From Tom's Desk

The 2019 CMS Final Call Letter is out and there were no big surprises. You can find a brief summary here.
Most of the recommendations in the draft letter from back in January were accepted, but there’s one tidbit which can make a bid impact on your bottom line.

Before November, 2017, it was CMS’ interpretation that every Medicare and Medicare Advantage beneficiary had to enjoy the same basic package of benefits, regardless of program or location.
That’s no longer the case.
Beginning in 2019, Medicare Advantage Organizations (MAOs) will be able to tailor benefits to specific populations based on disease burden and health status. 
The standard is no longer, “everybody must have the same coverage.” It’s now “similarly situated individuals must be treated uniformly.”
That’s a huge deal. No more “one size fits all,” more like,” you get what you need.”
Your patients will soon be able to enjoy a benefit package customized to their own personal medical requirements.
Whether they have COPD, diabetes or heart failure, they’re going to be able to get packages of benefits tailored just for them.
As long as “similarly situated individuals are treated uniformly,” the benefit sets will be limited only by the imaginations of the MAOs that come up with them.
And If you’re the one to connect them with that great coverage, they will be bonded with you for life.
Creating that connection will be insanely complex unless you have relationships with your insurers.  Now is the time to start meeting with them and gain an understanding of what’s expected to be on offer by the MAOs in 2019 in response to this new flexibility.
Then you can create or reinforce systems which connect beneficiaries to agents so that your patient can choose from the best benefit packages available---packages that will be far more valuable than in the past.
Facilitate that connection, and those patients will be yours---forever.

You Should Know

Of all the changes announced by CMS in its final call letter, one proposed change didn’t make the cut.
It looks like the risk-adjustment for total disease burden is going to be put off until at least 2020 to create more time for study. You can read more about that proposed adjustment here.
Although it’s a “final” decision by CMS, the total disease burden adjustment is actually mandated by law by the 21st Century Cures Act. If some legislators get a bee in their bonnet about the delay, it may be implemented outside the normal decision cycle.
At worse, it means you won’t get quite the payoff for comprehensive patient coding, at least not until 2020.
That doesn’t mean you shouldn’t do it, it just means now you need to do it exceptionally well.

Tip From Tom

Atherosclerosis of the Aorta ICD-10 I70.0.  Most of your patients have it. Most don’t have it documented or addressed. Do so and it’ll increase your monthly capitation by up to 30%.  What are you waiting for?
Copyright © 2018 Tom Davis Consulting, All rights reserved.

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