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. | Jul 8, 2019 | Fight the Good Fight, Pressure Cooker: Rethinking Pressure Ulcers
To paraphrase Bum Phillips, “There’s two kinds of doctors, them that’s been sued and them that’s gonna be sued.” I’ve been sued more than once but they were all “non-suited” except one. When I was on the medical school faculty, the University paid a settlement on my...
by Caroline Fife, M.D. | Jul 1, 2019 | Fight the Good Fight, Healthcare Payment Policy
Guest Post Written by Jule Crider As has been reported widely in the press, the President issued an Executive Order (EO) last week on price transparency that has implications for all healthcare providers. I have pasted below excerpts from the American Hospital...
by Caroline Fife, M.D. | Jun 27, 2019 | Fight the Good Fight, Healthcare Payment Policy
“The wounds with no name” (WWNN) are wounds that are due to trauma (not surgical complications) that never heal, PLUS the chronic ulcers that are NOT diabetic, arterial, venous or pressure related. These two groups (accidental wounds and ulcers which are not obviously...
by Caroline Fife, M.D. | Jun 10, 2019 | Fight the Good Fight
It’s unlikely that a physician – no matter what their specialty is – can get through their professional career without being named in a medical malpractice lawsuit. My first malpractice lawsuit occurred when I was still in residency. I responded to a “code blue” in...
by Caroline Fife, M.D. | Jun 7, 2019 | Fight the Good Fight
Two weeks ago, on May 24th, my husband, Alan G. Moore, MD, died after a long battle with dementia. In 2009, during a complex surgical procedure, he found himself struggling to remember the steps of an operation he had performed hundreds of times. Neuro-psychometric...
