On Episodes of Medical Care

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Another Medical Payment Paradigm Shift

einstein

[By Ann Miller; RN, MHA]

 “Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius — and a lot of courage — to move in the opposite direction.”

Currently, the Centers for Medicare and Medicaid Services [CMS] pay hospitals a single prospectively determined amount under the inpatient prospective payment system [IPPS] for all care given to an inpatient. Physicians who provide other care to patients are paid separately – accordingly to a Medicare physician fee schedule – for each service they perform http://www.HealthDictionarySeries.org

The ACE Project

A newer project, called the Acute Care Episode demonstration, will soon test whether a global payment will better align the incentives for both types of providers leading to better quality and greater efficiency; beginning in January 2009 www.HealthcareFinancials.com.

Bundled Payment Advocates

Like Einstein’s statement on simplicity, we are believers in bundling payments for medical providers. If done correctly, episodic medical care bundling may be an acceptable compromise for all. The current Medicare payment system treats physicians like virtual offending criminals. Every potential health claim is fraud; although this situation probably wouldn’t change. Any formula that buries E&M coding is a system worth evaluating. Many docs easily double the number of patients seen if paperwork and documentation was not so onerous. Not sure this is always a good thing; however. Bundling forces physicians to reevaluate, what is necessary and what isn’t. There is a much unnecessary productivity in medical care. “Too much friction – not enough movement” 

Assessment

Fee-for-service medicine has a way of creating business that need not be created. Will less be done under bundled care – will diagnostic care be upgraded for increased reimbursements?  Will episodic coding consultants come out of the wood-work? Maybe! And, can we can look at the DRG and MS-DRG experience as a potential harbinger of the future?

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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What’s Up with Plaid Management?

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A “Cold-Call” Cowboy for Financial Advisors

[By An Anonymous Subscriber]gears

We have been getting annoying cold robo-calls, monthly for about a year now, from one Tim Smith. It seems as though Mr. Smith is a financial services matchmaker from Plaid Management, who brokers deals between clients and those in the financial services [sales] industry desperate for them. His firm may also do this with patients and medical professionals too; but, at what cost?

Our Internet Search

So, as a financial advisory firm, we did a web search for his company in Houston. Of course, you can too. According to the site, Smith founded The Plaid Group as a resource to help companies improve financial performance by simplifying and stabilizing their business operations. So, he is not working for the client prospect or patient-consumer; at all. But, he does seem to have a marketing history that includes a Fortune 500 Diversified Financial Services Corporation; and in a gamut of industries that include CPAs, IT, law, training, employee assessment folks, and marketing firms. Yet we know nothing else about him, good or bad, sans his cheesy and automated cold-call techniques.

Why Plaid?

Plaid is a fabric with a consistent, repeatable, and predictable pattern. Like Tim, we’ve taken that idea and applied it to his constant gear-like marketing activities.

Assessment

In other words, we have placed his firm on our Do Not Call list; with email message block. If inclined, you can too; or not! The decision is your own; but caveat emptor. Here is the contact info:

The Plaid Group
PO Box 25247
Houston, TX 77265-5247
713-627-3569 info@plaidgroup.com

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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