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C58 - Business Strategies for Payer Negotiations and/or How to Go off the Grid

Event Time: Sunday May 5, 2019 1:00 pm to 3:00 pm
Topic(s): Practice, Policy, and Ethics, Academic, Career Essentials, Business of Neurology
Director(s): Joseph Fritz PhD
Description: Neurology practices struggle with shrinking reimbursements and payer policies that add to practice overhead and lead to provider burnout. Increasingly, physicians are being measured for quality, utilization and cost, and their value questioned when payer data analytics indicate poor performance compared to peers. This course will help neurologists improve documentation and ability to produce compelling analytics that demonstrate their value in the eye of the payer and improve the ability to negotiate in a fee-for-service environment. Benefits may be improved fee schedule, reduced prior authorization burden, network inclusion, and maintaining referral patterns from primary care physicians that increasingly must pay attention to the value of referred services. Alternative payment models have become preferred approaches by payers to share risks with providers. This model promises to remove micromanagement by outside entities by aligning financial incentives to reduce episode-of-care costs. These models require a good understanding of existing costs, along with clinical markers that can be used to stratify the patient population by complexity and expected costs. If done properly, payer "hassle factor" can be reduced and investments in efficiency yield increased net profits. Faculty will review the benefits and risks associated with not participating with payers, relying entirely on private pay. The resulting autonomy may eliminate many of the frustrations experienced by neurologists today. Effect on overall population health and health care economics for each of these approaches will be discussed by the panel.
Completion Message: Participants should be able to understand practice financials and essential metrics used by payers to assess performance, use data and benchmarking to recognize areas of improvement and identify payer relationshp strategies, identify resources that can assist in payer negotiations, assess alternative payment models that align with practice goals and abilities, and learn how to transition to a new payment model.
CME Credits: 2
Core Competencies: Patient Care, Professionalism, Practice-based Learning and Improvement, Systems-based Practice

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