Nurse Practitioners as you PCP

A common question:   I have a nurse practitioner that I go as my “doctor.” Can I select her as my PCP?   Usually, no. But you can select her supervising doctor as your PCP and still go to your NP.   Just ask them first.   The best way to do this is through the office manager. They probably have a policy in place to do just this.   If you’re seeing them now...

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Dealing With Failure

          I had several partners who had to pay money out of his own pocket each of the first few years they worked under his Medicare Advantage contract.       Some quit, other persevered.       The ones who persevered learned why they lost money, made adjustments and subsequently prospered better than most.       The ones who quit didn’t.       There are two reasons clinicians...

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Make a List

      Medicare Advantage is a complex payment system.     I involves many actors in the system duplicating services—or even working at cross purposes.     This inefficiency wastes mountains of money—and could be the key to your success.     Have someone in your organization sit down, list your goals for your contract and all the specific interventions being performed to achieve those goals.       Examples of goals include increasing...

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Sunday Links

      Making you look informed 52 weeks a year.     Medicare Advantage insurers may get billions in overpayments May?       From the files of “Medicare Advantage Pushback…” People who sign up for Medicare Advantage have lower spending before they sign up As we’ve been discussing in my newsletter, take all those industry-sponsored studies about cost savings with an enormous grain of salt. When entitlement reform finally becomes a necessity, these...

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Saturday Q and A

    Dr. Dianne asks:   The specialists I refer patients to are very uncooperative. They rarely send me notes and even bad mouth me both me and the Medicare Advantage insurance to their patients.  What do I do?   Get new specialists, but create those relationships intentionally.   Having a great network of specialists can be the difference between incredible performance and performance that’s just “ok.”   Create a stable of great collaborators. Contact...

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What You Should and Shouldn’t Do In Telemedicine

  Your value as a clinician comes from two sources, your expertise and your prescribing privileges.       Avoid telemedicine opportunities which seek to leverage your ability to prescribe—companies that sell braces, creams, diagnostic testing and the like. They seek to use you to extract money from the healthcare system.       Embrace telemedicine opportunities which seek to leverage your expertise.  Cross-coverage services are a good example. They look to add value to...

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PPO vs. HMO

      What’s the difference between a Medicare Advantage PPO and HMO?     HMO (Health Maintenance Organization) You choose a personal doctor (also known as a PCP or primary care provider). They must approve all visits with a specialist and all testing, but not all medications—your specialist can still prescribe them without your PCP’s approval. You can only go to a specialist or hospital that is “in-network.” That is, on the list of approved...

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Financial Engineering

    Ever wonder how your health system can afford all the buildings, equipment and sky-high compensation for the leadership while personnel cuts and “upgrades” to your EMR slows you down to the point where your productivity is less than half what it could be?     The term you’re looking for is “financial engineering.”     It’s the business strategy of increasing profitability without increasing productivity within a business organization.     Think of...

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Do You Understand Your Contract?

      The most surprising thing in my 25 years of working with docs and organizations under Medicare Advantage?   How few understand the nuts and bolts of their Medicare Advantage contracts.   Do you understand how the dollars flow through your contract?   Can you identify at least key three pressure points?   Then contact me.   With greater understanding will come much greater performance.      

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