by Caroline Fife, M.D. | Aug 5, 2019 | Fight the Good Fight, Healthcare Payment Policy
By Helen Gelly, MD Most people these days know their Credit Score. There are “apps” to check it and to improve it, even though it may be calculated in a complex way from a lot of factors. And even though the financial impact of a low credit score may be indirect, most...
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. | Jul 3, 2019 | Healthcare Payment Policy
There are days I feel like I am the only person who did not get the office memo. That’s how I feel about Disposable Negative Pressure Wound Therapy (dNPWT) when the patient has a home health agency. dNPWT has made NPWT more practical and convenient for smaller...
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...
