're going to be talking about contract negotiations and pair relationships. And I like how you brought it up today. So we had a coaching call today, our group call. Someone was talking about their issues with recruiting. Everyone's having issues with recruiting. Probably

[00:04:00] 90% of the country is having issues with recruiting providers. And they said that they had lost the provider because they couldn't provide similar benefits to a local hospital. And you flipped to the conversation from a recruiting conversation. And I like how you did that. And so frankly, I'd like you to kind of revisit that and take us through your thought process. Maybe give us a little backstory,

[00:04:27] if you have some behind why you would flip that conversation from recruiting to increasing cash flow, but just go down the same path you went through this morning. Yeah. So the first thing I think that the story was, listen, I can't, we lost a PT, right? Well, we lost a good candidate. I think they maybe extended an offer or whatnot. And The salary is a little bit higher, but the healthcare benefits were not correct.

[00:04:51] The healthcare benefits didn't quite match the hospital one. So they declined. And so Yeah. Yeah. Very common. And then going to continue to be more and more common. It's not going away. It's going to get worse, which is why you need to come to the conference so you can learn how to adapt and build your model so that you can get out of that curve. Right. Right. So rightfully so this person's instinct was to say like, okay, well maybe I can get,

[00:05:19] I can double down on LinkedIn or I can build out. Maybe I can spend more time on recruiting. I can hustle more. And I was like, well, what if you just figured out how to pay more? Would you just figure out how to pay them more? And that way you could just have a better offer. So let's kind of go back to the top, which is what's your average reimbursement per visit? Let's highlight that. The restraint isn't the health benefits package, the benefits package.

[00:05:47] That's not the restraint. It's the symptom. It's the symptom, right? The higher level restraint. Let's look at the real bottleneck. That is you can't justify because of your current revenue streams affording or paying for a better healthcare package. Right. I just wanted to highlight that. Yeah. Yeah. Yeah. For sure. That's, that's what it was. So it's like, let's fix the main thing. And it's a very common, it's literally probably the biggest cost in your business is you focusing on

[00:06:16] the wrong constraint, right? Which is she would have spent an entire quarter focusing on, let me shop around all these healthcare plans and let me get creative with this. And it's like, well, what if you just spent that energy on, on the primary thing, which is learn how to make more money in your practice so that you can afford the thing that actually attracts great candidates. And so, yeah, that's kind of where that conversation, that's where it landed. And that's what led us to this conversation. So what are some of those levers we can do to increase our average reimbursement per visit?

[00:06:46] Yeah. So to be clear, there's not that many. Maybe one hand. Yeah. There's not that many. Your private practice feels more complicated than it really is. It's not complicated, but like we have to assume that at least most people at this, if you've been listening, if this is not your first podcast, you already know that we're going to talk about over-the-counter collections. We're going to talk about the bill you could go here. But those are the basics,

[00:07:11] right? So we're not even going to talk about additional revenue streams until you have the foundational elements of financial management cleaned up and buttoned up really tight. Right. If you were interested in this podcast episode, because it said something about contract renegotiations, trigger warning, we're not going to talk about it until you got other crap fixed first. And if you try to skip those steps, I will find you bringing it up until you've improved

[00:07:37] some other things. I'm going to put you in a headlock and you're not going to escape until you do what we tell you to do, right? Button up your over-the-counter collections, make sure you're maximally billing and coding at the provider level, and make sure your revenue cycle is super, super clean from verification authorizations to billing in your AR. That's got to be so perfect before you even talk about messing with contracts. You know what I mean? Can I give a real world example? Yep.

[00:08:02] Had a conversation with an owner yesterday. He's like, hey, I just want you to know, you and Adam have been harping on over-the-counter collections and making sure you collect every dollar. And we noticed that we had a patient outstanding balance on our AR aging of $30,000. And we're in a small rural town and we want to play the nice guys, but these people aren't coming back and paying their bills.

[00:08:27] So we made a significant change because you guys have been harping on it. And he said they collected more over-the-counter collections in June of 2026 than combined April and May. Congratulations. And July is going to be significantly more than June. And we're only halfway through, we're three weeks into July. And it's just because he finally put his foot down and made a significant change. And I can promise you, he didn't say it explicitly, but I can promise you his bank account

[00:08:55] looks significantly better than it did in May. Right? And so doing some of the things that we're talking about makes significant changes to cashflow and actually will, I can promise you they're going to increase your revenues like 10%. If you have less than average management of these three areas, you will increase cashflow 10% just by doing those things without even renegotiating a single contract. Let's clean up our house first before we go out elsewhere looking for a reimbursement.

[00:09:23] And there's so many reasons to do it that way because what is it like chase two rabbits, you catch none or something like that, right? It's like, you can't do too many things at one time. You don't have, you're not smart enough. You're not skilled enough. You don't have the operational capacity. You can only, you're a human. So you have to be focused. And so if you try to getting really good at over-the-counter collections is going to take systems building and spreadsheets and tracking and accountability, and you're going to have to change behavior and you're going to have

[00:09:53] to have hard conversations with your team and your patient, it's going to kill you. You know what I mean? Then you got to go to the providers and be like, all right, we've got to build better. We got to do that. We got to change all that behavior and create accountability. Then you got to learn the whole revenue cycle and you got to button all those things up. And once those things are buttoned up, the systems are built, right? And you have at least one person in each of those seats who owns a key metric and who's owning that performance and it's in the green every week.

[00:10:22] Now you can free yourself up to have the bandwidth to focus on the next thing, which could, which is a good place to start is analyzing your contracts, right? And now you, because that's going to require a whole nother system, a whole nother process, a whole nother chunk of bandwidth that will require, that's going to be required for you to actually execute. So if you jump into this thing too quickly and you're over the counter, everything else starts slipping, you're just going to be spinning. You're going to be working hard. You're going to have another job, right? Another job and you're

[00:10:51] going to be broker and more stressed. So hopefully, hopefully that lands. Hopefully you guys get the point at this point. Well, yeah, let's look at it in real time where if you're thinking about contracting negotiations first and trying to increase your average reimbursement with a particular insurance company, it's good to start with a clear understanding of what your average reimbursement is for that particular insurance first. A hundred percent. Right. And so you need to know exactly where you're coming from and you need to know your cost per visit, which frankly, many owners

[00:11:20] don't know to understand if we're negotiating for is good or bad. Is it worth it or not? Because when I come back at you and this is our last and final offer, are you willing to drop at that point or are you just going to say yes? And you won't know if you don't have these measures to base that decision off of. A hundred percent. So that goes back to cleaning up your billing and collections department

[00:11:45] so that they are optimally collecting every dollar if they are and you have good metrics and you know, okay, based on this three month history, this is our average reimbursement for this particular payer. We know what our cost per visit, we know we need to ask for another $15 per visit at a minimum. That's like our baseline. If they can't get up to another 15 bucks, then it's worth dropping them

[00:12:10] because we just can't justify it. Right. And so it's important to have your ducks in a row before you even start these negotiations, not just by having the data, but know that knowing that your backend systems are really, really good in giving you, this is what we can maximally produce with this contract. You can approach those negotiations from a place of clarity, right? From a place of like, I kind of know what I need, right? And comfort and knowing that this just doesn't work anymore.

[00:12:38] So you mentioned two metrics. I just want to make sure we highlight them. One was average reimbursement per visit. And I don't know if you noticed, but even one of our clients, we asked her, what was her average reimbursement per visit? And she was like, ah, I had to go back and double check. That's literally the number one mistake of practice owners. They don't really know it. Red flag kicked up. I'm like, you're my coaching. I know. And you don't know it. I know because why she needs a provider. She's stuck on the treatment floor. Busy.

[00:13:05] She's busy. Right. So like know your average reimbursement per visit. Number two, know your costs per visit. Just have a weekly or a monthly cadence where you're measuring that thing every month, right? Have a VA or a front desk person measure it for you. Have your biller, have somebody measure it for you, right? Bookkeeper or CPA. Bookkeeper could do it. Somebody's got to own it. And then I think the other two metrics that are important to know here are going to be the percentage of visit volume that you see for each of those

[00:13:35] contracts. So if you can imagine spreadsheet with like Blue Cross, Medicare, Medicaid, United, or whatever, what percentage of total patient visits are you seeing? And then also lastly is a percentage of revenue, right? The percentage of revenue that is being generated at each of those contracts. I think at that point, you've got a pretty good pulse on at least objectively kind of where those contracts line up for you or stack up for you.

[00:14:03] That's really, it's really important to have those metrics because the assumption, and I've shared this many times is that like a flat rate payer, like United healthcare is going to pay me, let's say $65 a visit. You might assume that it's $65 a visit, but when you go through this exercise, you're not, what you aren't accounting for is denials, drawdowns or anything like that, such that when you do the math, it actually might come out to $58 and 71 cents, which another client

[00:14:31] of mine figured out and couldn't drop United healthcare fast enough at that point, because he recognized that, yeah, that's like, it's 15% of my patient load scary because that number of visits is going to fall off the schedule, but it only represents eight or 9% of my financial revenue. I can find other ways to make up eight or 9% of my finances and not see those visits,

[00:14:55] right? Maybe fill in those appointments with higher paying payers and yada, yada, yada. So it's important to have those metrics so you can build things off of, and I will add, these aren't necessarily KPIs that you need to track, but you also need to consider as you're looking at these insurances, what the administrative burden is. And so when I say administrative burden, are they, do they play nice, right? Are they getting

[00:15:22] you the off in the timely manner and giving you a significant number of visits to treat your, treat your patient to full plan of care, or are they giving you six initial and then crumbs after that two visits here, one visit there to continue. And in order to get that there's calls and faxes and reports and re-evaluations and denials and appeals. And that's administrative burden that has a price

[00:15:47] tag, although it's not easy to track, it's going to cost you and your, especially your administrative team time and money to deal with. Relieving the team of that headache could be a huge win in and of itself. Addition by subtraction, right? For sure. So you do need to consider that. And I recommend as you're looking at each of these insurances, like Adam laid out on a spreadsheet, not only are you looking at these key KPIs,

[00:16:13] but you also have, maybe have a, I have a formula to it. And if you wanted to, some kind of insurance analysis spreadsheet, feel free to reach out to me and I'll get it to you. But there's another column that you could add, which is zero to 10. How easy is it to get paid by these guys and get the visits that we need? And that's low. And the reimbursement is below the cost per visit. They are highlighted in red. These are the people we focus on first.

[00:16:40] Yeah. It's easy to do this when the schedules are relatively full and there might even be a waiting list or it's just hard to get in those, those initial evaluations. There is something to be said for someone. I will make this caveat. There's something to be said for keeping a low paying insurance. If you're having a hard time filling schedules and you still have to meet payroll, either that person is sitting, not seeing a patient or they're taking a low paying insurance.

[00:17:10] That that's below cost per visit. You could justify keeping that simply because you still have to meet their payroll and it's better that they see something instead of nothing. Yeah. Cause if you're, yeah, if your visits go, if your visit volume goes down, meaning like if your schedules aren't already full and you keep your current payroll expenses, but your total volume goes down. So now your, your schedules go from 90% full to 80% full. Well, your cost per visit

[00:17:38] is going to skyrocket. Right. And so then it's going to throw you into a whole different demographic. Ideally, we want to keep our cost per visit baseline. Right. And then drive, pull some of those people off the waiting list who have the insurance that you want to treat. And that way you can create more space between your costs and your, you know, your revenue. Yeah. Cause the conversation we had today with this provider was that she doesn't have to do marketing. They're busy and they can fill the schedule. Beautiful. That's a great place to be. Right.

[00:18:08] And she dropped. And so she dropped United healthcare reimbursement, average reimbursement per visit went up, didn't have a problem filling the schedule. Now she's like, I already know the other two that were dropping. Okay. Easy enough. Right. So I know we're talking about dropping insurance and already where the conversation might drop them. Frankly, I don't own a clinic anymore. So it's easier for me to say, just drop them. Damn it. Save your time and energy with the

[00:18:34] negotiation process and just drop them. There are some that are like that, but then there are some that are worth if they don't have a ton of administrative burden and they're closer to your cost per visit, just you need more margin. Then let's talk to them. Let's reach out to them. And so if we're looking at that renegotiations, you've had some success with it recently, right? And you're in the process of doing some more. What have you found that has been successful on

[00:19:00] your end from soup to nuts? Like how do you get started? Who do you talk to? What does your conversation look like? Is it a letter? Is it an email? How do you go about it? Yeah. I'll try to paint that picture, but I mean, renegotiation, it's really nothing more than a negotiation you would have with any other person in the world. Like you, every time you hire somebody, you're negotiating a salary. So it's like, you're just trying to get, have a conversation

[00:19:29] with the right person and negotiate your value, ideally a little bit of clarity and a little bit of composure. Right. And so first thing you have to know is like, who's the person to talk to? Right. And I believe there's somebody, there should be somebody, each of the insurance companies

[00:19:53] who is, they have a title that sounds something like contract manager or contract manager, something along those lines. Right. And so if you could find out who that person is, right, you want to try to email them and keep emailing them until you find out who that person is. And so that's kind of like step one, right? Finding out who that person is from there. Just a quick, can I ask, have you found difficulty in finding that person at times?

[00:20:23] Yeah. I think everything is difficult when you first start, right? So if you're looking at a spreadsheet and it's blank, you got to get on the website, you got to find, you know, get one of your patients, get back to their contract, their provider number, start getting on the call with them. Provider relations, right? You got to start there. But once you start collecting these, these, these contacts, right? It's like, okay, now I got a contact. I now have their email, I have their name, I have their phone number. The second time around, it becomes easier,

[00:20:53] right? Just like everything else, you start building repetition and familiarity with the process. Yeah. So you've got a spreadsheet with, this is my contact at this insurance company with this email address and this phone number. And you keep track of that. You've got that on file. It sounds like. Yeah. And you want to keep track of like, this is the record of our conversation, right? Here's, here's all our emails that we've, that we've get exchanged. Right. And so if you get really savvy, you can look at like, okay, here's the emails that actually led to a positive

[00:21:19] renegotiation and you can start pulling those together and you could repurpose them, you know, probably a good idea to repurpose them, you know? Yeah. So we're doing a podcast with a client of ours named trace and he was in Tennessee. I'm under trace. And he, and we were looking, he was looking to renegotiate with United healthcare and it took him probably 90 days to find the right person to talk to because there's one person who oversaw a region of three or four states

[00:21:47] and she oversaw United healthcare, Medicare, Medicaid, but there was someone else that oversaw United healthcare workers comp and federal programs. And so he had figured, finally figured out, he had to talk to both of them and they're like, well, do you want to get rid of it altogether or just these two plans? But if you keep this plan, you have to keep the other plan and you finally figured it out. Like, okay, I can, I can keep United healthcare Medicare supplement plan, but I'm

[00:22:17] going to get off of the Medicare VA or the United healthcare VA, or you'd have to go back and listen to the podcast, but it took him a long time to get to that point. But once he got to that point, now he can have a conversation and things started moving along rather quickly. Right. And so I'm just saying it does take some footwork and it does take some time. It's not as easy as you might think, because frankly, the pairs don't want to have these conversations. It's all hard. Yeah. Get used to it. Welcome to business. Yeah. That's why you need time. That's why you need to focus, which, which goes

[00:22:46] back. It's like, this goes back to the very beginning of the podcast. Like it's going to require your energy. It's going to require your effort and your team's effort. So like, make sure you got it, you know, make sure you have, you're, you're in a place where you're ready to deploy that focus energy and you will do anything. You're a smart person. You can, you're, you're capable. You'd be surprised at what you can do with 20 hours of work. You know what I mean? Like just focus on it for 20 hours. You'll be halfway there. So yeah. But once you kind of get into, you find the person,

[00:23:14] you can send an email with ideally a little bit of data, you know, that basically is going to say like, Hey person, this is who we are. Ideally, like with some type of professional letterhead, we've reviewed our data. You know, we've had a contract for this length of time and here's the data that we've pulled. Here's the volume of visits that we're currently seeing for you. This is how you rank against some of the competitive contracts in the area. And based on this,

[00:23:43] we need to have at least X in order to continue to create that even exchange. And we'd like to enter into that renegotiation. What are the next steps? Something like that. Is that the initial, is that the straight off for the first up email that you send off? Yeah. I mean, you want, yeah, you want them to see that email and say, Oh, they've done their homework. Okay. You know what I mean? They've done some homework. If the email sounds like,

[00:24:08] ah, I'm whiny and I want a free handout. You're just not going to be a valuable partner for them. You know what I mean? Like come with a little data, respect the relationship, but also come with something objective that can lead the conversation and not emotional. Right. Yeah. And some of it can be the value that you offer. Yeah. Some of the services that you do, what it might look like for people to get into your clinic, how long it takes and surrounding

[00:24:37] competition might be seeing or doing. I'm just throwing ideas out there, but you, like you said, you want to provide it as much objectivity as possible. So you can show the case that number one, we provide a ton of value. Your clients get results when they come to see us. Right. And in order to maintain this relationship, we're going to just need some, a better exchange. Yeah. Ideally you want to try to make it about the patient, right? It's like, Hey, in order to continue to provide the quality of care that I know that you value for your customers,

[00:25:07] we're going to need to be able to do this so that we can keep our people retained and maintain our compliance and blah, blah, blah, blah, blah, blah, blah. Right. And so, yeah, keep it like that, you know, and that's going to go kind of go back and forth. They might offer you something straight from the email and then you're going to say, no, sorry, that's not going to actually we reviewed it with our leadership team. It's not going to quite cut it. We're going to have to carve out the blah, blah, blah, blah, and you might have to escalate it to a phone call. Right. But essentially

[00:25:32] you're going to continue to push that professionally until they basically say like, Hey, this is all we're going to do. If you don't like it, you can drop it. And then there, you know, there you go. There's your line. Um, you know, you can make a decision and you can make a decision. You bring that to your leadership team, bring that to your data and you can decide like, can we do this? Should we do this? Right. Does this continue to align with who we want to be as a company? Do you find that that's taken a number

[00:25:58] of steps, a number of emails is, and is this a typically a two, three month process or what? I don't think so. I mean, maybe the first one, the first one probably, but like once you, so typical timelines that we've experienced is that you can enter into some form of renegotiation consideration

[00:26:22] every two years. Okay. That's typical timeline. That's pretty standard. And if you've been in business for longer than two years, then ideally they should know who you are. You know what I mean? They should know who you are. You should know who they are. You've been through this process before. So the first time's a little bit hard, like everything else. But then again, like that process speeds up pretty routinely, you know, pretty, pretty quickly once you kind of build that system.

[00:26:49] Yeah. And that should be a quarterly assessment. Every quarter, sit down with your financial department or your VA or whoever's keeping that up for you. And you're reviewing that. Your payer mix. Yeah. Your payer mix and you're making real decisions and priorities based off of that data and those timelines. Yeah. And how often you have someone on your team that kind of carries this out or is this you personally doing that? No. Yeah. Somebody, somebody on the team.

[00:27:16] And you're following up with them. How often weekly, monthly on these interactions? Yeah. We touch base weekly. We'll touch base weekly. And it also depends on how urgent it is, right? Like if, if I was somebody who was having a hard time retaining people because of money, they would probably be a pretty important priority and I might put a little bit more energy on it, but I'd say weekly, weekly touch point. Gotcha. How many contracts are you negotiating at one time? As many as are eligible. Okay.

[00:27:45] Every two years. You're four going at a time. Yeah, for sure. Sometimes it's zero. Sometimes it's one or two. Yeah. And once, soon as that two year window pops up, we are in the inbox. You know what I mean? We are in the inbox. It is time. Well, let's go. Give me a couple extra bucks on that revenue per visit. Like, yeah, it's time, you know, we want to be proactive about that. And you find yourself going back to the same insurances year after year or every two years. Yeah. Yeah. Sure. Some like to play nice. Some don't,

[00:28:14] but it's not always about renegotiation. Because sometimes you get to a point where, like we've mentioned, it's time to drop them. Because we've got the demand. We've got the systems built up. We can absorb the volume loss. It's time to drop them. But what you also may find from that as well is if you keep your data together, you're going to see very clearly, like there's two or three or maybe even four insurance contracts

[00:28:44] that are really paying you well. Could be some workman's comp stuff going on. Could be some Blue Cross or whatever it is. Right? And so then you get to say to yourself, like, okay, great. How can we go after more of those patients? What could we do to become a preferred provider for that insurance contract? Right? Can we build marketing plans around that? If it's workman's comp, can we start doing some workman's comp outbound stuff? Right? And you can start really shifting your payer mix. Right.

[00:29:11] You know, it's not an instant thing, but it's a game that you want to be in. Right? Well, it's an ongoing game you have to play. Right. Because there, as you've noticed, reimbursement rates are going to change year over year. And you don't want to catch it three years after the fact. Yeah. Let's stay on top of these and make sure that we're maximizing everything that we can and doing everything we can to maximize profit. And remember, this is to, in this case today, it was to,

[00:29:39] so I can retain better so I can recruit better so I can offer competitive salaries and benefits. How many of you dropped recently? We're in the last two years. So we have not dropped any. This year is the first year where we've really had to, had to change, right? Like we've always, yeah, I'm a systems guy. I know how to build systems pretty well. So like I've always found ways to be more efficient with VAs and technology and

[00:30:08] leaning things up, but now we're kind of running into the end of that rope. And so we are making plans to drop probably, we'll probably drop two, maybe three. What's your biggest fear about dropping them? Or do you have any fears? Of course. I'd say the biggest fear is probably, probably like, probably the team,

[00:30:33] you know, like I don't want to lay anyone off. That would be terrible. Like if like a volume became so low, like we just couldn't keep people busy because you dropped some of these because we dropped, you know, like that would probably be my biggest fear. Luckily, I mean, obviously financial impact is always a concern, but luckily, and if you come to the conference, you'll learn a little bit about

[00:30:59] it. I've built other revenue streams around me that like, I don't only depend on the clinics to feed my family, which is probably a good idea if you're an entrepreneur. So that's less of a concern. It's more about like keeping the team together and making sure they feel supported through the transition. Yeah. And I think especially as someone is considering dropping a larger pair,

[00:31:22] like a United healthcare or Cigna, whatever that low pair is, the concern is that we're going to exclude this large portion of our clientele, a part of the community, frankly. Right. And you didn't express this fear, but I hear it from plenty of other providers. Like how is that going to be seen by the team and by the providers, the physicians in the community? Right. And what I found over time is

[00:31:52] number one, get clear on the reasoning, get clear on your numbers, maybe even share your numbers with the team. Hey, this is what we get per visit from this insurer. This is what our cost is. Can you understand why we can't do this anymore and help them understand the narrative, but then come clear on, on the narrative, what you're planning to do, or your reasoning behind dropping the insurance. It doesn't align with our purpose. It doesn't align with these values that we hold

[00:32:20] sacred in our organization, keep it purpose values. And we just, we feel our services are valuable enough that they're not getting respected by the insurance companies. These are the reasons why we're doing it. And the reason I bring that up and that you want to make sure that narrative is the same throughout the team is because patients are going to ask, especially ones that are affected, why you guys are dropping my insurance. And if they get three different stories from three

[00:32:45] different people in the organization, it's going to lead to confusion and concern and blowback. But if they hear one story from the front desk, they get a letter that says the same thing. And then they ask the provider and they get the same message. Okay. I guess you guys are serious. I won't ask anymore. You know, I know why. And they're clear. And so that helps a lot. If everyone's on the same page and telling the same story, number two, I don't know about you,

[00:33:12] but I found that physicians understand. Yeah. Some of them are doing the same thing we're doing. They're dropping insurances. I'm tired of getting on those, uh, what are they? Case review calls? You know, it's like, yeah, Lord, I mean, it's crazy. Yeah. So they're, they understand, but the same narrative goes out to them, a letter, a visit, like, Hey, this is what we're doing. This is why helping them understand. So that narrative just stays the same. So it's unified. Mm-hmm.

[00:33:41] All your communication pieces. And so I think that's an important part to get clear on. And once you've done it once, uh, you drop the insurance, you go through the whole process. It's a usually 60, 90 day process. You start these communications 90 days ahead of the end date. You start sending out flyers 45 days before you're dropping the insurance. You help those

[00:34:05] patients who you won't be seeing anymore to find another local provider that you respect and would trust with your patients. And then once you've done that and you've gotten through it successfully and you haven't noticed a significant dip in your operations, I found that owners are, have a lot of confidence to be like, where's the next insurance I can drop? Mm-hmm. What's the next one I can do? Cause they recognize it's, it's not as heavy as a lift as it was to do

[00:34:33] it the first time. And a lot of their fears are allayed after they've gone through it. So it's really helpful to go through the process, but be clear on your messaging. And then once you've done it, like I said, these owners have a lot of confidence to go forward and do it again. Yeah. Just, I can see that too. I can see that too. I think one of the financial fear that you also brought up, and I think it's important before you

[00:35:00] do all the things, you have reasons why you're doing all these things. The numbers don't match. The administrative burden is high, et cetera, et cetera. But I think it's also important to have a plan. So we're not going to see this number of visits affect us with this decrease in revenue. What is our plan now to make up the difference? And just be clear on what that is. Let's have some forethought and put a plan together. We're going to increase average frequency per week for

[00:35:29] all the plans of care and do X, Y, Z. We're going to minimize cancellation rates. We're going to do X, Y, Z. So that 8% dip in our revenues is made up with a 12% increase to cover it. And so having that plan also helps out a lot. Yeah. It's the hard problem that needs to be solved, right? It's like, there's no convenient way to make this work. I think you've talked to enough owners that

[00:35:56] we're coming to a flexion point in the industry. And this varies depending on the state that you're in, but hard decisions are going to have to be made. Yeah, I agree. This is one of them. Yeah. We really haven't had to deal with this at a significant level. It's getting to the point where it needs to be dealt with more frequently than it has been in the past,

[00:36:18] simply because of the metrics. Yeah. That's why it's, I think, tackling the hard problem from a place of clarity with a team that is behind you and some strong systems to support you. I feel like that's a lot more fun than slowly going out of business year over year. You know what I mean?

[00:36:44] Like dying on the vine, you know, at least you could feel good about the work you're doing. At least you could feel like you're fighting the right fight. And as opposed to just like giving up and letting fear consume you. So yeah, I would say just like, if you're listening, I'm with you on that. Like we're fighting that battle too. So like, just lean in, like lean in and like, just do the things you will do it. You will be capable. Like you can take the charge. You know what I mean? Like

[00:37:14] go for it, you know, climb the mountain and your business might look a little different in a year. And that's exactly, that's what you need to do. You know, like it's gotta be different, right? It's gotta be different. Gotta play a different game, man. Got to play a different game. You've got to learn new skills and begging you to learn new skills, find a way to get off the treatment floor and learn how to run the, how, how to make these types

[00:37:39] of changes in your business. And my buddy, Will Humphries, his quote is profitability unlocks possibility. And when you can increase those profits, man, there's a lot more opportunity out there. You have a lot more options. A lot of things are solved with money. Yep. And it's not always about buying a new boat. I mean, that's not real. Like money solves a lot of problems. You know what I mean? Like in a business. Right. It can solve a recruiting problem.

[00:38:09] We've been marketing, recruiting, a lot of things, a lot of cool things can be solved. It can resolve a lack of knowledge problem. Cause not totally. You can hire coaches. You could write. There's a lot of stuff you could do. Go to conferences on October 15th through 17th with your team. You put that at the top. Cool. All right. Well, I think we covered a ton of it and I think anyone listening to this has

[00:38:35] definitely has some homework. We're going to put a worksheet for this episode. Just take some notes, put some thoughts down so they don't get lost. So your thoughts don't get lost. We'll put them in the show notes for you to follow along, but check out the website at ppoclub.com under resources and podcasts. You'll find this. And especially under any other podcast provider that you have. But while

[00:39:01] you're still listening, check out ppoclubevents.com for October 15th through 17th podcast or conference, the high performance practice register, bring your team. And we'll talk more about stuff like this. And then in our next episode, little teaser, dealing with RCM. We're talking about managing your billers. So maybe we did this in the wrong, since we said, you got to manage your billers before

[00:39:27] you talk about contract negotiations. Maybe that should have been number four and this should have been number four. Just follow along. It's a journey. We know what we're doing. We promise. It'll all work out. That's right. Cool, man. All right. We'll talk to you later, man. Later. Thanks for listening to the Private Practice Owners Club. If you enjoyed this episode, would you mind doing us a huge favor and leaving a review? This helps us get the podcast out to more

[00:39:54] clinic owners to help them create greater freedom and profits so they can own their future. And visit our website, ppoclub.com to find more resources and connect with us. Bye. Bye.