COVID Recovery Plan: What Now?
Main Points
COVID has disrupted the world and private practices are asking the question, "What now?"
As providers look at their recovery plans they are asking Practice Solutions to offer solutions for evaluating a panel or #insurance company to take on an in-network basis
Providers are starting to wonder what the mid and long-term impacts of COVID might be on commercial and government health insurance
It is no surprise that #COVID-19 has turned the global economy upside down and has created a multi-variate crisis within every industry. The #privatepractice industry is no different.
The impact of COVID on patients and practices can hardly be overstated, and now providers and practices are asking the question, "What now?". This is a fair question and one that should be considered carefully. Our team and our colleagues across the mental health industry are starting to see more providers exploring what it will look like to take insurance moving forward from the COVID crisis, and they are asking what it looks like to recover from COVID.
It is true that some practices have been more impacted than others, but all practices are looking at what the path forward looks like for the next 6-18 months on the road to recovery.
Some of the variables of the "What now?" question need to include:
Unemployment - the unemployment rate will have a direct impact on the insurance industry based on employer-funded insurance plans and group health plans. The cost factor for COBRA will limit the number of people that continue with their insurance. Additionally, the unemployment rate will impact those private pay clients because they have less free-cash-flow.
#Telehealth - innovation in the telehealth industry has absolutely skyrocketed! Some practices are opening telehealth as a service and most are not planning on removing this service any time soon. Insurance companies will likely have to change their telehealth policies as a result of COVID. #telehealth will be forever changed.
Hiring - economic downturn often presents a particular benefit for employers and that is a wider selection of talent in the job market. Private practices may have the opportunity to find talent otherwise unavailable at prices previously untenable for their size.
Marketing and practice growth - this is a tough variable to nail down because our team is seeing new patient intakes flatten or decrease, but patient retention is remarkably stable. Those patients that were attending treatment prior to COVID are continuing in treatment. It might be difficult to find new patients through the unemployment period that we are seeing, but it is still possible to grow a practice.
Billing - the current narrative from insurance companies is that patients who have telehealth benefits baked into their coverage (i.e. they had telehealth benefits prior to COVID) are covered at 100%. This is a huge benefit given the rates of unemployment and lack of free cash flow. However, #privatepractices that were exclusively cash-pay are now starting to ask if they should start taking insurance at an in-network basis. More on that below!
Profitability - one of the challenges that COVID presents is a decrease in cash flow and profitability. This means that you may have to develop strategies around risk mitigation and what levers you may have to pull to maintain the sustainability of your practice.
Should you take insurance to help mitigate your risk moving forward and how do you evaluate an insurance panel?
This is the million-dollar question and one that we have been receiving a lot of right now.
There are a few things to consider when researching whether or not you should take insurance.
First, if you are researching taking an insurance panel you need to ask yourself if you are okay with the risks that come with taking insurance as an in-network provider. here are some risks that are involved with being an in-network provider:
Potentially lower rates
Increased administrative burden
Delayed cash-flow vs. instant payment from cash-pay clients
The inevitability of denied claims
The inevitability of rejected claims
Carved-out insurance plans create confusion for patients and providers
Secondary claims can pose some ethical issues
Need for increased time working in the business vs. on the business
That list may seem like we are making a case against taking insurance, but you have to weigh the potential benefits and upside to taking insurance especially as a risk mitigation strategy and as a way to grow a practice through the #coronavirus crisis. Some of the potential upsides could be:
Free marketing from the insurance company
Greater clinical impact in your community
The ability to find more providers to bring into your practice
Help to decrease the cost of therapy for a group of patients
The ability to work with a specific patient demographic that you enjoy working with
Depending on the insurance company, the rates can be attractive and highly profitable
The ability to get telehealth covered
The ability to grow a practice outside of cash-only patients
Taking insurance doesn't need to be wildly complicated
Outsourcing administrative tasks can be affordable and even profitable
The decision to take insurance is a big one and it requires weighing all the options and deciding if your personality is built for taking on the risks knowing what the downsides and upsides might be.
How do I evaluate an insurance panel or insurance company?
This is the question that our team has received the highest volume of over the last few weeks, and it is a great question!
The paradigm that we espouse for evaluating an insurance company or panel involves three direct variables, and they are not complicated.
The three factors that you need to consider when researching an insurance panel are:
Profitability
Clinical Objectives
Administrative Burden
Let's begin with #profitability. If you as a business owner are not taking care of the business first, you are being irresponsible. In order to serve your patients, your staff, and meet your own objectives, you need to take care of the practice and make sure that it is sustainable. If you are looking at taking an insurance company as an in-network provider, you need to consider what the comparable rates are for that insurance company.
BUT that poses a big question: The rate schedules are confidential. How can I tell what the rates are?
That is a great question! Here are a couple of ideas to determine the local rates:
Ask your friends for a range that the insurance company's pay them. If they can give you a range +/- $10.00 that would be helpful. For example, "BCBS pays me between $100.00 and $110.00 per session".
See what providers are charging for their cash rates. Usually, cash rates are 10% to 20% higher than what the insurance company is paying them
Look at the Medicare or Medicaid rates in your state. Those will give you a baseline for determining if you want to take that insurance
Regardless, you need to know with a fair bit of certainty that you are going to be able to pay the bills and profit if you are going to become in-network with an insurance company.
Next, let's look at your #clinical objectives!
This is why you became a counselor. You became a counselor to help people from a wide cross-section of backgrounds and clinical issues, and taking insurance can be a simple way to hit those objectives.
Regardless of your clinical objectives, there is an insurance company that you can partner with to easily work with those clinical populations.
Finally, you will want to evaluate your #administrative burden.
It goes without saying, but not all insurance companies are created equal. Some are easier to work with than others and who you choose to work with matters. Did you go into private practice to be frustrated with your partners? Likely the answer to that question is a resounding no!
Here are some tips to find out how easy the insurance companies are to work with:
Ask your colleagues which insurance company is the easiest to work with. This is the simplest way to find out which insurance company is easy to work with. See which insurance companies pay on time, pay quickly, have the fewest denials, have the fewest rejections, and allow you to focus on patient care.
Contact the insurance company and see how quickly a person picks up and ask them some questions about their company and what working with them is like.
Ask around your community to see which insurance company and insurance plan most people have and what their thoughts are on that insurance company. You might be located near a large university or company that offers a certain insurance plan. If you are not in-network with that insurance plan you might be putting yourself in the best position to grow your client base.
Ask your cash-pay clients if taking their insurance would assist them in any way. It might improve your practice to take the insurance plans that your current patients have. Consider the impact that might have on the finances of the practice but consider the intangible assets of taking their insurance.
Once you have a clear picture of the profitability impact of taking insurance, if taking an insurance company will hit your clinical objectives, and have evaluated the administrative impact to your practice you are in a place to make an informed decision.
Considering the unknown impact of #COVID, what will the mid to long-term impacts of COVID be on the insurance industry and the private practice industry?
Like everyone else, we do not have a crystal ball that can see what the future holds and to pretend to is imprudent and unfair.
With that said, it has been the common narrative of insurance companies to increase access to care, not to decrease it. There are times that it feels like insurance companies are trying to limit providers given reimbursement rates and the byzantine rules and regulations imposed on providers.
However, it has been our experience that insurance companies want to help as many people as possible. The COVID crisis presents a few considerations that may have widespread impacts:
First, for the parts of the country that have seen an increase in domestic violence insurance companies will have to do something to address that health risk
Second, the trauma that is caused by COVID is yet to be seen and the political decisions made at the state level for shelter-in-place orders will likely dictate how insurance companies respond to telehealth needs
Third, there hasn't been data published on the number of patients have sought out mental healthcare given the telehealth policy changes lately, but if more patients have sought care because of greater access to care then you can expect insurance companies to adapt to that shift
Fourth, as providers see positive treatment results from their telehealth sessions, insurance companies will be forced to see the benefit of telehealth sessions at large
Fifth, as more providers seek to join panels, insurance companies may adapt their policies to support greater access to mental healthcare
Again, we don't have a crystal ball to tell the future, but we believe that given the global impact of this crisis, insurance companies will have to adapt and provide greater access to mental healthcare through the delivery of multiple treatment modalities.
In conclusion, we are eternally grateful for those providers on the front lines and helping society in whatever ways they can. We exist to help providers focus on patient care through billing and credentialing, but also through educating on best revenue cycle management practices.
If there is something that you would like Practice Solutions to research and produce content on please reach out and we would be more than happy to research and write a blog on the topic while featuring your practice and giving you credit for the question.
