From Tom's Desk

Survey 2019

An unscientific survey of administrators, executives, and providers at all levels of health systems, Medicare Advantage Organizations, and allied businesses. Respondents are contracted under at least one Medicare Advantage plan.  Responses may not add up to 100 percent due to rounding. Sent 10/31/18. Collected 11/1/18-1/31/19

Asked to participate: 2067
Answered: 662 (some partial)
"Do you share some level of financial risk for gain and/or loss, with your primary care providers?"
Yes 19%
No 71%
Don’t Know 10%
Of those who share financial risk---" Based on your own opinion, Is burnout, turnover or disengagement of primary care providers a significant problem within your organization."
Yes 41%
No 33%
Don’t Know/Can’t Say 25%
Of those who do not share financial risk---same question.
Yes 60%!!!!!!!
No 21%
Don’t Know/Can’t Say 18%
Not statistically significant so use at your own risk.
But experience teaches there’s nothing like skin in the game---for the patients, for performance and for providers.
More next week


You Should Know...

Revenue Growth Slowing Despite Risk-Code Harvesting Accelerating.

Healthcare Finance News is a nice little site for easy to absorb Medicare Advantage news---albeit filtered through the bias of the insurers who essentially pay for the site.
Every once in a while, you can find a real nugget of gold.

“Medicare Advantage payment rates for 2020 are expected to increase revenue by 1.59 percent, the Centers for Medicare and Medicaid Services said Wednesday, in releasing the second half of proposed MA and Part D payment and policy updates.

This expected average change in revenue is smaller than the 1.84 percent of 2019.

It does not include an adjustment for the underlying coding trend that is expected to increase risk scores, on average, by 3.3 percent in 2020. Last year, risk scores were 3.1 percent.”

Behold the fruit of risk-score “inflation.” The rate of increase in risk-scores accelerates, growth in revenue slows. 

When organizations invest in infrastructure to collect risk-codes, their pro forma assume a certain level of financial return. With the trend above, those pro forma are now called into question.

It's not a big deal on a national level (yet), but for marginal performers or those just starting out, failure to account for this dynamic will be the difference between success and failure.

Be very conservative in your projections and focus all your resources on the single metric that matters:

Getting >95% of the patients on your panel their yearly visit.

Getting that extra patient contact is the low hanging fruit. It will generate far more revenue for less cost than creating an infrastructure to intensively code them once they come in.

Once you hit the 95% metric, then you can analyze additional initiatives to further increase revenue.

But until you start making those yearly touches with your patient, much of your additional investment will be wasted.


Tips From Tom

Don’t want to risk share with your docs?  Having trouble getting patients to come in for their annual visit?

Pay your docs $25 a call to encourage their patients to schedule that appointment.  

Don’t pay your docs based on if their patient actually follows through and is seen, that’s a STARK III issue.
But paying your primes to perform a specific service---that’s not only ok, it's smart.

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