Sunday Links
Making you look informed 52 weeks a year. Medicare Advantage insurers may get billions in overpayments May? From the files of “Medicare Advantage Pushback…” People who sign up for Medicare Advantage have lower spending before they sign up As we’ve been discussing in my newsletter, take all […]
Saturday Q and A
Dr. Dianne asks: The specialists I refer patients to are very uncooperative. They rarely send me notes and even bad mouth me both me and the Medicare Advantage insurance to their patients. What do I do? Get new specialists, but create those relationships intentionally. Having a great network of specialists […]
What’s a Reasonable Non-Compete for an Employment Contract with my Health System?
1 year and 15 miles from your primary practice site. If they ask for more you can usually conclude they’re a predatory organization looking to treat you inequitably and lock you it long term—not because they’re a great place to work, but because you will have no choice. Proceed accordingly. […]
What You Should and Shouldn’t Do In Telemedicine
Your value as a clinician comes from two sources, your expertise and your prescribing privileges. Avoid telemedicine opportunities which seek to leverage your ability to prescribe—companies that sell braces, creams, diagnostic testing and the like. They seek to use you to extract money from the healthcare system. Embrace […]
PPO vs. HMO
What’s the difference between a Medicare Advantage PPO and HMO? HMO (Health Maintenance Organization) You choose a personal doctor (also known as a PCP or primary care provider). They must approve all visits with a specialist and all testing, but not all medications—your specialist can still prescribe them without your PCP’s […]
Financial Engineering
Ever wonder how your health system can afford all the buildings, equipment and sky-high compensation for the leadership while personnel cuts and “upgrades” to your EMR slows you down to the point where your productivity is less than half what it could be? The term you’re looking for is “financial engineering.” […]
Do You Understand Your Contract?
The most surprising thing in my 25 years of working with docs and organizations under Medicare Advantage? How few understand the nuts and bolts of their Medicare Advantage contracts. Do you understand how the dollars flow through your contract? Can you identify at least key three pressure points? […]
Sunday Links
What you need to know, when you need to know it. In most states, medi-gap plans can charge higher premiums based on pre-existing conditions Those states have higher Medicare Advantage re-enrollment These findings suggest just how price-sensitive Medicare Advantage enrollees are. If out of pocket costs for Medicare Advantage […]
Saturday Q and A
Dr. Beth asks: When is it appropriate to do testing to find risk codes? My boss is asking me to do routine Cxrs to find atherosclerosis of the Aorta. Beth It’s never appropriate to do testing to find risk codes. Ever. If you can, find a new employer. Yours is going to get […]
The Most Important Clause in Your Employment Contract
It’s your non-compete. Your employment contract is very one-sided. It’s only as good as a judge will enforce. And getting to a judge can be very expensive. Your employer has far more legal resources to take you to court and enforce their interpretation of your contract. […]