Steepling

  When you’re performing a video encounter that includes the top half of your torso, let the patient see you put your thumbs and forefingers together in front of your chest.     It’s called “steepling” and it communicates engagement and expertise better than any words will.   They will let you take charge of the visit and they will also have a higher chance of actually doing what you suggest.   Try it.  ...

Read More

Beware Extra Benefits

  For the first time this year, you’re going to be hit with people trying to sell you Medicare Advantage plans by telling you they’re going to cover in home personal care and housecleaning.   They will, but only under very limited and restricted circumstances.   And you won’t have control over who is going to be offering those services to you.   Be very careful when evaluating these new benefits.   Questions to ask:...

Read More

The One Question You Must Ask Your Prospective Employer

    In the past three years, has your organization ever paid a retention bonus to keep a clinician from leaving?   If the answer is yes, run.   Having to pay retention bonuses is a sign your organization is either poorly run or healthcare delivery is not its primary service line.   If it’s the former, they’re employee management strategy is to squeeze your compensation until you’re so miserable you’re about to leave. If...

Read More

What to Negotiate In Your Next Medicare Advantage Contract—Advice From Someone Who’s Obviously Never Done It.

  The AMA came out with this little summary of what to negotiate under your next Medicare Advantage Contract. I’m concerned someone will read this and take action on the assumption the authors know what they’re talking about. Over the next few weeks, we’ll dissect some of their recommendations in a series of short posts and then I’m going to give you about $100,000 of my fees by telling you what you should do. To...

Read More

Sunday Links

    Your reference for excellence   Medicare-for-All would be a boon for private insurers So says Fortune magazine. How did Great Britain get universal coverage passed in the face of overwhelming opposition from doctors? “I stuffed their mouths full of gold,” explained the founder. Those who run insurance companies are infinitely more sanguine than physicians. They understand any Medicare-for-All structure that wins their support will be short-lived—the money will quickly run out. They like...

Read More

Saturday Q and A

    Dr. Beatrice (who refers to me as a coding “rock star”—preen!) asks: What’s the deal with spinal enthesopathy?  It’s a risk code with a nice little bump in my RAF score. When should I code it and how do I support it?   Spinal enthesopathy is a condition where tendons, muscles or ligaments come into contact with the bones or joint capsules, resulting in inflammation, degeneration, and even affected function.   Tendon calcifications on...

Read More

Soft Risk Coding

    There are “hard” risk codes and “soft” risk codes.   “Hard” risk codes have objective data to back them up.   Hip fractures, pressure ulcers, pneumonic infiltrates are examples of those.   “Soft” risk codes are more judgement calls,   You can had some objective evidence support your conclusion, but often you do not.   Obstipation, and diabetic neuropathy come to mind.   If you’re going to submit a “hard” code, make sure...

Read More

Traveling and Working

    Many telemedicine services won’t let you perform encounters outside of the U.S.   Create your own Virtual Private Network, perform your encounters through it, and they will never know.   You can perform encounters anywhere you have an internet connection.    

Read More

The New Home care Benefit is Not What it Seems

    Beware of insurers trying to sell you on a new Medicare Advantage plan on the basis of the new home care benefit.     They will tell you that your insurance will pay for your bathing and housecleaning, but the conditions under which the coverage kicks in is very limited—and could be associated with some co-pays on your part.     Choose your Medicare Advantage plan on the access to clinicians you want...

Read More

The Employed Clinician’s Dilemma

    If the potential employer you’re considering is financially stable, chances are that healthcare is just a “loss leader” to them and they’re making money from other sources.     If you work for them, you’ll be an afterthought. Monetizing your expertise will be a fight.     If your potential employer is not financially stable, they’ll be absorbed by one who will.     And your ability to monetize your expertise will be...

Read More