From Tom's Desk

You Should Know...

CMS released it's final rule regarding whether to allow Medicare Advantage participation to count as an "alternate payment model” (APM) under MACRA/MIPS — and there’s less to it than meeting the eye.


The bottom line?  They decided to move up the timetable to make a decision.

That’s better than nothing, but doesn't justify the hype surrounding the announcement.
 

In the meantime, participation in Medicare Advantage will have to be it’s own reward---a tactic to serve your Medicare-eligible population without having to deal with the costs of complying with MACRA/MIPS.

Though there were other changes to the MACRA/MIPS program that were announced at the same time, they didn't impact the math of whether or not to participate.  the program itself remains a nebulous, incomprehensible mess.

The only way to win at MACRA/MIPS is not to play.

Concentrate on Medicare Advantage instead.

High-Value Insight

Phantom Limb Pain

Amputations below the waist are associated with increased capitation, above-the-waist amputations are not---even though both are associated with increased costs.

But don't worry, Dr Tom is here to help.

Phantom limb pain, (G54.6 RAF 0.5), can be diagnosed with any amputation, including fingers and thumbs.

Look for it. Address it if present. Document it.

And you can use the revenue to offset costs that your pool would otherwise have to bear.

Q&A with Dr. Tom

Patients that have passed away are still on my Medicare Advantage panel list months later and I am still getting their capitation payments attributed to me. What should I do?

Leave it.

Years ago, when I reconciled my patient list every month, patients who were deceased persisted on the list months—-sometimes for over a year.

I took to calling my insurer every month to correct the error, but the patient names persisted on the list despite my efforts.

I was told that revenues were reconciled and inappropriately credited monies were corrected in the final yearly calculations before any checks were cut.

I looked for it. I and my OCD followed the dollars just to see. I never found a single dollar clawed back. Not a one.

I brought this up to our insurer liaison at the time of one of our final yearly reconciliations. He pulled out an attestation of compliance signed by the corporate compliance officer and said “don’t worry about it.”

So I cashed the check, but I still followed the dollars.

And waited for the clawback.

The clawback never came.

Later, we were told that CMS was able to interface with state death databases, which would “fix the problem.”

I saw no difference.

After a while, I stopped looking at the deceased patients on my list. No action I could conceivably take had any result, so I stopped wasting my time and worked on issues where my attention had some effect.

You should to.