by Caroline Fife, M.D. | Jul 25, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, Fight the Good Fight, Nutrition & Wound Healing
This month in TWC, learn about the history of total parenteral nutrition and how the Space Race of the 1960’s helped patients with malabsorption. I explain why QCDR quality measures have been a disappointment for all specialties, why Practice Improvement Activities...
by Caroline Fife, M.D. | Jul 24, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, Fight the Good Fight, Healthcare Payment Policy
I started this series of blogs with a discussion of Medicare audits and the impending bankruptcy of Medicare. We determined that audits come from perceived improper use and the reason that audits are accelerating is the impending bankruptcy of Medicare. Medicare is...
by Caroline Fife, M.D. | Jul 22, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, Fight the Good Fight, Healthcare Payment Policy
Every practitioner is being positioned on a grid in relation to the cost of care as described, and their quality score which is usually a score obtained from MIPS quality reporting. The ideal position on the grid is the top right corner. To CMS, that person delivers...
by Caroline Fife, M.D. | Jul 18, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, Fight the Good Fight, Healthcare Payment Policy
Why do my patients cost so much? I showed you the numbers in my MIPS “cost” category which concluded that I spend $58,000 per episode rather than $16,000, which is the average for a family practice doctor. Remember that these costs are being triggered by...
by Caroline Fife, M.D. | Jul 17, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, Fight the Good Fight, Healthcare Payment Policy
The table below is from one of my Quality and Resource Use Reports (QRUR). You can see the “ambulatory care-sensitive conditions include the conditions I mentioned on my last blog: bacterial pneumonia, urinary tract infection, dehydration, diabetes complications,...
by Caroline Fife, M.D. | Jul 15, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, Fight the Good Fight, Healthcare Payment Policy
Depiction of Total Per Capita Cost (per provider) After CMS calculates Medicare Spending Per Beneficiary (MSPG), it calculates a practitioner’s Total Per Capita Cost. This is the overall cost of care provided to each of the beneficiaries attributed to a specific...
by Caroline Fife, M.D. | Jul 11, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, Fight the Good Fight, Healthcare Payment Policy
I need to start with a disclaimer that I have no expertise when it comes to Medicare cost calculations. I am muddling through this by reading the materials on the CMS website. If you have a correction to anything I’ve posted or have better insight, I really want to...
by Caroline Fife, M.D. | Jul 10, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, Fight the Good Fight, Healthcare Payment Policy
A few people are starting to whisper about their experience with the Targeted Probe and Educate (TPE) process directed at claims for Hyperbaric Oxygen Therapy (HBOT). The Medicare Administrative Carriers (MACs) are supposed to educate the doctor, but so far, the...
by Caroline Fife, M.D. | Mar 11, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, US Wound Registry
In Greek mythology, Sisyphus was cursed by the gods to spend eternity rolling a boulder up a hill, only to have it roll down again. In the March issue of TWC, I talk about my Sisyphean Mondays with heart failure patients, who represent a quarter of my wound care...
by Caroline Fife, M.D. | Jan 9, 2019 | Cassandra Chronicles: Regulatory and Coverage Policy, Do the Right Thing: Thoughts on Quality, Hyperbaric Oxygen Therapy
I heard a few firecrackers on New Year’s eve, but the big fireworks in our industry go off on January 7th, 2019. That’s because the Centers for Medicare & Medicaid Services (CMS) has established a new physician specialty code for Undersea and Hyperbaric Medicine...
