Capitation Fees from HMOs

[DPMer]

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To all the Board Certified Podiatrists out there: 2 questions

How much are you paid under capitation to perform these procedures by HMOs, for example on 1 adult patient in their 40s?

1) Ingrown toenail with phenol and alcohol

2) Austin procedure

3) Calcaneal fracture ORIF

4) Pilon fracture ORIF

5) OATS procedure

6) Injection to relieve heel pain

7) Weil Osteotomy

8) Lapidus procedure

9) Terminal Symes procedure

10) Symes procedure

11) Cotton procedure

12) Logroscino procedure

Second question: are you satisfied with your pay, in the context of all the rigorous training and education you recieved to be STATE LICENSED and BOARD CERTIFIED?

 

[347932]

I don't quite understand your question for this reason.

Capitation plans work like this. You are given a bulk sum per annum to cover ALL patients within that capitated plan. What this means is that you aren't paid per procedure or visit or anything of the sort. You get one bulk payment from the capitated plan and are expected to do everything for those patients you would normally do for all your other patients with no individual fee schedule. This can be something hard to live with, since whether you see 10 patients or 1000 patients you get the same money. I hope I explained that understandably.

 

[347932]

Second question: are you satisfied with your pay, in the context of all the rigorous training and education you recieved to be STATE LICENSED and BOARD CERTIFIED?

It is our job as medical health professionals to treat patients and relieve their foot pain. I think if you talk to any medical professional these days (other than the very extreme specialists) they consider that they are underpaid by any standard.

To be state licensed, most states require one year of residency. It has nothing to do with whether you feel your training and education was rigorous. Being board certified does require a significant effort and dedication, but all medical specialties require board certification to one extent or another so see my above comment about pay.

 

[DPMer]

I don't quite understand your question for this reason.

Capitation plans work like this. You are given a bulk sum per annum to cover ALL patients within that capitated plan. What this means is that you aren't paid per procedure or visit or anything of the sort. You get one bulk payment from the capitated plan and are expected to do everything for those patients you would normally do for all your other patients with no individual fee schedule. This can be something hard to live with, since whether you see 10 patients or 1000 patients you get the same money. I hope I explained that understandably.

WOW! Thanks for the clarification! That does not look good! So podiatrists are underpaid by HMOs after all.

So for example, if the HMO plans to pay a podiatrist only $100,000 for 300 patients under the capitation plan in 1 year, that means the podiatrist only gets $100,000 in 1 year whether that podiatrist did only nail trimming or whether the podiatrist did only ankle fracture ORIFs that whole year? Sucks.

 

[DPMer]

It is our job as medical health professionals to treat patients and relieve their foot pain. I think if you talk to any medical professional these days (other than the very extreme specialists) they consider that they are underpaid by any standard.

To be state licensed, most states require one year of residency. It has nothing to do with whether you feel your training and education was rigorous. Being board certified does require a significant effort and dedication, but all medical specialties require board certification to one extent or another so see my above comment about pay.

Thank you. I will still adhere to the Hippocratic Oath and be a patient advocate during my years of rigorous training, despite the fact that HMOs do underpay podiatrists that it is so ridiculous.

 

[DPMer]

Thank you. I will still adhere to the Hippocratic Oath and be a patient advocate during my years of rigorous training, despite the fact that HMOs do underpay podiatrists that it is so ridiculous.

H.M.Os say they are trying to save money in healthcare costs when using capitation fee schedules. But I can't help imagining this in my head: A podiatrist gets paid the same amount of money per month whether that podiatrist does nothing that month or performs 300 pantalar fusions that month!

 

[PADPM]

WOW! Thanks for the clarification! That does not look good! So podiatrists are underpaid by HMOs after all.

So for example, if the HMO plans to pay a podiatrist only $100,000 for 300 patients under the capitation plan in 1 year, that means the podiatrist only gets $100,000 in 1 year whether that podiatrist did only nail trimming or whether the podiatrist did only ankle fracture ORIFs that whole year? Sucks.

I am not attempting to make fun of your inexperience regarding the capitation world, but I almost fell off my chair when I saw your post.

When I saw your hypothetical situation that an HMO would pay $100,000 for 300 patients I realized that you may not have a realistic understanding of the situation you may eventually encounter.

You may have to sit down when facing this reality. In most capitated HMO plans along the East Coast region, if you were capitated to 300 patients, your monthly capitated check would probably be in the range of a few hundred dollars per month. Yes, you read that correctly. A few hundred dollars per month, plus any co-pay the patient may have per visit.

The overwhelming majority of capitated contracts pay literally between 1 dollar and 3 dollars per patient per month. And once again you also collect co-pays which can range from 0-50 dollars per visit, this is all figured out by actuaries to attempt to make it "fair". It's all based on statistics and utilization.

So you are contracted to X number of patients and get a check for X amount of dollars, plus co-pays for visits.

In order for you NOT to lose money, there must be a utilization rate of approximately 5-10% depending on who you speak with and what types of procedures are performed. That means if you are contracted to 5,000 patients, realistically you're not going to see all those patients for foot/ankle ailments and should really see between 5-10% of those patients to not lose money, although you ARE getting paid that small amount per patient/per month every month.

As per Kidsfeet's post, this includes all procedures that need to be performed, including surgical. The upside is that if it snows and your office is closed for 2 weeks, you still receive a check. The downside is obvious.

The major question is WHY any practice would accept capitation, and that's obviously an excellent question. However, if you practice in an area that is heavily "capitated", you may need to accept these patients to survive.

We have an extremely large referral base of primary care doctors, and those doctors participate with these plans. These doctors are very busy and don't want to be burdened with having to send SOME patients to our office and then other capitated patients to another DPM's office. They set their referral patterns and want to know that they can send ALL their patients to one practice. They get turned off by practices that pick and choose, especially if the primary accepts the insurance. It pisses off the PCP that they can accept the plan, but you don't.

So if you don't accept the plan, you can watch a significant amount of your referral base disappear.

Our practice monitors our PCP's very closely. If we have a PCP who sends us nothing but HMO patients and nothing else, and there is a huge utilization rate of his HMO patients, we may opt to drop the contract with that particular doctor if it's costing us money.

One more advantage of accepting these patients is word of mouth referrals and ancillary services. Happy patients refer other patients and that's how a practice thrives. Naturally, many of the patients that they refer are not HMO. Additionally, some of these HMO patients may need custom orthoses which are not covered by insurance and they will pay for out of pocket. Some may require other services not covered by HMO and will pay.

And of course the bottom line is that if and when you do eventually end up in a situation where you may accept these contracts, you must monitor your income and costs closely to see if the benefits outweigh the risks/negatives. If you believe it's not working for you, the solution is quite simple. You cancel your contract, no one is forcing you to sign the dotted line.

 

[DPMer]

I am not attempting to make fun of your inexperience regarding the capitation world, but I almost fell off my chair when I saw your post.

When I saw your hypothetical situation that an HMO would pay $100,000 for 300 patients I realized that you may not have a realistic understanding of the situation you may eventually encounter.

You may have to sit down when facing this reality. In most capitated HMO plans along the East Coast region, if you were capitated to 300 patients, your monthly capitated check would probably be in the range of a few hundred dollars per month. Yes, you read that correctly. A few hundred dollars per month, plus any co-pay the patient may have per visit.

The overwhelming majority of capitated contracts pay literally between 1 dollar and 3 dollars per patient per month. And once again you also collect co-pays which can range from 0-50 dollars per visit, this is all figured out by actuaries to attempt to make it "fair". It's all based on statistics and utilization.

So you are contracted to X number of patients and get a check for X amount of dollars, plus co-pays for visits.

In order for you NOT to lose money, there must be a utilization rate of approximately 5-10% depending on who you speak with and what types of procedures are performed. That means if you are contracted to 5,000 patients, realistically you're not going to see all those patients for foot/ankle ailments and should really see between 5-10% of those patients to not lose money, although you ARE getting paid that small amount per patient/per month every month.

As per Kidsfeet's post, this includes all procedures that need to be performed, including surgical. The upside is that if it snows and your office is closed for 2 weeks, you still receive a check. The downside is obvious.

The major question is WHY any practice would accept capitation, and that's obviously an excellent question. However, if you practice in an area that is heavily "capitated", you may need to accept these patients to survive.

We have an extremely large referral base of primary care doctors, and those doctors participate with these plans. These doctors are very busy and don't want to be burdened with having to send SOME patients to our office and then other capitated patients to another DPM's office. They set their referral patterns and want to know that they can send ALL their patients to one practice. They get turned off by practices that pick and choose, especially if the primary accepts the insurance. It pisses off the PCP that they can accept the plan, but you don't.

So if you don't accept the plan, you can watch a significant amount of your referral base disappear.

Our practice monitors our PCP's very closely. If we have a PCP who sends us nothing but HMO patients and nothing else, and there is a huge utilization rate of his HMO patients, we may opt to drop the contract with that particular doctor if it's costing us money.

One more advantage of accepting these patients is word of mouth referrals and ancillary services. Happy patients refer other patients and that's how a practice thrives. Naturally, many of the patients that they refer are not HMO. Additionally, some of these HMO patients may need custom orthoses which are not covered by insurance and they will pay for out of pocket. Some may require other services not covered by HMO and will pay.

And of course the bottom line is that if and when you do eventually end up in a situation where you may accept these contracts, you must monitor your income and costs closely to see if the benefits outweigh the risks/negatives. If you believe it's not working for you, the solution is quite simple. You cancel your contract, no one is forcing you to sign the dotted line.

Thank you thank you for educating me. I am naive about the details of capitation. I wish my podiatry school would teach us this in more detail so that we students do not get overwhelmed in the real world after residency. Our podiatry school only offers malpractice issues and laws about limitations of practice. But NOTHING about medical billing/coding issues from HMOs. Thank you PADPM again for this valuable information!

 

[DPMer]

I am not attempting to make fun of your inexperience regarding the capitation world, but I almost fell off my chair when I saw your post.

When I saw your hypothetical situation that an HMO would pay $100,000 for 300 patients I realized that you may not have a realistic understanding of the situation you may eventually encounter.

You may have to sit down when facing this reality. In most capitated HMO plans along the East Coast region, if you were capitated to 300 patients, your monthly capitated check would probably be in the range of a few hundred dollars per month. Yes, you read that correctly. A few hundred dollars per month, plus any co-pay the patient may have per visit.

The overwhelming majority of capitated contracts pay literally between 1 dollar and 3 dollars per patient per month. And once again you also collect co-pays which can range from 0-50 dollars per visit, this is all figured out by actuaries to attempt to make it "fair". It's all based on statistics and utilization.

So you are contracted to X number of patients and get a check for X amount of dollars, plus co-pays for visits.

In order for you NOT to lose money, there must be a utilization rate of approximately 5-10% depending on who you speak with and what types of procedures are performed. That means if you are contracted to 5,000 patients, realistically you're not going to see all those patients for foot/ankle ailments and should really see between 5-10% of those patients to not lose money, although you ARE getting paid that small amount per patient/per month every month.

As per Kidsfeet's post, this includes all procedures that need to be performed, including surgical. The upside is that if it snows and your office is closed for 2 weeks, you still receive a check. The downside is obvious.

The major question is WHY any practice would accept capitation, and that's obviously an excellent question. However, if you practice in an area that is heavily "capitated", you may need to accept these patients to survive.

We have an extremely large referral base of primary care doctors, and those doctors participate with these plans. These doctors are very busy and don't want to be burdened with having to send SOME patients to our office and then other capitated patients to another DPM's office. They set their referral patterns and want to know that they can send ALL their patients to one practice. They get turned off by practices that pick and choose, especially if the primary accepts the insurance. It pisses off the PCP that they can accept the plan, but you don't.

So if you don't accept the plan, you can watch a significant amount of your referral base disappear.

Our practice monitors our PCP's very closely. If we have a PCP who sends us nothing but HMO patients and nothing else, and there is a huge utilization rate of his HMO patients, we may opt to drop the contract with that particular doctor if it's costing us money.

One more advantage of accepting these patients is word of mouth referrals and ancillary services. Happy patients refer other patients and that's how a practice thrives. Naturally, many of the patients that they refer are not HMO. Additionally, some of these HMO patients may need custom orthoses which are not covered by insurance and they will pay for out of pocket. Some may require other services not covered by HMO and will pay.

And of course the bottom line is that if and when you do eventually end up in a situation where you may accept these contracts, you must monitor your income and costs closely to see if the benefits outweigh the risks/negatives. If you believe it's not working for you, the solution is quite simple. You cancel your contract, no one is forcing you to sign the dotted line.

@PADPM: is the whole East Coast and whole West Coast heavily capitated? Which regions are minimally capitated? Thanks.

 

[DPMer]

I am not attempting to make fun of your inexperience regarding the capitation world, but I almost fell off my chair when I saw your post.

When I saw your hypothetical situation that an HMO would pay $100,000 for 300 patients I realized that you may not have a realistic understanding of the situation you may eventually encounter.

You may have to sit down when facing this reality. In most capitated HMO plans along the East Coast region, if you were capitated to 300 patients, your monthly capitated check would probably be in the range of a few hundred dollars per month. Yes, you read that correctly. A few hundred dollars per month, plus any co-pay the patient may have per visit.

The overwhelming majority of capitated contracts pay literally between 1 dollar and 3 dollars per patient per month. And once again you also collect co-pays which can range from 0-50 dollars per visit, this is all figured out by actuaries to attempt to make it "fair". It's all based on statistics and utilization.

So you are contracted to X number of patients and get a check for X amount of dollars, plus co-pays for visits.

In order for you NOT to lose money, there must be a utilization rate of approximately 5-10% depending on who you speak with and what types of procedures are performed. That means if you are contracted to 5,000 patients, realistically you're not going to see all those patients for foot/ankle ailments and should really see between 5-10% of those patients to not lose money, although you ARE getting paid that small amount per patient/per month every month.

As per Kidsfeet's post, this includes all procedures that need to be performed, including surgical. The upside is that if it snows and your office is closed for 2 weeks, you still receive a check. The downside is obvious.

The major question is WHY any practice would accept capitation, and that's obviously an excellent question. However, if you practice in an area that is heavily "capitated", you may need to accept these patients to survive.

We have an extremely large referral base of primary care doctors, and those doctors participate with these plans. These doctors are very busy and don't want to be burdened with having to send SOME patients to our office and then other capitated patients to another DPM's office. They set their referral patterns and want to know that they can send ALL their patients to one practice. They get turned off by practices that pick and choose, especially if the primary accepts the insurance. It pisses off the PCP that they can accept the plan, but you don't.

So if you don't accept the plan, you can watch a significant amount of your referral base disappear.

Our practice monitors our PCP's very closely. If we have a PCP who sends us nothing but HMO patients and nothing else, and there is a huge utilization rate of his HMO patients, we may opt to drop the contract with that particular doctor if it's costing us money.

One more advantage of accepting these patients is word of mouth referrals and ancillary services. Happy patients refer other patients and that's how a practice thrives. Naturally, many of the patients that they refer are not HMO. Additionally, some of these HMO patients may need custom orthoses which are not covered by insurance and they will pay for out of pocket. Some may require other services not covered by HMO and will pay.

And of course the bottom line is that if and when you do eventually end up in a situation where you may accept these contracts, you must monitor your income and costs closely to see if the benefits outweigh the risks/negatives. If you believe it's not working for you, the solution is quite simple. You cancel your contract, no one is forcing you to sign the dotted line.

@PADPM: what are ways that podiatrists can get paid in a respectable way by HMOs and only have capitated patients at a minimum? Thank you, from a naive podiatry student 😕

 

[PADPM]

I'm really not sure and wouldn't say that the entire East Coast is capitated. There are specific geographic areas that are more heavily capitated than other areas within miles. Western Pennsylvania has very little capitation and Philadelphia has a high amount, South Jersey has a fair amount of capitation and North Jersey has less. I believe NYC area has a fair amount of capitation.

Florida has a decent amount of capitation and many areas of California are heavy with plans like Kaiser. You have to do your homework before you practice in an area.

I'm not sure how to answer your other question regarding how to get paid in a respectable manner from an HMO or how to keep the amount of HMO capitated patients to a minimum.

First of all, you really have no choice in most cases regarding "how to get paid". The contracts are set and you either accept the payment or you don't. There is little room to negotiate.

DPM's are responsible for this mess in my opinion. If we ALL rejected the contracts early on when these contracts were introduced, they simply would not exist. Unfortunately, it was a cut-throat environment and when some turned it down, others were quick to accept the ridiculously low payments. That opened the door for the HMOs to get away with the low fees. Once some accepted the payments, they had an audience.

Now we all have to live with that decision. As per my prior post, in order to compete and appease our PCP's, we accept these capitated HMO's because THEY do, and we want them to refer ALL patients. If we select not to accept the HMO patients, it's very likely they will stop sending ALL patients and begin sending patients to the doctor who DOES accept the HMO patients. That's reality. Unfortunately it doesn't always have to do with the quality of care we provide, it has to do with what's convenient for them and their staff.

If for some unlikely reason you're the ONLY provider in your area, you may be able to negotiate fees. We attempted to do that since we are the largest group in the region, but we failed.

As far as how to keep the amount of capitated patients to a minimum....that's easy. Once again, you simply don't have to sign the contract, or you don't have to accept any new PCP's who want to refer to you. You can have 1 PCP refer to you or 100. Each PCP will have a list of X amount of patients, and at any time you can "drop" a PCP or they can drop you.

However, once you do decide to accept these patients, you have to provide the same quality of care regardless of the payment you receive per visit. You must treat the patient, not their insurance carrier. If you are going to change the type or quality of care you provide based on the patient's insurance, don't accept that insurance. It's not fair to the patient and it doesn't speak well of your practice ethics.

 

[DPMer]

I'm really not sure and wouldn't say that the entire East Coast is capitated. There are specific geographic areas that are more heavily capitated than other areas within miles. Western Pennsylvania has very little capitation and Philadelphia has a high amount, South Jersey has a fair amount of capitation and North Jersey has less. I believe NYC area has a fair amount of capitation.

Florida has a decent amount of capitation and many areas of California are heavy with plans like Kaiser. You have to do your homework before you practice in an area.

I'm not sure how to answer your other question regarding how to get paid in a respectable manner from an HMO or how to keep the amount of HMO capitated patients to a minimum.

First of all, you really have no choice in most cases regarding "how to get paid". The contracts are set and you either accept the payment or you don't. There is little room to negotiate.

DPM's are responsible for this mess in my opinion. If we ALL rejected the contracts early on when these contracts were introduced, they simply would not exist. Unfortunately, it was a cut-throat environment and when some turned it down, others were quick to accept the ridiculously low payments. That opened the door for the HMOs to get away with the low fees. Once some accepted the payments, they had an audience.

Now we all have to live with that decision. As per my prior post, in order to compete and appease our PCP's, we accept these capitated HMO's because THEY do, and we want them to refer ALL patients. If we select not to accept the HMO patients, it's very likely they will stop sending ALL patients and begin sending patients to the doctor who DOES accept the HMO patients. That's reality. Unfortunately it doesn't always have to do with the quality of care we provide, it has to do with what's convenient for them and their staff.

If for some unlikely reason you're the ONLY provider in your area, you may be able to negotiate fees. We attempted to do that since we are the largest group in the region, but we failed.

As far as how to keep the amount of capitated patients to a minimum....that's easy. Once again, you simply don't have to sign the contract, or you don't have to accept any new PCP's who want to refer to you. You can have 1 PCP refer to you or 100. Each PCP will have a list of X amount of patients, and at any time you can "drop" a PCP or they can drop you.

However, once you do decide to accept these patients, you have to provide the same quality of care regardless of the payment you receive per visit. You must treat the patient, not their insurance carrier. If you are going to change the type or quality of care you provide based on the patient's insurance, don't accept that insurance. It's not fair to the patient and it doesn't speak well of your practice ethics.

@PADPM: Hmmm. Very interesting. I am already overwhelmed but really educated at the same time. I truly think podiatry school should have a class about how podiatrists deal with HMOs and capitation fees. There should be a good Practice Management course that deals with this complicated and highly political and controversial topic. At least podiatry students will not be naive when they hop on board into residency. I saw in wikipedia that capitation depends on geography, gender, age, and past medical history. Anyway, thank you again for educating me about the real world of medical/surgical billing for podiatrists!

 

[DPMer]

I'm really not sure and wouldn't say that the entire East Coast is capitated. There are specific geographic areas that are more heavily capitated than other areas within miles. Western Pennsylvania has very little capitation and Philadelphia has a high amount, South Jersey has a fair amount of capitation and North Jersey has less. I believe NYC area has a fair amount of capitation.

Florida has a decent amount of capitation and many areas of California are heavy with plans like Kaiser. You have to do your homework before you practice in an area.

I'm not sure how to answer your other question regarding how to get paid in a respectable manner from an HMO or how to keep the amount of HMO capitated patients to a minimum.

First of all, you really have no choice in most cases regarding "how to get paid". The contracts are set and you either accept the payment or you don't. There is little room to negotiate.

DPM's are responsible for this mess in my opinion. If we ALL rejected the contracts early on when these contracts were introduced, they simply would not exist. Unfortunately, it was a cut-throat environment and when some turned it down, others were quick to accept the ridiculously low payments. That opened the door for the HMOs to get away with the low fees. Once some accepted the payments, they had an audience.

Now we all have to live with that decision. As per my prior post, in order to compete and appease our PCP's, we accept these capitated HMO's because THEY do, and we want them to refer ALL patients. If we select not to accept the HMO patients, it's very likely they will stop sending ALL patients and begin sending patients to the doctor who DOES accept the HMO patients. That's reality. Unfortunately it doesn't always have to do with the quality of care we provide, it has to do with what's convenient for them and their staff.

If for some unlikely reason you're the ONLY provider in your area, you may be able to negotiate fees. We attempted to do that since we are the largest group in the region, but we failed.

As far as how to keep the amount of capitated patients to a minimum....that's easy. Once again, you simply don't have to sign the contract, or you don't have to accept any new PCP's who want to refer to you. You can have 1 PCP refer to you or 100. Each PCP will have a list of X amount of patients, and at any time you can "drop" a PCP or they can drop you.

However, once you do decide to accept these patients, you have to provide the same quality of care regardless of the payment you receive per visit. You must treat the patient, not their insurance carrier. If you are going to change the type or quality of care you provide based on the patient's insurance, don't accept that insurance. It's not fair to the patient and it doesn't speak well of your practice ethics.

It seems like there is this vicious cycle of accepting capitated patients by podiatrists to appease PCPs in order to get referrels for a large patient base in the practice to keep the office running and to be profitable, at the same time offer quality care. But to me capitation is an insult to podiatrists because ultimately it means being overworked and underpaid, or am I wrong? That is the impression I am getting here. What doctor wants that? Doctors want to work and get`paid, not overwork and be underpaid! Capitation seems to do just that to podiatrists.

 

[PADPM]

It seems like there is this vicious cycle of accepting capitated patients by podiatrists to appease PCPs in order to get referrels for a large patient base in the practice to keep the office running and to be profitable, at the same time offer quality care. But to me capitation is an insult to podiatrists because ultimately it means being overworked and underpaid, or am I wrong? That is the impression I am getting here. What doctor wants that? Doctors want to work and get`paid, not overwork and be underpaid! Capitation seems to do just that to podiatrists.

I'm not sure you're completing understanding the entire global picture.

1) We don't "appease" the PCP's just to get the HMO capitated referrals. We "appease" the PCP's since the vast majority of the PCP referrals are NOT HMO capitated patients. If we pick and choose which patients we want and don't want, the PCP office becomes confused regarding who they can send, who they can't send, etc. They want to keep it simple and want to know that the office they send patients to for foot and ankle care accepts ALL the plans they refer, or they will choose some other office that will accept these plans.

2) Our office would be profitable without the HMO capitation, but would also not be as busy. We are not losing money by accepting HMO capitated patients or we would not be participating.

3) The ENTIRE insurance industry is an insult. If you don't want to overwork and get underpaid, find another profession or don't accept insurance and work for cash/fee for service only. In my opinion, there are NO insurance carriers that presently pay us fairly for our time, efforts or educational background. So you'd better get over that issue quickly, or go into research.

4) As stated before, I guarantee you that no one will ever put a gun to your head to sign any insurance contract. Signing these contracts is 100% voluntary. You can opt out ANY time you want if you believe it's unfair or you are overworked/underpaid. And as I previously stated, you will not be treating the entire capitated population, but realistically will probably treat about 5-10% of the patients who are capitated to your practice. Actuaries are very bright people and have figured out an equitable way to make it work. The insurance company isn't losing money and the doctors aren't making huge profits , but they are getting reimbursed according to what statistics show to be fair based on utilization rates. If you are knife happy and perform surgery on every patient that walks into your office, I would advise against signing a capitated contract.

5) Additonally, as I also previously stated, if a particular doctor or doctors "dumps" on you and over-utilizes your services by sending you nothing but his capitated patients, and no other patients, and you figure it's a losing situation, you can simply drop that doctor from your provider list and still stay in the program. His patients will be reassigned to another DPM.

You never have to do what you don't want to do. Participating with insurance companies is voluntary, not mandatory. Our practice is very large and we have decided to participate with most companies, and we take the good with the bad. Every doctor in our practice works hard, and I also believe every doctor in our practice in underpaid by ALL insurance carriers. But that's simply reality.

Forget about what they teach or don't teach in school. It's time to spend time shadowing some DPM's in their office to see what's actually happening in real time practices.