Staying Independent...Together

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   RE: opportunity for imps Please respond?
 From: Jean Antonucci
 To: Member Forum
 Posted: 05-13-2017 10:19
Thank you Mamantha Scott and Mike

I did make an error and now have had long talk with Gordon Moore about details
(I do get 1.00 a day myself from a small plan plus incentive not mediciad mike,  Medicaid in Maine   by political action,FOR PCPS THAT ARE  INDEPENDENT  is paid at medicare rates. but anyway...)
Current proposal is 2.00/day/patient  and for  people with high burden of disease 3.00/day
Suppose 1000 medicare patients for the sake of simple  math MOst of us have  more like 100-300--- 2/3 are low burden  so 2$ x 365 for 666  is 481,800  and 1/3 very ill  361, 350    so make that 100 patients  48,180 + 36,135= over 83,000 a yr  for 100 of your patients  You can take care of  people for  that !!  If your overhead is low you can do really well  and if you want  increase it  to buy a nurse and increase your panel  which helps the shortage and  help[s you earn more

 IMP should help you lower your overhead and do the imp basics. eg if you have a phone tree that says  please allow three days for a rf,  uh uh  not much of an imp 

 Flu shots and immunizations cost you so are a carve out-- do not count.
There are many people you see never or once a year and others 5-7 average is 2 1/2 to 3 and roughly 500  dollars a yr average( so 100 patietns average 500 a yr is only 50000 AND THAT IS WITH MIPS  crap
Some  docs are good at milking- doing the depression screen and adv  care stuff at wellness visits etc Some of us cannot remember to do all that at that type of visit only and do the codes for that  I am after simple fair sustainable
There are some details to work out but I will not wrangle.  We have to move, here folks.

  One problem is that some  of you are not lowoverhead butt his still should work    1.00 a day  is fabulous for low overhead

 You will need to be an IMP for this- superb access continuity comprehensive care  care corodination

I have  gotten multiple positive responses already but ALMOST NONE from  the imps from thislist servs.

 THe MAine group and the AFFP group seem to get it MAybe no one reads this forum

 What I cannot do is post to AAFP small practice group and if you are on  there I need you to post   for me
I need 5000 patietns minimum and  prob have access to 1000 now


     Jean Antonucci MD
     115 Mt Blue Circle
     Farmington ME 04938
ph 207 778 3313   fax 207 778 3544

------Original Message------

This is not simple.  Sorry for the long post.   I believe we are really undervaluing ourselves.  Please look at the CPC Plus program by CMS. The way I read it:
Track 1 pays:
Care management average of $15 pmpm. (ie $ 0.5 pmpd)
It also pays for FFS billing!!  Which I believe is around $600 to $760 per Medicare patient per year.  ($1,65 - $2 pmpd)
Extra $2.5 pmpm potential for performance  (.$083 pmpd)

Track 2 proposal:
$28 PMPM for care management ($ 0.93 pmpd)
reduced E & M code reimbursement
Some additional FFS reimbursement
$4 pmpm performance incentives

Jean  -   I believe the $1 per day you are earning is for Medicaid patients, which of course pays less.

Scott - Why do you feel $2 per day is out of line?   Your question about how are patients attributed to primary MD is a good one.   Although i presume CMS has a way to do it for CPC +,

Some of my thoughts - Those of us in private practice in primary care have become used to earning less income then our colleagues.  To make up for the relatively low reimbursement for cognitive codes vs proceedure codes, we have learned to  use a slew of additional codes, in addition to the typical E and M codes.

$1 a day as Jean calculates earns you $185,000 a year.    Not bad compared to most of our patients and fellow citizens.  But I think a goal of this program should also be to attract medical students to chose primary care and for residents and unhappy doctors in mega groups to consider the option of independent practice.

I propose average $2 to $2.25 per day per patient if we are not doing any FFS billing.    $730 to $820 per year for high quality primary care is not a lot.

Might consider combination of Care management of $ 0.5 pmpd plus FFS billing   or $1 pmpd plus E/M billing.

There should also be some performance / reward criteria or shared savings proposal.

I bill the average Medicare patient: 3 99214 visit per year, 1 AWV,  and maybe two CCM visits.   a "nurse" visit - 99211, Flu shot,
99214 = 115 x 3 = 345
AWV  =    124
CCM x 2 = 45 x 2 = 90
99211 x 1   $21
Flu shot earns approx $30 ?
That comes to $600.  or $1.65 pmpm.     There are also many other codes we often use.   I am not saying I want to use those codes, but I need to, in order to earn a living.  I am not sure which, if any, are covered in CPC Plus.

Is there a way to include a modest copay?   $15-$25 per visit.  Is there a benefit to doing that?

That's enough for now.  Could go on and on.

Michael S. MD

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