Posted on July 31, 2018 by Tom Davis

Rigged Markets Create Shortages

One morning recently, I opened my mail and there they were. Twenty-one employment offers for general medicine services in my area. They were all pretty similar in compensation and work responsibilities. If you’ve made yourself available for recruitment, you know that twenty-one in one day is not unusual, but I figured I’d take the opportunity to test a hypothesis. I wanted to know if there was a free market for my services. If you put...

Posted on July 30, 2018 by Tom Davis

The Bigger the Consultant Firm, the Less Value They Generate

The Bigger the Consultant Firm, the Less Value They Generate It was 1998 and my partners and I were looking to merge with another similar size group as our next growth step. There were some sticky issues and personalities. We all agreed to contribute to the hiring of a consultant to help grease the wheels and bring us together. We had a collaborative leadership model at the time, so we needed a consensus choice. For...

Posted on July 29, 2018 by Tom Davis

Sunday Update

Keeping up with the latest trends so you can look smart with little effort. It’s what I do. Medical coding going global Medical coding is a luxury item in populations where the risks to health are acute, like malaria. Once those risk transition to chronic conditions, then you have the time to devote to data collection. This is a reflection of life expectancies growing in the third world, and chronic illnesses like diabetes...

Posted on July 28, 2018 by Tom Davis

Saturday Quiz

Designed to enlighten and enthrall Can you get the right answer? How often are Medicare Advantage diagnostic risk codes reset back to zero? A. one month B. six months C. one year D. two years E. they are never reset, once a diagnostic risk code is sent to CMS, it’s there permanently. Answer below Answer: C one year. That’s why it’s so important...

Posted on July 27, 2018 by Tom Davis

Compensation Based on the Number of Patients in Your Panel—Just Say No

Compensation Based on the Number of Patients in Your Panel—Just Say No The latest trend in compensation is paying primes, at least in part, based on how large their patient panels are. Holy cow, what a bad idea. What a bad, exploitative, short-sighted idea. An organization who pays you in this way is just trying to get you to run on the treadmill ever faster—and that’s the last thing you need. But don’t just avoid...

Posted on July 26, 2018 by Tom Davis

How the New Medicare Payment Plan Affects Your Organization

CMS just announced a proposal to pay physicians a flat $93 for every office visit, no matter the length or complexity of the visit. The change would take place on January 1, 2019 No more E and M codes, no more “Levels of Service.” The only way to explain this change is that the CMS wants to drive patients to Medicare Advantage. No one with a chronic disease would want to receive their care where...

Posted on July 25, 2018 by Tom Davis

How the New Medicare Payment System Affects Patients

The government just announced that starting on January 1, 2019, they propose doctors are going to be paid the same amount of money for each patient visit no matter what that visit was for or how long it took. Saw the doctor for a cold? He gets paid $93 For cancer? 93$ For 5 minutes? $93 For 50 minutes? $93 If you have traditional Medicare, be prepared to be moved through the system like a...

Posted on July 24, 2018 by Tom Davis

How The New Coding Changes Will Impact Clinicians

Imagine a world where you won’t have to code a level of service for a visit. No 99203. No 99214s. No fumbling about looking for an additional data point on the ROS, or trying to justify “nature of the presenting complaint” just to get paid. No audits. No RBVs Just a single flat payment for a visit. Regardless of whether the patient was seen for a cold or cancer, for five minutes or fifty, you...

Posted on July 23, 2018 by Tom Davis

How to Use Your Medicare Advantage Contract to Improve Your Month-to-Month Cashflow

How to Use Your Medicare Advantage Contract to Improve Your Month-to-Month Cashflow When we started our Medicare Advantage plan, the insurance company pre-paid us $25 per member per month (pmpm) every month to meet our monthly expenses. Then, they paid us the balance after reconciliation every six months. Fifteen years later, they were paying us more than $100 pmpm. Why? We asked. As our performance improved and our reconciliation checks grew larger (one was so...

Posted on July 22, 2018 by Tom Davis

Sunday Update

Molding you into a Medicare Advantage Master MA patients spend less time in rehab Isolated data points like these drive me crazy. The big question is whether they do better and spend less money afterward? Consumers more “enthusiastic” about their Medi-gap purchases compared to Medicare Advantage. I’m not sure what “enthusiastic” means, but I wonder if it will continue once mandatory monthly out of pocket costs hit next year. ...