Scribes for Primes are More than Cost-Effective—They’re Essential.

Under a data-based contract such as Medicare Advantage, your PCP’s time is the most valuable real estate your system can build on—are you treating it that way?     In my professional work, I’ve noticed the trend is moving away from risk-sharing with primes under their Medicare Advantage contracts.     I’m told this decision is based on the idea that Medicare Advantage is a pure data play.     Collect the data, book the...

Read More

Sunday Links

Your Secret Weapon     Insurers boast about Medicare Advantage growth in JP Morgan conference. It’s pretty much the only service line they have left—as far as accelerated revenue growth is concerned. When competitive bidding for Medicare Advantage comes along and limits the potential for these products, watch out. The industry fallout will be something to see.       CMS proposes to contract with URAC for six more years of “deeming authority.” When you...

Read More

Saturday Quiz

Designed to enlighten and astonish   A patient can change their Medicare Advantage coverage outside of the normal enrollment calendar in “special situations.”  How many special situations does the government recognize? A. 2 B. 8 C. 12 D. 18 E. 20   The astonishing answer next week.       And now, last week’s answer     Your patient finds themselves in a Medicare Advantage plan she didn’t remember signing up for (also known as...

Read More

Are Your Charitable Contributions Effectively Supporting Your Personal Brand?

There was one patient in my practice who referred more new patients to me than any other.       She was tireless in beating the drum for me.  Over the years she sent more than fifty Medicare Advantage patients—dual-eligibles, the best kind.       I asked her how she became my biggest booster.  Her answer surprised me.     She was the treasurer of one of the “couple” bowling leagues my wife had us...

Read More

What Anthony Bourdain Taught Me About Telemedicine

In his great work “Kitchen Confidential,” Anthony Bourdain tells of how, when he was an itinerant cook in New York City, he always knew when the restaurant he was currently working in was getting ready to close.     The liquor distributor started asking for cash on delivery.     Time to find a new job.     One of my best telemedicine services recently stopped paying for missed encounters.     I would take...

Read More

Looking to Grow Your Panel? Consider Veterans.

There was a bar and grill in the basement of the local VFW where I practiced—and I loved going there.   The stories, the atmosphere. It was a great way to get out of the office for a half-hour lunch and recharge.   Little did I know that it was also a great way to recruit patients for my Medicare Advantage panel.   Back then, veterans were the best Medicare Advantage patients to have. They...

Read More

Success Codes—Patient Condition Counts, The Sun Tzu Edition

Last week, we distilled down CMS’s most recent 60-page proposal to revise the risk-coding system down to a couple of paragraphs.     Today we look at how to take that information and get ahead of the curve?     The first step is to back to your Sun Tzu in The Art of War—“They who try to control everything, controls nothing.”       A given patient will be awarded a higher RAF score if...

Read More

Sunday Links

Stay ahead of the curve   Eight things your Medicare Advantage patients don’t know about their plans or their providers that may surprise you From a survey of 781 members though Helathmine. CMS insiders tell me that they take independent surveys like this very seriously.         AMGA backs Telehealth expansion. When the industry group which has captured the regulators is publicly on-board, it’s full steam ahead. Pushback like this will merely be...

Read More

Saturday Quiz

Designed to enlighten and astonish   Your patient finds themselves in a Medicare Advantage plan she didn’t remember signing up for (also known as “getting slammed”).  She likes her old plan. She comes to you for help.  Which one should you NOT do:     A. advise her to call her insurance company and ask them to undo the change. B. advise her to find a reputable agent, settle down into an “insurance home,” and...

Read More