Dan Neissany spends a lot of time talking to people who own clinics.
Doctors. PTs. Chiropractors.
Practice owners watching reimbursements fall, denials climb, and everything else they pay for (malpractice, salaries) move stubbornly in the opposite direction.
So when he had me on All Things LOCS, we got right to who’s squeezing them.
Everything in health care is upside down.
Employers pay more to the carrier, and doctors get paid less. Cut the carrier out, and the doctor gets paid more while the employer pays less.
For my clients, I start with the network. An employer can fire Cigna and still rent Cigna’s network. Your claim goes to Cigna first, Cigna applies its contracted rate, and then the employer pays.
The contracts everyone signed (the employer, the TPA, and you) say the network is Plan A. Nobody gets to cut a better deal around it unless the network approves. I’d argue those provisions violate the Sherman Act, and DOJ’s antitrust division ought to be coming after them.
Most specialists who stay in the network are making a rational choice.
A rheumatologist needs enough RA cases every year to justify walking away from the volume the network delivers. Independent practices can’t break out one at a time. For it to work well, it has to be a movement: employers, local hospitals, the chamber of commerce. Monthly lunch-and-learns with local CEOs and HR leaders. One conversation at a time.
Nobody's jumping off a cliff right now. You're just learning.
In one Midwestern community, it’s already happening. Three hospitals (one big academic medical center and two smaller ones) built their own network, put their own employees on it first, then contracted with the independent specialists and primary care docs they needed. They’re beating Blue Cross rates. The carriers don’t see it coming. But even with everyone on board, a build like that takes one to two years.
The endgame isn’t a better direct contract.
It’s actually cash pay at scale. One price for every service, with providers competing on it like every other industry.
Dan asked what a practice should do first thing tomorrow. That’s an easy one.
Clinicians should take a hard look at their cash price and make it competitive.
Make sure your billing software and your card processor can handle it. Put it on the wall. Tell every HR leader you know. Then get to know your local churches, because many of their members belong to health care sharing ministries looking for cash-friendly practices.
There is a way out. Give the episode a watch: