Don’t Be a Tool
Per the great Seth Godin. Industrial labor: Break any task down to its component parts. Make it replicable. Use the lowest skilled labor possible. Make sure the labor is replaceable. Make sure the labor is as cheap as possible. Automate processes. Do what you’re told. Meet spec. […]
Addenda are Your Friends
It’s common to see a patient in your office but be unable to provide a definitive diagnosis at the time of the visit. If you don’t have a diagnosis, document your assessment using the diagnostic codes appropriate for the patient’s symptoms and wait for your confirmatory testing to come back. Once complete, those […]
The Value Lexicon—Gotcha Guidelines
Gotcha Guidelines noun. Clinical guidelines developed by part-time and non-clinicians that are unworkable in a practical environment. Created out of bureaucratic processes rather than outright malice, they ostensibly address an “urgent problem” or drifting metric identified at a higher level, usually far removed from actual clinical practice, and are often crafted with the “help” […]
How do I select the best Primary Care Provider Under Medicare Advantage
Make a “get to know you” visit. Ask them how they are paid. Ask them how well they understand the system under which they are paid. The answers will tell you a lot. Medicare Advantage is designed is a special way. You and your clinicians have your interests aligned. Like the pilot and […]
Wherein You Learn From My Failure
I did so for more than twenty years—in a small group practice, which then expanded into an increasingly large multi-specialty group—one that not only grew too fast, but threatened the status quo in many, many ways.. The result? Fragility in the face of a volatile regulatory environment. Discord. Dissension. Vituperation. Merger. Acquisition. Subjugation to the […]
The One Thing You Must Do to Succeed In Medicare Advantage
You know all about RAF scores. Now, let’s talk the timing of data collection. Remember, this is not what your insurers or organizations want you to know for THEM to be successful. This is what YOU need know to be successful. Yourself. And your patients. Shared by a peer […]
The Pendulum Swings
Marcus Welby is on his way back And the job of personal clinician is once again on the cusp of an epic boom. Observe: Clinicians disengage by the thousands, repelled by the industrial model of corporate healthcare delivery. Insurers push back against provider consolidation, looking to diversify their provider bases with advantageous payment rates. Increasing […]
I Saw It at Sears
I went into what used to be one of the largest retailers in the world the other day. Tumbleweeds. What happened? For more than a century, This retailer was the most powerful retailer around. It had enormous market share, bulletproof branding, all the regulatory protection money could buy. What happened? Innovation. The Law […]
How Do I Get the Most Out of Medicare Advantage
Get your own personal insurance agent. In my medical practice, I always dreaded the first of the year, when the changes the patients had made in their Medicare Advantage coverage became effective. There were always screw-ups and unintended changes. Many, the result of pure fraud. I remain appalled at how many unscrupulous people […]
I Wonder
CMS just got badly spanked by the Government Accounting Office (GAO) regarding Medicare Advantage risk coding compliance. The reaction is going to be swift. And probably overboard. The clawbacks will be epic—up to five years worth. And at least a few fraud prosecutions will take place. Many organizations have paid big money to secondary […]