Practice Management

Being relatively new to the medical industry I am appalled at the differing reimbursements 'offerred' (take it or leave it) offered by some insurers.

Is there some hope in possibly leveling the playing field?

Due to the Federal Law about monopoly activities (i.e. negotiating as a group of companies) our hands are tied and many of the insurers offer this 'take it or leave it' attitude without restriction.

I see some large groups who receive TWICE the reimbursement while the smaller groups (we have six MRI centers with plans to open two additional within the next 15 months) getting reimbursements that indicate that the smaller practices are going this alone.

How do we equalize these reimbursements and allow us to keep our doors open and provide the best service to our patients?

We must all 'Hang Together or Hang Separately' and about time a group such as the RBMA take a positive, measured approach to this travesty in our medical marketplace.

My intention is not to be heavy-handed but just the ability (through the RBMA or other associations) to publicly address this inequality which negatively affects all.

Thank you

Bill Kisse


------------------------------
William Kisse
COO
Washington Open MRI, Inc.
Rockville, MD
bill@womri.com
(301) 424-4888
https://www.linkedin.com/in/billkisse/
------------------------------

Bill

As you have discovered, imaging centers that offer a better value proposition (in the eyes of the person sitting on the other side of the negotiating table), get better rates.  Of course, that person generally isn't the patient, and often isn't even the entity paying the bill.  Unless you can make a compelling case based on something other than price, price will govern.  For better or worse, that's the way the market works, and I have a hard time coming up with an argument as to why the person on the other side should not pay based on their perception of value.

It seems to me that you may have some options:  you can try to offer a superior value proposition, you can make yourself the low cost provider and try to win on volume and pricing pressure on your competition, or you can try to find a niche that is not well served by your competitors. 

If you feel that more negotiating leverage might be helpful, there is at least one structure that allows independent healthcare organizations to negotiate collectively: a Clinically Integrated Network.  However, setting up a CIN is a major project that involves significant capital investment and of course willing partners.

I think it's worth noting that there seems to be significant pricing pressure on the horizon, which is likely to drive down the high end, and may tend to have an equalizing effect.  To the extent that hospital owned provider based facilities get better rates, the CMS initiative to reduce site of service differentials will tend to work in that direction, and it's easy to imagine that Congress might tighten those rules up further because it's an easy source of savings.  It's also easy to imagine that the Presidents price transparency initiative might put pressure on those with higher contracted rates, especially in outpatient imaging.  Of course, Medicare for All would result in the level playing field you want, and I expect that even a public option based on Medicare rates would apply significant pricing pressure in that direction.

As for RBMA's role here, obviously the organization can't take the risk of becoming a vehicle for illegal collusion.  Even if we could, I don't think it would make sense for RBMA to argue that some members should get better rates, which implies that other members should get lower rates.

Good luck!

------------------------------
David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387
------------------------------

Original Message:
Sent: 06-29-2019 13:25
From: William Kisse
Subject: Fair and equitable insurance reimbursements

Being relatively new to the medical industry I am appalled at the differing reimbursements 'offerred' (take it or leave it) offered by some insurers.

Is there some hope in possibly leveling the playing field?

Due to the Federal Law about monopoly activities (i.e. negotiating as a group of companies) our hands are tied and many of the insurers offer this 'take it or leave it' attitude without restriction.

I see some large groups who receive TWICE the reimbursement while the smaller groups (we have six MRI centers with plans to open two additional within the next 15 months) getting reimbursements that indicate that the smaller practices are going this alone.

How do we equalize these reimbursements and allow us to keep our doors open and provide the best service to our patients?

We must all 'Hang Together or Hang Separately' and about time a group such as the RBMA take a positive, measured approach to this travesty in our medical marketplace.

My intention is not to be heavy-handed but just the ability (through the RBMA or other associations) to publicly address this inequality which negatively affects all.

Thank you

Bill Kisse


------------------------------
William Kisse
COO
Washington Open MRI, Inc.
Rockville, MD
bill@womri.com
(301) 424-4888
https://www.linkedin.com/in/billkisse/
------------------------------

Thank you, David.

​"As for RBMA's role here, obviously the organization can't take the risk of becoming a vehicle for illegal collusion"

Of course, 'collusion' is in the eye of the beholder and collaboration is certainly legal and of value - especially within the membership of the RBMA.

I absolutely agree that this could be misconstrued, but from my perspective it's at least worth a discussion among all member-providers as to the proper and most effective way to negotiate higher rates.   Basically a position of 'here's why I deserve higher compensation' and that's the key.

From my analysis, large groups secure higher compensation most likely as they are 'too big for the insurers to lose', but this says nothing about the quality of service other than meeting minimum ACR guidelines.

I've recently contacted Covera Health and they have the beginnings of a national plan to offer what I would describe as ensuring participating certified members greatly exceed these 'minimum standards' in all respects.  Let's call it the "Good Housekeeping Seal of Approval" that would be recognized by insurers, referring physicians and patients alike.

As part of my membership in the RBMA I wish to offer, refine and exchange these industry best-practices as it is foolish to not do so among us in a confidential (within our membership) manner.

Sincerely, my goal is to be recognized as among the "Best of The Best" and I believe I've found that in our association and I am proud to be accepted as a member.

"Even if we could, I don't think it would make sense for RBMA to argue that some members should get better rates, which implies that other members should get lower rates."

Certainly, we all offer the same services (within our specific modalities), have the same expenses, are held to the same standard and there should be a level playing field in reimbursements.

But, if we do digress to a single-payor we face the possibility of additional headaches when - as Medicare has done in the past - 'take it or leave it' rates.

Fortunately, we have run our business very lean and have zero debt on all our equipment and only incur monthly expenses for utilities and maintenance.

I've see too many competitors shutter their doors as their business models were based on previously higher (and fair) compensation who could not adjust to the current reality of our marketplace.

I am a retired CEO with 40 years of working in multiple technology-related businesses and have never seen commodity pricing that was artificially and IMHO arbitrarily mandated by the government.

So we must all keep a close eye on expenses, changing laws and additional opportunities that may at least partially offset this troubling maze of confusion we all face on a daily basis.

------------------------------
William Kisse
COO
Washington Open MRI, Inc.
Rockville, MD
bill@womri.com
(301) 424-4888
https://www.linkedin.com/in/billkisse/
------------------------------

Original Message:
Sent: 07-01-2019 10:03
From: David Smith
Subject: Fair and equitable insurance reimbursements

Bill

As you have discovered, imaging centers that offer a better value proposition (in the eyes of the person sitting on the other side of the negotiating table), get better rates.  Of course, that person generally isn't the patient, and often isn't even the entity paying the bill.  Unless you can make a compelling case based on something other than price, price will govern.  For better or worse, that's the way the market works, and I have a hard time coming up with an argument as to why the person on the other side should not pay based on their perception of value.

It seems to me that you may have some options:  you can try to offer a superior value proposition, you can make yourself the low cost provider and try to win on volume and pricing pressure on your competition, or you can try to find a niche that is not well served by your competitors.

If you feel that more negotiating leverage might be helpful, there is at least one structure that allows independent healthcare organizations to negotiate collectively: a Clinically Integrated Network.  However, setting up a CIN is a major project that involves significant capital investment and of course willing partners.

I think it's worth noting that there seems to be significant pricing pressure on the horizon, which is likely to drive down the high end, and may tend to have an equalizing effect.  To the extent that hospital owned provider based facilities get better rates, the CMS initiative to reduce site of service differentials will tend to work in that direction, and it's easy to imagine that Congress might tighten those rules up further because it's an easy source of savings.  It's also easy to imagine that the Presidents price transparency initiative might put pressure on those with higher contracted rates, especially in outpatient imaging.  Of course, Medicare for All would result in the level playing field you want, and I expect that even a public option based on Medicare rates would apply significant pricing pressure in that direction.

As for RBMA's role here, obviously the organization can't take the risk of becoming a vehicle for illegal collusion.  Even if we could, I don't think it would make sense for RBMA to argue that some members should get better rates, which implies that other members should get lower rates.

Good luck!

------------------------------
David Smith FACMPE
Executive Director
United Imaging Consultants
Mission KS
(785) 393-8387

Original Message:
Sent: 06-29-2019 13:25
From: William Kisse
Subject: Fair and equitable insurance reimbursements

Being relatively new to the medical industry I am appalled at the differing reimbursements 'offerred' (take it or leave it) offered by some insurers.

Is there some hope in possibly leveling the playing field?

Due to the Federal Law about monopoly activities (i.e. negotiating as a group of companies) our hands are tied and many of the insurers offer this 'take it or leave it' attitude without restriction.

I see some large groups who receive TWICE the reimbursement while the smaller groups (we have six MRI centers with plans to open two additional within the next 15 months) getting reimbursements that indicate that the smaller practices are going this alone.

How do we equalize these reimbursements and allow us to keep our doors open and provide the best service to our patients?

We must all 'Hang Together or Hang Separately' and about time a group such as the RBMA take a positive, measured approach to this travesty in our medical marketplace.

My intention is not to be heavy-handed but just the ability (through the RBMA or other associations) to publicly address this inequality which negatively affects all.

Thank you

Bill Kisse


------------------------------
William Kisse
COO
Washington Open MRI, Inc.
Rockville, MD
bill@womri.com
(301) 424-4888
https://www.linkedin.com/in/billkisse/
------------------------------