# What a PT Practice’s Waitlist Can Mean in Payer Negotiations

In a Half Hour Ahead interview, Brace Health CEO David O’Hara explains how documented access and near-term cost evidence can inform PT payer negotiations—and where that case has limits.

Brace Health co-founder and CEO David O’Hara joined Ben Barron on *Half Hour Ahead* on October 22, 2026, to discuss what a physical therapy practice’s waitlist can signal to a payer, how to make a rate request more relevant, and why a negotiation is never a guaranteed increase. This recap highlights the practical ideas from their conversation; read the [full interview](https://halfhourahead.substack.com/p/your-wait-list-is-a-negotiating-position).

## A waitlist may describe an access gap—not automatic leverage

A three-, six-, or twelve-week waitlist can be more than an operational headache. It may help a practice show that local demand exceeds available capacity. For a payer, the useful question is not simply “How busy are you?” but “What access would your members lose if this practice were unavailable?”

That case needs specifics: how long patients wait, which services or specialties are difficult to access, where the practice is located, what hours it offers, and what realistic alternatives exist nearby. A waitlist by itself does not prove a network-adequacy problem, and it does not compel a payer to change a contract. It is one piece of evidence to test against a payer’s network, market, and contracting process.

In the interview, O’Hara describes the goal as showing what the practice provides that the payer’s network may have difficulty replacing—for example, geographic coverage, a specialty, or appointment times that serve a local workforce.

## Make the financial case near-term and local

Practices may lead with inflation, staffing costs, or the long-term value of physical therapy. Those points can matter to the practice, but they may not give a particular payer a reason to act on a contract now.

O’Hara describes a different approach: investigate what could happen in the next year if the practice left the network. What providers are available nearby? Could members shift to a higher-cost setting or a more expensive episode of care? A useful request connects those questions to local facts rather than relying on a broad claim that PT saves the health system money over time.

That is a hypothesis to evaluate—not a universal payer rule. The relevant alternatives, costs, contract terms, and decision-maker vary by market and payer. Do not claim a cost saving or access gap unless the practice can support it.

## Expect follow-up, uncertainty, and payer-specific limits

The conversation also gets concrete about the work after a request is sent: identifying the right network or provider-contracting contact, following up, understanding the payer’s criteria, and tracking the response. O’Hara recounts a negotiation that took eleven follow-ups before the payer responded with an increase. The lesson is not that eleven attempts will work every time; it is that silence may not be a definitive answer.

O’Hara says Brace has worked on hundreds of negotiations. In the interview, he reports that about 35% of practices Brace works with receive increases, with a median increase of about 10%; he also says roughly 65% do not receive an increase. These are company-reported results from the interview, not a promise or an estimate for any individual practice. Outcomes depend on the payer, contract, market, and practice.

He says the negotiations discussed involve commercial payers and some workers’ compensation plans—not Medicare or Medicaid—and are not a fit when a practice does not control its contract through a centralized contracting organization. That scope matters: examples from one type of contract should not be generalized to every payer arrangement.

## What a practice owner can take from the interview

Before deciding to renew, renegotiate, or leave a contract, gather the evidence that helps answer a practical question: does this payer relationship support the care your practice can sustainably provide?

- Document wait times, service availability, location, and other access facts accurately.
- Compare the contract and actual payment data before assuming low reimbursement is the only issue.
- Identify realistic local alternatives before making a near-term cost argument.
- Confirm who controls the contract and whether the payer accepts negotiations.
- Track the contact, materials sent, follow-ups, response, and effective date of any change.

Brace Health’s [payer-negotiation overview](/payer-negotiation) describes how the company approaches payer research and negotiation support. As O’Hara emphasizes in the interview, taking care of a practice is part of preserving its ability to care for patients—but a stronger case still has to be specific, supportable, and honest about the possibility of no increase.