Some questions and comments from last night, annotated by me.
Back to the Q&A:
Does the gap in well visits hold true equally for Medicaid enrolled and commercially enrolled children?
Good question - I don’t have that data handy, but it’s something to explore. While most Medicaid measures lag measures for kids covered by commercial insurance, that’s not universally true. Note, though, that the nature of the data I provide describes performance within our client practices - it does not reflect the status of children who aren’t covered. In other words, I think our clients do a really good job regardless of whether their patients are Medicaid or not (in fact, there is an interesting collection of high Medicaid practices at the top of our clients’ clinical performance dashboard). But our data won’t include the millions of kids who aren’t seen by our clients and who may not be seen by anyone. I hope that makes sense.
but isn’t that because we are doing more expensive well visits and still hardly any sick?
I believe this is in reference to the charge/payment gap and the answer is, fortunately, no. I don’t think so. Why? Because in a typical summer, your well visit volume goes up significantly as your sick visits drop and what we’re comparing here is volume week-to-week. July 2020 looks a fair amount like July 2019 just with a lot less sick, as you say, but that’s actually normal. Where the pain will hit is between now and December when your sick remains low.
Are PCMH payments considered capitation?
For the purpose of what I was describing, yes. Any P4P, capitation, PCMH, etc., recorded by our clients will explain why payments didn’t decrease at the same relative rate that charges decreased. I should have made that more clear. However, I don’t think it includes and CARES act, PPP money, etc., as our clients didn’t put that into our system as a rule. And to answer @abaumel, those are gross charges.
can these slides be posted on the forum?
You can find all the slides right here!
I’m going to open a topic for the questions for @hlavania.