When we work worth practices in adult primary care, OB/GYN, and pediatrics, we often recommend they consider proactively recalling patients for preventive visits. Because preventive visits are usually reimbursed entirely by insurance with no patient cost-sharing, helping patients stay current with preventive care can be a win-win for patients and the practice. A preventive visit […]
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A recent Peterson-Kaiser Health System Tracker study revealed an interesting finding: average copayments are declining. Their study, which analyzed claims data from Truven MarketScan, found that average copay amounts paid by patients decreased by 26% from 2004 to 2014. Seems like a positive trend for patients and practices … except that it’s not. It’s part […]
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A key factor in the patient-centered movement gaining traction is the Affordable Care Act and its intention to improve population health and reduce healthcare costs in the United States. This is expected to be accomplished through improved patient satisfaction, coordination of care and better clinical outcomes. The Patient-Centered Medical Home (PCMH) is viewed as a […]
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Hospitals are acquiring or partnering with medical practices at break-neck speed and for good reason. It makes sense to align with physicians in a changing marketplace. It will strengthen the hospital’s position for both bargaining power and marketing their brand.   Physicians on the other hand, fear the unknown and are often uncertain about the strategies […]
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Health Affairs has a nice analysis of the ACA’s 90-day grace period on cancellation of enrollment for subsidized patients who miss premium payments.  But one piece of the puzzle that their article doesn’t touch on is the perverse incentive for health plans not to vigorously pursue those missed premiums. Under the grace period, plans are […]
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This is certainly a reasonable question to ask considering the rapid-fire change, threats and unknown factors medical practices face due to the Affordable Care Act.   But here are a few things you can do to deal with all of this. First, keep your eye on the ball.   Don’t throw up your hands in frustration, but […]
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Leadership sets the tone for the entire practice.  Staff will model your commitment and follow your expectations.  Much of the manager’s role focused on managing practice finances, maintaining practice viability, and keeping a highly motivated and efficient staff that is respectful and trustworthy.  Add to the list a new yardstick that changes how physicians get […]
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The New York Times reported today that “On Health Exchanges, Premiums Maybe Be Low, But Other Costs Can Be High.” This is something we’ve been talking about for a couple of months now — often getting skeptical looks here in our super-blue home-town.  But it’s not about partisanship.  The ACA is simply accelerating the trend […]
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It seems like forever now that practices have been dealing with multiple, complex, incentive and penalty initiatives from the federal government: Meaningful Use, PQRI/PQRS, eRx, PCMH and, more recently, “value-based” programs (value-based purchasing for hospitals, and the upcoming value-based purchasing modifier for physicians). If you’re like us, the onslaught of these programs has seemed more […]
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There is still time for providers to avoid the PQRS penalty for 2013 reporting, which will mean a 1.5% deduction from Medicare reimbursements in 2015 (ouch!).  The following two methods still apply for individual providers: -Submit via a qualified EHR vendor — if your EHR is provided by a vendor that has been permitted by […]
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Many practices already suffer losses from surprise payment retractions by health plans.  These can occur when patients attempt to exploit system update lags after leaving their employer (and therefore the employer’s plan) or the grace period after failing to maintain payments on their own policy.  (So, the patient knows he’s not paid his premium or […]
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Will your practice be taking part in this eight-state pilot? Requirements will include EHR, flexible hours, various preventive and individualized care activities. http://www.innovations.cms.gov/initiatives/Comprehensive-Primary-Care-Initiative/index.html  
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