From Dr. Tom's Desk

As part of the 2019 Call Letter for Medicare Advantage CMS announced relaxing of tele-health rules. Starting in 2020, Medicare Advantage Organizations (MAOs) will be able to include tele-health services in their benefit packages.
The implications will be profound.
Tele-medicine as delivered by current models offer primary care clinicians far greater remuneration per hour than any other practice option.
Smart organizations will tie up their clinicians with exclusive service clauses so they can have the right of refusal should their medical staff decide to moonlight providing tele-health services.  Once they get a taste of earning $400/hour taking phone calls from their hot tub, as I did last January, it’s going to be hard to keep them in the office paying them, at best, half as much.
And don’t even talk about urgent care.
The tele-health expansion of Medicare Advantage is a big deal.  Address the implications now so you don’t get caught behind the curve.

You Should Know 

Don’t go to sleep about this next paragraph. It’s going to significantly affect your overhead.
As part of the “Final Rule” of proposed regulations that started six months ago, CMS announced that starting in 2019, both fraud prevention and medical therapy management activities will be included as expenses in Medical Loss Ratio calculations for MAOs.  This will only encourage an increase in spending on these items---big time. And you will feel the downstream effects.
The result to you will be greater demands on the time of your staff, and your patients.
You can expect more record requests, more internal audits---and your patients can expect to be contacted that much more often about their meds.
Prepare your staff accordingly---and your patients.
Your patients have already said they are getting tired of being pestered to death by their Medicare Advantage insurance company.  This is only going to make things worse.
Starting today, begin the educational process with your patients that the pestering will get worse. Tell them to feel free to reject the service if they like, but warn them what’s coming.
It’ll make you look like the Medicare Advantage Master that you are, and the collaborative partner in their care that you want to be.
Copyright © 2018 Tom Davis Consulting, All rights reserved.

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