From Tom's Desk


Uber Cuts Your Costs

Once again by reading this space, you're ahead of the curve.


Consider this the “You-Knew-Before-Anyone-Else” issue of Value-Based Transformations.


As reported here weeks ago, innovative Medicare Advantage organizations (MAOs) have been partnering with Uber to reduce their medical transport expenses and their no-show rates for medical appointments.


And here comes an until recently little-noted study that UberX reduces ambulance use.


People are taking UberX to the ER because it's cheaper than an ambulance.


Innovation from the bottom, up.


Buried in the study is a little tidbit that patients are also increasingly taking UberX to their medical appointments too.


It’s more reliable than the contracted medical transport mandated by CMS for Medicare Advantage plans.


Unsurpringly, Uber is not thrilled with the liability associated with this (not so) surprising source of customers.


But they might be a bit more thrilled if they get paid extra for it---at least that's what the Medicare Advantage/Uber pilot projects we discussed months ago are trying to prove.


At the very least though, if transportation is a problem for a patient and your contracted medical transport is providing terrible service, you might suggest that they take an Uber if they're feeling up to it.


You just might find a formal contract with the ride share of your choice is your next step to Medicare Advantage success.


And remember---you read it here first.

You Should Know...

MEDPAC to Completely Overhaul STAR Ratings

MedPAC, the official advisors to Congress on Medicare policy, announced on December 8 that it will begin an effort to revamp the Medicare Advantage STAR rating system. 


It seems MedPAC has evidence that MAOs are putting considerable resources into gaming the metrics upon which the quality STAR ratings are based.  Things like keeping two sets of books.


In other words, all the effort, all the time, all the  treasure you put into creating a system to excel in the STAR ratings--- well, the return on that investment might not be what you thought it would be.

Sure, maybe some of your current systems and resources can be re-allocated to these new measurements.  But if CMS intends a total revamp, there's probably not going to be much overlap.


But you already know all this. Why?  Because It's a trend that we already discussed in this space some months ago.


What should you do?


I'll repeat myself.


Don't worry about the STAR ratings. The increased revenue you realize is offset by their cost, complexity and the constantly changing targets.


Create systems where primes can excel while taking care of a panel of not-too-many patients within a system that encourages both patients and clinicians to stay in place for a long time, engendering and strengthening that therapeutic, value-generating relationship.


That's an investment that will pay off forever---no matter what the payer environment will be.

High-Value Insight

Chronic Histoplasmosis

Practice in the Midwest?


Then you know Chronic Histoplasmosis (ICD-10 B39.1 RAF approximately 0.2) is endemic and asymptomatic.  It's a very common finding in the radiographic studies of the elderly---and a nice source of additional revenue to bank against a rainy day.


When you get a chest study and histoplasmosis is mentioned, address it with the patient over the phone. Then write up an addendum to the visit during which it was ordered and send the documentation on for submission


You could increase your monthly capitation by up to a fifth.

And that'll help you take better care of your patients.


Q&A with Dr. Tom

My Medicare Advantage plan is offering tele-health services beginning in January. Does my documentation for those encounters count for risk code submission?


Not as of this writing.


And until it does, you can be sure that codes submitted from tele-health encounters will be audited and the revenue based on them will be clawed back---just like CMS does from any other "non-qualified encounter."


However, many organizations are going to submit risk codes from tele-health encounters over your signature anyway.


Your tactic?


You can't control what your employer does.


Though you can be sure somewhere in their coding department some low level coder is keeping notes in preparation for her qui tam suit against her employer---a 30% whistleblower fee focuses the mind wonderfully.


But you don't have to worry about that.


Just treat those visits like they never happened, from a risk code perspective at least.

Any codes submitted from a tele-health encounter won't be reflected in your yearly RAF score.


Simply continue what you're doing now.

See your patients once a year, systematically approach risk code collection--


And prosper.




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