“Thousands of doctors and other medical professionals have steadily billed higher rates for treating elderly patients on Medicare over the last decade — adding $11 billion or more to their fees and signaling a possible rise in medical billing abuse.”

That’s a statement from a study of Medicare billing and coding practices released by the Center for Public Integrity, and is the lead on a lengthy and well-documented article detailing the dramatic increase in higher-complexity medical codes billed to Medicare over the last decade.

The implications for taxpayers, private insurers, workers comp and auto payers are obvious.  If docs and their billing departments are upcoding for Medicare office visits, they almost certainly are doing the same for all patients.

Interestingly, the increasing use of electronic medical record systems by many physician practices may be a contributing factor, as the systems “make it easy to create detailed patient files with just a few mouse clicks.”  These details are essential to demonstrating and documenting the level of work and time commitment involved in specific office visits.

That said, just because a doc has mostly higher-level office visits doesn’t mean they are doing anything wrong. Some providers’ patients are just sicker (“higher acuity”) than others’, requiring more time and effort.

What does this mean for you?

It is highly likely your mix of E&M codes has trended towards the more complex over time.  You may well want to identify those docs where the mix has swung dramatically at some point as that may indicate inappropriate billing.

Aetna’s presentation at an investor conference addressed the acquisition of Coventry and provided just a bit of insight into their plans for workers comp…

Here’s what CFO Joe Zubretsky  – who some have said is “no fan of workers’ comp) said…

“The second point I would make — so there is specialty revenue. The second point I would make is, and we didn’t count this as well, but I’m quite excited about it, because it’s been a vision of ours for many, many years, to unlock the value of workforce optimization by combining the skills of long-term disability, health care, and workers compensation. And when you think about it, all of those three lines of business and coverages intersect with the healthcare system, and somebody is not at their desk every day.

With this morning’s post, we’ve moved to WordPress as the publishing platform.  We’ve also updated the look and feel of MCM to make it a bit “sleeker”, easier to navigate, and more user-friendly.  Julie Ferguson and Chris Miller (boss at Artefact Design) have done all the work; I just write the checks (and the posts).

MCM has been around for eight years now, a lifetime in the brave new world of social media.  Over those years, we’ve published 2471 posts, all accessible via the search function on the home page (yup, kept my unfortunately wrong ones too; Rob Gelb you haven’t been forgotten).

We’re up to 3471 subscribers (after cleaning up the list a bit) and average around 1700 readers a day (with pretty wide swings).

Couple things worth noting

What is ‘publishable’

Folks either are a) eager to get their name/company/new product-customer-idea published in MCM or b) anything but.  Many of my conversations with industry execs start with “this is confidential, right?”  The answer is always “Yes”.  I could not survive in the consulting world if my clients feared they’d appear on MCM (without their express approval).

At the other end of the spectrum, I am often approached by people eager to use MCM to get some publicity.  Mostly, I gracefully decline (ok, sometimes not so gracefully).  Occasionally the approach is professional enough, and the ‘thing’ topical enough, that it merits publication.

MCM ‘attitude’
Every now and then I get myself into a bit of hot water (sometimes an ocean’s worth) over a post, a characterization within a post, or an honest mistake. I’ll continue to retract and apologize for errors. I will also continue to opine assertively when I think the issue merits assertive opining. When I hear something that’s newsworthy, I’ll post it (after verifying thru at least two sources). And of course you can always rely on MCM to debunk stories, press releases, and flat out BS, with the tone and histrionics directly in proportion to my level of outrage.

Comment policy
You would not believe the spam comments I get – over a hundred a day, and sometimes two hundred. We’ve tried everything to ensure your comments get thru (even ones I take issue with) while blocking spam; for now I have to review all comments before they go thru. Hopefully this new platform will help.

As always, rants and comments disagreeing with me will not be posted unless opinions are backed by sources cited accurately. That’s not to say I won’t post different opinions; always have and always will.

What’s coming up.

The election season – also known as the Silly Season – is upon us (painful sigh).  My politics are well known (sometimes to my detriment) but I won’t hide my views.  If you don’t like my stance, I’m happy to hear from you – keep it professional and courteous.  If you are tempted to insult, I’d suggest you consider this.

About a year ago, I received a particularly nasty string of emails from someone on the opposite end of the political spectrum calling me, among other things, a commie, socialist, leftist, idiot, liar.  This person’s boss’s boss is also a subscriber and has become a friend – even though he’s also very conservative. He offered to discuss the issue with my antagonist; I declined.

The internet is forever, folks.  Be smart, be professional, be respectful.

 

 

It is time to upgrade, and update, this blog. To that end, we’ll be switching to another platform – WordPress – which has several advantages over our current one.
The move will take place next week, and you’ll get plenty of notice.
This will likely require subscribers to renew their subscription – no need to do anything now. The ‘renewal’ will be very simple, merely requiring you to enter your email address on the blog’s front page.
The new platform will make it much easier to add video, images, and files to posts; manage subscribers; handle spam comments (we get about 50 a day!); and speed up the posting process.
I’m often asked how much time it takes to maintain and post on MCM; short answer is about 45 minutes a day, but that’s only because I have excellent support and guidance from Julie Ferguson and hosting handled by Chris Miller (owner of Artefact Design).

While I don’t profess to be an expert in the use of social media for marketing/brand development, there are a few things I’ve learned in the eight years I’ve been blogging.
1. Don’t inundate bloggers with press releases that are, at best, tangentially related to the blog’s subject matter. I don’t need nor want to know which institutions are the top ten for dental hygiene nor do I care that your company just convinced another company to use your electronic self-care product.
2. Don’t swamp LinkedIn and other groups with posts and topics clearly intended to market your firm. I’ve seen some marketers post a couple times a day to LinkedIn groups – all that does is get you labeled as annoying and your company a reputation for mindless mailbox filling.
3. Don’t use comments on blog posts to pitch your company or tout your services. Sure, you can opine and sign your name and your company affiliation, but don’t use someone else’s blog as your marketing forum.
4. Be mindful of the potential to offend. I know, shocking that someone who’s demonstrated a well-honed ability to do just that has the temerity to advise others, but note I did not say “don’t offend”, just be conscious that your words may have that effect.
5. Don’t disagree without citing some support for your position; the corollary is to not opine without providing links to material upon which you base that opinion. Opinion based solely on personal belief is not likely to convince anyone of the merits of that opinion or belief.
6. Be respectful – when that respect is merited.
7. Recognize that the social medium you use has to correspond to the audience you seek. Few executives in the health plan or insurance world spend their days trolling (pun intended) Facebook or Twitter, but more and more are reading blogs. While younger folks are definitely moving in the Facebook/Twitter/media du jour direction, people who write the checks aren’t there yet. And may not be for a good while.
8. If you begin a social media campaign, be patient, be persistent, and manage those expectations. It has taken me eight year to reach almost 3500 subscribers, and the work has absolutely paid off. That said, it is infinitely harder to build a brand these days than it was back in the 00’s, so be creative, be smart, and hire someone who really understands social media.

This isn’t a rant, a polemic, a diatribe. It’s a question.
I had breakfast yesterday with a highly-regarded executive at a top-shelf TPA, and during the course of our conversation we got to talking about the Republican convention.
From there the talk turned to the current GOP platform of small government and government-controlled social engineering and then to a discussion of how the party has evolved from small government, low taxes, controlled entitlements and social libertarianism to where it is today – using entitlement expansion to schmooze specific constituencies (Part D, pharma, and senior citizens), using social issues to motivate groups (abortion, immigration), and what can only be described as fiscal irresponsibility (current antagonism towards any increase in taxes despite huge deficits).
As a self-described Democrat, I long for the “olden days” of the GOP, the party of adults who trusted individuals to make their own decisions about their lives, relationships, religion, sexual choices, procreation. The GOP of the sixties railed against Medicare as an intrusion into the private health insurance/care industry, a principled stand (OK, with a bit of pandering to the AMA, but pandering consistent with their ethos of the time) that stands in sharp contrast to the GOP passage and promotion of Part D.
Part D is moment the GOP went completely off the rails. A sop to seniors passed by Republican Congress and signed by a Republican president, Part D has added $16 trillion to the ultimate deficit.
The party of Goldwater would no more have passed Part D than substituted la Internationale for the Star Spangled Banner. It would have been unthinkable.
Now that same party condemns the opposition for its own expansion of health coverage, citing a (highly inaccurate) projection that Obamacare would add a trillion dollars to the deficit (a projection that is directly contradicted by CBO figures).
Sure, that’s politics, and this is convention time, and it’s all about winning the election.
But at what cost? The GOP has strayed so far from their fiscally-responsible roots as to be more like the Democrats than the Democrats are these days.
What does this mean for you?
When thoughtful, educated, influential executives like my breakfast companion are gravely concerned about the party that used to be their’s, one wonders where the GOP will be in the future.

Yesterday afternoon the medical directors from two of the three largest workers comp
Insurers told listeners at WCI precisely what providers needed to do to get paid.
And you were…where?
Providers’ and vendors’ complaints about getting paid are constant and loud. Waaaah waaah waaah is what payers hear from providers far too focused on billing and not near enough focused on delivering services intended to speed healing and return to work.
So Dr Rob Bonner’s brief talk detailing exactly what the Hartford would and would not pay for was exactly what providers needed to hear. There were very few providers in attendance, far fewer than have booths on the trade show floors, advertisements hanging from the rafters, events in their suites.
I guess it’s far more important to pass out trinkets to every Tom Dick and Mary walking y your booth than actually listen to the medical director of a top-four insurer tell you what he wants to buy. Or break away from that lunch date to hear David Deitz of Liberty Mutual tell you how he defines quality in medicine.
Why are you even IN Orlando?

Jaan Sidorov has posted the best of wonkerdom for your beach reading pleasure. Lots to read, or just quickly peruse at this week’s edition.

Sources indicate the deal for MSC is done; Odyssey is buying the big DME, home health and transportation/translation firm.
According to the official announcement, MSC has “entered into a definitive merger agreement” with imaging company OneCall Medical, (which in turn is affiliated with, STOPS, Express Dental to make up a work comp services firm that will rival long-time industry powerhouse Coventry in terms of sheer size. Terms won’t be published but the price will almost certainly be above $400 million.
With this acquisition Odyssey further positions its portfolio as a major player in the services industry; there are substantial synergies among and between the various services and product offerings that will make the combined entity a formidable competitor.
Current OCM CEO Don Duford will assume that title at the newly merged company, while MSC CEO Joe Delaney will be named President.

Buying decisions are often “illogical”, if you base the definition of “logic” on doing what appears best for the organization.
Those same decisions are quite logical, if you think about them from the perspective of the people making the decision. Unfortunately, few “sellers” understand that.
I’ve been dwelling on this for several weeks, as I’ve spent more than a few hours speaking with incredibly bright investment analysts about various potential investments in the managed care “space”. The conversations usually follow the same path…
Smart analyst (SA) – We’re trying to understand the value proposition of Company X…
Me – Well, Company X claims they save Y% on this or that type of medical service, which is more than their competitors.
SA – Wow, that’s a lot. How much of the market can they capture?
Me – Probably about xx%.
SA – Why not more?
Me – Well, their program requires the employer to make an investment in IT &/or training &/or change a business process &/or do things a bit differently.
SA – But in order to save all that money, that’s a no-brainer.
Me – You have to think about it in the context of the insurance market, which has been very soft for years, so there’s not a lot of capital available to invest in process or IT, staff to do the work, or hours to train staff who are processing claims.
SA – But in order to save all that money, that’s a no-brainer.
Me – Not necessarily; the person who has to make that decision has other priorities too, namely getting other critical IT projects that deal with compliance issues done, keeping claims moving to resolution, answering queries from her boss about progress on her boss’s boss’ pet project, and budgets are coming up too.
SA – But if Company X does the IT work, won’t that speed things along?
Me – Again, not necessarily; the vendor’s IT staff needs someone at the Customer – on the other end of the phone line – to work thru issues…
SA – So, let me get this straight. Company X can save an employer a gajillion dollars but employers won’t use them because some bureaucrat has other priorities?
Me – Yes, you got that straight.
SA – that makes no sense.
Me – [thought but not said] – not to you it doesn’t; to the “bureaucrat’ it makes all the sense in the world.
So what does this mean for you?
Employers don’t buy, people do. The ‘sale’ isn’t to an amorphous entity, it is to an individual or individuals, who succeed or fail in large part based on their decisions, the impact of those decision on other priorities, and whether their culture allows/accepts/rewards risk.
Don’t think about ‘business objectives’. Think about the person you’re talking to, who they are, what they do, and how you can make them successful while minimizing downside risk.