Shared-Risk Success for Specialists? Cater to Your Primes

    “Tom” he said, “If it keeps me in the O.R. it’s good, if it keeps me out it’s bad.”  “Good,” he said gesturing to right, “bad,” he gestured to his left. “That’s all you need to know.”   Such was the wisdom imparted by my then new orthopedic partner when I asked him how we could best collaborate.   So I spent the next 15 years sending him the joints and the breaks...

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Medi-Gap vs. Medicare Advantage

Regular Medicare only pays for about 80% of your covered healthcare costs. “Medi-gap” plans are separate insurance plans that pay for the rest.   They’re expensive and they can exclude you based on pre-existing illnesses, but generally pay the remaining costs of all Medicare-covered expenses.     In the past, they were the way most Medicare patients controlled their costs.   Now, they are simply the alternative to Medicare Advantage plans.   Including your Medicare...

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Your Opportunity to Become a More Than a Clinician

A large part of general medicine’s attraction is the broad skill set that is required. As an FP or Internist, you have a predilection to a broad mind.   If you wanted deep expertise in one narrow area you’d be a specialist.   And now, with your shared-risk patients, you’re actually being compensated to apply that rare predilection even more broadly. You’re getting paid to care for ALL the aspects of your patient’s health and...

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Success Codes—Diabetic Eye Edition

  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 done so with incredible results....

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Your Biases are Being Used Against You.

  This is an important month.   It begins the last MACRA/MIPS attestation period for 2017.   The last chance to “qualify” for the “benefits” of the program.   The last chance to “preserve” your revenue for 2019.   If you’re in a very small practice, you’re ok. CMS has recently increased the amount of income you can receive or the number of Medicare patients you can see and maintain an exemption from the MACRA/MIPS...

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What this Hurricane Season Teaches You About Medicare Advantage

Everything regresses to the mean.   No major hurricanes for 11 years, then “BAM!” Three in a row.   Your Medicare Advantage patient panel is exactly like that.   400 patients without a serious illness for one, two or three years—-then BAM.   A net negative year.   I once had a partner who couldn’t catch a break.   The patients on his panel had a knack for developing serious illnesses. Not due to his care,...

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For Patients—Understanding the Two Types of Medicare Advantage

For Patients There are actually two basic types of Medicare Advantage plans.   Their differences are summarized at the bottom of the page.   Because if you’re considering enrolling in a Medicare Advantage product, it’s important to recognize the differences between the two so you get exactly the coverage you want.   The first type is an “HMO” (the letters used to stand for something, but they don’t anymore).   They’re the ones we usually...

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The Healthcare Question of Our Generation

  Can the electronic health record replace, on a mass scale, a personal clinician?     Even without artificial intelligence, do we really need to have PCPs?  Can’t patients just go from specialist to specialist, undergo their revenue-generating testing efficiently without duplication and have their care-coordinated remotely by phone, by Alexa, by iPad?     Isn’t it just a matter of getting the EHR design just right?     Can’t PCPs be the buggy whip...

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Success Codes—Diabetes with Renal Complications Edition

  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 done so with incredible results....

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How Much is Your Time Worth

Healthcare delivery organizations love to use their in-house talent to increase revenue.   They love, love, love it.   They also love to do so with as little additional expense as possible.   They love, love, love that too.   Your time is yours to spend.   How does your organization persuade you to spend it on their behalf?   One of their influence tools is a cynical appeal to your strong ethics and sense...

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