We all know that insurance participation (namely PPO participation) affects new patient flow.
Practices with little or no insurance participation generally, not always, get less new patients than practices with more participation. However, is there a point where there are diminishing returns on increased PPO participation? That’s the question we looked into.

Anecdotally, it’s been my experience that practices that participate in almost every PPO available don’t necessarily get that proportionally a greater number of new patients. So, we asked our statistics guy, Anantha Santhanam, to look into our considerable database and sort this out.

As a marker for PPO participation, we use the collection percentage. With increased PPO participation, the collections percentage (gross collections/gross production) is going to be less than for offices with no PPO write offs.


The graph shows that with zero or very little insurance participation new patient numbers are
quite low. However, when you get past mid-range participation (so that the collection percentage is under 80%- 84% in our area), the marginal increase in new patients for the increased write offs fades quickly.


As with all things, balance matters. Balancing PPO participation is just as important as it used to be to have your fees balanced and set wisely. In fact, PPO participation decisions are beginning to trump fee setting as far as importance to your actual reimbursement levels.