No. 005 · Sunday
THE MEMO
I never went cash overnight. I opted out one plan at a time, worst first, and I'd tell anyone to do it the same way.
To know which plan is the worst, you have to run one number. Take the total money a plan paid you over the year and divide it by the number of that plan's patients you saw. That's your average revenue per patient, by insurance. Line them up. The bottom of that list is your first cut.
Then add the part the spreadsheet doesn't show. How hard is this plan to work with? Denials, prior auths, appeals, the admin headache your staff carries every week for a plan that pays you the least. That moves a plan down the list fast.
In my case, Aetna went first. Then Humana. Then all the HMO plans. Step by step.
What it cost. Less than you'd think, on paper. Once you decide, you write a letter: effective such-and-such date, I will be out of network. That's the whole mechanism. Two cautions, though. Some plans have changed their contracts so you can only opt out inside a window, and if you miss it you wait until next year. And some contracts now run multiple years. Read yours before you decide anything.
The real cost is the first month. You will lose volume, specifically the patients on the plan you dropped. That feels bad, even when you know it was the worst plan and it barely touched your bottom line. Your schedule has holes in it and you're staring at them.
What it returned. Those holes fill. The slots that plan was taking get taken by patients on better plans and by self-pay patients. I didn't plan for that. It just happened, and it has happened to every doctor I've helped do the same thing.
So, no, don't rip everything out at once. Plan it. Rank your plans, read your contracts, pick the worst one, write the letter. Then do it again next year.
TJ
THE SIGNAL
Three things worth your attention this week.
AI scribes saved emergency physicians 1.6 minutes per note. Human scribes saved 3.3. Neither changed how much work a doctor billed per hour. That's a study in Annals of Emergency Medicine from Mass General Brigham, covering 198,178 emergency visits across four hospitals in 2025, and it got its first wide coverage this week. The time came back. The revenue didn't move.
Half of medical groups have gone three or more years without a commercial payer rate increase, and only 29% got one in the past year. That's an MGMA poll of 203 practice leaders from late August. Among the groups that did get a raise, threatening to leave the contract was one of the most-cited reasons it happened.
82% of physicians say they're overworked, and 46% are now considering early retirement, up from 34% a year earlier. That's Doximity's 2026 Physician Compensation Report, from surveys of US physicians fielded in June. Over the same period, physician compensation rose 2%.
WHERE I’LL BE
MIS Intensive Private Cadaver Lab
September 25-26, 2026 · Glenview, IL · CME Dynamics HQ
misintensivelab.com
Practice Profits Workshop, In Person
October 23-24, 2026 · Glenview, IL
privatepracticeaiworkshop.com
