KBH Negotiation Services
KBH professionals are experienced managed care negotiators who can either represent you fully at the managed care chess table, or coach you from behind the scenes to make the right moves. In small urban and rural communities, we strike a delicate balance. First, we present an image to payors of highly skilled and assertive negotiators, ready to fight the hospital's battles if things turn adversarial.
Has Managed Care
Become a Costly
Game of Chess?
Secondly, our 30+ years of experience working in the heartland communities of the country has allowed us to maintain an equally important image as the friendly low-key advocate of local community values, working cooperatively with area employers, community leaders and area residents in a constructive problem-solving mode.
Significant advantages of KBH handling your negotiations:
- Keep your decision maker away from the negotiation table. This is a basic tenet in negotiation strategy, i.e. avoid having your final decision maker sit at the chess table while active negotiations are taking place.
Your final decision maker may be your most talented representative available. However, just as in a chess game, it is your pawns, knights, bishops and rooks who are typically the first to skirmish with the opposition. Their role is to position both sides strategically so that your leaders can strike quickly and surgically.
Similarly in managed care negotiations, it is often advantageous to prudently minimize access to the person who has the clout necessary to break a stalemate or deliver a hammer blow of a veto when necessary. While we are strongly committed to keeping the CEO and CFO fully informed, having that person too close to the fray inserts unnecessary risk, and reduces their strength as the last recourse.
- Ask your attorney for "legal" advice. For "practical" advice, ask your KBH consultant. We are not attorneys, but we work closely with your legal counsel when appropriate. Over thirty years of successful negotiation experience have taught us that both "practical" and "legal" advice are important, though they may differ considerably.
For instance, it is not unusual for managed care organizations to agree to clauses in provider agreements which they subsequently ignore or select not to implement. Many payors attempt to unilaterally supersede the agreement language by addressing the issue differently in their provider or procedural manuals, then they unilaterally proclaim those manuals to be non-negotiable.
KBH consultants ensure the agreement language is well understood by both parties, and variances from that standard is discoverable and enforceable in daily practice. Experience negotiating with managed care payors of all sizes in over 20 states has caused KBH to be meticulous in contract language, and sensitive to the operational issues within those organizations that can cause the intended agreements to be negated in practice.
KBH clients also have access to the vast KBH knowledge base of contract clauses that have proven effective in other (anonymous) locations and with other payors (also anonymous) in analogous situations.
- A successful negotiator on your side can result in significantly improving provider reimbursement. KBH negotiators are keenly alert to identifying when payor representatives use a different language reminiscent of the "Double Speak" of George Orwell, stating their supposed intentions, while they insert clauses that have strong potential for very different results.
Unfortunately, many hospital executives have had unexpected career changes due to their agreement upon managed care contract language that initially appears benign, but in reality can cause significant harm to the providers.
For instance, the definitions section of the contract is often ignored because it is boring and appears mundane. Many think only commonly accepted terms would be used, e.g. "affiliates", "hospital based physicians", and "average price increase". Actually, the wrong definitions of such terms can have a devastating impact upon reimbursement.
The hospital's investment in a professional negotiation team could save your hospital literally hundreds of thousands of dollars. You need to be protected from hazards that can result in lost revenues due to unexpected interpretations of key words and clauses.
- Nobody can be an expert at everything. Hospital executives rightly perceive their education and training to have prepared them for a wider diversity of experience and knowledge than executives in almost any other industry.
And, managed care contract negotiation requires a similar set of generalized expertise as that found in other specialties that include a negotiation function, such as physician contracting, group purchasing, and funds development activities. However, the managed care contracting environment has become so complex that the generalized skills set is no longer sufficient.
A community driven hospital needs representation at the negotiation table by a highly skilled wordsmith who can relate to the local community's needs as well as those of the medical staff, clinical and ancillary departmental management. Most importantly, that representative must be familiar with the most current strategies being used by payors to reduce provider revenues. For KBH negotiation specialists, this is a full time, every day function.
- What is NOT said in a contract can be as important as what is said. Often, the most important issues affecting hospitals and physicians are not even present in the contract language proposed. Unfortunately, some of the most vivid examples of this are from the small community hospitals where a mid-level manager or administrative person has accepted the contract language as initially presented by the payor.
The contract proposed by payors are written by payors to protect payor interests. This can be seen particularly in those wrapped in a cover letter claiming to be of minor importance. Watch our when you hear "Just putting it on new paper", or "A new way of saying how we already do things", or "This is our standard national contract, used for all our providers everywhere", or "We cannot change it for one provider without changing it for all."
KBH consultants know what language is being accepted elsewhere and by other payors. And, at times more importantly, we know what is being left out by the payors, i.e. significant clauses designed to protect the provider interests. Our favorite response we hear from payors is "Nobody has ever asked us for that before." That is typically a sign that we've hit upon an issue worth attention.
- An expert from the outside may be needed to keep political peace among the many constituents of a community driven hospital. Your KBH consultant often serves as an objective third party among the many constituents important in a community driven hospital setting.
A recognized expert from an independent consulting firm such as Katz Brunner Healthcare can assist in settling differences of opinion or perspectives between the complex array of constituencies present in the community driven hospitals. These may include Board Members, medical staff, hospital executives, department heads, clinical professionals, local area residents, employers, media, etc.
KBH consultants bring that broad experience of working with all those groups on a professional level. One of their skills of particular note is the ability to establish working relationships that "manage ambiguity", a common challenge in managed care issues.