Check your contract to make sure your non-compete is centered at the primary office in which you practice, rather than any office site the health system owns. The “primary office”language has long been standard, but as competition for clinician labor heats up (I recently saw a pop up ad recruiting general internists for Mayo), non-competes are becoming as restrictive as the law can make them. The fact that health systems...
Read MoreI find it curious to that even as clinicians, we ourselves have training in the process of helping our clinicians make positive change—quitting smoking, losing weight—we don’t see the process of our own career transitions as similar. They are. Change involves addressing both the emotional and practical aspects and implications altering our habits. And whether it’s smoking or changing career focus, unless you address both in a...
Read MoreIf you contract with an outside service to help you recover diagnostic risk-codes and those codes are rendered invalid through a whistleblower suit, it’s your revenue that’s going to be clawed back. I’m not just taking about the standard CMS audits (although if extrapolation becomes official policy, those audits will become more dangerous too). I’m talking about qui tam and whistleblower lawsuits. Code-harvesting arrangements usually involve the health system...
Read MoreKeeping you ahead of the curve It’s open enrollment season! And in a reflection of the impact Medicare Advantage is having on our industry here’s Bloomberg’s take on the “mad rush” to enroll payment. They’re not wrong. Another whistleblower lawsuit, this one instigated by a coder and, uniquely, includes coding companies. That makes 18 active cases involving allegations of coding fraud. Medicare Advantage will be the Enron/Madoff/Sub-prime of...
Read MoreDr. Lee writes Thank you for all your generous information over the years. The nursing home I work with is intentionally working to switch my patients away from Medicare Advantage and onto other insurance programs. What do I do? Dr. Lee, Approach the administrator. Tell her that Medicare Advantage is the only insurance program that compensates you adequately for the value you generate in the nursing home environment. Advise them that, should...
Read MoreEmployed or practicing on your own, if you have a risk-sharing arrangement under Medicare Advantage, a nursing home practice will supercharge your success. The details are shared in this work—it’s literally worth more than its weight in gold. Nursing homes are badly in need of clinicians who practice good medicine. Medicare Advantage risk-shares are a great payment system to reward you for your efforts. Under fee-for-service, nursing home...
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Read MoreMedicare Advantage plans are offering all sorts of goodies this year. Home health, house cleaning, even Apple Watches. Don’t get distracted. None of these have been proven to help your health. You’re not buying health insurance for all the add-ons, you’re buying it for access to the doctors you want and to limit the personal expense of your healthcare. ...
Read MoreJust back from serving on the faculty of the SEAK Non-Clinical Careers Conference where I’m privileged to serve as faculty. Over two days, I had direct contact for at least 15 minutes with over one hundred individual clinicians “seeking” information. It made for two very long days indeed. Now multiply that against dozens and dozens of similarly qualified faculty, and you can see the...
Read MoreI’ve seen this in two different organizations who don’t financially risk-share with their physicians. Their clinicians do no risk-coding. None. Zero. Their back office coders extract risk-codes from the documentation of every office encounter and submit them in aggregate to their insurance partner through a spread sheet. They know that even if their own internal staff misses a code, their...
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