From Dr. Tom's Desk

Advance practice nurses.
 
So many practices leverage the skill of their APNs to “extend” their physicians.  Yet, fee-for-service compensation effectively limits the financial return on employing their services.
 
Not so with Medicare Advantage.
 
A good APN can connect with hundreds of patients. With Medicare Advantage you can pay them beyond the ninety-ninth percentile of their average compensation and still come out far, far ahead.  These patients would still designate you as their PCP, but their nurse practitioner would be their “doctor.”
 
I employed a world-class NP. She and her family were well-known and loved in our community.  People wanted Dr. Barb as their doctor---but to get that they had to select me as their PCP for their Medicare Advantage plan.
 
And that was ok with them.
 
She told the patients they would have to see me once a year and that I may have to come in to the exam room for consults on complicated medical conditions---but otherwise, she would call the shots.
 
We never had any resistance from patients. Not once.
 
Leveraging APNs in this fashion is a great way to scale your systems without having to wait on recruiting those hard-to-find primes.  I know doctors who use groups of nurse practitioners to take care of patient panels two thousand strong.  Their financial performance is phenomenal, and all their APNs make tremendous compensation.
 
The most common of these models involves the physician seeing most of their enrollees once a year for their comprehensive visit and being available to consult with the NP staff whenever a complicated case arises. The docs take care of the hospitalizations and rehab stays---and they live a low-stress, happy, prosperous life.
 
You don’t even have to train your APNs in the finer points of Medicare Advantage---just supervise them normally and reap the benefits.
 
If you want to scale but can’t yet find that special prime---leveraging your APNs may be the way to go.
 
Unlike under fee-for-service medicine, the return on using APNs can be outrageous---for everyone.
 

You Should Know


CMS announced that it will accept Medicare Advantage as alternative to participation in MIPS.
 
Though expected and set forth with lots of caveats, this is a big, big deal.
 
The Merit-Based Incentive Payment System (MIPS) is complex, ever-changing, and expensive to comply with.  It’s an abomination---everything that a compensation system shouldn’t be.  CMS allows for an exemption from participation if clinicians work within certain other alternate payment models.
 
Now, Medicare Advantage is one of those models.
 
The decision is only for a limited pilot and only for clinicians who actually take a financial risk, but there’s every reason to expect that the exemption will eventually expanded.
 
What a recruitment tool for your organization.
 
“Work for us and you won’t have to deal with MIPS.”  That should be the headline on every one of your brochures.
 
Even better, “We don’t have the expense of dealing with MIPS so we can share the savings with our clinicians.”
 
Medicare’s alternative payment models are so convoluted and complex, their full implications are hidden from clinicians. A year from now, that won’t be the case. Those same clinicians will be filled with anxiety and alarm. The organization that can offer an “opt-out” through risk-sharing with their primes will be at an enormous advantage.
 
Get there first.
 
If you risk-share with your primes, then start using the “opt-out” as a recruiting tool. Once they’re on board, Educate them. Mentor them for success.
 
If you don’t risk-share---start!
 
In the new world of healthcare to come, you will thrive.

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