Value-Based or Fee-For-Service—Pick One

Most organizations make the mistake of forcing their primes to live in two worlds at once.       There’s the Medicare Advantage “value-based” world, in which relationship, data-collection, and cost control are key.       And there’s the “fee-for-service” world, where the primes are being asked to feed your specialists so they can keep generating high-dollar procedures.       Either world is very lucrative, though generating data-based revenue is much, much cheaper....

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Sunday Links

Al the News That’s Fit to Link     Most of the news this week was in regard to the 2020 final rule, which I discussed in my newsletter this week (sign up, here).   There were still a few tidbits floating around:   An excellent tool for industry-wide enrollment and plan comparison information It’s subscription-based and I don’t get a commission. But it’s fabulous.       A brief, readable summary of insurer’s concerns...

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Saturday Q and A

Dr. Hassim writes   When is it ok to fire a patient who won’t be seen for their annual wellness visit? How can it be done?     I was the only doctor in a small town so I never felt comfortable firing patients. But my partners who worked in more broadly covered areas felt very differently.     If you’re not the only doc in town and they refuse to hold up their end...

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Deep Breaths

Deep breaths are vagal stimulators.     They’re one of a set of actions called “pacifying behaviors”—things you do to make you feel less stressful.     In business situations, like when you’re dealing with your supervisor or administrator, they are seen as signs of anxiety, uncertainty, and weakness.     A well-trained counterparty is trained to look for them and adjust their behavior accordingly. They will demand more, be more assertive, accept less—all because...

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How to Deal With Your Telemedicine Partner’s Clinical Limitations

Every telemedicine provider has a set of things they don’t want their doctors to do.     No lifestyle drugs. No anti-depressants. No tick bites.     I even have one that won’t let you manage a sunburn with blisters.     These “never treats” are usually in response to a bad outcome or a lawsuit—and there are not very many.     Keep a mental note of them—if you violate them and there’s a...

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Your Insurance Home Can Turn Your Benefits On and Off

Didn’t get the plan with dental benefits but now wish you had? Or wish you had a different drug plan?     All is not lost.     Contact your insurance home. See what they can do for you.     You might be surprised by how easily you can change your benefit.     Your insurer has only one goal—to retain you on their plan. If you approach it correctly, you might be able...

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Non-Competes

A reasonable non-compete for a clinician is in the range of 1 year and fifteen miles from your primary practice site (not the hospital or the “headquarters” or some arbitrary geographic point).     Though I’m not a lawyer, I’ve discovered anything more restrictive is difficult to enforce—although it will be expensive for you to assert your rights.     Anything more should be associated with additional compensation in addition to your market rate.  ...

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Don’t Fear Losses

So many of the challenges of the organizations I consult with could be fixed with a little clarity.       Health systems put a lot of pressure on their primes to control costs. They alienate their Medicare Advantage enrollees with that pressure as well.       Most “stop-loss” insurance for Medicare Advantage contracts pay 90% of losses after a $10,000 deductible, and 100% after the losses hit 100k. There’s some variability in benefits...

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Sunday Links

Keeping You Ahead of the Curve     Thinking of Starting a Medicare Advantage Plan in 2021? Start Now. I’ve been telling our faithful community that we’ve reached “peak” Medicare Advantage. A month ago in my newsletter, readers will remember about not one but two clients who pulled out of the business of Medicare Advantage plan consulting due to a saturated market. Now a high-quality outfit like Lumeris has to advertise for new business—telling.  ...

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Saturday Q and A

Dr. Donna asks:   “What’s the most effective method of getting a patient in for their yearly visit?”     Ask them personally. Leverage your credibility. Make a connection.     If a direct contact from me doesn’t work, like say through a phone a call or catching them at the store, then you have a decision to make.       I was the only doctor in a small town, so I didn’t believe...

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