Okay, I admit it. I am a Geek. I was so happy to be attending my first conference at Microsoft Headquarters in Redmond, Washington, that they didn’t even have to really impress me.
But they did.
I can’t say I was agog at the actual Conference Center; although everything is well-done, it is also simple and unassuming. I was very agog at the people who presented at the Health Users Conference (HUG, which is a users group alliance program sponsored by HIMSS), and with the Christmas morning of information that rained down on my head at the Developer track I chose to attend (other track choices were IT Pro, Health Plans, and Clinical Informatics.)
I have lots and lots I want to report on from the conference and will be doing so over the next few weeks:
* Interview withBill Crounse, MDon what Microsoft has to offer the private medical practice and his predictions for the future of EHR pricing * Interview with Melissa Markey, healthcare attorney specializing in technology on why practices come to her for advice and counsel * Some fascinating demos of products being created with MS technology * Some interesting perspectives of MS people and my brief experience with the MS culture * An eye-witness report on “Surface” and how it will be used in healthcare (it went on sale today but I failed to bring my checkbook with me and my cards are all maxed out) * Heard while at MS: some very interesting statements that I didn’t expect to hear * My own wild ideas for my practice after being exposed to some gee-whiz products at MS
But first, back to work and the real world tomorrow, then some vacation time to spend with my daughter who’s visiting from 3,000 miles away, and hopefully, some serious posting on my blog, which is about to change from “healthpromeme.com” to “managemypractice.com.” Either name will work.
With the Centers for Medicare and Medicaid Services (CMS) revealing yesterday what the Medicare premiums and deductibles will be for 2009, it seems like a good time to brush up on Medicare and what choices providers have in enrolling and participating in Medicare.
Medicare is a health insurance program created in 1965 for:
people age 65 or older,
people under age 65 with certain disabilities, and
people of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant)
TRADITIONAL/ORIGINAL FEE-FOR-SERVICE MEDICARE
Medicare Part A – 99% of patients don’t pay a premium for Part A (hospital insurance) because they or a spouse already paid for it through their payroll taxes while working. The ,068 deductible for 2009, paid by the beneficiary when admitted as a hospital inpatient, is an increase of from 24 in 2008. Part A helps cover:
inpatient care in hospitals
including critical access hospitals
skilled nursing facilities (not custodial or long-term care)
some hospice care
some home health care
Medicare Part B – Part B (outpatient/doctor insurance) base premium for 2009: .40/month (no change from 2008.) Premiums are higher for single people over 65 making more than K per year and for couples making over 0K. Part B premiums cover approximately one-fourth of the average cost of Part B services incurred by beneficiaries aged 65 and over. The remaining Part B costs are financed by Federal general revenues. In 2009, the Part B deductible will be 5, the same as it was in 2008. Part B helps cover:
doctors’ services and outpatient care
some services of physical and occupational therapists
some home health care
Medicare Part D – Starting January 1, 2006, Medicare prescription drug coverage became available to everyone with Medicare. In 2008, the deductible is 5, in 2009 it will be 5.
MEDICARE HEALTH PLANS (MEDICARE ADVANTAGE)
Medicare Part C – Medicare now offers beneficiaries the option to have care paid for through private insurance plans. These private insurance options are part of Medicare Part C, which was previously known as Medicare+Choice, and is now called Medicare Advantage. Medicare Advantage expands options for receiving Medicare coverage through a variety of private insurance plans, including private fee-for-service (PFFS) plans, health maintenance organizations (HMOs) and preferred provider organizations (PPOs), and through new mechanisms such as medical savings accounts (MSAs), as well as adding payment for additional services not covered under Part A or B.
COMPARISON OF MEDICARE PLANS
Original Medicare Plan
WHAT? The traditional pay-per-visit (also called fee-for-service) arrangement available nationwide.
HOW? Providers can choose to participate (“par”) or not participate (“non-par”.) Participating providers accept the Medicare allowable and collect co-insurance (20% of the allowable.) Reimbursement comes to the providers. Non-participating providers may charge 15% more (called the “limiting” charge) than the Medicare allowable schedule, but the patient will receive the check, which is why some non-par practices require payment at time of service for Medicare patients. To charge patients for non-covered services, patients must sign an ABN before the service is provided.
Original Medicare Plan With Supplemental Medigap Policy
WHAT? The Original Medicare Plan plus one of up to ten standardized Medicare supplemental insurance policies (also called Medigap insurance) available through private companies.
HOW? Medigap plans may cover Medicare deductibles and co-insurance, but typically will not cover anything Medicare will not. Medicare primary claims will “cross-over” to many Medigap secondary claims so the practice does not have to file the secondary Medigap claim. Patients may still have a small balance that is cost-prohibitive to bill for.
Medicare CoordinatedCare Plan
WHAT? A Medicare approved network of doctors, hospitals, and other health care providers that agrees to give care in return for a set monthly payment from Medicare. A coordinated care plan may be any of the following: a Health Maintenance Organization (HMO), Provider Sponsored Organization (PSO), local or regional Preferred Provider Organ. (PPO), or a Health Maintenance Organization with a Point of Service Option (POS).
HOW? You have to have signed a contract or be grandfathered in (called an “all-products” clause) under an existing contract to see patients and get paid. Primary care providers may have to provide referrals and/or authorization for specialty services and providers. A PPO or a POS plan usually provides out of network benefits for patients for an extra out-of pocket cost.
Private Fee-For-Service Plan (PFFS)
WHAT? A Medicare-approved private insurance plan. Medicare pays the plan a premium for Medicare-covered services. A PFFS Plan provides all Medicare benefits. Note: This is not the same as Medigap.
HOW? Most PFFS plans allow patients to be seen by any provider who will see them. PFFS plans do not have to pay providers according to the Medicare fee schedules or pay in 15 days for clean claims. Providers may bill patients more than the plan pays, up to a limit. It would be a good thing to notify patients if your practice intends to bill above the plan payment.
I’ve been reading blogs and blog comments so much lately that my eyes are almost crossed, but one thing that does jump out at me is the tendency for many writers to confuse the two words your and you’re.
Remember the rule for its and it’s? This one is almost the same.
If you can substitute the words “you are” in the sentence, use the apostrophe. For example, “You’re reading my blog” can also be expressed as “You are reading my blog.”
If the words “you are” make no sense whatsoever as a substitution, do not use the apostrophe. For example, “You’re blog is fascinating,” sounds fine, but makes no sense when you substitute it with “You are blog is fascinating.” This is the place to use “your”, as in “Your blog is fascinating.”
Your choice of words makes all the difference, and you’re the one to make that choice.
Here’s a Monday Special that will knock your socks off! Barbara Duck at Medical Quack has an invaluable list of resources on her website – links to K-Mart, WalMart, Costco, Kroger and Target pharmacy pricing. Not too long ago, a patient asked me why her doctor couldn’t help her by letting her know where she could get the drug he was prescribing for the lowest price. Why not indeed!
Why not consider setting up a program at your practice to help patients find the lowest prices for their prescriptions? With links to your local pharmacies, you could come up with some creative ways to quickly look up prices for patients. If you’re looking for a way to distinguish your practice from the rest, this is a sure patient-pleaser. However, if you have more patients than you can handle, your expenses are under control and you can’t find ways to spend all the money your practice is making, as Miss Emily Latella on Saturday Night Live used to say, “Oh, that’s very different…Never Mind!”
TED is Technology, Entertainment, Design and the TED Conferencewhich began as a way to bring together thinkers from the three converging fields, will celebrate 25 years in 2009. My son told me about TED Talks a few months ago, and I loved the very first TED Talk I ever watched. Each TED Talk is 18 minutes (or less) long and is given by “the world’s most fascinating thinkers and doers, who are challenged to give the talk of their lives.”
TED Talks are available to be shared under the Creative Commons license and you can make them accessible to your staff or your management team. You can use them as a catalyst for creative thinking and an opportunity to think about problems in a different way.
My practice spends about $9,000 a year going to the bank. That’s what it costs for the time it takes for one person to open the envelopes, separate the checks from the EOBs, add the check totals, stamp the backs of the checks, copy/scan the checks, write the deposit slip and go to the bank on a daily basis.
Now my practice is evaluating one old option and one relatively new option. The lockbox has been around for a long time, but as technology has become more sophisticated and less expensive, and time has become more valuable, the lockbox has seemingly become more affordable. Evaluating it now, it seems like a great deal to have someone else perform all the steps listed above as well as having the check and EOB images stored online for easy access.
The newer option is the check reader that scans and uploads the check image to your bank, depositing a group of checks in the bank from the comfort of your own office. BusinessWeek had a good overview of this technology in a video recently. Click the link below to see the video.
High-Tech Banking if you’re spending too much money depositing your money, maybe you should call your banker.
I’ve always advised my children that if they can use its and it’s appropriately, if they can balance their checkbooks and can fry an egg, then they can be wildly successful in the world. In other words, if they paid attention briefly in English, Math and Home Economics, success is within reach.
Now most people balance their checkbooks online and there are hundreds of websites to guide you in the cooking of a fried egg, but it is still clear to me that many people don’t know the difference between its and it’s.
Here’s how I remember which one to use, because it doesn’t come naturally to me either.
If you can substitute the words “it is” in the sentence, use the apostrophe. For example: “It’s my blog” can also be expressed as “It is my blog.”
If the words “it is” make no sense whatsoever as a substitution, do not use the apostrophe. For example: “The kitten licked its paw,” cannot be expressed as ‘The kitten licked it is paw.”
In this instance, you have my permission to forget the rule that “‘s” means “belongs to.”
Okay, I feel much better having gotten this off my chest.
Oh, and p.s. I also taught my kids to look people in the eye when they give them a firm handshake. Maybe I should have taught them the fist bump instead – it’s (it is) more sanitary.
This is the curse of many working woman with children, and one that I struggled with until both kids moved out of the house (for the second and third times.)
Here’s a heartfelt and interesting post and comments from Penelope Trunk’s blog Brazen Careerist. She is frank, funny, and worth the time to read. Her tag line is “Advice at the intersection of work and life.”
I’ve been very meticulous about not doing anything that has to do with this blog while I am at my real job. I do know, however, that there are others in my organization who do work that is not related to the practice while being paid by the practice.
At a previous job, a newly hired 20-something medical assistant was day trading while he was working the clinic floor. When other employees reported this to me, I was dumbfounded. Not that he was doing it, but that he thought it was okay to do it. And he was surprised that I thought it wasn’t okay to do it. As far as he was concerned, if he didn’t have something to do, he was free to pursue another vocation in his spare moments.
Here’s a partial list of things I’ve seen employees do while on the clock:
Balance checking accounts
Make grocery list or Christmas gift list
Answer personal e-mail
Apply for other jobs
Look for other jobs for friends and spouses
Look for new apartments, homes and cars
Write letters to the editor
Read books, magazines, and newspapers
Plan a wedding (this was a manager!)
My questions are threefold:
What do employers have a right to expect from employees during the workday?
What do employees (of all generations) have the right to do during the workday?
What policies should employers have in place to protect their human resource investment, yet acknowledge the changing needs of employees?
If you have this problem in your workplace, please comment and let me know what your thoughts are.