From Tom's Desk
VA Improvements Put You at Risk
The Veteran’s Administration is making great strides in improving the care of its beneficiaries.
Although still far from perfect, wait times are decreasing, clinical and administrative deadwood is being pruned and and outcomes are improving.
More vets are giving it a try.
But a challenge to your Medicare Advantage panel.
Many veterans who get their care through the VA hedge their healthcare bets by also enrolling in a Medicare Advantage plan. Medical care delivered by the VA is not paid for out of your Medicare Advantage pool. However, the medical documentation from the VA is not used by CMS to calculate your monthly capitation.
Fail to see them at least once a year and your capitation amount will be calculated as if they have no chronic illnesses at all.
But if they receive care outside of the VA system, you're on the hook for the costs.
In effect, if you don’t see your patient at least once every calendar year, you could have a very ill patient with a very low monthly capitation show up very sick in a non-VA ER and generate huge costs for your pool—with no offsetting capitation for years.
On top of that, CMS down-adjusts the base capitation rate based on the percentage of enrolled VA eligibles in your area.
As more and more veterans opt for the free care of the VA, your collaborative relationship will suffer and they’ll be less likely to see you every calendar year for your health maintenance/code collection visit. Your risk for a catastrophic loss will increase.
If you check, I’ll bet you'll find far more of the patients on your Medicare Advantage panel get their care though the VA than you realize.
And as the VA thankfully improves and more vets age into Medicare, your challenge in caring for them is only going to get worse.
You must make a conscious effort to get them in every year. A personal effort.
They’ll be more resistant than the average patient. You’ll have to make a strong value proposition to get them in, especially as the VA does a better job.
But you gotta do it.
You’re taking on more risk than you know.