Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Tuesday, May 19, 2009


I received an envelope in the mail today containing a thick sheaf of papers. It turned out to be from a management company, an intermediary specializing in worker's compensation and auto insurance, that was trying to get us to join their network. Actually, you had to read the first paragraph pretty carefully to figure that out. Here's how it began:
As our network expands, we continue to seek facilities that can provide quality care for our claimants. Kindly review the enclosed information and return it to us so that you can be included in our growing network. In order to expedite this process, we are enclosing and application and contract for your convenience and review. If you choose to complete these documents, we would be pleased to count you among the providers already servicing our clients! [emphasis decidedly not theirs]
Here's the problem. Following the next page, which lists the documents that need to be returned (signed service agreement; completed application; license; DEA; current malpractice insurance; board certification; CV; W-9), comes a blank "network application" and a 19 page contract labeled PARTICIPATING PROVIDER AGREEMENT. At least this one actually includes all the appendices it refers to; not all of the contracts I receive do. But the cover letter concludes:
...Once credentialing has will also receive our manual that describes [our] policies and procedures.
Ahem. Why would anyone in their right mind sign a contract before reviewing the company's policy and procedure manual? Hell, right there in the contract, it states that I'm agreeing to:
Comply with the rules, regulations, policies and procedures as...summarized in the Provider Manual.
Hell, there are two full pages devoted to "Obligations of Provider" without ever mentioning any obligations on their part (like prompt payment of clean claims, for example.)

Interestingly, they have a website. After perusing it for 10 minutes, I can say this is 15 minutes of my life I'll never get back. It's so incredibly generic, I could probably co-opt several sections of it for myself! Here's what they say about their "commitment":
Our organization understands that our clients have a variety of needs and expectations. We also recognize they share common goals, for outcome based solutions that address their needs, while also enhancing their performance. We deliver services how, where, and when requested and make a difference where it counts: by achieving measurable results.
How do they do this? With these "Strategies":
[We] prides [ourselves] on our basic structure of client service teams. We first understand and evaluate each client's specific needs and then tailor an organized program, with individual or combined services, that will make a difference. Our strategy is to formulate innovative, visionary and technology enhanced solutions that meet our common delivery of excellence, exclusively to our clients.
Wow. That could just as easily be a motorcycle repair shop! I also love their all-purpose Mission Statement:

Our mission is to understand and respond proactively to our client's needs, to exceed all expectations, and to devote ourselves to quality, innovation and service.

We will continue to strive towards excellence and to ensure a consistently high level of service to all involved parties.

Our goal is to initiate and develop a total customer-centered program by providing uncompromising professionalism and responsiveness.

We vow to maintain our competitive edge and adjust to the ever-changing health care environment without relinquishing the integrity we've achieved and maintained throughout the years.

WTF? Talk about meaningless gibberish.

The worst part is that deep in the fine print, it turns out that the rate they're offering to pay me is 20% below my usual charge. Er, given that my two largest payers are currently compensating me at only 95% and 88% of Medicare, all I can say is take this contract and shove it where not even the colonoscope shines.


At Tue May 19, 08:15:00 AM, Anonymous craig said...

I don't know why you bothered reading any farther than the words "workers compensation". You should have know right away that the fees would be low, the patients looking for something for nothing and the hassle factor enormous.

At Tue May 19, 09:49:00 AM, Blogger #1 Dinosaur said...

Because the words "workers compensation" didn't appear until the third paragraph. That IS where I stopped.

At Tue May 19, 10:42:00 AM, Anonymous Anonymous said...

That really depends on the market. In some markets, workers comp is actually pretty reasonable in terms of payment -- you still might not want the patients, but that's an individual decision.

I worked with a rural health clinic that did a pretty good volume of high reimbursement procedures for workers comp -- a lot of sewing up wounds, etc.

At Tue May 19, 06:15:00 PM, Blogger Evan said...

Make no mistake: ridicule is an especially pernicious form of intolerance.

At Tue May 19, 10:27:00 PM, Anonymous Anonymous said...

I just read one that said they pay 105% of "their" RVBS. NO mention of what this figure might be. I told my office manager to tell 'em I needed the fee schedule in dollars and cents in English. Or they can go pound sand. Like I need another crap PPO for my practice....

At Sat May 23, 04:47:00 PM, Anonymous Dr. Know said...

Hope you are dropping the payers that pay under Medicare. Just say no.

At Sat May 23, 04:52:00 PM, Blogger #1 Dinosaur said...

Let's see, Dr. Kn: given that my two biggest payers pay, respectively, 88% and 95% of Medicare, and that they represent about 80% percent of my patients, dumping them would be the equivalent of going cash-only. That is part of my eventual plan, though.


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