From Dr. Tom's Desk

What’s the best telemedicine service for your value-based healthcare plan?
Your PCP’s own personal phone number.
Telemedicine services are marketing their product to you as a means of decreasing costs while they’re also marketing their services to your patients as a convenient way of accessing healthcare.
If your patients access their healthcare through anyone other than their PCPs, your costs are going to go up, not down.  Ask your primes on the ground.
Incentivize your PCPs to give out their phone numbers and pick up those after-hours calls---give them skin in the game, don’t overload them with too many patients, streamline their IT tools.
But if your organization hasn’t got that far yet, for the love of heaven be circumspect when considering the usefulness of these telemedicine services.
If you don’t, you may be in for an ugly cost surprise.

You Should Know

CMS has released its annual STAR rating report.  The best summary is here.
The trends?
  • 75% of MA plans are 4-5 STAR.
  • 90% of patients have access to 10 or more Medicare Advantage plans. 
  • The number and percentage of 4-5 STAR plans is increasing.
  • The final estimates for 2019 enrollment suggests an increase in Medicare Advantage membership of 10% (I’ll go out on a limb and suggest that severely understates what the final number is---by at least 50%. Check back in this space in May and we’ll see if I’m right.  I was last year)
What’s not in the report?
No mention of increasing fraud prosecutions for mis-representing quality data in order to get higher STAR ratings. As an expert witness, the number of cases I’ve been asked to consult upon has been exponentially increasing.
Your actions?
  • Make sure you have a stable of at least three 5-STAR MA plans that you contract with. That way, you have a clear path for patients to follow if one of your plans loses a STAR due to fraud---something that can happen very quickly through administrative action and requires no formal adjudication.
  • Be leery of signing up 1-3 STAR plans. This data suggests that the path to climb to STAR improvement (honestly at least) is steepening.  STAR ratings depend for the most part on patient compliance and the most compliant patients gravitate to the 5-STAR plans. 
  • Enjoy these fat times of explosive growth, but prepare for the lean as well. With trillion-dollar deficits as far as the eye can see, every entitlement is going to be under financial pressure. When the fire hose of capitation is reduced to a trickle, will your organization have the systems in place to be a survivor?
One opportunity for you to significantly increase your Medicare Advantage revenue.

Tip From Tom

A free ten-minute informational presentation for patients on “Primary Care in Renal Failure” sponsored by a dialysis center followed by twenty minutes of Q and A will net you at least a few new high-risk, high-capitation patients---with the resultant opportunity for financial and professional gain.
It’ll be the best time you ever spent.
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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