Posted on July 31, 2017 by Tom Davis

How are RAF Scores Calculated?

RAF Scores What You Need to Know The more accurately and completely you represent the disease burden of your patient in your documentation, the greater your monthly capitation and the lower the chance of clawbacks. The relative RAF adjustments for different disease burdens are not necessarily intuitive. An amputated pinky toe carries triple the capitation adjustment of controlled diabetes. Make sure you see your patients at least once every 12 months to keep them healthy...

Posted on July 18, 2017 by Tom Davis

Every Person Deserves Their Own Confidentialist

One clinician’s Cri de Cœur.

Posted on July 9, 2017 by Tom Davis

How Medicare Advantage Works

Our Federal government can’t pay for all the healthcare coverage it promised under the Medicare program–the liability is now in the trillions. It created the Medicare Advantage program to try to decrease the costs of those promises. Under Medicare Advantage, private insurance companies agree to be fully responsible for the healthcare costs of patients who sign up. The government pays the insurance company a fee every month for every patient who signs up. The amount...

Posted on July 8, 2017 by Tom Davis

Bob Kocher was Wrong

Robert Kocher MD was the only physician on the President’s National Economic Council in 2009. He was one of the architects of health care reform—the ACA. He has publicly stated it was his intent for the law to force consolidation in healthcare delivery, believing it would enhance efficiencies and promote scaling of the most effective practices. He now says he was wrong. He openly acknowledges what five years of research into health care reform has...

Posted on July 4, 2017 by Tom Davis

One Simple Trick to Dramatically Improving Your Performance

Ask Jim Ming or Dee Forshee owners of Ming Senior Services to serve on your plan’s board of directors. For over two decades from their humble small town, they have created, executed and grown one of top Medicare Advantage insurance sales and service organizations in the nation. In the nation. How? Supporting their clients with expertise about the program and alignment with the program’s goals–in a way I have rarely seen replicated anywhere. They created...

Posted on July 2, 2017 by Tom Davis

Abundance

You need a mindset of abundance The scarcity mindset sees limited resources from which an individual must get their share. Things are being done “to” them. They are not in control The abundance mindset sees only the opportunity for innovation generating infinite resources. It’s proactive, optimistic. To succeed in a value-based, risk-sharing environment, you as a provider must develop a reflexive mindset of abundance. A sick patient is not a drain on your emotions and...

Posted on July 1, 2017 by Tom Davis

The Specialist Advantage

Procedure-dependent specialist are sensing the instability of their referral streams as they see primary care services fragment. And I’ve yet to meet one specialist division that’s satisfied it can thrive on internal referrals alone. Fortunately, as a specialist at the top of your field, you have a secret weapon. Your own skill. If you’re accepting one or more Medicare Advantage plans, reach out to your allied primes. Make them see the asset you can...