Mrs. Dr. Tom has a bad back. She’s been to the doctor any number of times. Exercises, shots, anti-inflammatories. She’s trying them all. But not braces. That’s why I was stunned to get a call from a number in San Diego asking me if she needed a back brace. The guy said her insurance company suggested it. Welcome to deep data. You know that bunch of papers...
Read MoreI once got lost in Rome using an English language digital map. No matter how much I turned the damned thing, no matter how much I tried to match the names, I couldn’t find that damned Coliseum. Then I realized I had pulled up a map of Rome—Texas. Practicing medicine within a large organization is the same. The roadmap I had created as a resident in an academic medical...
Read MoreThis week finally solves the mystery as to why I developed “Success Codes.” It’s joy. I experienced so much joy in caring for patients from disadvantaged populations. Intellectual challenge, resource management, and personal gratitude were only a few of the benefits. When it came time to build rapport, I usually found they had led pretty damned interesting lives. Anyone can successfully manage...
Read MoreIssac Thompson didn’t think he was doing anything wrong. He worked as a PCP in a medical practice with a large panel of Medicare Advantage patients. He saw all the inappropriate risk-coding requests. The letters from the insurance company: “We’ve reviewed your patient’s chart and determined that he has risk code XXX.XX, so we’re submitting it in your name.” (I’ve seen those letters personally about my...
Read More20% of the patients on your panel generate 80% of your costs. Your organization is probably spending a lot of money to identify those high-spenders. Data extraction and analysis, cost-scoring. It’s all expensive rubbish. You can go down your list of 500 patients and pick out the 25 that are going to cost you the most money next year. How? Because you know them. ...
Read MoreThe “Star System” for Patients The facility left much to be desired. It smelled of urine, the floors were dirty, and there wasn’t a nurse to be found. And when I did find one, what I saw astonished me. She had a company scrub top on—promoting the facility’s five-star rating. That’s when I began to suspect something was up. And I really started to look...
Read MoreLexicon of Value “Bad Fit” A situation where the employee cannot or will not generate the value required by their boss—usually arising out of an incomplete understanding by the employee of the true nature and role of their employment. e.g. “Dr. Smith was a bad fit. She couldn’t see the number of patients every day that she needed to.” e.g. “Dr. Jones was a bad fit. he...
Read MoreTime 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 terminologies 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. ...
Read MoreI remember the straw that broke the camel’s back. I was closing up the last visit of the day two hours after the final patient had hit the door. I was dog tired, frustrated and smelled really bad. That’s when the fortieth colonoscopy reminder of the day popped up on my screen—and I realized it was never, ever going to get better. Never. Like an alcoholic, I had my...
Read MoreYou may be hearing stuff about how Medicare Advantage is transitioning from something called “RAPS” to something else called an “EDS” for risk code collection—and how it’s going to devastate your cash flow. Don’t worry about it. Those acronyms simply refer to different sets of patient encounters from which data is pulled for data-based payment. Medicare believes one set will create a more accurate representation of a patient’s disease...
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