The Illness-Adjustment Loop

  For Clinicians and Organizations   Observe. Orient. Decide. Act.   OODA . The OODA loop is an essential tool for strategic analysis.   Twenty plus years ago, when I first looked over our first Medicare Advantage contract, it appeared to be a complex mess.   But with all the deferred revenue payments, the data-driven revenue adjustments and action/reaction format, it read uncannily like a form of an OODA loop.   So I applied that...

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During a Natural Disaster–A Patient’s Guide to Medicare Advantage

If you or someone you love has been displaced by one of the hurricanes and needs chronic medical care—-read on.   Folks covered by Medicare can seek any care they need by any medical provider that takes Medicare, they just have to present their card at the time of service.   Lost that card?  Call 1-800-Medicare for a replacement.   If you’re covered by Medicare Advantage it’ll take a bit more effort for you to...

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Mind the Costs–Don’t Underestimate That Red in the Ledger

For Clinicians and Clinicians-to-be.     I spoke to my son’s allergist the other day. He’s sixty-four, runs his own practice and was calling me back at 7pm at the end of a fifty patient day. Having collaborated with him for over 25 years, I asked him if MACRA was going to finally drive him out of his clinic. With strong emotion in his voice, he answered me. “I’m sixty-four,” he said “and I’ve been...

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Medicare Advantage and Disasters—A Clinician’s Guide

  For Clinicians and Organizations. The last thing you should worry about in a disaster situation is what’s going to happen your Medicare Advantage pool.   But your patients have evacuated far out of the network area, getting their healthcare from who-knows-whom at who-knows-what cost—-and at least some is coming out of your pocket.   Should I really not worry about that?   How do they get their medication?   How do they prevent an...

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Performance Improvement Plans

For Clinicians and Students   I recently applied for a couple of additional state licenses.   I was appalled to find one of the questions was “Have you ever been placed on a Performance Improvement Plan (PIP)?   PIPs are corporate tools, ostensibly used to provide additional assistance to clinicians who are facing emotional or professional challenges.   They are also a necessary step so that employment contracts can be terminated with less of a...

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How to Succeed in Medicare Advantage—Specialist Edition

  For Clinicians and Organizations   Medicare Advantage is no more than the government setting a somewhat adjustable global payment cap for promised Medicare benefits and then off-loading their financial risk to a risk-bearing entity such as an insurance company.   If the costs of that patient’s care exceeds the payment cap, the insurer loses money. If it’s less, a profit is made.   Right now, for specialists serving Medicare Advantage patients, times are fat....

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How to Stop Calls From Your Health Insurance Company

For Patients       One of the worse things about these Medicare Advantage plans is that they give the insurance company every incentive to call you about your health.   It’s usually not even your insurance company making these calls, rather one of many different companies the insurance company pays.   They communicate poorly among themselves, call you repeatedly about the same thing and generally annoy the hell out of you.   Basically, they’re...

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How The Eclipse Can Help You Land Your Dream Medical Practice

    When interviewing with a prospective employer, ask a few of the employees you meet what the practice did during the eclipse.   “We blocked the schedule, shut down, went outside and watched”—possible keeper. Bonus points the longer the party and the better the food.   “Nothing special”—yellow light.   “We had administrators call at totality to make sure we were answering the phones”*—run away.   *yes, that’s a real thing.      ...

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Success Codes—Renal Edition

For 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 ago—and...

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One Simple Trick to Telling If Your Prospective Employer is a Keeper.

For Clinicians and Students   If they include the well-being of their caregivers as part of their mission statement, they should be a keeper—and as rare as hen’s teeth.           Physician, Nurse Practitioner or Physician’s Assistant, read more specific and actionable tactics for success in selecting and making the most of your new practice opportunities.  New strategies and insights are posted every Tuesday and Friday, sign up on the side bar so you...

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