From Dr. Tom's Desk

Telemedicine is a threat, not an opportunity.
That was the most surprising thing I learned mentoring the dedicated docs at the recent Texas Medical Association PracticeEdge Conference.
Telemedicine services are increasing their costs, making it harder for docs to meet their metrics and, worst of all, disrupting the doc’s relationships with their patients.  That relationship is the foundation on which all value-based revenue rests.
They’re harming you in the same way.
They’re prescribing antibiotics that count against your ACO metric, they’re sending people to the ER and the Urgent Care, they’re getting your patients in the habit of calling them instead of calling you.

Instead of being a useful adjunct to your healthcare services, they are evolving into a threat to your success---a big one.

I’ve written often about how important it is to provide every patient on your panel with your own cell number and encourage them to use it.

I’ve written that if you don’t do it, you’re not really serious about working your Medicare Advantage plan.

Well, those statements are no longer true.

Given the risk telemedicine services are increasingly presenting to your financial performance, teaching your patients to use your telephone number is no longer optional---it is essential.

Best tactic:
Don’t just give your patient your cell number.

Explain to them that you are their own personal telemedicine service. That it is your job to care for them. That you want them to call you.

I did for almost twenty years---and I never had anyone abuse it, not even once.

But that simple act, performed once with an attitude of service and reinforced yearly, generated millions of dollars of revenue for me and my partners.

And protected us from the influence of outside telemedicine services.

It will do the same for you, too.

You Should Know

 CMS has issued its “final rule” for its “long-term care hospital prospective payment system.”
It’s a complex document with lots of implication for value-based care systems and the physicians who work within.
First off, know that this new payment system won’t affect your costs. Your insurance partner has a separate contract setting payment terms for your skilled nursing vendors.
You should also know that there will no longer be a financial penalty for post-acute care facilities who accept more than 25% of their admissions from the same source.
This penalty was one of the factors preventing the integration of post-acute care facilities with acute-care hospitals.
With those penalties rescinded, look for greater integration between hospital systems and the post-acute care facilities they refer to. In fact, look for those hospital systems to get back into the post-acute care business.
Long ago, my partners and I learned that internalizing care systems was the best way to save on costs and enhance the overall efficiency of care delivery. We used that tactic to grow into a regional health all-in-one “super system.”
Now that the disincentive of the “25% rule” has been removed, look to health systems to re-discover our found wisdom.
And as hospital systems re-align with skilled nursing partners, you’ll be able to piggy back on their efforts. The hospital’s choice of nursing homes will be more interested in keeping down their average length of stays in order to keep receiving the hospital’s referrals.
As I wrote in my book Medicare Advantage Mastery, the hardest part of limiting your post-acute care costs is finding a skilled nursing facility who “gets it.”
With the elimination of the payment penalty, your hospital’s referral pattern will direct you to the best performing homes.
Then use the tactics in my book to enjoy even greater nursing home performance.
You and your patients will do very well.

Tip from Tom

Don’t interact with drug reps. Don’t allow your clinicians to do it. Don’t allow your staff to do it.
Ban them from your organization.
They are not educating your clinicians. They are not providing anything of value.
They are using highly effective influence tactics to divert resources into the prescribing of more expensive drugs.
Under Medicare Advantage, the resources they are diverting isn’t the government’s or some insurance company’s---it’s yours.

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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