Although you may not want to see those patients go, your practice will be financially healthier and your staff will be happier if you make the move.

Don't forget that the ideal payer mix should involve a combination of several payers, not just one or two. Practices that rely too heavily on only a couple of payers often find themselves in bad shape when their payers go bankrupt, change their payment rules, or break off their contracts. If you do decide to let go of one or two of your payers, then try to replace them with other payers whenever possible. Of course, do a little research before you enter into an agreement with another payer so you don't end up in a similar situation. Talk to other physicians who do business with the potential payer and get their feedback on the payer's practices.

Athena Health has produced a new resource for assessing payer quality. PayerView taps into a large database of physician and payer interactions to rank payers by a variety of metrics. This promises to be one of the best resources for controlling your payer mix. 

The Bottom Line

Controlling your payer mix is an important factor in maintaining the profitability of your practice. The good news is that controlling the mix through scheduling and through patient acceptance is not as difficult as you might think. Just remember to read through your payer contracts before making any changes.

Resources Used in Article

Ideal Payer Mix - Physicians Practice

Setting Payer Mix - Physicians Practice

Dump a Health Plan? How to Decide - Medical Economics

Blocking Schedule for Better Payers - Physicians Practice

Financial Checkup - Physicians Practice

About the Author

Amy Jorgensen is a freelance writer based in southern Indiana. Her articles have appeared in a variety of publications, including Southern California Physician magazine.

The author has no financial relationship to any of the companies listed in the article.

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