From Tom's Desk 


Your revenue is at risk from another cost center.
 
In 2019, Medicare Advantage insurers will be allowed to pay for non-medical home care.
 
The details are still hazy, but the commercial home care providers are licking their lips at the chance to wet their beaks in your patient pool.
 
Read the linked article above. 
The problem?  The money to pay them is not going to come from Medicare, it’s going to come from your pool.  You’ve assumed the financial risk of your patient’s care costs.  And in 2019, that risk is going to be stretched to include non-medical home care.
 
The idea is that offering these services will increase the number of beneficiaries willing to sign up for Medicare Advantage.
 
Will these increased numbers offset your costs?  Can you even service more patients sustainably?
 
These are open questions.
 
What’s not a question is whether or not your existing patients will avail themselves of these new services at your expense.
 
You bet they will.
 
And you can also bet the companies that will be providing them will be marketing these services to your patients directly.
 
For the first time, you may find out what being at financial risk is all about.
 
If you have a strong connection with your patients, I suggest you begin the messaging now.  “These services are for the frail elderly, that’s not you,” or “You can expect this service to be marketed at you, talk to me with any questions.”
 
If you don’t have strong connections with your patients, I suggest you work hard to create them.
 
You’re gonna need them.

You Should Know

 
There’s a huge opportunity out there right now to grow your Medicare Advantage revenue.
 
As part of National Minority Health Month, CMS released its annual report on race-based healthcare disparities.
 
Such disparities do exist.
 
Using admittedly flawed, imprecise and easily-gamed “quality” data, CMS found gaps in a significant number of health measures African-American and Hispanic-Americans health measures compared against other racial groupings.
 
The release of the report was an opportunity for CMS to trumpet the ongoing reallocation of revenue from advantaged populations to disadvantaged ones through adjustment in RAF score calculations.
 
With these ongoing RAF adjustments, organizations can generate higher revenues without taking on significantly greater financial risks just by caring for more patients in these underserved populations.
 
Are these populations more challenging to care for?  Sure.
 
But with the systems you already have in place, your organization should be able to make a substantial impact with little additional effort.
 
It’s a huge opportunity for easy growth.
 
Reach out to these patients.  Make it easy for these patients to reach out to you.  Use shuttles, encourage home visits. Be an innovator.
 
Encourage your clinicians to do the same. It might present them with a greater sense of mission and professional challenge than their current practice provides.
 
CMS wants you to serve these patients.  They’re paying you substantially more to do so.
 
So, do it.
 
Everyone will win.
Copyright © 2018 Tom Davis Consulting, All rights reserved.


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