surviving & thriving in ppaca -...
TRANSCRIPT
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SURVIVING & THRIVING IN PPACA
FEAR NOT!
WE DO HAVE SOME CONCERNS
WE DO HAVE SOME CONCERNS
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WE DO HAVE SOME CONCERNS
FEARFEAR NOT!
SHOULD WE BE AFRAID OF OBAMACARE?
MOST DOCTORS ARE AFRAID OF OBAMACARE
• MOST PATIENTS ARE (52%)MOST PATIENTS ARE (52%)
• ALL TAXPAYERS ARE (47% OF USA)
• MOST BUSINESS OWNERS ARE
• SOME DOCTORS ARE
• NOT ALL DOCTORS SHOULD BE
WHICH DOCTORS SHOULD BE CONCERNED ABOUT THE PPACA OR UCA?
SURGEONSRADIOLOGISTSUROLOGISTS
OTOLARYNGOLOGISTS
NEPHROLOGISTSGYNECOLOGISTSPEDIATRICIANS
ANESTHESIOLOGISTSOPHTHALMOLOGISTS
PODIATRISTSNEUROLOGISTS
DERMATOLOGISTSPHYSIOLOGIST
ALLERGISTSIMMUNOLOGISTS
PULMONOLOGISTSPSYCHIATRISTS
PSYCHOLOGISTS
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CONCERNED ABOUT 2014?
WHY?• REDUCED MEDICARE PAYMENTS FOR SURGERIES
INCREASED BUNDLING RULES• INCREASED BUNDLING RULES• INCREASED # OF UN-INSURED – CASH PATIENTS• 3 MONTHS GRACE PERIOD – CAN BE DANGEROUS• INCREASED # OF MEDICAID – PREVIOUSLY INSURED
• ALL OF THIS WHILE DOCTORS SEE INCREASED TAXES, FEES & INSURANCE PREMIUMS
WHICH DOCTORS SHOULD NOT BE AFRAID OF THE UCA?
SMART GENERAL PRACTITIONERSSMART FAMILY PRACTITIONERS
SMART INTERNISTSSMART GERIATRICIANSSMART CARDIOLOGISTS
WHY THE WORD ‘SMART’?
SMART DOCTORS RECOGNIZE THAT THEY HAVE TO CHANGE UNDER NEW
GUIDELINES OR THEIR PRACTICE WILL
DIEDIE
FOOLISH DOCTORS WILL CONTINUE DOING WHAT THEY HAVE ALWAYS DONE, THE WAY THEY HAVE
ALWAYS DONE IT – WITHOUT CHANGE
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DON’T LIMIT YOURSELF
SO – HOW DO I DEAL WITH ALL OF IT?
WRONG WRONG RIGHT!
CHANGE?
1. Your Patients?2 Your Insurance Participation?2. Your Insurance Participation?3. Your office policies?4. Your staff?5. Yourself?
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What has happened that necessitates that I make changes in my practice?
CHRONILOGICALLY
- HMOs started 1959 – absorbed doctors- AMA grew – own CPT – dictate/define codes- Voluntary Fee Freezey- Medicare MAAC- Carriers advising patients docs overcharge- Government/Newspapers demonize doctors- Doctors sold their souls to PPO & HMO- Patient – Physician relationship damaged
CHRONILOGICALLY
- Physicians sold out to hospitals- RHC/FQHC boom- Evidenced Medicine Guidelines Adopted
Physicians bought practices back- Physicians bought practices back - Medicare moved money into EBM- PQRS adopted to incentive doctors into EBM- Obamacare created- RHC/FQHC drops as EBM makes FFS $ - Doctors panic after PPACA upheld by USSC
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SO – WHAT CAN I DO?1. INCREASE PROFITS2. REDUCE EXPENSES
ACCOMPLISH BOTH WITHOUT LETTING STRESS KILL YOU, CAUSE YOU TO DIVORCE,
CAUSE YOU TO BECOME ADDICTED, OR CAUSE YOU TO LOSE YOUR MIND… OR YOUR
HAIR
TOO MANY CENTER ONLY ON #2 - AND FAIL
1. INCREASE PROFITS2. REDUCE EXPENSES
If the trend in the medical profession was temporary – reducing expenses only – and
riding it out may work – but this is not temporary!
Cutting back on staff, cutting hours, cutting services to patients,
cutting quality ofcutting quality of medical care you are
providing –IS NOT THE ANSWER
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That is what the losers are doing. Don’t be a loser. Find out what works, what the payers want to , p y
pay you for, what achieves better outcomes for your patients & go
that route! Don’t be afraid!
How many times are people told to either “DO NOT BE AFRAID” or
“FEAR NOT” in the Bible?
365 times!
Fear is a human response – but not always the right response
Ok – I got it – now what do I need to do in my practice?
1. Review your patient population. Are you too invested in one carrier or one type of insurance?
2 Are you providing services the carriers WANT to pay2. Are you providing services the carriers WANT to pay for?
3. Are you providing services that are getting reductions in $?
4. What sets YOUR practice apart from every other practice?
5. How did you set your fees? Has someone convinced you that adjustments are a bad thing? If so – slap them!
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Ok – I got it – now what do I need to do in my practice?
6. Are you sending the profitable diagnostics out so someone y g p gelse gets to make the money on them?
7. Are you concentrating on increasing patient volume instead of quality of care?
8. Are you trying to work harder instead of work smarter?9. Are you missing time with family, yet still losing ground?10.Are you the only profit center in your practice? FAIL!
Ok – I got it – now what do I need to do in my practice?
6. Are you not increasing profit because of poor business y g p pdecisions?
7. Have you tried to stay “inside the box” only to discover that the box is sinking?
8. Have you followed advice from idiots that told you that primary care practices cannot make money seeing Medicare patients?
1. INCREASE THE NUMBER OF MEDICARE PATIENTS YOU ARE NOW SEEING. MEDICARE PATIENTS ARE PROFITABLE IF YOU RUN A SMART
PRACTICE PRACTICE GOOD MEDICINE
SO – WHAT IS YOUR PRESCRIPTION?
PRACTICE, PRACTICE GOOD MEDICINE AND TREAT PATIENTS THE WAY YOU
WANT YOUR FAMILY TREATED
TYPICAL BCBS PT VISIT: $120 MEDICARE PT VISIT: $273
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2. QUIT TRYING TO LIVE ON E&M VISITS ALONE AND GET SMART AND START DOING DIAGNOSTIC TESTING
THAT ARE PART OF EVIDENCED BASED MEDICINE. LOOK AT THE
ONES THAT HAVE RECEIVEDONES THAT HAVE RECEIVED INCREASES OVER THE PAST 8 YEARS
OR MORE.
TYPICAL INCREASE IN PRIMARY CARE P/MONTH FOLLOWING DON’S ADVICE ON EBM: $23,350 PER MONTH CONSERVATIVE
DON’T REINVENT WHEELFOLLOW
• AHRQ GUIDELINES• MEDICARE/CMS ADVICEMEDICARE/CMS ADVICE• PQRS• PCFH GUIDELINES• MEDICARE LCDS & NCDS• HARVARD BASED RESEARCH• EVIDENCED BASED GUIDELINES
WHY EVIDENCED BASED?• 8.3% of all Americans have diabetes• 26.9% of those 65 & older have diabetes• 33% of diabetics over 50 have P.A.D
33% f h t i 50 h P A D• 33% of hypertensives over 50 have P.A.D.• 23% of Americans 65 & older have P.A.D.• P.A.D. accounts for up to 90% of amputations• P.A.D. is the leading cause of amputations
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17003 ↓ 39.4%
20550 ↓ 14.6%
20610 ↓ 21.6%
69210 ↓ 23.6%
91065↑ 229%91065 ↑ 229%
93922 ↑ 110%
94010 ↑ 37.6%
95923 ↑ 78.9%WHERE HAVE YOUR DOCS BEEN CONCENTRATING THEIR EFFORTS?
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3. TEACH YOUR STAFF ON ERISA AND QUIT BELIEVING LIES TOLD TO YOU BY INSURANCE CARRIERS OR
YOUR OFFICE MANAGERS OR BILLERS
YOU DO NOT HAVE A 90 DAY FILINGYOU DO NOT HAVE A 90 DAY FILING LIMIT ON BCBS ON CLAIMS,
REGARDLESS OF WHAT IT SAYS IN YOUR CONTRACT WITH BCBS
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NO ONE EVER LIES TO YOU!
“I DID NOT HAVE SEX WITH THAT WOMAN, MS LEWINSKI”
3. TEACH YOUR STAFF ON ERISA
YOU CAN PREVENT BCBS OR OTHER COMMERCIAL CARRIERS FROM RECOUPING ON CLAIMS AS IT IS NOTCARRIERS FROM RECOUPING ON CLAIMS AS IT IS NOT YOUR MONEY THAT IS OWED TO THEM…. PER ERISA &
THE UNITED STATES SUPREME COURT.
CAN YOU MAKE ONE PATIENT PAY YOU MONEY BECAUSE A DIFFERENT PATIENT OWES IT TO YOU?
NEITHER CAN INSURANCE CARRIERS!
Not knowing about ERISA costs a
Simplicity of ERISA
typical office $Thousands &
hospitals $Millions each year
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If I ask the Insurance company questions about ERISA, willabout ERISA, will
they tell me the truth?
NO ONE LIES TO YOU.
“READ MY LIPS – NO NEW TAXES” QUOTE FROM 1988QUOTE FROM 1988
1990 CONGRESSIONAL BUDGET – HE RAISED
TAXES
NO ONE EVER LIES TO YOU
“IF YOU LIKE YOUR PLAN, DOCTOR, HOSPITAL – YOU CAN KEEP IT”
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Medically Necessary
•40
SAY WHAT? NOW TELL ME WHY YOU BELIEVE
THIS LIE!!!
WHOSE CLAIM IS IT YOU ARE FILING?
THE CLAIM IS THE PATIENT’S CLAIM –REGARDLESS OF WHO FILES THE CLAIM OR WHO IS
BEING PAID
4. STOP GIVING AWAY SERVICES FOR FREE BECAUSE YOUR STAFF HAS NO
IDEA THEY CAN BE BILLED FOR
“WE CAN’T DO THAT IN OUR OFFICE BECAUSE OF THE CONTRACT WE HAVE THE PAYER”CONTRACT WE HAVE THE PAYER
WRONG! READ THE CONTRACT! DON’T BELIEVE WHAT THE CARRIER REP LIED TO YOU ABOUT!
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NO ONE EVER LIES TO YOU!
“DURING MY TERM IN THE U.S. CONGRESS, I TOOK THE INITIATIVE
IN INVENTING THE INTERNET”
1977 – 1985 – HE SERVED IN CONGRESS
INTERNET CREATED IN 1969 & NAMED IN 1972
5. LEARN THAT MEDICARE’S RULES DO NOT APPLY TO EVERYONE!
“WE CAN’T BILL CONSULTATIONS TOCONSULTATIONS TO ANYONE BECAUSE
MEDICARE STOPPED PAYING FOR THEM AND MY BILLER SAYS EVERYONE
ELSE STOPPED ALSO”Tell me again why you
believe that!
6. PERFORM AWV ON EVERY MEDICARE PATIENT EVERY YEAR!
IF YOU SEE 25 PTS A DAY, AND 40% OF YOUR
AND NOT ONE OF AND 40% OF YOUR
PATIENTS ARE MEDICARE, THAT IS AN ADDITIONAL *
$97,500 PER YEAR INCOME
THEM NEED TO SEE THE DOCTOR, AN NP OR PA DURING THE
VISIT
* IF FOLLOWING DON’S ADVICE ON HOW TO DO THE AWV
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7. START PERFORMING EXECUTIVE LEVEL ANNUAL VISITS ON PATIENTS
CONTRACTED THROUGH COMMERCIAL PAYERS
4 PATIENTS PER DAY = 6 PATIENTS PER DAY = $1,255,000 PER YEAR GROSS INCOME OR
$734,028 NET
ONLY FOR CLINICS PUTTING PATIENT CARE FIRST & ACCEPTED INTO DON’S HEARTWISE PROGRAM
$1,904,556 PER YEAR GROSS INCOME OR
$1,299,956 NET
8. STOP UNDER-CODING, DOWN-CODING & LETTING CARRIERS
INTIMIDATE YOU
COMPARE YOUR KNOW THAT THE CODING TO THE
NATIONAL AVERAGESAVERAGE FAMILY
PHYSICIAN UNDER-CODES
COMPARE CODING
25 0%30.0% 35.0% 40.0% 45.0% 50.0%
FAMILY‐PRACTICE ‐ EST PT O.V.
0.0% 5.0%
10.0% 15.0% 20.0% 25.0%
99211 99212 99213 99214 99215 FAMILY‐PRACTICE 3.7% 4.3% 48.2% 40.2% 3.6%
Your Provider 0.0% 0.0% 0.0% 0.0% 0.0%
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9. FIGHT THE FIGHT YOU WOULD FIGHT IF THE MONEY WAS YOURS.
A PERSON SAYING “IT CAN’TA PERSON SAYING IT CAN T BE DONE” IS USUALLY
INTERUPTED BY SOMEONE WHO JUST DID!
TWO BOOKS TO HELP YOUTWO BOOKS TO HELP YOU
& MONTHLY 8 PAGE NEWSLETTER, SUBSCRIBED BY THOUSANDS
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