A Decade of Desperate Patients

Posted on December 18, 2007 by Dr. David Edward Marcinko MBA

Patients Disenfranchised from the System

Staff Writers 

“When was the last time you had freedom of choice in, of all places, a hospital? One choice is no choice at all, and it only makes people feel frustrated and powerless. People have a fundamental need to choose for themselves-give your customers the power of choice.”

-Roger Dow and Susan Cook, 1996 

Examples of patients disconnected form the domestic US healthcare system abound. Here are just three for consideration from the past decade: 

The Disconnected and Disenfranchised 

  1. An HMO cost cutting measure, known as the Drop in Group Medical Appointment (DRGMA) is particularly onerous to some patients. In this largely still voluntary model, group visits of 10-15 patients take place simultaneously. During each visit, patients are examined in the group or privately, charts are reviewed, vital signs are taken, medications adjusted, tests are ordered and results discussed.
  2. Virtual e-health visits took a step forward recently as the First Health Group became the first managed care organization to establish another voluntary cost cutting program that eventually will pay doctors about $25 for online consultations with disembodied patients conducted via their web site.
  3. In a most unusual court case, a physician and six patients covered by Kaiser Permanente file suit accusing it of endangering patients’ lives by forcing them to accept double size pills. The plaintiffs alleged that the HMO forced them to buy medication at a higher dose and then split the pills in half. Some pharmaceutical and medical experts opine that the practice is harmful to patients; others support it.

More Patient Concerns 

And, according to Charles S. Lauer, publisher of the Modern Physician, through a study conducted by ARA Marketing and HBOC McKesson which appeared in the Harris Interactive Healthcare News a few years back, other pressing patient concerns include:

· 60 percent: “forgetting to ask all my questions when I am with my doctor, and

· 29 percent: “not having enough time with my doctor”, since the amount of face time between patient and doctors now amounts to about three-five minutes. 

In a more recent study, Harvard University reported that half of U.S. physicians believe their ability to deliver quality healthcare has deteriorated in the past five years.  

In yet another example, according to a survey of the Employee Benefits Research Institute (EBRI):

· Only 23 percent of employees considered themselves familiar with managed care.

· Fewer than 27 percent said that healthcare has gotten better in the last five years.

· Only 43 percent of those who received care expressed high satisfaction with its quality.

·  Almost 40 percent said they were not pleased with healthcare costs, despite HMOs.  

Conclusion 

Is it no wonder that patients, along with their healthcare providers are increasingly becoming despondent over the domestic healthcare imbroglio?  

Please, send us your comments, examples and most importantly – your solutions to the disconnect?

For related info: The Business of Medical Practice [Advanced Profit Maximization Techniques for Savvy Doctors]
http://www.springerpub.com/prod.aspx?prod_id=23759 

Filed under: Health Insurance | Tagged: | Leave a comment »

Kindred Hospital Liability Policy

Posted on December 18, 2007 by Dr. David Edward Marcinko MBA

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The Medical Waiver Issue

[By Staff Writers] 

Recently, Kindred Hospital of Wyoming Valley, PA has come under fire from two attorneys who fear patients may be signing away their rights to seek a jury trial if they are injured through malpractice.  

Introduction 

Kindred Hospital, a long term acute care facility, is asking patients to sign a waiver that would mandate any claim for injuries go through mediation or binding arbitration. These are alternative legal processes utilized in lieu of filing a lawsuit.

According to the hospital, such voluntary waivers benefit the patient by allowing for faster resolution of malpractice claims. 

Not so Fast! 

But, lawyers who reviewed the document say they are concerned that it is being presented to patients who, because they are under duress due to their illness, might not understand its implications. 

Enter the Guidance Counselors 

Upon investigation, Kindred said that admissions counselors review documents to ensure patients understand it, and do not attempt to pressure them in any way. Patients also have the right to revoke the document within five days of signing it, according to the Times Leader; in February 2007.  

Assessment

Kindred Healthcare operates various types of health care facilities nationwide where the form is used. Is anyone familiar with these folks who can make an informed opinion on this tactic?

Hospital with paper MRs

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Insurance Agents – Raising the Bar

Posted on December 18, 2007 by Dr. David Edward Marcinko MBA

[Few] Insurance Agents Learn About Modern Health Economics  

Staff Writers  insurance-book

As a registered health underwriter [RHU], insurance counselor, long-term care or life insurance agent, it seems that almost everyone today is also acquiring a general securities license, or becoming a “financial advisor.”

Introduction 

Currently, about 240,000 of the nation’s life insurance agents – down from more than one million in 1965 – are being pressured to move toward financial planning as distribution of insurance products over the Internet spreads like wildfire.

Meanwhile, the same insurance and investment companies that are knocking on your door are also courting the medical professionals with their practice enhancement and risk management programs. 

The Pondering 

So, even if you were not interested in doing financial planning for doctor’s, you have seen the status of the American College erode as your own business has declined because of the World Wide Web. 

And, in the eyes of your former golden goose doctor-clients, you may have become a charlatan as everyone is clamoring for a piece of your insurance business and cloaking it off in the guise of the contemporary topic of the day; medical practice management, healthcare business consulting and personal financial planning for physicians.  

Think this is an exaggerated statement? A prior – and oft repeated – survey first conducted by Deloitte & Touche Consulting Group of New York, found insurance agents ranked last in having the trust of a wide selection of the public!  

So you ponder and consider how to regain this lost trust and try to understand contemporary managed medical care and the current healthcare industrial complex?  

But, how do you learn about it at this stage in your career? 

  • What ever happened to the traditional indemnity health insurance, with its deductibles and 80/20 patient responsibility?
  • Where did the whole-life insurance policy buyer go, with its fat-profits for me and my sponsoring company?
  • How did I become a dinosaur insurance sales-agent?  

The Realization 

It was so easy to sell insurance in the good old days – your product provided good coverage – and the agent made a nice sales profit. So what – if it was expensive for the client?  Now, you realize that making a living will be more difficult in the future.  Like all the struggling collateral advisors in healthcare, you find yourself asking; how do I talk the talk and walk the walk – in this new era of insurance change and health reform turmoil?  

The Epiphany 

Slowly, as you study and re-engineer, you become empowered with knowledge for new risk management derivatives that provide added-value to physician clients.

And, you learn to integrate physician-focused financial planning concepts with medical practice management principles.  You learn something about health-economics and you seek to become a “fiduciary” and actually work for the client; not the insurance company. 

You are no longer just an insurance salesman, but are becoming a trusted advisor for the medical community.  You are slowly recreating your career and may successfully avoid the managed care “ripple effect”, after all. 

Educational information: www.CertifiedMedicalPlanner.com

Related Info: http://www.jbpub.com/catalog/9780763733421

Filed under: Insurance Matters | Tagged: | 3 Comments »

Professional Relations 101

Posted on December 18, 2007 by Dr. David Edward Marcinko MBA

Establishing Rapport within Your Medical Community

Staff Writers 

The following are useful “tips and pearls” to enhance your awareness among known and unknown physician colleagues in your area: 

  • Send office announcements to all health professionals in the community. Include pharmacies, pediatricians, family practitioners, nursing and convalescent facilities. All are potential sources of patient referrals.
  • Meet other health professionals personally and establish a one-to-one relationship with them. This will serve to educate them to your abilities and practice.
  • Send written reports to all practitioners who refer patients.
  • Do not hesitate to refer patients for consultations, as indicated. This is not only good business sense but good medicine.
  • Use novel business cards, such as the new CD-ROMs cut into the size of a standard business card, by One Voice Technologies, of San Diego. For about a dollar, depending upon quantity, you can order a labeled disc with all the business information of a standard card, which also functions as a CD-ROM containing up to 100 megabytes of multi-media data about your practice.

So, how did you establish yourself and practice brand, in your local area? 

For related info: The Business of Medical Practice [Advanced Profit Maximization Techniques for Savvy Doctors]
http://www.springerpub.com/prod.aspx?prod_id=23759 

 

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Medical Practice Business Insurance

Posted on December 18, 2007 by Dr. David Edward Marcinko MBA

More Needed than Just Medical Malpractice Insurance

 By Staff Writers

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There are several insurance, risk management and related liability mattes that physicians face today. These include, but are not limited to the following issues:  

1. New Thoughts on Malpractice Liability Insurance: 

The Capitation Liability Theory of malpractice views liability management and premium costs in light of the managed care revolution.  For example, although the indemnity reimbursement model was the bedrock of healthcare financing, the incidence of litigation is believed to be the most frequent in this system.

Similarly, errors of commission, which may be more likely in a fee-based system, are easier to prove than errors of omission in a fixed system.  

Conversely, a capitated reimbursement system suggests the level of malpractice risk, and associated litigation, decreases as the volume of capitated care increases.  

 Therefore, since the future is unknown, choose a malpractice insurance company rated “A” or better by AM Best (http://www.ambest.com). True indications of a strong company are often reflected in the firm’s net premium to surplus ratio, where a lower ratio is better and the industry average is about .81; net liability to surplus ratio, which the industry average is 4.1; net average ratio, where the industry average is 4.9; and reserve-to-surplus ratio, in which the industry average is about 3.6-4.1. (Physicians Insurers Association of America) 

2. Fire, Theft and Liability Insurance: 

Fire and theft insurance is used to cover office equipment and contents, while leasehold insurance protects against loss due to the termination of a favorable lease caused by the insured perils. 

3. Worker’s Compensation Insurance:  

Worker’s compensation is mandatory to cover a loss of income, medical expenses, and rehabilitation. Most states also have established second-injury funds which are designed to compensate employee’s who suffer a second disability injury and thus shield the employer physician from the increased costs associated with a second injury.

4. Business Interruption / Loss of Income Protection Insurance: 

This covers the ongoing medical offices expenses and income loss, because of office damage, and continues during the Period of Restoration.  Most business interruption is written on an indemnity basis, and consists of two broad types: Business Income Coverage Form (Add Extra Expense) and Business Income Coverage Form (Without Extra Expense).  

Either type requires co-insurance and both require a choice of three income coverage forms: (1) business income including rental value, (2) business income excluding rental value, and (3) rental value only. Consideration should also be made for man / woman insurance and account’s receivable insurance.  

5. Dishonesty Insurance: 

A Fidelity Insurance Bond protects the doctor employer against employee dishonesty and covers the loss of money, securities or other property resulting from acts by the bonded person.

In a Surety bond, one party (surety) agrees to be responsible to a second party (obligee) for the obligations of a third party (the principal).

In medicine, surety bonds are used in situations in which one of the parties insists on a guarantee of indemnity if the second party fails to perform a specific act. Such a requirement may arise in connection with professional medical employment contracts or other situations in which there may be doubt concerning the ability to perform medical or office related business tasks.

6. Billing Errors & Omissions Insurance

This coverage protects you against liability for unintentional billing errors when you bill a third party, including Medicare/Medicaid, or managed care organizations. This is usually a separate policy that provides limits of liability from $100,000/$100,000, up to $1 million/$1 million to cover both defense and indemnity costs. 

Other endorsements may also be obtained to pay civil fines, penalties, judgments and settlements, or increased limits of liability, up to $1 million/$1 million. All terms, conditions and limitations are outlined in the actual policy form

Conclusion

What other types of medical practice risks are out there, and how do you mitigate them; if at all?

For more related information: “Risk Management and Insurance for Physicians and Advisors” http://www.jbpub.com/catalog/9780763733421

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