From Dr. Tom's Desk
We’ve recently discussed how next year, CMS is going to allow Medicare Advantage Organizations (MAOs) to offer home care services, with no additional compensation to fund this new, potentially very expensive benefit.
What we didn’t discuss is that those non-medical home care services are going to include adult day care.
That’s right, dementia patients and others who qualify will be able use adult day care services on your dime.
How much is the risk adjustment for the diagnosis of dementia? Zero
Adult day care will just be another expense coming out of your pool. You’ll be required to pay for this new benefit with absolutely no additional resources. Depending on the costs, it could represent a significant drain on your performance.
Well, the expense is not yet great enough to recommend cherry picking younger, healthier patients for your panel---ones that are ill enough to generate revenue but not yet so ill as to require these new benefits. But if the trend of expanding services without offsetting increases in capitation accelerates, we may get there---as distasteful as it sounds.
You see, Medicare Advantage Organizations believe these new benefits will help them recruit new patients, and thus offset their costs.
You, as a provider, can only take care of so many patients---so the marketing upside of these new benefits is of no real value to you.
All you can do is counter-market these services to your individual patients and try to limit their use best you can.
And watch for the trend.
If things get too bad, cherry picking patients may be the only defense you have.