Welcome

I'm thrilled to introduce the inaugural issue of Value-Based Transformations, a newsletter designed for healthcare professionals and executives who are committed to excellent value-based care.

For over 20 years as a family physician, I've worked to leverage value-based care systems for my patients, my partners, and my practice. This newsletter brings together my insights from those years of experience—plus a laser-like focus on the most pressing issues that face today's healthcare organizations.

Why Value-Based Transformations?

Because, to date, thousands of my patients have benefited greatly from total risk and value-based contracts such as Medicare Advantage. I've spent years developing and sharing best practices for physicians, managers, and healthcare partners to leverage value-based care systems for both profitability and patient health.

And now, I want to share my expertise with you.

The truth is, I see and hear a tremendous amount of cynicism and negativity around risk products like Medicare Advantage. But making the jump from fee-for-service to value-based care systems can be an transformational net-positive move for healthcare professionals and their organizations — if it's done the right way.


From Tom's Desk

It's begun.

The reality of MACRA and MIPS has started to hit clinicians across the care spectrum.

The result?

According to my survey of state medical societies: accelerating dis-enrollment of physicians and independent nurse practitioners from the Medicare program. It's not in anyone's interest to report this so you won't find it in print...yet. But the anecdotal evidence is all around. Just look.

The trend is not surprising, it always happens after Medicare payment changes. But this is different. This is now becoming access problem.

Where are the clinicians going?

Not fleeing to the protection of health systems—those with the predisposition to do so already have.

Not discontinuing taking new Medicare patients—p to a quarter of all primary care providers nationwide have already tried that. Caring for any Medicare patients is now a financial and personal loser with opportunity costs through the roof, plain and simple...a simple business analysis will tell you that.

Nope, these clinicians are going to the cash pay/concierge model and opting out of Medicare completely. And that's a damn shame. Understandable, but a damn shame all the same.

You see, the only way caring for Medicare patients makes any sense is to use it as a recruiting tool for your Medicare Advantage product. The difference between traditional Medicare and Medicare Advantage benefits will become so great that your patients will naturally migrate away from one and toward the other. And for primes, your Medicare Advantage contracts are now probably your only vehicle to generate an equitable return on your professional educational investment.

It you have Medicare Advantage contracts, now is the time to revisit them.

If you don't have access to them, now is the time to rethink your relationship with traditional Medicare. Your data now will be used to cut your pay in 2019. By then the last train out of Medicare town is likely to be pretty crowded.

You Should Know...

Part of the "Doc Fix" bill in 2015 that gave us the MACRA monstrosity also eliminated first dollar coverage by Medicare supplements beginning in 2020. Most Medicare supplements are designed to prevent any out of pocket costs to the patient for covered services. They are expensive but they do serve the needs of a certain group of Medicare patients.

They are also thought to drive demand ant thus encourage expenditures. Reducing those expenditures was one way to pay for the "doc fix". Once there is a mandatory gap that the patient must pay, these products are going to be much less attractive, and Medicare Advantage enrollment is going to benefit...BIGLY.

Operate on the assumption that the majority of your current traditional Medicare patients are going to be enrolled in your Medicare Advantage panel come 2020...because they are.

High-Value Insight

Dependence on opioids (ICD-10 F11.1xxxx), benzodiazepines (F13.1xxxx), and amphetamines (F15.1xxxx) are all diagnosis codes that will increase your RAF scores...and your insurance company's capitation. However, if you are the clinician routinely prescribing these medications to your patient, you cannot submit the dependence codes, even if the conditions are present and appropriately addressed. Submit the appropriate codes for long term use instead. If you see them for withdrawal or complications, those codes are ok, but not the dependence codes.

It may seem nit-picky but these diagnoses are associated with significant funds, funds that can be recovered years after they are booked if identified by an auditor. And if the auditor is paid based on percentage of revenue recovered, like RAC auditors are, believe me, they'll be looking.

Case in the Spotlight

My Medicare Advantage contract is the only one that is worth the effort and risk. What is the best way to grow my panel of patients?

The best way is develop the reputation of taking good care of your patients.

Once that's in place, consider personally visiting the local health insurance agents who have the same reputation about taking care of their clients.

Personally introduce yourself. Let them know of your expertise in caring for patients under the program and your interest in growing your population. Then send them a hand written thank you note for meeting with you as well as for each time they send you one of their clients.

Treat them with respect and let them know they can trust you to do a good job.

Do this with the top five local insurance agents and you're population will explode.

Tom Davis Consulting Get Your Copy Now! Contact Tom