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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Saturday Q and A

Dr. Hakim asks:   What are the diagnostic risk codes my patient probably has and I’m missing?   Atherosclerosis of the Aorta (review past imaging, it may be an incidental finding) Stage 1 diastolic CHF (review past echos) Renovascular hypertension (HTN + atherosclerosis of the renal artery on a past imaging study) Emphysema (review past chest x-rays) Peripheral Neuropathy (perform sensory testing on their feet)     These are the most common. There are more—check...

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The Best Reason for Practicing Telemedicine I’ve Heard Yet

Dr. Michelle writes:   I think you’ve completely missed the best reason for practicing telemedicine. In the office, I’m getting paid to prescribe meds for patients whose best treatment is a lifestyle change. I prescribe antipsychotics to restrain demented patients in the nursing home and anti-hypertensives to people who were doing fine before the guidelines changed and now are getting sick from the side effects. Telemedicine has helped me win back my self-respect. It’s healing...

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Sunday Links

It’s not who you know, it’s what you know!   CMS sends MAOs notification that they will start collecting data in 2020 and begin eliminating low performing plans in 2023 Three “3-STAR” ratings in a row and an MAO’s plan can be terminated by CMS.   Its authority to do this was temporarily rescinded by the 21st Century Care Act but that change was not extended past its expiration at the end of this year....

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Saturday Q and A

Dr. Carlos inquires: What’s the highest RAF score one of your patients has achieved?   18.6 That’s not a typo.   this patient had six hospitalizations in one year for multiple amputations and every complication you can think of—with some chronic illnesses on top—one of which, surprisingly wasn’t diabetes.     The care managers and I got him through them, and the next year when all his diagnoses popped up, he came in at an...

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A Friday Funny

I try to populate this space with high-quality tactics—but sometimes you just need a laugh.     Was recruited the other day to a well-known regional health system     Time was they tried to entice with salary and incentives, benefits and time off, call schedules and nice neighborhoods.  Check this one out.     “$350k+ with great benefits and a “guaranteed half-hour for lunch.””     “Guaranteed half-hour for lunch.” HAHAHAHAHAHAHA     How far...

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Why Not “Claims-Made” Malpractice Insurance?

“If they offer anything short of that—say, claims made without a tail—you might want to think long and hard about working with them.”     I wrote that last Thursday, and since then I received hundreds of different variations on the  question “Why?”     Telemedicine is in its “wild-west” phase. Many telemedicine services seeking to recruit clinicians are poorly funded. Some are “fly-by-night.”     Claims-made insurance is the cheapest, so offering that sort...

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Targeted Care Management

Assign a care manager one or more doctors.   Based on your budget, allow each PCP a specific number of active cases–3% or 4% of their panel.   Let the care manager work directly with the PCP on specific tasks that will decrease the patient’s overall care costs.   Forget all the rest.   Like so many other systems, care management can become a bloated, ineffectual and self-perpetuating mess.   There is already a pushback...

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Sunday Links

You’re Amazing!   Everybody’s up in arms about the return of extrapolation to Medicare Advantage internal audits. As mentioned in my newsletter this week, the audits are still internal, the results self-reported and enforcement increasingly difficult in this legal environment. Short of obvious fraud, the only thing these changes represent is a marketing opportunity for compliance companies. Be honest and all will be well.       How does Risk Selection Respond to Risk Adjustment?...

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