For clinicians and clinicians-to-be Consistency bias is a strong motivator of compliance. We all tell ourselves stories. We clinicians make dozens of life or death decisions every day, so to survive we must tell ourselves the story that we’re good at our job. Further, our education has socialized us to appreciate the objective value of hard data. So if we’re asked to generate hard data to support the story of our value, we’ll...
Read MoreSo that you too can be wildly successful in caring for your Medicare Advantage and Managed Care Medicaid patients, I’m going to tell you absolutely everything you need to know about the construction of the Hierarchical Condition Category (HCC) coding system. What the heck are HCCs? When diagnostic codes for Medicare Advantage or Managed Care Medicaid patients are submitted for payment, the government maps them to one of about 70 different HCCs. Here’s...
Read More“This preparation has not been evaluated by the FDA for safety or efficacy.” This statement is on every nutritional supplement sold over-the-counter in the U.S. Doesn’t matter if they’re “memory power” or “male enhancers” or even “joint preserver.” It’s on every one of them—look for yourself. You’ll find it in the smallest print on the lable. It means “The Federal Food and Drug Administration (FDA), by law, doesn’t have the...
Read MoreFor Clinicians and Organizations. Time for another edition of my wildly popular “Success Codes” series. If you haven’t already, you may want to review my world class, yet humbly simple (yes, really) explanation of RAF scoring—it’ll help you understand some of the shorthand terminology below. It’s the only one on the web written by a PCP who’s been in the trenches blocking and tackling since Medicare Advantage first arrived on the scene 20+ years...
Read MoreFor clinicians and clinicians-to-be Illness burden. Medication burden. I’ve got a new one for you—meeting burden. When evaluating a potential practice, make it your business to find out exactly what’s expected of you in terms of meetings. I’m not talking about grand rounds or noon conference. I’m talking about the meetings, the training, the online “experiences.” All of it uncompensated—with content sure to slowly add to your anxiety...
Read MoreFor Clinicians and Organizations. As my partners and I struggled to integrate our multi-specialty group across the prime/specialist divide, we stumbled on to a great tool—the spillover effect. The workflows required to meet quality targets for specific populations will inevitably “spillover” and cover all patients—with unexpected benefits all round. Years ago, when the NCQA decided to offer a quality certificate for diabetic care, my PCP partners and I went all...
Read MoreFor patients. Your “Problem List”. Everyone that goes to their clinician today has one. I’m not talking about the “reason you went to the office today.” I’m talking about the list of active medical problems you’re under treatment for. Didn’t know you had one? You do. And it’s very important you take control of it. Why? Because it is possible for you and your problem lists to be used for fraudulent payments—without...
Read MoreFor Clinicians and Clinicians-to-be. As the compensation for your labor is reduced over the next three, revolutionary years, it’s time to take a simple test. Are you . . . In a practice small enough to be excluded from MACRA/MIPS? Getting the majority of your revenue from direct patient payments? Getting the majority of your revenue through shared-risk from a managed care program such as Medicare advantage? If the answer to...
Read MoreFor Clinicians and Organizations Time for another edition of my wildly popular “Success Codes” series. If you haven’t already, you may want to review my world class, yet humbly simple (yes, really) explanation of RAF scoring—it’ll help you understand some of the shorthand terminology below. It’s the only one on the web written by a PCP who’s been in the trenches blocking and tackling since Medicare Advantage first arrived on the scene 20+ years...
Read MoreFor Clinician and Clinicians-to-be As your EHR pushes you from task to task, patient after patient, day after day–keep one thing in mind: Short order cooks rarely change the world. Absolutely nothing wrong with short order cooking—nothing at all. If that is your dream. Have a question about getting the most out of your current training program, finding your ideal job or making your current...
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