From Tom's Desk

With patients who are on dialysis now being eligible for Medicare Advantage programs, vistas of opportunities are opening up for those who choose to innovate.  For someone who wants to generate excellent income from a moderate amount of effort, adding dialysis patients to your panel is a great tactic for success.
These patients carry significant disease burdens and need comprehensive, hands-on care.  Under fee-for-service, these are exactly the kind of patients you want to avoid.  But, under Medicare Advantage you actually get paid for doing a good job, and these are exactly the patients who will reward your skill.
As nephrologists are poorly equipped to be these patient’s medical home, you’ll find dialysis patients starving for good comprehensive care.  They are ripe for recruitment---and you know exactly where they’ll be 3 days a week.
The dialysis centers.
I’ve seen doctor’s leave their cards, go by and visit with patients for a few minutes a couple of days a week, even hold sponsored events.  I’ve even had doctors meet with their local insurance agents and tell them they are especially interested in dialysis patients.
Bring 1 or 2 on your panel every month and pretty soon, your revenue will go through the roof.
But again, aren’t these patients time consuming?
Sure, just don’t take so many you don’t have the time to give them good care. Your strategy is predicated on establishing a good relationship with these patients. With that relationship you can guide their care and limit their costs.
The capitation for these patients are very high, with generous bonuses for risk codes on top.  Even after the expenses of dialysis, which after all is simply a commodity, you can do well.  Very well.
How well?
With a fifty percent shared risk contract that’s fairly standard, you can earn the family medicine median income with a panel of a little more than 100 patients.
100 patients!
Compare that to the 2000+ fee-for-service patients you’re servicing now.
It’s a great opportunity that you can jump on ahead of the curve. If you move now.

You Should Know

Risk codes in institutionalized patients are paying less. 
The monthly capitation for nursing home patients is still high, but the risk adjustment themselves are moderating---and in some cases are disappearing altogether.
Conditions like stroke, pneumonia and seizures pay a fraction of what they do in beneficiaries who do not reside in a nursing home. And some, like hip fractures, pay none at all.
Your strategy is clear.
Collect as many nursing home patients on your panel as you feel comfortable with. Take good care of them. And don’t sweat the risk-coding so much.
If you have a good relationship with your nursing homes, you can leverage these patients for significant revenue. These changes in nursing home risk scores allow you to concentrate on what you do best, delivering great care---and then be rewarded for it.

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