Prosperity in Primary Care by Managing Medicare

Prosperity in Primary Care by Managing Medicare

Four score and seven years ago…

I'm not going to recite the Gettysburg address but many of our Medicare patients were born, more or less, four score and seven years ago. It is our duty and our honor to care for these people, who are our elders, and have contributed much to our country and our culture. I'm going to talk about how primary care doctors can thrive and continue to care for our Medicare patients and prosper at the same time. I'm Dr. Paul Haver, a family physician in Athens GA, serving Georgians for the last 25 years.

As the cost of healthcare increased, big businesses for profit as as well as not for profit, like hospitals, insurance companies and financial institutions have taken an interest profiting from health care. Ultimately, doctors largely gave up control of healthcare. And what are the results? Health Care costs have soared, waste and fraud are massive problems.

I started my medical practice 25 years ago. A lot has changed in that time.Many physicians now realize that they have lost their autonomy, lost much of their revenue, lost their independent practices and decision-making, and lost their ideals.The medical profession is at risk of no longer being the "calling" that it had been.

Doctors: It is time to regain control of the health care of our patients. M Force will attempt to stop current trends, and bring
physicians back to independent practice. M Force is dedicated to helping doctors to put their hearts back into the practice of medicine, to care for our patients the way we dreamed of as a medical students, and to care for our patients 24/7 with coordinated care.

Today Medicare has created programs to incentivize doctors to take care of Medicare patients in high quality, cost effective ways, and help to preserve the doctor-patient relationship.

Can you believe that now medicare has become almost gold? I will show you how to transform your practice to increase your practice revenue at least by 20% in 2015.

1. Develop and train a team of medical assistants who can help you to do annual wellness visits (AWV), transitional care management (TCM) visits, and chronic care management (CCM) and preventative care.
2. Locate and contact all of your Medicare patients, whether fee-for-service or advantage.
3. Check eligibility for preventive care visits using Cahaba – Insight.
4. Schedule AWV on all Medicare patients every year
5. Screen and do preventative services as recommended by the United States preventive task force.
6. Follow up with all patients admitted to the hospital or seen in the Emergency room and schedule an appointment
7. Do transitional care management TCM visits to reduce hospital re-admissions. The hospitals will thank you and medicare will reward you.
8. On Medicare patients with two or more chronic medical problems do chronic care management.
9. Check quarterly on your progress using reports from your ACO or your EMR.

Let’s calculate and estimate what can happen if you have 1000 medicare patients.

1. Annual Wellness Visits: $150 X 1000 = $150,000
2. TCM visits: follow-up from hospital or Emergency Rooms.10% of admission rate =100 patients X $200 = $20,000.
3. CCM for patients with 2 chronic medical problems: 75% of 1,000 patients (estimate) = 750 patients X12 months X $42.60 = $383,400.
4. Annual Physical exam E/M code and visit is X 4 per year per patient = 4,000 visits X $100 (average cost) = $400,000
5. Preventative care is $200 per patient per year for 1,000 patients = $200,000
TOTAL: $1,153,400 per year per 1,000 patients (this is just an estimate)

Now, go to your practice and please spend time with your billing manager to see if what I am telling you makes sense . If it does not, please contact M Force to help you. You may use the comments section here on YouTube or you can use the contact information listed below.

What happens if we don't regain control of healthcare?
1. Businesses will perform annual wellness visits and chronic care management: Walmart, Walgreens, or Kroger will happily collect the money that you leave on the table.
2. You will find your patients being seen by freestanding businesses with hired healthcare provider with no interest in your patient’s long term outcome
3. M Force wants you to regain your position in the healthcare arena, remain independent, and to work for yourself.

Join an ACO
Benefits of joining an ACO:
1. Joining an ACO will help improve the functioning and profitability of your practice while increasing patient well-being and satisfaction.
2. Providers get a chance to make more money without financial risk.
3. Patients get care that is focused on keeping them out of the hospital and off the operating table.
4. Medicare patients are free to see other doctors inside or outside the ACO. There are no patient restrictions.

Prosperity in Primary Care by Managing Medicare

One thought on “Prosperity in Primary Care by Managing Medicare

  1. Great ideas Dr. Haver! Like President Lincoln, I believe you are on to
    something with M Force! Much of these opportunities are untapped
    opportunities for PCPs, including Transitional Care Management. Phyzit
    TCM™ streamlines the TCM process through an automated, streamlined workflow
    with reduction of readmissions and increased revenue of approximately
    $1000-2000 per PCP per month. You can find more information at

    Thank you!

    StephenCanon, M.D.

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