You’re Not Imagining It: Why It’s Harder to Run a Practice Now (and How to Negotiate Better Rates)
If it feels like running a behavioral health practice has gotten harder in the last few years, you’re not wrong—and you’re not doing it wrong.
Across the country, practice owners are feeling squeezed from all sides: rising costs, heavier administrative burdens, and slower insurance payments. Even well‑run practices are finding that the math doesn’t work the way it used to.
Let’s break down what’s driving the pressure, and then walk through a realistic, step-by-step approach to advocating for better reimbursement without burning yourself out.
Why Running a Practice Feels So Much Harder Right Now
1. Overhead Keeps Rising
Rent, utilities, EHRs, billing software, cybersecurity tools, benefits—everything costs more. Even practices that haven’t expanded staff are paying significantly more just to operate than they were a few years ago.
2. Administrative Work Is Expanding
Prior authorizations, changing payer rules, credentialing delays, audits, and documentation requirements all take time. That time often comes directly out of your clinical capacity or your personal bandwidth as an owner.
3. Payments Are Slower and Less Predictable
Higher deductibles, increased denials, payer “reprocessing,” and delayed remittances mean revenue is less predictable. January slowdowns now seem to stretch well into the year for many practices.
4. Reimbursement Hasn’t Kept Up
While costs rise, reimbursement rates often stay flat—or increase so minimally they don’t offset inflation. Over time, this quietly erodes margins and contributes to burnout.
The Result: More Work, Same Rates, Less Cushion
When overhead rises, admin increases, and payments slow, the pressure lands squarely on practice owners. Many respond by seeing more clients, working longer hours, or putting off strategic decisions like rate negotiations because they feel overwhelming.
But avoiding those conversations only locks in the problem.
A Step‑by‑Step Strategy to Negotiate Better Rates (Without Burning Out)
Step 1: Get Clear on Your Numbers
Before contacting any payer, you need a realistic view of:
Average reimbursement by payer and CPT code
Denial and underpayment rates
Days in A/R by payer
Cost per session when you factor in overhead and admin time
You don’t need perfection—just clarity. This gives you confidence and credibility.
Step 2: Prioritize Which Payers to Approach
Not every payer is worth the effort. Start with:
Payers that make up a large percentage of your volume
Payers with high admin burden or denial rates
Contracts that haven’t been reviewed in years
Focus your energy where change will actually move the needle.
Step 3: Build a Simple, Data‑Backed Case
Your ask should be calm, professional, and specific. Anchor it in:
Increased operating costs
Length of time since last rate adjustment
Market comparisons (when available)
Your consistency as a provider (volume, outcomes, access)
This is about sustainability just as much as it’s about emotion!
Step 4: Ask for More Than Just a Rate Increase
If a straight increase isn’t possible, consider:
Faster payment terms
Reduced admin requirements
Fee schedule adjustments for high‑volume codes
Contract amendments instead of full renegotiations
Small wins add up.
Step 5: Set Boundaries Around the Process
Negotiations take time, but they shouldn’t take over your life. Set:
Clear timelines for follow‑ups
Defined decision points
A stopping point if the return isn’t worth the effort
Protecting your energy is part of protecting your practice.
Step 6: Revisit Contracts Regularly
Negotiation isn’t a one‑time event. Build a rhythm—annual or biannual reviews—so rates don’t quietly fall behind again.
You’re Not Failing. The System Is Under Strain.
If running your practice feels heavier than it used to, it’s because the environment has changed. The solution isn’t to work harder. It’s to work smarter, set boundaries, and advocate for sustainability.
You deserve rates that reflect the care you provide and the real demands of running a modern practice.
