Sunday Update

    Where you can understand it all—in less than five minutes!   Medicare Advantage Market Healthy and Robust It certainly is—for now. A nice summary of the current state of affairs.     Hospitals call for overhauls of prior auth rules. Great insight into the PR campaign pushing back against tighter PA rules. Medicare Advantage was initially created to give CMS an agent at the point of care with skin in the game—the clinician...

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Having Your Clinicians Start Taking Downside Risk? You Must Do This First!

When organizations tell their clinicians they’re going to have to take downside financial risk through medicare advantage, they do just that, they emphasize the downside.   They don’t do a good job telling their staff about the possible upside and even more importantly, how to best achieve a benefit.   In fact, when I’m contacted by a health system in trouble with their medicare advantage contract, I always find that that they were flippant when...

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Sunday Links

How do know all this stuff?   The greater the number of Medicare Advantage plans in a given area, the higher the “quality” ratings and the higher the premium they charge. No surprise there. “Quality” ratings are extensively gamed and in a world of limited resources, such gaming would occur in areas with the greatest competition. Does suggest there is great opportunity in the mostly rural areas with less competition.     Confirmed:  Medicare Advantage...

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Saturday Q and A

  Dr. Becca asks:   “Hey Dr. Tom, you’re great. Thanks for all the great info. What’s your favorite risk code to look for as an incidental finding?”     Thrombocytopenia D69.6 It’s not uncommon, rarely reflects pathology, requires a simple, inexpensive treatment plan to address (lack of physical findings, no history of easy bruising or bleeding, f/u labs), yet the boost to your capitation is very significant.   Look for it on the blood...

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