From Dr. Tom's Desk

Healthcare manufacturers are urging your patients to spend your money.
The Detroit Free Press recently editorialized that giving Medicare Advantage patients free blood pressure monitors would save insurers millions of dollars. Others have suggested continuous blood glucose monitoring improved outcomes for broad categories of diabetics. Even the Apple watch has succeeded in getting FDA approval for its heart monitor.
More is not better.  Beware of research that suggests it is. It’s probably no more than paid PR.
This is not the government’s money these organizations are suggesting to spend---it’s yours. Out of your Medicare Advantage contract.
Could more intensive monitoring help improve outcomes in specific patients? Possibly.
Should you innovate closer and tighter observation with select patients? Certainly---especially those who are costing you the most money in the form of higher expenses.  They offer the opportunity for the greatest return on such an investment.
Will applying such intensive monitoring across your entire patient population without long term outcome and cost-benefit data improve your performance?  Never. Such interventions benefit only one group---those who make the technology.
Remember, if you share in financial risk you’re the insurer now.  It’s your money.
That doesn’t mean you shouldn’t innovate, just do it wisely, tailored to the patients that your primes know so well.  Best practice is from the bottom up. Your organization can offer the technology but leave it to your clinicians to decide how to most effectively implement it.  Top down “initiatives” may look good to your boss and the board, but they rarely generate any real value.

You Should Know

Nursing home censuses are in decline across the country. Nursing homes are closing and fewer doctors are doing nursing home medicine as a result.
That’s the surprising conclusion of a recent New York Times investigation (behind paywall).
And it’s an enormous opportunity for you and your Medicare Advantage contract.
As we’ve discussed before in these pages, caring for nursing home patients is a key tactic for any clinician or organization who wants to goose their Medicare Advantage performance.  Their capitations rates are high, they’re less dependent on risk-coding than outpatients and, with the new nursing home payment system, the nursing homes themselves will catch the few risk-codes that need to be caught.
Ten to twenty percent of your patient panel should be nursing home residents. If not, you’re missing out on significant financial performance.
I know, such patients are seen to be troublesome and time-intensive, but they’re not nearly as much as advertised. That’s more the prejudice of your clinicians than any accurate assessment.
With my clients, once they understand exactly how much they can earn caring for these patients, the clinicians fight among themselves for the opportunity to enroll nursing home patients onto their panels.
In my book, Medicare Advantage Mastery, I describe exactly how to partner with your local nursing facilities to generate excellent financial performance and deliver great care. And with fewer physicians unwisely unwilling to take on the perceived “burden” of nursing home patients, you have a great chance to capture that performance.
Contact your local nursing home. I’m certain they’re having trouble getting doctors to come in. Use the tactics in the book and go from there.
Your performance will astound. Your patient care will gratify.

Tip From Tom

A good RAF score is not and end in itself---stop treating it as one. At best, it’s a sign that the clinician is engaged with their Medicare Advantage contract.  Many a Medicare Advantage contract has performed poorly when the leadership has concentrated on raising the RAF score without getting the medical staff on board for the totality of the contract.
You can always spend more than you can earn.
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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