How Your Game Partners Can Elevate Your Game

EPISODE SUMMARY

In this special "Game Changers" episode of The Claim Game, Jeremy Zug sits down with Dan King, co-founder and in-house counsel at Fireside Strategic, to get a behind-the-scenes look at the evolving landscape of healthcare. Dan, a former M&A lawyer and executive coach, shares his unique journey and reveals how his "aha moment" led him to prioritize the human side of business in rapid growth.

Discover Fireside Strategics' mission to acquire and grow outpatient private practices while treating providers "like gold," creating a virtuous circle of people and profit. Dan makes a compelling argument for why in-network practices are actually more valuable from an enterprise perspective, delving into the concept of "insurance arbitrage" and the scalability possible with commercial payers. He also offers candid insights on identifying good insurance partners, the impact of low reimbursement rates on burnout, and the non-negotiable importance of reliable communication in any partnership, whether with an insurer or an M&A firm. This episode provides invaluable strategic advantage for any practice owner looking to optimize their game!

KEYWORDS

Payer Selection, Insurance Partners, Mergers and Acquisitions (M&A), Private Practice, Burnout, Organizational Culture, Strategic Growth, Reimbursement Rates, Insurance Arbitrage, Fireside Strategic, Dan King, The Claim Game, Revenue Cycle Management (RCM), Commercial Insurance, Government Payers, Patient Outcomes, Provider Well-being.

TAKEAWAYS

Prioritize People and Systems for Sustainable Growth: Don't delay building robust people and operational systems. Intentional, slower growth upfront leads to culturally and financially sound businesses in the long term.

In-Network Practices are More Valuable for Acquisition: From an enterprise perspective (especially in outpatient healthcare), practices that are in-network with commercial insurance are more scalable and thus more valuable, due to broader patient reach and the potential for "insurance arbitrage" (applying higher rates across multiple practices in a state).

Higher Margins Empower Better Care: Adding higher-margin services (like specialized diagnostics or advanced treatments) allows practices to pay providers more and invest in infrastructure, leading to better patient outcomes and increased referrals.

Choose Insurance Partners Wisely: Look for responsive insurers who treat providers with respect and have broad coverage. Niche services meeting high demand can also lead to better rate negotiations.

Beware of Low Reimbursement Rates: Consistently low reimbursement rates are a "recipe for burnout" for both practice owners and providers, as it necessitates seeing more patients for less income.

Scale Can Influence Negotiation Power: Larger practices or those with unique niche services can gain more leverage in rate negotiations with insurance companies due to their volume and variety.

Partnership is Key in M&A: When considering an acquisition, prioritize alignment with the founder. A partnership model (where the founder retains a minority stake and operational role) often leads to greater success and a potentially larger second exit.

Communication & Reliability are Paramount: Whether with an insurance company or a business partner, consistent, reliable communication is a crucial indicator of effectiveness and the ability to win the "war of attrition" against bureaucracies.

RESOURCES

Today Guest Information: Dan King and his work at Fireside Strategic

Learn More About The Claim Game: Visit practicesol.com/theclaimgame

The Hourglass Learning Hub: Dive deeper into RCM best practices and downloadable tools mentioned in this episode, like the various checklists and templates, by visiting The Hourglass Learning Hub.

Our Blog: Explore years of educational articles on billing and practice management at Practice Solutions Blog.

Book: For a comprehensive guide on navigating insurance, grab your copy of Insurance Billing Basic