Now that we’ve had the benefit of some hindsight, I think we can say that the Great Shutdown of 2020 and the ensuing challenges of operating a practice during the COVID-19 pandemic presented some beneficial opportunities for our practices. This global event tested our grit, our teams, and our systems, revealing flaws that otherwise escaped our attention, pre-crisis. The greatest flaw I observed was my dependency on preferred provider organizations (PPOs).
Like many of you, I had signed several contracts to become in-network with the larger PPOs when I started my practice. It’s easier to accept discounted fees and put up with a flawed claims process when you have wide-open holes in your schedule. As my business grew over the years, my partner and I would occasionally toss around the idea of dropping our worst plan. In the winter of 2019, we were operating at capacity and were still just thinking about it. Then came the shutdown.
When we were able to reopen over the summer, we were operating well above capacity—thanks to pent-up demand, slower room turnover, etc. Our time for casually entertaining the idea of dropping a PPO plan was over. We needed to get serious. If we went out-of-network with our lowest-paying plan (which also had the most disputed claims), we estimated a worst-case scenario of losing 7% of our patients. That was a risk we were willing to take since our schedules were overbooked. We put together a plan to inform patients, terminated the contract, and held our collective breath.
I’ve learned that you don’t need a natural disaster or economic crisis to drop a PPO. My partner and I could have made this decision years ago, and we would have reaped the benefits earlier. In this issue, we’ve collected several articles that will help you become less dependent on PPOs. You’ll learn how to leave your contract, retain the patients who might stay, and find new patients to replace the ones who leave.
It’s been almost a year since we tore up that PPO contract, and we couldn’t be happier. We miss the patients who decided to leave the practice, but have been pleasantly surprised at how many chose to remain. And our practice is still operating near capacity, which has us contemplating whether it’s time to drop the next one...