From Dr. Tom's Desk

In last week’s newsletter, I told you I felt something in the air.
All things were building toward big regulatory changes that would encourage patients to sign up for Medicare Advantage at the expense of traditional Medicare.
I put that newsletter to bed on July 11th, irretrievably sending it out for eventual publication. and then went to see a movie with my family.
And the very next day, CMS issues this press release.
Medicare is proposing making dramatic changes to the way it pays fee-for-service care in the office. 
One flat fee. Minimal documentation.
No more 2/9 ROS points or “what was the nature of the presenting complaint?”
Essentially you’re going to be paid just for being in the room with a patient.
It’s an enormous, earth shattering change. The current E and M coding system is the product of 50 years of fine tuning.  For almost every physician practicing today, it’s all they’ve known.  And it’s gone.
 Just. Like. That.
The final proposal, entered into the Federal Registry on the 27th, accurately reflects the material in the press release. There’ll be a comment period and then the proposal will be finalized sometime in early November.  Don’t expect any changes.
I’ll be exploring all the implications in my ongoing series you can find here. But What do you need to know from a strictly Medicare Advantage perspective.
The pressure on primes to increase the numbers of patient visits per day will be enormous.  Patients with chronic medical problems will be asked to come back repeatedly, with an individual office visit for each problem. There will be denials that this will happen. Health systems will put “safeguards” into place to ensure it doesn’t.
Don’t you believe it.  Patients will experience it.
And if they have multiple chronic diseases, the marketers will let them know that, under a Medicare Advantage plan, their doctors will spend more time with them.
I’m told from stakeholders involved in the preparation for this decision that after a year of negotiations it was apparent that the parties--organized medicine, health systems, the electronic health vendors, even the coders--were never going to come to an agreement.  So, CMS threw up its hands and unilaterally made the big change.
Don’t believe this either.
This is a policy with the direct intention of shifting patients into the Medicare Advantage program.
Everything points to it, from insiders jumping on boards of Medicare Advantage plans to the unprecedented favorable treatment Medicare Advantage received in the recent annual patient information publication that was sent to 30 million beneficiaries.
The wind couldn’t be any more at your back.
Are you prepared to succeed?

You Should Know

Hidden among the enormous change in the 2019 payment announcement above is this little gem: We propose to eliminate the requirement to justify the medical necessity of a home visit in lieu of an office visit.”
Currently patients have to be demonstrably disabled by disease or pain to qualify for a home visit under Medicare. If this proposal goes through, no longer.
The key metric for your practice to meet under Medicare Advantage is getting 95% or more of your patients into your office every calendar year for their yearly visit. Illness can be addressed, health maintenance testing scheduled, codes submitted.
Most organizations are satisfied with 80%.  While 80% will get you average financial performance---for now at least,  95% will get you to places you’ve never dreamed of.
But getting to 95% is an enormous challenge.
This regulatory change opens up a tactic of immense power in your quest to hit that key metric.
If a patient really doesn’t want to come in, for whatever reason, you can now arrange to come to them.  I wish I had this tool at my disposal ten years ago.
Bonus pro-tip:
A physician could literally create a Medicare Advantage practice out of thin air. With essentially no overhead. Just out of their own home.
Creating one now is problematic. Patients who qualify for house calls are usually quite infirm. Once they qualify, their life expectancy is short enough that a physician may not have time to recover her losses once they sign up for her panel. The patient turnover taking care of only homebound patients is too great to be supported financially.
But now…
I’m thinking of starting one up myself.
Can telemedicine fill the gap when Samantha loses her doctor?  She learns more than she bargains for trying to keep her family safe. Share her journey.

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