The Patients Who Are Veterans Are Putting You At Risk

The Veteran’s Administration is making great strides in improving the care of its beneficiaries. Although still far from perfect, wait times are decreasing, clinical and administrative deadwood is being pruned and outcomes are improving. More vets are giving it a try. Great news. But also a challenge to the Medicare Advantage panels of your clinicians. Many veterans who get their care through the VA hedge their healthcare bets by also enrolling in a Medicare Advantage...

Read More

The Corporate World is Not For Everyone

“The corporate world is not for everyone.” That’s what the executive vice-president of a national Medicare Advantage organization told me at dinner the other night. He was headhunting me to be the executive medical director of their line of Medicare Advantage products. It was a breathtaking offer. With the potential to put another zero on my best year’s pay. But that comment got me thinking. Corporations are largely responsible for the collective affluence in the...

Read More

Micro-Hospitals

Ten years ago, I built a micro-hospital. It was a three-bed facility, fully licensed and with a functioning ER. It was so threatening to our competition, they bought us out—for a lot of money. I’m glad they did. Running it would have been a bad idea. “Micro-Hospitals,” — three to thirty bed hospitals serving as satellites to regional medical centers — are all the rage. “They’ll save money.” “They’ll make healthcare more affordable.” “They’ll provide...

Read More

Gratitude, the Government Hospice Survey and You

When my patients had a really good experience in my office or my nursing home, they commonly asked what they could do to say thank you. I told them to write a letter to the editor—and mention the people they were thankful for by name. That way everyone in our little town could see it. And the helpful person in question could swell with pride. And it worked. Every. Single. Time. But today healthcare is...

Read More

Why So Nervous?

Offered an employment contract? You wouldn’t be human if you weren’t nervous. You had a lawyer look at it. She told you it’s a “standard contract. Nothing out of the ordinary.” So why are you still nervous? Well, you are talking a  three year committment here. Three years plus another year non-compete. And that compensation formula . . . you can’t even begin to figure out what all that means. Maybe instead of that pediatric neurology rotation,...

Read More

What You Can Learn From Cigna

So Cigna is buying Express Scripts A large insurer, buying a pharmacy benefit manager. Why? Because the executives at Cigna see what’s coming. They see that soon, their last opportunity for revenue growth is going to involve being paid a monthly fee and paying for the care of their beneficiaries out of that amount. Oh sure, that “fixed” fee is going to be adjusted based on disease burden and demographics, but in the end, if...

Read More

No One Seems to Want to Share

It was in a meeting of top level executives of a large healthcare delivery organization. I walked in, made and received introductions, and sat back to watch the meeting begin. I instantly knew what was really going on, what the actual objectives were—and that, though my presence served a purpose, I was going to have absolutely no impact on the outcome. Outcome independent, I took a deep breath, relaxed and took it all in. That’s...

Read More

Dear Dr. Tom

Dear Dr. Tom, How do we educate our doctors to do better in Medicare Advantage? Please help. That’s a summary of the most common question organizations ask me. And they pay me six figures for the answer. But today, against my wife’s vehement wishes (she hates me giving stuff away), I’m going to give the answer away for free. Mentorship. Clinicians are trained through mentorship. From med school on, that’s how we’ve been taught.  And...

Read More

Old Friends

My wife and I went over to an old friend’s house to play some cards. We’ve known each other for 35 years.  We were roommates while we were in graduate and professional school. We froze on float trips together, stayed up all night playing bridge together, worked and ate and faced hard times together. He is a much better friend than I deserve. Once, when he was in law school, he sprained his ankle running...

Read More

Shared Risk? Insane Return.

Looking For an Investment With an Insane Return? Do you have a shared-risk contract but are not doing as well financially as you had hoped?  Are you uncertain of how it works and poorly supported by your organization. Education is the key.  The return on the brief amount of time you spend on targeted learning and mentoring will be unbelievable.  

Read More