The conversation usually starts the same way. A practice owner has just run the numbers on their PPO contracts — or they've been handed a 4% fee reduction notice from a major plan — and they're thinking, seriously this time, about whether there's a way out. Going insurance-free is one of those ideas...

I've had this conversation a hundred times. A practice owner tells me they're "pretty sure" they're making money on their PPO contracts. They're staying busy, the schedule is full, and the collection numbers look reasonable. Everything seems fine. Then we sit down and actually run the numbers. And u...

The math on PPO participation gets worse every year. Write-offs that once felt manageable now consume 35 to 45 percent of production in many markets. Fee schedules that haven't moved in a decade are being applied to a cost structure that has. And yet the conventional wisdom — that you can't exit PPO...