Practice consultant Ron Howrigon explains here how health insurers beat down physicians in contract negotiations with, as Medscape puts it,  “fuzzy numbers, run-arounds, and other ruses associated with used-car lots.”

Mr. Howrigon knows his stuff, having worked for 18 years in the managed-care industry, running provider networks and negotiating contracts with medical practices.

“When I worked on the payer side, we used to joke all the time that negotiating with physicians was like negotiating with somebody who brings a knife to a gunfight,” said Me. Howrigon, president and chief executive of Fulcrum Strategies, based in Raleigh, N.C., “You don’t win many of those, so be prepared,” he told a group of physicians.