From Dr. Tom's Desk
I sound like a broken record---and that’s good thing
As I read back over a years worth of Value Based Transformations, I realize that I’ve been telling you repeatedly about one or another opportunity to improve your Medicare Advantage peformance, each one “great” or “incredible.”
I’m doing it again below.
They’re all different. They’re all filled with potential. And they’re all backed up with my personal experience.
And that’s the wonderful thing about the Medicare Advantage payment system.
It rewards your innovation.
Every adjustment to the payment system informs your innovation that much more.
In the past year we’ve discussed about how a panel of patients, heavy on nursing home patients and dual-eligibles can reward you with 30% more revenue for doing the same, or even less, work.
Next, it’s veterans. New rules will encourage them to effectively contribute to that mix. Read more below.
Supplement changes, new benefits, dialysis patients, carve-ins, carve outs.
Every week there’s been a new tactic to help you to stay ahead of the curve.
To make yourself a Medicare Advantage Master.
Stick with me and I’ll keep telling you about these new opportunities as they crop up.
Pick and choose the ones you want and use them to serve your patients with ever growing success.
The VA Choice Bill was recently signed into law, and it represents yet another opportunity to strengthen your Medicare Advantage performance.
Vets can now more easily get their care from physicians outside the VA system. The bill is an expansion and improvement on a previous attempt to do just that.
The bill is directed at vets without any other kind of insurance, not even Medicare. But with the educational campaign that’s funded by the measure, it will further normalize the idea that vets can get their care from a private doctor while still staying connected to the VA.
And that’s where your opportunity lies.
When the first version of this bill was passed several years ago, it represented a sea change in how many vets sought care in my own office. I had been recruiting vets into my panels for two decades. I figured that even when they signed up with me as their PCP, they still got almost all their care from the VA. I was able to capture their capitation, give them good care and when they did need expensive treatments they got it from the VA---and the expenses didn’t have to come out of my pool.
It was nice little buffer on my panel performance.
CMS knows this. For years they’ve adjusted the base capitation rate downward depending on the density of the Medicare-eligible veterans population in a given area. Through those lower capitation rates, every Medicare Advantage PCP in that given area is paying for the healthcare of Medicare-eligible veterans, even if they’re no veterans on their patient panel at all.
Getting those vets on my panel was a nice deal, plus they were great patients to take care of---interesting, pleasant and generally willing to consider what you suggest. Culturally, though, it was hard to recruit them into my practice. They have a love-hate relationship with the VA and the special status it allows them to enjoy.
Over the past decade, declines in the quality of care have changed that love-hate into more of a hate-hate. Then the first version of the VA Choice Act passed---and something fundamental changed.
I’ve always been connected to the local VFW and Legion halls. Bingo, blood drives, donations. I worked hard to keep a presence. When the first VA Choice Act passed, it suddenly became ok for these vets to get their care from me. There were too many restrictions on the program for me to get very many such patients, but the change in attitude was real.
I expect the passage of this second version to open the floodgates.
Recruit them. Hard.
Go to the VFW hall, the Legion. Let them know you’re open for business---especially for potential Medicare Advantage patients. But do them a favor and take them all. They need your good care.
The word will get around and your reputation will soar.
Get them in, get their medical problems addressed. Introduce them to an insurance agent. If appropriate, get them enrolled in Medicare Advantage. Code them up and give them great care.
They’ll still more likely to get their expensive specialty needs cared for at the VA, it’s cheaper for them to do so. And when they go, the expenses for their surgeries, their hospitalizations, and their ER visits won’t come out of your pool---the VA will pay for them.
And the nice little buffer that I had will become a great big success for you.