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...

Read More

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...

Read More

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?...

Read More

Saturday Quiz

Designed to Amaze and Enlighten   Yes or No? In the course of a routine exam your patient undergoes an EKG where you discover evidence of a past MI.  He remembers some chest pain a month ago that went away—he put it down to heartburn. Can you diagnose him with an acute MI? The shocking answer below. x x x x x x x x x x x x x x x x Answer:  Yes...

Read More

Saturday Quiz

Designed to enlighten and amaze   Which of the following patients offers you the greatest potential financial return under a full-risk Medicare Advantage contract? A. A 65 year-old male with COPD B. A 70 year-old female with Diabetes and an amputated toe. C. An 85 year-old male with hypertension D. A 60 year-old woman on dialysis, a remote history of lymphoma, Congestive Heart Failure, and left-sided weakness from a stroke. E. A 67 year-old female...

Read More

Sunday Links

The Source of Your Power   My “Greatest Hits” Sunday Links was so popular, this week we’ll link to the most popular newsletters in my archive.   Subscribe now and avoid missing even one high-value tactic     Kickbacks will kill your Medicare Advantage performance I’ve seen this up close, and yes—it will. Dialysis patients present an enormous opportunity for your Medicare Advantage panel One of my clients runs a panel that’s essentially dialysis-only patients.  His...

Read More

How to Get Paid 360K/year Taking Care of 300 Patients

Mrs. Smith was livid, I had given her sister bragging rights over her and she was greatly displeased.   Mrs. Smith had called the office requesting I come see her for a house call and then “went off” on my great staff when I refused.   I had done one for her sister days before. Her sister was homebound from a stroke and I, new in town, saw her at home for a visit in...

Read More

The Day My Staff Revolted

One day I had had enough.  And boy did I learn something.   Something about the power of persuasion.   I should explain.  You have the second-best office staff in the nation.   How do I know that?   Because I had the first.   Top to bottom.   Compassionate, skilled, team-oriented.   Fun.   They were the best.   Then one day, I decided to stop seeing drug reps and attending their lunches.  ...

Read More

Saturday Quiz

Designed to Enlighten and Amaze   A “Qualified Patient Encounter” is one for which the diagnostic risk-codes that affect your capitation rate can be submitted to CMS. Each one of the following patients is eligible for a “Qualified Visit” in the place where they reside instead of in the office EXCEPT     A. A patient who doesn’t want to come into the office because of fear of getting sick from the other patients. B....

Read More

Sunday Update

“How do you know so much about this stuff?”     The University of Colorado System Stops Seeing United Patients Presented as an example of how United isn’t having EVERYTHING their own way.         Using AI to Enroll Dual-Eligibles They might identify them and they might enroll them, but they sure as heck won’t keep ‘em—or even know which ones to keep. As far as I know, only Cisne Health has demonstrated the...

Read More