Brave New Practice: An Ophthalmologist Opts Out of Medicare
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Transcript of Brave New Practice: An Ophthalmologist Opts Out of Medicare
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8/15/2019 Brave New Practice: An Ophthalmologist Opts Out of Medicare
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Bra ve Ne w Pr
ac t ice
K r i s t in S tor y H
e ld, M. D.
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Brave New Practice
Time to be a Trailblazer!
Trailblazer: a erson wo ma"es a new trac" tro#$wild co#ntry% a ioneer% an innovator: He was atrailblazer for many ideas that are now standard fare.
&rab yo# $#mtion not yo#r an"les!
mtion: co#ra$e and ener$y% initiative%reso#rce'#lness: It took a lot of gumption to do a jobthat hard. ()' #ncertain ori$in.*
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Mission
Preserve Hiocratic, etical medicine centered onte atient+ysician relationsi
Based on Tr#st+ liberatin$, innovative
&et $overnment o#t o' medicine, 'or$e alternate#niverse otion to sin$le ayer, socialized medicine
Based on ear, ab#sive, sta$nant
Save te atients, ractice, and '#t#re o' ro'ession
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State o' Practice
)talmolo$y and )talmic s#r$ery 'or over - years,to#sands o' loyal atients wit valid, lon$+standin$ atient+ysician relationsis
/ombination o' o0ce and s#r$ical ractice 'or atients o' alla$es sannin$ 1 $enerations
Most common oeration+ cataract s#r$ery wic isredominantly in Medicare o#lation
New tecnolo$y not covered items or services
23S4K and re'ractive s#r$ery not covered by ins#rance
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5ere 4 was
inised residency otalmolo$y, 6oined 'ac#lty at 7THS/S3 inDeartment o' )talmolo$y, remained in academic medicine 'or 8years. 9#ality 3ss#rance, /PT, ;7s evolvin$
Started Solo Private ractice, o0ce sarin$ wit establised soloractitioner. Too" o#t
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5ere 4 was
)bama elected (-A*, )bamacare assed (-=*
/an$ed Medicare stat#s to Non+articiatin$ (-* (8AC o'ractice was Medicare*
/an$ed o0ce mate 'rom older asin$ o#t to yo#n$er revvin$# (-=-* (1AC o' ractice was Medicare*
-=1+ Be$an to wean o@ commercial ins#rance, re'#sed to be innetwor" 'or )bamacare lans+ 'o#$t 3TN3 'or a year
)ctober =,-=8 oted o#t o' Medicare and all E rd artycommercial ins#rance (1=C o' ractice was Medicare*
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Transition Process
7nderstand yo#r ractice 'romincome?eFense standoint
7nderstand yo#r ayer miF+ Medicare,Medicaid, /ommercial, Private ay, /arity
7nderstand Erd arty ayer dynamics
7nderstand ealtcare law
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Transition
)t o#t o' Medicaid+ rovide tr#e carity#ncained
/an$e Medicare stat#s to Nonarticiatin$+$ets atients and sta@ #sed to eFcan$in$ <and seein$ wat item and services act#allycost? $limse o' s"in in te $ame
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Transition
val#ate ayer miF+ Medicare and commercial
Ma"e sreadseet 'or to (-* codes and all ayers./omare i$, low, avera$e, Medicare, and yo#rassessed val#e 'or eac.
/reate yo#r own c#stomized 'ee sced#le
Dro te lowest ayer, let tin$s re+eG#ilibrate
/omm#nication wit and ed#cation o' atients is "ey
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Transition
e+determine wat ercenta$e o' yo#r reven#e andwat ercenta$e o' atients come 'rom eac ayer
)nce a$ain, dro te lowest commercial ayer.
Noti'y atients yo# are committed to tem and
enco#ra$e tem to stay in yo#r care #tilizin$ teir o#t o'networ" benets.
Pa#se, re+eG#ilibrate, reassess, and reeat+ #ntil tey>reall $one+ let last 'ew $o at once
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Transition
Ne$otiate 'ees wit s#r$ery center+ Medicareas re'erence oint
Ne$otiate 'ees wit anestesiolo$ist
/reate billin$ models+ direct ay v. ybridmodel
/omm#nication "ey+ 2etters, 'ollow+# letters,one calls, social media, website
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Transition
;isit wit 'amily
;isit wit ban"er+ ta"e o#t line o' credit (4 avea line o' credit 'or
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&o Time!
Saddle 7!
ollow 33PS )t )#t instr#ctions and ab#ndantreso#rces and s#ort systems
)t )#t+ )ctober =, -=8 'or me. How abo#t yo#I
Terminate o#tside billin$ comany (sad,#nintended conseG#ences*
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5ere 4 am now
3ssess reven#e
3ssess eFenses
)n$oin$, relentless ed#cation+ sta@, atients,
collea$#es/oays, cost+sarin$, remi#ms, ded#ctibles, in+networ" vs. o#t+o' networ", billable vs. allowable,transarent 'ee sced#le
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5ere 4 am now
Seven Months Post Opt Out vs. Seven Months Pre Opt OutJ o' Patients J o' Patient nco#nters &ross /ollections
Pre )t )#t =C =C =C
Post )t )#t E.8C .=C E.L8C
Total /an$e(-L.8C* (-.C* (L.E8C*
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5ere 4 am now
Collections and Billing Service&ross /ollections Billin$ Fenses Net /ollections
Pre )t )#t =C C EC
Post )t )#t E.L8C E.L8C
Total /an$e (L.E8C* .L8C
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5ere 4 am now
Post opt Out vs. Pre Opt Out (Billing service efect)J o' Patients J o' nco#nters Net /ollections
Pre )t )#t =C =C EC
Post )t )#t E.8C .=C E.L8C
TotalChange
(26.5) (2!.!) ".65
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5ere 4 am now
4 am wor"in$ EC less and collectin$ =C more. Myatients and sta@, my 'amily and 4 are te beneciaries. Tr#e access and G#ality care.
How can 4 s#stain and imrove tisI How can yo# do tistooI
/#rrent system sG#andered my otential to care 'or moreatients.
4 miss bein$ in te ) more as a s#r$eon at tis sta$e o'my career
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5ere 4 am now
Medicare # o$ PatientsPre )t )#t Post )t )#t Total /an$e
Medicare E.AC -.EC (=.8C*
Not Medicare L.1C .C =.EC
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5ere 4 am now
Medicare # o$ Patient %ncountersPre )t )#t Post )t )#t Total /an$e
Medicare 1=.AC E-C (.AC*
Not Medicare 8A.-C LAC .AC
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5ere 4 am now
Medicare o$ CollectionsPre )t )#t Post )t )#t Total /an$e
Medicare 1=.1C -8.-C (=L.-C*
Not Medicare 8A.LC 1.AC =L.-C
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5ere 4 am now
Medicare Patient %ncountersPre )t )#t Post )t )#t /an$e
Me 1=C E-C (C*
3ssociate(articiatin$
M/ rovider*
E8.1C 1-.C .8C
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5at 4 m#st do
4denti'y stren$ts and wea"nesses
5y do atients stayI 5y do tey leaveI
d#cate sel', sta@, atients, 'amily
Stay vi$ilant+a$$ressively stay abreast o' state and 'ederallaws, r#les, and en$a$e+ M3/3 r#les imossible
5at are tey # to nowI
Protect yo#r a#tonomy and stay o#t o' tro#ble
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5at 4 M#st Do
Stay 'oc#sed on mission
Don>t let yo# 'eelin$s or e$o deter me
5at we do is li"e notin$ else+ we are invested in o#ratients to o#r very core+ ris"y b#siness on call -1?.
Don>t #nderval#e tat.Be a victor not a victim+ say no to b#rno#t and ab#se
3lternate #niverse+ wor" wit collea$#es to be te aradi$msi't, tin" o#tside te boF, be te li'eboat
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5ere am 4 $oin$I
3ction 4tems+ stay on to o' o#t o' networ"? oted o#tcaveats+ secondary vs. s#lement vs. relacement vs. Tricare. P#rs#e best tar$ets.
)n$oin$ ed#cation o' atients, sta@, and collea$#es
ene transarent 'ee sced#le
ene website, social media, letters, one calls
Branc o#t+ 3lt 7, Healtsarin$ ministries, Networ"in$(Medibid, Doc /ost, local connectionsO*
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My 'ees vs. /ollea$#e in $eneral vicinity+ ybridmodel
2aserQ 2aserQ 2aserQ2aser 3sti$matism 3sti$matism 2ens
M#lti'ocal 2ens
Medicare Particiatin$ S#r$eon
Patient m#st ay tis additional
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Pearls and Pit'alls
Set my ractice aart+ send < on innovation over$overnment comliance and data collectin$
)n$oin$ eval#ation o' atient trends
New atientsI 3m 4 attractin$ new atientsI How can 4 dobetterI
2oyalty vs. te lon$ $ood+bye. 3m 4 retainin$ atientsI Howcan 4 do betterI
;al#e in relationsi vs. entitlement. 3m 4 a artner or a#ncin$ ba$I
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Hay Trails
Stay 'oc#sed and vi$ilant
Protect and P#rs#e increasin$ 3#tonomy+rescrition writin$? disensin$, M)/,licens#re, ysician owned 3S/>s, contacts O
Medical ed#cation+ '#t#re ysicians+ ioneersvs. indent#red servants, liberty vs. oression
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Hay Trails
#st Do 4t! Pro#dly! No one else can do wat we do, norwill tey do it 'or #s. )nly we are G#alied andeG#ied. rom one rite o' assa$e to te neFtO
Trailblazer
mtion
It took a lot of gumption for physician trailblazers to resistthe insolvent government takeover of medicine and createa viable ethical system that puts the patient rst.
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Tan" o# 33PS
Te 3ssociation o' 3merican Pysicians andS#r$eons is te #ltimate reso#rce 'or rivateand asirin$ rivate ysicians and te#ltimate rotector o' te atient+ysician
relationsi.)mnia ro ae$roto+ 3ll 'or te atient
nco#ra$e all ysicians to become a
member.
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/ontact 4n'ormation
Kristin Story Held, M.D.Stone )a" )talmolo$y
E-8 Sonterra Blvd., S#ite =
San 3ntonio, TeFas A-8A
www.Stoneoa"eyes.com
www."riseldmd.wordress.com (atient lettersO*
www.3mericandoctors1tr#t.or$
Messa$e me on Twitter+ Kris Held,MD U""seld
http://www.stoneoakeyes.com/http://www.krisheldmd.wordpress.com/http://www.americandoctors4truth.org/http://www.americandoctors4truth.org/http://www.krisheldmd.wordpress.com/http://www.stoneoakeyes.com/