The financial reports you get from your employer and your insurance partners are the key to your happiness.       Understand them, and you’ll understand where your can capture the greatest value for your labor.       Fail to do so, and you’ll simply push yourself to create more billable encounters as you seek to generate more revenue. That’s a recipe for burnout, depression, and worse.       I’m a...

  Employed 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...

If you are taking financial risk under Medicare Advantage, the edge you need to improve your performance might just be your hospitalist.     Every morning, check the census list(s) at the hospitals your patients commonly use and connect with the hospitalists who are caring for your patients.     Find out what’s going on with them, their anticipated discharge date, their follow-up plans.     The hospitalist will love you for it.  You are...

If your patient with IBD has back pain, make sure you note any spondylitic changes on the plan films of the spine you may order.     Other inflammatory spondylitis (ICD-10 48.8x depending on location) is the appropriate code for such changes—-and can increase the monthy payment for this patient’s care by the government by as much as 30%     This is not something the back office is going to pick up. Neither is...

  If you’re taking downside financial risk your employer must give you transparent, and verifiable financial information on. a regular basis—otherwise they will just use the opportunity to pay you what they decide and massage the numbers to support it.       If you’re not getting these numbers—and they’re not independently verified, then you have to assume your employer is not being honest with you.     Best practice is to have  organizations which...

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...

    Medicare Advantage can be very overwhelming.     Administrators and insurance companies are trying to leverage your position to extract the last dollar of revenue from your patient’s insurance.     They can overwhelm you and drive you nuts with their demands—making you feel “substandard” in the process.     Here’s a tactic.     Don’t worry about it.     Don’t worry about any metric, about any goal they want you to meet....

    Every few months I like to re-post my very first blog entry and remind myself why we’re doing what we do.       Mr. Biondo is a real person and a good man. He gave me permission to tell his story if I thought it might help someone.       When I first met Mr. Biondo he was not at all well.  He had lost a leg through misfortune. The bed...

    How do you do really, really well under a shared-risk compensation system such as Medicare Advantage.     The title gives it away.     Round on your inpatients. Twice a day if necessary.     You don’t have to care for them, just coming . Your physical presence is is enormously valuable.     Coming in to the hospital to see your patients is so rare these days, just doing it once...