Posted on February 28, 2018 by Tom Davis

The United States Preventative Health Task Force—A Reader Replies

For Patients Loyal reader Ethyl sent me a note that I had to share. “Dr. Tom, I looked on the USPHTF site like you suggested. I was dismayed at first by all the recommendations that were listed, then I started looking at them. Very few recommended that I do anything. Most just said there was not enough evidence to consider them. In fact, those that recommended doing nothing outnumbered those that recommend...

Posted on February 27, 2018 by Tom Davis

Loving the Corporate Life

Dr. Bruce is tooling through life. He works 8-5 five days a week at his office, owned by a regional healthcare delivery network. Impervious to the various dictates from his medical director and administrator, he sees 15-18 patients a day, does his data entry and leaves. He goes home to his gunsmithing while taking some telehealth calls on the side. He occasionally moonlights in an...

Posted on February 26, 2018 by Tom Davis

Success Codes The Next Generation—Psychosis

The 21st Century Cures Act directed CMS to expand the risk-coding system to include additional mental health conditions. We talked before that, though these changes are not revolutionary, they will give you the chance to gain some additional risk-based revenue. We also discussed how important it is to start coding these conditions now, even though the changes are going to be phased in over three years starting in 2019. Experience teaches...

Posted on February 23, 2018 by Tom Davis

Gains Over Time

The Three Rules Rule #1 Everyone Gets Sick and Dies Rule # 2 In the end, clinicians can’t prevent #1 Rule # 3. As a result of #1 and #2, if a clinician is in a shared-risk contract, then the clinician will suffer financial losses. Everyone in a shared-risk contract has had it happen to them. The otherwise healthy patient, with whom you have no...

Posted on February 22, 2018 by Tom Davis

Pay Your Vendors—or Pay Yourself.

In a gold rush, the miners don’t make the money. The merchants selling them supplies do. In Medicare Advantage, those vendors selling you tools to passively extract risk codes from documentation are the modern day merchants in today’s Medicare Advantage gold rush. They will kill your margins with their purchase costs, subscription fees, and hardware requirements—not to mention the constant upgrades and the loss of productivity each one entails. You’ll only...

Posted on February 21, 2018 by Tom Davis

Quackwatch

Eating the right amounts of good food will keep you at a healthy weight right for your body. So too will consuming the right amount of good health information help you keep your body healthy—and your pocketbook fuller. We talked about how you should avoid the “scare segments” on your local news and favorite websites. We also talked about how you should avoid other sources of health information sponsored by...

Posted on February 20, 2018 by Tom Davis

Dealing with Distaste

Editor’s note: This post is directed to clinicians. Some of the content may be upsetting if you’re not used to dealing with illnesses. While working with the Indian Health Service in Alaska years ago, I spent a week flying from village to village with the public health nurse doing home visits. Kotlik. Alakanuk. Emmonak. Each was more isolated than the last. At one stop, there was...

Posted on February 19, 2018 by Tom Davis

Success Codes The Next Generation—Disease Burden

Late last year, in response to the 21st-Century Cures Act, CMS released its proposed tweaks to the risk-coding system. They’re not huge, but they will make a difference. Especially if you incorporate the coding in your changes now and get ahead of the game. The most novel change involves your patient’s total disease burden. Starting in 2019, your patient’s overall risk score will be adjusted based on their...

Posted on February 16, 2018 by Tom Davis

Put Yourself In Her Place

Imagine you’re the NP from this headline: This Mom Went To Her Doctor For Postpartum Depression—And Was Escorted To The ER By The Police. Sure, it’s a click-bait article, designed to grab eyeballs on the cheap. But it’s also true. This new mom was struggling with violent thoughts and turned to her clinician for help. Now, no one really knows what actually happened in the exam room—articles like this are...

Posted on February 15, 2018 by Tom Davis

Managed Care Medicaid

Managed Care Medicaid is a different beast from Medicare Advantage. A different beast altogether. The risk scores are calculated differently. The margins are very, very narrow. Monstrously so. Despite this, with the right group of risk-sharing primes, you could generate a nice financial return on your time. Certainly, the return would be much greater than for fee-for-service Medicaid. All you need to do...