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    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

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    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

    Dr. David E. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA, FPA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

    Marcinko is “ex-officio” and R&D Scholar-on-Sabbatical for iMBA, Inc. who was recently appointed to the MedBlob® [military encrypted medical data warehouse and health information exchange] Advisory Board.

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New-Wave Medically Focused Financial Advisors

Avoiding the “Managed Care Ripple Effect”

By Dr. David Edward Marcinko; MBA, CMP™

The healthcare industrial complex represents a large and diverse industry, and the livelihood of other synergistic professionals who advise doctors depend on it as well. These include financial planners and investment advisors who themselves wish to avoid the collateral ripple effects of the current health and managed care debacle.

Future Growth Potential in Financial Services

As a CFP, CFA, financial planner, CPA, investment advisor or general securities representative, you realize that the financial service sector is going to become the next great growth opportunity of the 21st Century.

Even H & R Block and the Charles Schwab Corporation are trying to build medical professional interest in their respective firms and compete with your independent practice. They are fervently wooing away one group or another to interface with their embryonic management, accounting or advisory programs.

For example, it has been estimated that more than one-third of the nations 60,000 accounting firms are contemplating the introduction of investment and medical management services to their business line. 

Another 100,000 solo CPAs are interested in personal financial planning for their physician and lay professional clients; a survey several years ago of senior CPA partners conducted by Prince & Associates of Shelton, Conn., revealed that more than 60 percent were “highly interested” in offering investment management services, and three quarters of those said they were evaluating the best approach for their firms.

The Migration to Advisory Services

Meanwhile, more than 260,000 of the nation’s brokers are moving into the investment advisory and financial planning business because securities sales and transactions are being commoditized by the internet’s World Wide Web.

In another survey several years ago, conducted for the old International Association for Financial Planning [the older IAFP is now the Financial Planning Association, or FPA], clearly demonstrated the dominance of registered investment advisors [RIAs], over stockbrokers [regardless of nomenclature derivatives], among clients 35-49 years old.

With the average Merrill Lynch private client well over 60, and the firm and industry imploding in 2008, it’s easy to spot the future vulnerability of this business model.

Valued Industry Players

When asked to determine the added value of key industry players, baby boomers in a more recent Dalbar study ranked financial planners first, followed by stockbrokers, CPAs, mutual fund companies, insurance agents, and commercial bankers, respectively.

Even if you are a CFP® or investment adviser, and despite the proliferation of investment advisors, evidence suggests that your individual impact is still narrow.

Furthermore, a Prince & Associates study of 778 affluent individuals, each with more than 5 million dollars to invest, examined the relationship between clients and their providers of five key financial services; retirement planning, estate planning, investment management, executive benefits and health-disability insurance.  Prince found that 59 percent of the clients had been serviced in only one area by a particular advisor.

Despite the significant assets of each client, the advisers have been unsuccessful at broadening these relationships — a key indicator that many affluent clients do not have a primary financial adviser.

Medical Niche Players

Among the challenges you face to broaden your influence is to offer your clients value-added services, perhaps by establishing your expertise in the medical niche and capitalize on being different; as in the Certified Medical Planner™ online health economics program of iMBA, Inc.

You must not be just another of the more than 250,000 or so individuals who claim to be financial planners, with a collective universe of an additional 700,000 or so who purport to be financial advisors, in some fashion or another. You must begin to develop the strategic competitive advantage of practice management knowledge to synergize with your existing financial service and product line.

Integration of Disciplines is Key for the Healthcare Space

Integrated practice management and financial planning will also become much more competitive among physicians because of the above professional fusions.

No one is suggesting therefore that you abandon your core financial advisory business for business management. It is merely a fact that medicine has drastically changed during the past decade, and the knowledge that you used yesterday will no longer be enough for you to get by on in the future.

Assessment

Medical practice management is the natural outgrowth of traditional financial planning services, and investment advice, in turn, is central to the implementation of a contemporary medical office business plan. The most successful physician-focused financial planners therefore, will be those who incorporate medical management services into their practices.

Disclaimer: Dr. Marcinko, a former stock broker, Certified Financial Planner and investment advisor is Founder of the Certified Medial Planner™ program for all fiduciary consultants in health economics, finance and medical practice management www.CertifiedMedicalPlanner.com

Conclusion

Your thoughts are appreciated; please opine?

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

Subscribe Now: Did you like this Executive-Post, or find it helpful, interesting and informative? Want to get the latest E-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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Copyright 2008 iMBA Inc: All rights reserved, USA, unless otherwise noted. Use is restricted to Executive-Post subscribers only. No redistribution is allowed. To avoid violation of iMBA Inc copyright restrictions and redistribution policy, please register for your own free Executive-Post membership. Detailed information and registration links are available at:

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Guidelines for Medical Evaluation & Management Services

An Important and Changing Document for Physicians

By William “Duffy” LaCava; PhD, Esq.biz-book

A most important document that every medical practitioner should be intimately familiar with is the Documentation Guidelines for Evaluation and Management Services [DGEMS], published jointly by the American Medical Association [AMA].

Continual Revisions

The E&M guidelines are continually revised in the direction of requirement of more detail in documentation. 

For example, one of the really nasty, “unfair requirements” which the guidelines impose is that medical records be legible: if the entries cannot be read, then there is no documentation at all.  And, as a doctor, you do not want to join the list of practitioners who, at deposition, under oath, have to admit that they cannot read their own handwriting.

By the way, whether you can read the entries is irrelevant–it is the reviewer who must be able to read them. 

D.G.E.M.S. Guidelines

The guidelines rank all patient-practitioner encounters by level of intensity of services rendered and require levels of documentation consistent with those intensity levels.  The documentation at every level must include “history, examination and medical decision making.”  And, if you look at the outline suggested in the guidelines, you will find our old friend, the acronym SOAP, lurking beneath. 

“Subjective” and “Objective” are combined in the first entry, then come “Assessment” and “Plan.”  Added to the standard list is a requirement for the date of service and the identity of the practitioner providing same services.

The guidelines also suggest beginning with chief complaint.  Please note that few patients complain that they have “paroxysmal nocturnal dyspnea.”  They are more likely to say, “I wake up in the night choking for air.” 

I personally advocate keeping subjective reports separate from objective examination in order to handle those cases when the two do not match up, e.g. the patient who says, “My back is killing me,” but has no trouble hopping up onto the examining table.

It’s About Encounter Intensity!

The detail required for recording the patient’s history of the present illness, past medical history, allergies and surgeries, family history and/or social history varies according to the level of intensity of the encounter. 

However, the only exception in recent guidelines for the required detailed history is for emergency conditions which take up so much time and skill of the practitioner that he or she cannot take the time to obtain those facts. The review of systems may be included in the history, and all positive findings must be recorded.

Nevertheless, recent changes no longer allow silence to indicate that there were no significant negative findings. Significant negative findings are required as well.

The Logical “Why?”

What is fairly new in the guidelines is the requirement that the process the practitioner goes through in determining how to handle a patient’s problem be apparent from the documentation.  There must be an indication in the records of a logical why, a test was ordered. This requirement aids a reviewer in judging whether the expense of the test was justified. 

Assessment

Another requirement is that if an addendum is made to the record, it must be dated on the day that it was added to the record, not the date of service. This requirement can be troublesome for practitioners who dictate all or a portion of their records and have the typed dictation inserted into the record when the dictation is transcribed.

Conclusion

You thoughts and opinions are appreciated. Is this a medical, legal, quality, insurance, finance or reimbursement necessity? 

Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

Subscribe Now: Did you like this Executive-Post, or find it helpful, interesting and informative? Want to get the latest E-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Copyright 2008 iMBA Inc: All rights reserved, USA, unless otherwise noted. Use is restricted to Executive-Post subscribers only. No redistribution is allowed. To avoid violation of iMBA Inc copyright restrictions and redistribution policy, please register for your own free Executive-Post membership. Detailed information and registration links are available at:

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Referrals: Thank you in advance for your electronic referrals to the Executive-Post

 

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