From Tom's Desk

I met this young man at a family wedding recently, I call him Chad. He worked for a venture capital firm who buys up distressed medical practices for their covered Medicare Advantage lives.

They employ the doctors and use population health tools to massage the value of their patient panels. Once they reach a critical mass they intend to sell them for the greatest return.

When payment is based on data, a patient’s financial value can be quantified---and they will be bundled, bought and sold just like any other financial instrument.

When I asked why these doctors don’t just work their Medicare Advantage contracts on their own, especially when large insurers are willing to give them more advantageous contracts, he answered that they don’t know how.

They don’t know how.

If you’re in this position and don’t want you patients treated like a 2008 mortgage backed security, learn how to work your contracts.

Start here. It’s free. I don’t even want your email address.

I’ve been blogging tactics for Medicare Advantage success every day for the past year because I know how you feel. I’ve been there.

Above all, if you have any doubts about selling out, wait.

Put some efforts into your workflows and practice design first.

And you can be your own boss.

So educate yourself first.

Chad and his checkbook will always be there. Make him wait.

The hens are letting the fox in the henhouse.

For the first time ever, CMS is inviting representatives of Medicare Advantage Organizations themselves to have a seat at the table where quality metrics are designed. The implications are clear. The metrics that determine STAR ratings and their associated financial bonuses should be easier to meet, the data more passively collected and compliance worries less of a concern.

Once this is in place, the revenue per Medicare Advantage beneficiary should climb and the emphasis on gaining covered lives should increase.

The upshot for you? Less active participation for clinicians in gathering data and more emphasis on actually delivering care to decrease costs. You won’t see any changes until Jan. 1 2020, but when you do, the decrease in documentation burden will be noticeable, even if strip mining the Medicare trust fund with more questionable quality measures is the cost.

And because your clinicians will have more time to actually take care of patients, the workflows you put in place will generate even more value in 2020. Get a head start now!