Value-Based Care in High-Acuity Situations

Avoid contracts that apply metrics to situations with high clinical acuities—such as ER, ICU, or Oncology.     Your only way to win in metric-based contracts is to control the costs of the first two standard deviations of patients enough that you can afford the losses generated by the outliers.     In high-acuity situations, EVERYONE is a potential outlier. And each is an outlier in their own individual way. No system will cover enough...

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Grow Your Panel With Personal Referrals

I once met the leading salesman for all of GM.     He was a short, fat, dumpy guy—the exact opposite of a slick car salesman.     But he personally had sold more cars for the company than anyone else—ever.     He was teaching the secret of sales and I wanted to know how much was applicable to growing the Medicare Advantage panels of myself and my partners.     Turned out, it...

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Mr. Biondo

Every few months I like to re-post my 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 The bed sores from his outdated mobility equipment had let infection...

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Is Your Employer Actually “Risk-Sharing” With You?

If your organization claims they’re risk-sharing but you’re not seeing any real financial benefit, they may just be pretending to risk-share to gain your compliance while having no actual intention sharing the financial benefits of your mutual success.   This is a sadly common situation.     Red flags to look for:   Your employer devotes great resources in encouraging you to perform the specific tasks which advance the value of their Medicare Advantage contracts—such as...

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Specialists, Doubling as Primes Can Support Your Declining Income

If you’re boarded in internal medicine as well as your subspecialty, consider adding a Medicare Advantage contract to your revenue mix.     A modestly sized panel of a couple hundred patients, an off the shelf contract and you’ll quickly find the extra revenue rivals that of your primary service lines.     I was weaned on this model in my practice.     A cardiologist and a GI both followed this model—and did very,...

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Telemedicine Sucks My Will to Live

Actual quotes from physicians, shared to help understand what your peers are saying, NOT to set up a strawman.     “Answering calls about yeast infections and runny noses all day—no thank you.”   “Sounds dull.”   “I want to do something that actually helps people.”     I have an answer for all these statements, but for the docs that said them, they are valid concerns.   Frequent readers are also bored with reading...

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A Health System that Owns Real Estate or a Real Estate Company Whose Tenants Deliver Healthcare.

Since I started consulting, I’ve been contacted to interview with a number of large health systems that, in the end, declined to purchase my services.  Of course, I’ve been contacted by more who have.   What was the difference between the non-purchaser and purchaser—besides, of course, that the purchaser ended up doing fantastically well?   For months I’ve been trying to puzzle it out. The pitch was the same, the need the same, the potential...

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House Call Only Practice Live Blog

Readers will recall I took the challenge of commenters and started the process of creating my own house call only Medicare Advantage practice.  CMS has proposed changing the rules in 2019 so that any beneficiary can qualify for a Medicare Advantage house call, not just the infirm.   The idea is, with no office and little overhead beyond my malpractice insurance and a compliant cloud-based EHR, I could generate significant net revenue with a very...

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Telemedicine vs. Office Practice Smackdown

Looking for clarity about your work as a physician?   Telemedicine Office Practice Earn $25 to $39 per encounter—and your employer will cover the cost of your malpractice.     Earn $98-$102 per encounter—and your employer will cover the cost of your malpractice   Less the taxes.   Less the cost of benefits.   Less the taxes.   Less the cost of benefits.   The cost of your phone, your home office, your internet connection...

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