Passing the Costs Upwards

  Your Medicare Advantage insurance partners are doing everything they can in their contracts to push care costs down to you.     You can be certain they’re altering your contracts, debiting you for expenses you’re not responsible for and hoping you won’t notice, they’re even taking kickbacks and giving exclusive rights to certain vendors to service your patients—and charging the higher-than-market rates to you.     This is all cynical, I know. but it’s...

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Sunday Links

    What you need to know, when you need to know it.     Humana creates Telehealth system for Medicare Advantage beneficiaries told ya….     Why are Medicare Advantage Organizations moving more slowly than expected to integrate new benefits into their plans? Because they want to figure out which ones will make them money, This is a surprise to exactly no one who engages with this content. but that’s only half the story....

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Saturday Q and A

    Dr. Amy writes;   “I’m being pressured to take care of a lot more patients than I’m comfortable with. How many Medicare Advantage patients is too many?   How many can you form a thorough therapeutic relationship with?   For some, it’s 100, for others it’s 300, for a few it’s 700.   For me, it was 500.   If you care for more than you are comfortable with, you’ll quickly find yourself...

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The First Advice to Medicare Advantage Primes

When I’m retained to help a PCP improve their Medicare Advantage performance under a shared-risk contract, what’s my first piece of advice?     Relax.     If they’re working under a shared-risk contract, Medicare Advantage will reward them for doing what they do best—taking great care of their patients.     Sure, they’ll be bombarded with metrics they have to meet and risk-codes they have to submit.     I tell them to forget...

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YourTelemedicineCommunity.com

    Point your browser to YourTelemedicineCommunity.com and follow all my regular postings dedicated to your success in telemedicine.     Industry insights. Actionable tactics. Business tips.     The ONLY place on the net where you’ll find all this purely from a clinician’s perspective and 100% directed towards your success.   YouTelemedicineCommunity.com   Be there!    

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Don’t Pick Your PCP at Random

    When you enroll in a Medicare Advantage plan, if you don’t pick a PCP one will be assigned to you “at random.”       That should be your last option.       Get recommendations from your friends and family for a PCP. (Avoid online ratings, but that’s another post.)       Or better yet, get a recommendation from the agent at your “insurance home.”       They very much...

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How to Navigate the Corporate World

    Medical training does not prepare you for the corporate world.     Yet that’s where you’re probably going to be spending most of your career.     Without the knowledge of how and why things work, the flow of decisions and information will be mystifying.     That lack of understanding is a huge source of burnout and stress.     Interestingly, nurses do better than docs when they become employed clinicians—they’ve spent more...

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Stop-Loss Opportunity

  If your organization takes downside financial risk from your Medicare Advantage insurer (and if you don’t you soon will), then you have some sort of line item for “stop-loss insurance” to protect you against an adverse experience.       Stop-loss insurance covers you in case a patient’s care costs exceed a certain threshold—it keeps you in the game when you suddenly have an unusually large number of patients pop up with health problems....

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Sunday Links

    Keeping you ahead of the curve. . .   The top ten states for baseline capitation payments It’s a handy little reference I’ve never seen before MAOs and their venture capitalist investors have followed this information for years, but instead of moving business to these states, they’ve lobbied CMS to alter the baseline in states with the most customers. The article states that setting these rates are a mystery—they are not. They are...

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Saturday Q and A

    Dr. Ramone writes:     I’m having a lot of trouble getting people in to see me for their yearly visit. What’s the best way to get them in?     Anything is fair play     Call them. Write them a note. Arrange a house call (they don’t even need to be ill).     You can even drive them to your office yourself (I’ve done that more than once.)    ...

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