The Future of Hospitals

Between a “Rock and Hard Place”

By Dr. David Edward Marcinko; MBA, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™rock-and-hard-place

A recent white paper by the Joint Commission suggests that hospitals must respond in new ways to meet the increasing complexity of patient care and to address rising health care costs. Duh! What an insight. Why did it take so long for them to declare same?

 

The Hospital Accreditation Competition Heats-Up

Was it because of competition from DNV Healthcare Inc? Was it their new ability to determine if hospitals are in compliance with Medicare Conditions of Participation [COP]? DNV joins the Joint Commission on the Accreditation of Healthcare Organizations [JCAHO], and the American Osteopathic Association [AOA], as the only national hospital accrediting agency approved by the Centers for Medicare and Medicaid Services [CMS].

Link: https://healthcarefinancials.wordpress.com/2008/10/03/hospital-accreditation

Recommendations

Nevertheless, the JCAHO report recommends action in five areas:

  • Economic viability and ROI
  • Technology adoption and use
  • Patient-centered collaborative care
  • Medical and human resources staffing
  • Hospital architectural design

Patient Centered-Philosophy

Of course, it is no surprise that patient-centered care should be philosophically at the core of any partnership between a patient and his/her hospital and medical providers. Yet, just think of the last time you saw your HMO doctor and tried to engage in a collaborative health 2.0 discussion with him/her? Na-da!

Health Information Technology

The Joint Commission, despite the interoperable eHR controversy often presented on this blog, suggests that technology adoption can play a major role in improving patient care, safety and quality.

Link: https://healthcarefinancials.wordpress.com/2008/12/19/the-case-against-inter-operable-ehrs

This transformation from paper to electronic records, according to the report, will involve:

  • Making the business case for ROI and funding
  • Redesigning business processes with HIT implementation
  • Extending the digital footprint to the “medical-home”
  • Engaging IT leaders for guidance on prior mistakes 
  • Improve workflow – minimize labor intensive activities

Of Hospital “Insider” Administrators

One local hospital administrator insider, here in Atlanta, confidentially tells us that a single hospital bed is currently worth about a million bucks a year to the institution; private or public. And, the mantra of most hospital CEOs to staff doctors, is: “fill the beds”; “schedule the procedures”; and/or “book the operating rooms.”  So, the priorities outlined in the report really don’t seem appropriate; do they?

IOW: Put the hospital first; not the patient? And, this echoed our experience in hospital administration two decades ago. Has anything changed?

Assessment

Nevertheless, it may be refreshing to see an approach to healthcare technology implementation that seems to leverage the experience and knowledge of other industries. Privacy concerns however, are the biggest obstacle to HIT and true inter-operable eMRs, in our opinion. Yet, it doesn’t need to be. Who cares if grandma has a bunion, or dad had his cataracts repaired. They aren’t running for public office; are they?

The road to the Hospital of the Future will be bumpy, but we are hopeful enough to trust the benefits will be great once we arrive.

Full report: hosptals-future 

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Are hospitals today “between a rock and hard place?” Is technology and business process reorganization being offered as a substitute for critical thinking and true collaborative medicine? Especially, in light of the healthcare capitalistic thrust to: “do more – in order to earn more.”

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

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Collaborative Dental Health 2.0 [Part One of a Three Part Series]

Consumerism is the Hippocratic Way

By Darrell K. Pruitt; DDSpruitt1

The Appearance of DR. Oogle

By September of 2005, when I finally worked up enough courage to ask a patient to post a review for me on DR. Oogle (doctoroogle.com) – a web-based patient referral site – my dental practice had been invisible and struggling for a few years and was still disappearing.  It was the most discouraging period in my career. 

Following the Golden Rule 

In spite of my efforts to always treat my patients like I would want to be treated myself, I was headed for either managed care, which I consider to be an unethical model for dentistry, or bankruptcy. The progressive betrayal of my profession and my patients by leaders in dentistry spawned bitterness and high blood pressure that I still suffer today – even though my practice has fully recovered. My hygienist and I are currently booked almost solid for the next two weeks. I know also that in the next three, misfortune could arise. I have no idea what is in store for dentistry in tomorrow’s economy. If I was in the business of selling advice, or DR. Oogle, I would probably be tempted to radiate much more confidence than I truly feel.

Back in the Day 

When I graduated from dental school in 1982, I was reassured by dentists I respected that one’s practice location is not important if one works hard to consistently provide patients with one’s best efforts.  Dr. Earl Estep, a practice development guru from Athens, Texas, taught me decades ago that word-of-mouth is much more effective for attracting patients who are ready to spend money than advertisements provide, and that one should never forget to ask for referrals, even if it feels “unprofessional.”  This is still solid advice.  For example, two days ago, in a special marketing feature on Jim Du Molin’s The Wealthy Dentist Blog, Chris Barnard suggested,

“Enlist your existing patients in your practice success. Actively seek those all-important word of mouth referrals from your patients.”

Link: http://www.thewealthydentist.com/blog/727/practice-marketing-in-down-times

Even though Barnard doesn’t mention patient referral sites such as DR. Oogle, his other ideas which may or may not fit one’s practice image include quarterly letters, $10 gas cards and iPod raffles in order to

“… Let them know who you are beyond that white lab coat …!”

Just Do it … and Ask

I personally think it is much less complicated, as well as much cheaper, to simply select a recently satisfied patient, look the person in the eye and ask,

“Would you mind putting in a good word for me on this website?” 

Handing a patient a business card with the website handwritten on it becomes easier to do after the first dozen or so, but don’t expect immediate results. My success rate was around 45% when I was actively pursuing favors. When I reached 90 reviews after around nine months, I quit pestering my patients with requests for reviews. Active participation in a patient referral site also provides the incentive to improve one’s practice by motivating both dentists and staff to become wrapped up in treating each patient with extra-special care in the hopes of a nice review. Before anyone knows it, personalized, attentive care becomes a habit, I have found. Other than those who sell ads and party favors, everyone wins.

Enter Dr. Oogle 

I came across DR. Oogle in March 2005. The open-source patient satisfaction measurement application was born in San Francisco at the very end of the .com bust, and had been actively gathering word-of-mouth data about dentists for over two years when I began observing its progress.  By then, DR. Oogle had already accumulated an impressive amount of information concerning patient satisfaction with many of nation’s dentists. I suspect that today, Dr. Oogle’s volume of data is insurmountable by potential competitors. 

Akin to Wikipedia 

I found DR Oogle’s revolutionary marketing concept fascinating simply because like Wikipedia, it is not supported by advertising – thus avoiding a tremendous built-in and transparent bias. The company’s profits are derived solely from dentists like me who agree to pay reasonable monthly fees for the opportunity to participate in the application by displaying their customers’ opinions for public scrutiny. It is what I call playing to win rather than playing not to lose. Five months before I purchased the service, I published an article about DR. Oogle in The Twelfth Night, the monthly newsletter of my local dental society. I believe mine was the first mention of such web-based patient referral sites in any dental publication. Here is the article:

Patient Driven Referral Services

[From: “The Twelfth Night” April, 2005]

In a small community people as a general rule know a lot more about their neighbors than do people in a city.  They also know a lot more about the doctors and dentists in town since there are only a few.  It is fairly common to talk to neighbors and friends to get opinions on who is the best dentist, who to avoid, who is the cheapest, who has the most up to date equipment. 

In a small community, as well as in a city, even a neighbor’s recommendation carries more weight than a dentist’s paid advertisement.  I would imagine that sales of 1 800 Dentist subscriptions are significantly lower in rural Texas than in the metropolitan areas on a per capita basis.  The dentists in small communities know that they are far too easy to find to need to spend money for a referral service or for much advertisement at all. 

Well, Fort Worth and cities across the nation are becoming smaller dental communities because of the internet.  If any of you have googled your name, you may have picked up a hit by one or more patient driven referral services (PDRS). And, if you have not done this lately, you should.  There is a good possibility that the information about your practice location may contain errors.  But more importantly, you may read something pleasingly flattering or terribly humbling about your practice written by a patient you saw last week.

Dr. Oogle is presently the most popular PDRS. A patient’s comments about his or her dentist is posted only after the patient accepts the terms of the agreement; which are that the patient is neither a relative nor an employee of the dentist and that the patient is not otherwise being compensated for the review. The website also requires an authentic e-mail address and other personal information for verification purposes.

There is a filtering system in place in which employees of Dr. Oogle reject (at their discretion) comments which are too good or too bad to be credible.  And there are other ways in which dentists can handle bad reviews and are described on their website. There is, I suppose, always room for an attorney or two if the other attempts at removing a bad review fail.

But, if the PDRS’s survive the lawsuits, and if the first review which comes up under your name happens to be a real stinker written by an easily disgruntled and fervently vindictive patient (I think his name is Fred. You probably know him as he changes dentists often), and if you cannot get it otherwise removed, perhaps you should bury it under as many good reviews as you can encourage your patients to submit. This reaction, not surprisingly, is the reaction recommended by Dr. Oogle.  In fact, they also recommend that we routinely ask our patients to submit reviews to them.  I imagine that there are already dentists who have had cards printed for this purpose. 

Like it or not, our patients are being given more power in the marketing of our practices and their influence is growing. Dr. Oogle’s first reviews of dentists in the greater Ft. Worth area occurred in September of ’04. By the first of February, 5½ months later, there were only 18 dentists who had been reviewed by at least one patient.  As of today, one month later (March 7), there are 16 more. By the time this is published the number could be close to 50. Who knows how many reviews will be posted a year from now if the public perceives value in this kind of information. Many more of us will be listed as either good or bad dentists; legitimately or not. 

Regardless of the outcome of Dr. Oogle’s venture into dentistry, the fact that the public has a thirst for “unbiased” sources of information concerning our practices tells us that more than ever before we have to treat each patient as our most important source of new business or a disappointed patient could soon become a significant obstacle for growth.

Another good thing is that a patient who has to choose a dentist from a list at least soon may have some guidance; other than the fact that his insurance company thinks they are all equally swell.

Darrell K. Pruitt; DDS

[April 2005]

Investigative Reporting 

Since writing the unprecedented article, I have performed numerous simple investigations comparing DR. Oogle’s ratings to dentists’ names on preferred provider lists for various cities.  Invariably, the vast majority of the dentists who sign managed care contracts are found in the bottom 50% of the ratings. Sorry if I hurt some colleagues’ feelings, but that is cold fact. Anyone with a preferred provider list can confirm it. I suspect it has been done thousands of times by many anxious people holding new annual lists of strangers’ names in just the last year. Alert dentists should note that humans are choosy when it comes to trusting someone to use sharp, rotating instruments in their mouths. Dentistry is not like buying a can of beans as discount brokers would have their naïve and trusting clients believe, and most importantly, ethics are not for free.

Apart from the common sense rule that a purchaser of intricate handwork to exacting tolerances generally gets what the dental patient pays for, what else causes fee-for-service dentists to be generally favored over preferred providers?  I think it has to do with hunger.  If one’s meals arrive daily without effort, one forgets how to fish.

Managed care and preferred provider lists protect contract dentists from the naturally cleansing free-market principles taught by economist Adam Smith centuries ago. The beauty of competition in the marketplace occurs every time a dis-satisfied patient shops for a new dentist. When reliable information about patient satisfaction is available, quality is rewarded and encouraged in the neighborhood. Free-market capitalism works as reliably as classical operant conditioning in the best of possible worlds.

Assessment 

It is my opinion that there has always been something dishonest and un-American about discount dentistry with no quality control. I think we need to expose the unfair and unethical managed care business model to free-market forces even if it involves the calculated promotion of a simple, foolproof scheme for dentists interested in graduating from preferred provider lists. Those who feel trapped can begin their escape immediately by preparing some business cards for their managed care dental patients who by now are easily impressed by compassion. I’ll share more in Part 2.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. If US dental patients are lucky, Web 2.0 transparency arrived just in time. Consumerism rules naturally.

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Medical Employment, Jobs and New Positions

Advanced Medical Recruitment, Inc.

ADVERTISEMENT

By Otis J. Archie

stk178242rke

Many ME-P readers and subscribers have asked for us to start sending you our newsletter, with job openings. Now, we have implemented this change as an attachment.

Link: advanced-medical-recruiting-newsletter

Referral Bonus

Also note that we pay up to $1,000 dollars for referrals that are placed on a job. This agreement is good for 6 months from the date of the referral. If you know of someone who would appreciate our services, please call us with their name and number and, if possible, we will be happy to assist them. 

Otis J. Archie

President

AMR, Inc.

949/340-2136

Email:  advancedmr@cox.net

www.advancedmr.net     

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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Economics of Medical Fraud

Join Our Mailing List

Healthcare Leads the Pack

[By Staff Reporters]mardi-gra-skulls

All Medical Executive-Post readers and subscribers are aware of the Federal False Claims Act. Since 1986, False Claims Act [FCA] judgments and settlements totaled over $20 billion dollars. 

Of Miscreants and Feasors

According to outside unverified resources, below are the top 20 alleged FCA recoveries to date. Notice that all twenty, of the top 20, are healthcare and big Pharma related.

The Top 20

  1. Tenet Heath Care – $900,000,000
  2. HCA – $731,400,000
  3. Merck – $650,000
  4. HCA – $631,000,000
  5. Serono – $567,000,000
  6. Taketa Abbott Pharmaceutical Products Inc – $559,483,560
  7. Schering Plough – $255,000,000
  8. Abbott Labs – $400,000,000
  9. Fresenius Medical Care (National Medical Care) – $385,000,000
  10. Cephalon – $375,000,000
  11. Bristol Myers Squib – $328,000,000
  12. SmithKline Beecham [DBA] GlaxoSmith Kline – $325,000,000
  13. HealthSouth – $325,000,000
  14. National Medical Enterprises – $324,200,000
  15. Gambro Healthcare – $310,000,000
  16. Schering-Plough – $292,969,482
  17. AstraZeneca Pharmaceuticals – $266,127,844
  18. St. Barnabas Hospitals – $265,000,000
  19. Bayer Corporation – $257,200,000
  20. Schering Plough – $255,000,000

More: You can read all the details regarding these fraud judgments & settlements here 

Assessment

The above are the very companies that doctors, patients and many stakeholders rely upon. They bombard us every hour with TV advertisements and information on the latest drugs and newest procedures. They often promote cures for the exaggerated illnesses and nebulous ailments they seek to treat. Is this expense model just business-as-usual; or the cost-of-doing business?

Link: http://www.taf.org 

Channel Surfing the ME-P

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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WellCare Medicare-Advantage Scandal

Company “Misled and Confused Medicare Beneficiaries”?

By Dr. David Edward Marcinko; FACFAS, MBA, CMP™dr-david-marcinko20

According to Jacob Goldstein, of the WSJ, on February 20, 2009, WellCare the publicly traded company that some folks “love-to-hate”, and manages health coverage for Medicare and Medicaid beneficiaries, is in trouble again. In a recent letter, the Feds ordered the company to stop enrolling new Medicare beneficiaries, effective March 7, 2009. The sanction will be in effect until the Centers for Medicare and Medicaid Services [CMS] is satisfied that the company has corrected the alleged deficiencies.

Letter from the Feds

Adjusted for enrollment, the rate of complaints about WellCare’s marketing of Medicare Advantage plans are three times the national average, the letter says. The letter goes on to allege that the company “misled and confused Medicare beneficiaries” and “engaged in unauthorized door-to-door solicitation.” CMS also accuses WellCare’s agents of “misleading beneficiaries and misrepresenting WellCare plans at sales events in December 2008″ and failing to “discover forged applications through its own monitoring systems.” Of course, the company said it would continue to work with independent third-parties to ensure that it is compliant with CMS.

Click here to read the letter.

Oh Regina – Say it Ain’t So!

Finally, and perhaps the most personally distasteful for me in this whole sordid affair is not the fact that WellCare allegedly tried to rip off old folks. It’s just that Dr. Regina Herzlinger, the Harvard Business School professor – mother of a physician herself and proponent of healthcare competition and Consumer Directed Health Care Plans [CDHCPs] and a WellCare BOD member – apparently sold $2.3 million worth of stock in Wellcare three months before the FBI arrived.

Assessmentbiz-book5

 I first became aware of Regina Herzlinger’s work while in business school [not HBS] in the early 1990s. I recall calling her office for advice and referencing her several times in both editions of my best-selling book, the Business of Medical Practice [Profit Maximizing Techniques for Savvy Doctors]. She even came to Piedmont Hospital, here in Atlanta, last year on a healthcare speaking tour promoted in the local newspapers. What a shame. All co-incidence; ask Regina? Link: www.MedicalBusinessAdvisors.com

Industry Indignation Index: 35

Full disclosure: I am the founder of www.CertifiedMedicalPlanner.com and a reformed insurance agent, registered investment advisor and Certified Financial Planner™

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Do you think WellCare “Misled and Confused Medicare Beneficiaries?” You may opine and decide.

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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About In-Situ Medical Practitioners

Searching for Definitional Clarity

Staff Reporters

solo-consultant2Apparently, there is a growing trend toward so called “in-situ medical practitioners”. In this model, specialists like internists or diabetologists, add a certain medical expertise to address a large number of patients with specific needs in a general or primary care practice. 

Link: www.HealthDictionarySeries.com

Business Savvy

This clearly indicates that physicians are becoming more business savvy, are becoming more sophisticated in driving the growth of their practice, and better understand the structure and needs of their local health care market. 

Assessment

Regardless, the basic principles of relationship building and relationship management apply – treating each party with mutual respect and engaging in open and honest dialogue. Of course, we seek input form readers and subscribers to further define this emerging trend; if not merely a group of isolated incidents made known to us.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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

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About Fi360.com

Education for Financial Fiduciaries

Staff Reportersnyse1

According to the firm and website, www.Fi360.com offers a full circle approach to investment fiduciary education, practice management and support that has established it as the go-to source for investment fiduciary insights.

 

The Term “Fiduciary” Defined?

And, Fi360 defines an investment “Fiduciary” as:

“Someone who is managing the assets of another person and stands in a special relationship of trust, confidence, and/or legal responsibility”

Related definitional info: www.HealthDictionarySeries.com

Practitioner Based

With substantiated best-practices as a foundation, the firm offers training, tools and resources that are essential for fiduciaries and those who provide services to fiduciaries to effectively and successfully manage their roles and responsibilities. Fi360 say it is committed to assisting those who rely on their education programs, Web-based analytical software and resources to achieve success.

Training

Fi360 offers both AIF® and AIFA® training curriculums. The AIF® curriculum instructs investment fiduciaries on how to fulfill their duties to a defined standard of care. The AIFA® curriculum instructs participants on how to assess the conformance of investment fiduciaries to a Global Fiduciary Standard of Excellence [GFSE] using an ISO-like assessment process. These training curriculums are available in both classroom and Web-based settings; customized program are also available. Participants who successfully complete the programs, submit dues, agree to a code of ethics and meet other prerequisites may earn the AIF® or AIFA® designations, respectively.

Goals and Objectives

The goal of Fi360 is to help investment fiduciaries manage their responsibilities. But, according to Bennet Aiken AIF®, Fi360 Communications Coordinator, it is important to realize that AIF® / AIFA® designees are not required to be fiduciaries. While these designations are symbolic of training, knowledge and ongoing fiduciary development, they do not mean certification holders will always be acting as a fiduciary.

Assessment

Publications, blogs, articles, national conferences, assessments and more material for the collective and ongoing support of the fiduciary community are available; many for free and/or for the general public.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. But, why would a healthcare institution, medical practice, clinic or individual physician-investor hire anyone who will not act as a fiduciary and put their interests first; especially an AIF®/AIFA certification holder?

Note: Beginning today, and for the entire month of March 2009, we will be posting an exclusive interview with Bennett Aikin AIF®, the Communications Coordinator for fi360.com. Our topic will be on the rules, regulations and very definition of the modern financial fiduciary. Perhaps he can explain it all? Don’t miss it!

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Big Blue and UHG’s New Health Plan Model

Innovative Model -or- Just another Paradigm Shift

By Staff Reporters56372274

According to Reed Abelson, and David Kadlubowski of the electronic New York Times [NYT].com edition, on February 6, 2009, a new medical practice business plan and health care insurance reimbursement model could allow family physicians to practice medicine the way they used to practice. How so?

Exit UHG

The giant insurer UnitedHealth Group is testing a new model of health care that some policy experts say holds great promise, but has yet to prove itself. An earlier trial of the model by UnitedHealth, in Florida, never got off the ground because doctors refused to participate.

Enter IBM

This time however, the insurer is teaming up with seven doctors’ groups to make another attempt, in Arizona, at the prodding of one of the state’s big employers, and IBM. UnitedHealth will try giving doctors more authority and money than usual in return for closely monitoring their patients’ progress, even when patients go to specialists or require hospitalization.

Link: http://www.nytimes.com/2009/02/07/business/07medhome.html?_r=3&ref=health

Moving toward Value-Added Models and Episodes of Care

The insurer will also move away from paying doctors solely on the basis of how many services they provide via CPT® codes and will start rewarding them more for overall quality of patient care [value added and/or episodes of care model].

Link: https://healthcarefinancials.wordpress.com/2009/01/28/a-medical-payment-paradigm-shift

Assessment

One comment heard through the grapevine was “caveat and vendor emptor”; while another sarcastic observer wondered if this was the same “Useless Healthcare Group that we all despise?” And, who is to define the term “medical quality -or- value added care”?

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Early-adopter insight and reports from Arizona participating practitioners is appreciated.

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Internal Healthcare Marketing and Patient Satisfaction

Managing Expectations and Perceptions

By Dr. David Edward Marcinko; MBA, CMP™

By Dr. Gary L. Bode; MSA, CPA, CMP™ (Hon)gary-bode

Patient satisfaction occurs when patient perceptions exceed their expectations. They get an intangible “something extra” from the visit, above what they, or their TPA / health plan / Medicare / Medicaid plan, paid for. 

Managing Perceptions

We’ll concentrate on managing patient perceptions. Note that when patient expectations match their perceptions, mutual obligations are fulfilled, making both practitioner and patient “even”.

Clinical Outcomes

The clinical result, within a relevant range, is only part of the patient’s perceptions. Numerous unconscious impressions comprise the remainder.

We’ve all had patients love us despite a less than optimal result. And, we’ve all had patients angrily leave the practice over some non-clinical matter like a trivial billing dispute.

A patient’s perception of any health care service is colored by a vast array of prior experiences that set up current expectations. The patient is pleased to the extent that his current perceptions exceed his pre-existing expectations. This encompasses far more than the clinical result (within a relevant range), and includes such non-treatment issues as the demeanor of the staff, condition of the physical premises, psychological comfort during the visit, etc.

Patients Talk

Remember, all patients talk about you anyway.

A happy patient tells four others about what a nice doctor you are.

They are more likely to complete treatment and follow instructions, thus obtaining a better medical outcome, and, generating additional fees for the practice.

They pay quicker, cause less bad-debt and help create a pleasant environment for us to work in.

An unhappy patient vehemently tells nine others what a nasty rip off artist you are. Sad, but true!  They are not as likely to complete treatment, thus incurring a less than optimal result, and generate fewer fees. They pay slower, if at all, create a stressed environment and detrimentally affect the attitude of other patients in the office.

Soft Managerial Science

Try to eliminate problems that might cause negative perceptions (i.e., a filthy restroom) and implement controls that help assure positive perceptions.

Patient satisfaction is a soft managerial science. It is a numbers game. Most patients don’t pre-define what would be “acceptable” from this encounter, but have vaguely defined ranges of prior expectations anyway, gleaned from a lifetime of health care related experience. Any variance between these this “acceptable” range of expectations and each trivial encounter invokes some degree positive or negative feeling in the patient.

The total perception of the office experience is an aggregate of multiple trivial, often subliminal, observations. Patient satisfaction is an intangible and amorphous process complicated by: 

  • Inter patient variables: Significant differences between patients in their “expectations”. 
  • Intra patient variables: A single patient can perceive the same thing or situation differently at different times, depending on uncontrollable variables like mood, or, context of occurrence which may (sometimes and/or partially) be controllable by the practice.
  • Luck of the draw” in physical variables: Does Sally or Mary escort the patient to the exam room?  Was it the blue or green exam room: Did the last patient to use the rest room, five minutes ago, leave a disgusting mess?
  • Heterogeneous staff variables: Even with appropriate training, people are not machines and have their own quirks.

By proactively anticipating the entire visit, from the patient’s perspective, the medical practitioner can structure and arrange things so that most patients have, generally positive perceptions, most of the time. This can be done despite all the potential heterogeneity of the above factors. Patient satisfaction can be improved in any office, and can be done by anyone.

Assessment

Because patient satisfaction is a multi-faceted amorphous subject, there are multiple correct approaches to the subject and no “cook book” recipe on how to proceed. Try and get the big picture: 

  • Identify the worst areas and fix them.
  • Identify the best areas and reinforce them.
  • Proceed slowly.

It can be done one facet at a time. Adapt things to your own managerial style and personality. Be completely open to new suggestions, innovation and change.

Conclusion

How do you mange patient expectations, as an increasingly vital concept for CDHCPs, concierge medicine, retail and onsite medical practices and clinics? Please comment.

Related Information Sources:

Medical 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 him at: MarcinkoAdvisors@msn.com  or Bio: http://www.stpub.com/pubs/authors/MARCINKO.htm

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Understanding Healthcare Competition

Funneling Porter’s Five Forces of Business

Staff Reporters

ho-journal12Michael Porter PhD, of Harvard Business School, is considered by many to be one of the world’s leading authorities on competitive strategy and international competitiveness.

In 1980, he published Competitive Strategy: Techniques for Analyzing Industries and Competitors, in which he argued that all businesses must respond to five competitive forces. And now, these thoughts have been condensed for the healthcare industrial complex by Robert James Cimasi; MHA, CMP™ of Health Capital Consultants, LLC, in St. Louis, MO. They are cited below from the print journal-guide www.HealthcareFinancials.com

1. The Threat of New Market Entrants

This force may be defined as the risk of a similar company entering your local marketplace and winning business. There are many barriers to entry of new market entrants in healthcare including: the high cost of equipment, licensure, requirement for physicians and other highly trained technicians, development of physician referral networks and provider contracts, and other significant regulatory requirements.

Certificate of Need (CON) laws, which require governmental approval for new healthcare facilities, equipment, and services that have been in place since they were federally mandated in 1974. State CON laws create a regulatory barrier to entry. New medical provider entrants commonly faced substantial political opposition by established interests, which is manifested in the CON review process.

2. The Bargaining Power of Suppliers

A supplier can be defined as any business relationship or vendor you rely on to deliver your product, service or outcome. Healthcare equipment is a highly technical product produced by a limited number of manufacturers. This reduces the range of choices for providers and can increase costs.

3. Threats from Substitute Products or Services

Substitute products or services are those that are sufficiently equivalent in function or utility to offer consumers an alternate choice of product or service.  An illustration of this in healthcare would be diagnostic imaging, or PET scans, as a substitute for surgery, which is often a more costly and risky option for patients. The threat of less invasive or less expensive diagnostic tests other than diagnostic imaging is relatively small for the near term future.

4. The Bargaining Power of Buyers

This force is the degree of negotiating leverage of an industry’s buyers or customers. The buyers of healthcare services are ultimately the patients. However, the competitive force of buyers is manifested through healthcare insurers including the US and state governments through the Medicare, Medicaid, TRICARE, and other programs; managed care payers (e.g., Blue Cross/Blue Shield affiliates); workers’ compensation insurers; and others. 

In addition to the government, many of these healthcare insurers are large, national companies, often publicly traded, commanding significant bargaining power over healthcare provider reimbursement.

5. Rivalry among Existing Firms

This is ongoing competition between existing firms without consideration of the other competitive forces which define industries. Healthcare providers face pressure from other existing providers to obtain favorable provider contracts; maintain the latest technology; increase efficiencies; and lower prices.

Link:

http://www.thehealthcareblog.com/the_health_care_blog/2009/02/making-price-competition-work-.html#comments

Assessment

And so, these forces should be considers by all new, mid-career, and mature independent medical practitioners. They should also be combined with an internal organizational SWOT analysis as well.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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

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Goodnight Willem J. Kolff MD

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A Medical Inventor and Bio-Engineering Pioneer

By Dr. David Edward Marcinko; FACFAS, MBA, CMP™

[Publisher-in-Chief]dr-david-marcinko19

OK; let’s get this right out into the open. Although I did a little reconstructive bone and traumatic joint surgery in my career, I am not a cardio-vascular surgeon, nor am I a cardiologist, or even a nephrologist. But, I did treat more than my share of diabetic, alcoholic or other patients on renal dialysis and was well aware of the immense contributions of Willem Kolff to the profession. Therefore, I was saddened to learn of his recent passing at age 97. You see, Dr. Kolff not only developed the well known blood cleansing process that is now portable; he was also originator of the artificial-heart.

About Willem Johan Kolff; MD

When Willem Johan Kolff began work on the artificial kidney, few believed it possible. To draw a patient’s blood, cleanse it of toxins and return it seemed beyond the expertise of the most sophisticated medical centers. In the beginning, Dr. Kolff had no resources to draw upon. He was the sole internist in a small-town hospital, in the middle of the occupied Netherlands, during wartime. Materials were in short supply. The first 15 patients to receive the treatment failed to recover, but Dr. Kolff persevered. The dialysis treatment he pioneered and since perfected saved the lives, and limbs, of hundreds of thousands of patients, all over the world.

Link: http://www.achievement.org/autodoc/page/kol0int-1

Assessment

Dr. Kolff went on to design the heart-lung machine that made open-heart surgery possible. He pioneered artificial eyes, ears and arms, and for 25 years led the effort to develop the artificial heart. In 1982, a heart designed under his supervision was successfully implanted in Barney Clark, an event that captured the imagination of the world. All this was accomplished before such medical media stars as Dr. Robert Jarvik [Kolff’s student at the University of Utah in 1971] were lauded on TV, and then ignominiously dissed, for never having actually practiced medicine on real patients. In fact, Jarvik never pursued a medical internship, is not licensed to practice and can’t legally prescribe. Just imagine that!

Link: https://healthcarefinancials.wordpress.com/2008/02/14/the-jarvik-affair 

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Conclusion

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Seeking ME-P Viewer Help!

Goals on Thought-Leadership

By Hope Rachel Hetico; RN, MHA, CMP™

Managing Editor

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The Medical Executive-Post blog seeks to double its membership in 2009.You can help us reach our goal to be thought-leaders in healthcare economics, finance and administration in three ways:

  

1. If already registered; please ask your friends to subscribe.

2. If not a member, please subscribe to increase functionality.

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Medical Practice Financial Accounting

The Three Methods of Medical Office Accounting

 By Dr. Gary L. Bode; CPA, MSA

gary-bode2

Did you know that there are three recognized methods of financial accounting used in medical offices today? If not, this brief rundown on all three methods will help: 

1) Cash method  

Here, money is counted only as you deposit it, and “spent” only when write a check.  Simplistic, but intuitively obvious, this resembles your check register.

Unfortunately, the true cash flow method is seldom seen.  Most accountants use a tax-modified version of the cash flow method, as required by the IRS for tax reporting purposes.

2) Accrual method 

Here, income is counted as you earn it, so your accounts receivable is counted as income when you treat patients, despite receiving no cash for it as yet. Expenses get entered as you incur them.

In other words you enter a supply order as an expense as it’s placed, not just when you pay for it.  This method affords logical treatment of a wider variety of accounting issues than does the cash method and the IRS requires it once certain criteria are met.  

3) Modified cash (tax) method 

This is the cash method modified by depreciation and amortization as required by the IRS. 

Now, which accounting method is used in your situation, and why?

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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

Our Other Print Books and Related Information Sources:

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Physician Advisors: www.CertifiedMedicalPlanner.org

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Dubious Medical Practice Accounting

gary-bodeWhy Financial Statements are Sometimes Suspect?

 By Dr. Gary L. Bode; CPA, MSA, CMP

Medical practice financial statements have potential problems and are often suspect for several reasons.  

First, they rely on unverified information from the practitioner. A practice’s internal bookkeeping, even with the highest of intentions, is often sloppier than an accountant might hope for.  Professional liability with the IRS, and time constraints, keep the average accountant from doing anything but merely compiling figures given them.  The standard disclaimer on their financial statements states this fact.   

Second, most accountants are generalists in that they service other industries, like hog farms and flower shops; besides health care.  Specialization developed in medicine and health care for a good reason – it became too complex for a single person to have a comprehensive grasp on all of it.  The accounting industry has not followed suite.  Thus, CPAs often have little direct experience in the health care professional space.

Finally, accountants generally limit their scope of service to interfacing with the government for you on tax issues.  Therefore, their statements reflect tax position, which is only one component of the practice’s total financial condition. While important, this is hardly all your accountant is capable of doing.

Now, have you ever experienced a problem relative to the above post?

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Hospitals: www.HealthcareFinancials.com

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About Phreesia Practice Access Management

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What it is – How it Works

[By Staff Reporters]horizontal-nurses

Phreesia is an intentional misspelling of a flower (Freesia) and is a medical office access management product that replaces a physician’s traditional patient data-gathering clipboard with a free easy-to-use wireless touch-screen device called a PhreesiaPad. Everything else required [absent the broadband internet connection], including a wireless network, is supplied by the company

www.Phreesia.com

Customizable

Patient interviews can be as short or as long as desired by the physician. On average, a patient interview will take anywhere from 2 to 6 minutes. The PhreesiaPads come with a built-in tracking device as well as multiple anti-theft warning signs to prevent theft. The PhreesiaPad does not operate outside a physician’s office. They are reportedly very durable and rugged. However, if one does happen to break, it is replaced free of charge

Benefits

  • Capture optimized and comprehensive patient information.
  • Enable patients to verify, rather than re-enter, previously recorded information.
  • Conduct pre-visit personalized interactive patient interviews in the waiting room.
  • Completed interviews automatically printed as a report for physician review.
  • Engage patients while they wait.
  • Offer up-to-date health education relevant to patient medical concerns.
  • Provide patients with practical information for healthy living. 
  • Display custom messages about the medical practice.
  • Better prepare patients for office appointments.
  • Ensure important information is acquired.
  • Automate current HIPAA, Medicare and patient payment agreements.

Assessment

Phreesia is not a substitute for clinician-patient dialogue. However, patients often find it easier to confide sensitive information to a computer than directly to a clinician (i.e. alcohol use, drug use, psychiatric evaluation, depression, etc.). Additionally, Phreesia encourages a more structured, meaningful clinician-patient conversation by better preparing providers and better informing patients in advance of every visit.

More Info

110 East 23rd Street
Suite 400
New York, NY 10010
Phone: 888-654-7473

Fax: 646-607-1776
info@phreesia.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. One comment was that this device resembled the Amazon Kindle electronic reader. Early-adopter insight is appreciated.

Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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Healthcare Inventory Management

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Understanding Medical Inventory Cost Accounting

[By DavidJ. Piasecki; CPIM]

[By Hope Hetico; RN, MHA]

Prof. Hetico

Inventory cost accounting methods are seldom used by medical practitioners. After all, doctors and healthcare organizations provide a service, and generally do not sell things. However, inventory is playing an increasingly important role in the financial viability of procedurally based medical practitioners, clinics, and hospitals.

Durable Medical Equipment

This occurs because hospitals and these healthcare entities maintain, dispense, and use durable medical equipment (DME) more abundantly than ever before. Voice systems, RFID, OCR, pick-to-light and laser scanners, CCD scanners, hand-held batch and RF terminals, vehicle-mounted computers, and wearable computers are now all part of the modern healthcare system inventory data-collection and management picture.

A Decade Old Challenge

Ironically, the financial challenge of hospital inventory management was first articulated in the Efficient Healthcare Consumer Response Report (EHCR) in 1996. The report identified $11.6 billion of cost saving opportunities in the American healthcare system directly due to inefficient product movement and ineffective inventory control and materials management. Now, more than ten years later, this situation has only grown worse. As material costs have increased, our overburdened health system cannot afford such inefficiency.

For example, DME stock-out emergencies are real and costly. And, inventory models such as economic order quantity (EOQ) costing have been in existence long before modern data capture inventory costing methods, just-in-time (JIT) inventory controls, total quality management protocols, and the other supply chain inventory management (SCIM) initiatives often used to prevent them.

Medical Supply Chain Inventory Management

Medical SCIM is a method of accounting that takes into consideration raw materials, the construction of useful products, and the distribution of those products. Physician proceduralists, medical dispensers, and hospitals must understand SCIM, because a healthcare entity’s profitability will suffer if it has too much, or too little DME inventory on hand. DME can be both a cost center or revenue driver, depending on its management.

Perpetual Inventory Management

A perpetual [periodic inventory] costing method is the traditional way to account for DME usage. With periodic costing, the cost of inventory is determined once, at the end of the period. With a perpetual costing inventory, a new unit price is recalculated with each order.

EOQ Methods

How can the healthcare entity determine the proper DME inventory level? One uncommonly used, but increasingly important, approach is the EOQ method. Some astute clinic and hospital administrators are just now using EOQ to manage their DME inventory. They are increasing their financial benefits by determining the most cost effective answers to the questions: 

· How much inventory should I order?

· When should I order the inventory?

· How can I increase efficiency and reduce channel costs?  

Assessment

In other words, how can a hospital or healthcare organization optimize inventory levels, reduce expenses, and still improve patient care and safety?

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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Dismal World Video-View of American Healthcare

BBC Documentary Takes on Obama’s Plan

Staff ReportersUS Capitol 

Did you know that a new British Broadcasting Corporation [BBC] documentary takes on newly elected President Barack S. Obama’s plans for American health care system?

Emotional Pleas Tug at Citizenry Heart Strings

According to Nick Cargo – of the BBC on January 25 – a January 19th episode of BBC’s One’s Panorama, the world’s longest running television documentary show, tackles the dismal state of health care in the United States. Of course, it emotionally parses on the lengths to which our estimated [high-side] 45 million uninsured citizens [only 8 million remain uninsured for 2 years, or more] go in pursuit of care, the pharmaceutical industry’s rigged pricing against the American patient, and the insurance industry’s efforts to deny care whenever possible.

About Health Care for America Now

According to documentary comments regarding freedom-of-choice in our medical care; “It’s really a system of legalized bribery,” said Richard Kirsch of Healthcare for America Now. “As one congressman says, we’re the only people in the world who are expected to take money from strangers and provide nothing in return.”

Health Care for America Now is a national grassroots campaign organizing millions of Americans to win a guarantee of quality, affordable health care for all. Their goal is to create organizations that can mobilize people at work, at home, in their neighborhoods, and online www.healthcareforamericanow.org

Assessment

Due to licensing restrictions, the Panorama episode, “What Now, Mr. President?” is not for domestic consumption and is only officially available to view online from connections within the United Kingdom. However, it has also been uploaded to YouTube, where it appears in three parts below.

Video: http://rawstory.com/news/2008/BBC_documentary_takes_on_Obamas_plans_0125.html

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Watch the video and decide for yourself; then opine here. Is the BBC view equal to the world view of US healthcare modernity?

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

Our Other Print Books and Related Information Sources:

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

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Collaborative Dental Health 2.0 [Upcoming Three Part Series]

Hippocratic Dental Consumerism

By Darrell K. Pruitt; DDSpruitt

Even before the downturn in the economy sent dentists scrambling for new sources of patients, these were already times of revolutionary changes in the marketing of dental care. To those who are alert, the Internet-enabled chaos signals a rare opportunity if one sides with consumers rather than tradition. It takes confidence to welcome transparency, and it looks increasingly bad when dentists resist accountability in traditional ways – like suing. Yelp; because of a bad review that was posted on the patient referral site. That is the second stupidest thing one can do. Being perhaps a geeky student of the Internet, and sort of nosey, I have been tracking the popularity of dentists’ comments on a few Internet venues for quite a while, because of my own curiosity.  I also get ornery enjoyment from reporting to my friends my opinion of what is really happening in my profession that nobody else talks about. My hobby could be called fuzzy data mining based on a platform of precise subjectivity. 

For more intricate and dependable real-time information, I choose the surveys reported on The Wealthy Dentist Blog, hosted by Jim Du Molin. They are the best around.

Link: http://www.thewealthydentist.com/blog/

American Dental Association

The ADA also provides nice, formal presentations of even more accurate information, but it is often dated and not ground-level relevant like Du Molin’s studies. Until the Internet came along, gathering useful information about dentists’ prevailing attitudes outside one’s professional circle was virtually impossible, and dentists are well aware that even within these circles, colleagues’ opinions at dental meetings are sometimes intentionally misleading – perhaps mine are less reliable as well at social gatherings. I never talk this frankly in real life. 

Dental Information Silos 

Talk about information silos!  No less that 85% of dentists in the nation are owners of solo private practices (ADA News), and only 2% have bubbly personalities (my guess). Dentists’ quiet isolation, which is arguably favored by what I would guess would be around 85% of dentists in the nation, is a unique characteristic in modern healthcare that is part of a unique labor-intensive art – performed to exacting tolerances in an unpredictable environment – intricate work that most consumers know little about. Yet the ultra-personal accountability welcomed by almost all solo dentists is the way even neighborhood physicians once practiced their trade for thousands of years before modern stakeholders became involved. 

Hippocratic Oath

Is working alone with one’s chosen staff the most efficient way to provide dental care?  No way.  But for me personally, maintaining complete control of the care I provide from start-to-finish for those who depend on me is safer for them and a better business model for me than any alternative I have seen yet.  In my opinion, there is no room in the Hippocratic Oath for less than 100% devotion to the patients’ interests. More than two thousand years later, it is called consumerism, and it is 180 degrees counter to stakeholders’ interests, preferred provider lists and universal healthcare. And, it probably comes as no surprise that last October I observed that the most popular comments that were posted shifted from news about the benefits of high-tech inventions in dentistry to advice for how to survive in a tough economy. The whole nation is concerned about finances, and getting one’s teeth cleaned is commonly sacrificed when things get tough. Don’t even mention implants and crowns.

2009 Recession 

At the risk of sounding ostentatious as well as pedantic, I will offer that (for the time being) my practice is not suffering from a downturn that many of my local colleagues are enduring. In fact, I am actually busier than I was this time last year – and I made more profit in 2008 than ever before in 26 years of practice. I am also discovering that patients I lost long ago are returning now that they no longer have provider lists. They are also finding that my prices are not so high after all (in fairness, I should add that it has been longer than usual since I have raised fees – except for full gold restorations, of course). Since I am not in the business of selling advice, I am not afraid to also admit that my practice still experienced a couple of slow periods in the late fall – directly attributable to the initial shock of the downturn.  But I cannot say that the slowdown was any worse than other times in the last few years, and it certainly hasn’t been as bad as what dentists in Michigan must endure. My sympathy and best wishes go out to my colleagues up north. Things could all turn for the worse for me tomorrow, but for right now, I’m somewhere between surviving and thriving, for what that is worth; nothing spectacular, but solid.

Three Part Series 

This posting, which I hope some readers find useful, will be a multi-part series. I haven’t worked everything out yet, and my outline is subject to change, but here is what I have in mind.

In Part One, I’ll describe how my active participation in DR. Oogle (doctoroogle.com) has not only kept my name off of preferred provider lists, but it has also improved the quality of care my staff and I provide, as well as improved the working atmosphere in the office. Transparency will do that.

Then, in Part Two, I will offer my suggestion how one can use DR. Oogle or similar patient referral site to “graduate” from managed care into fee-for-service dentistry without losing patients or profit. As a naughty teaser, let me hint that over three years ago, I offered the idea as an article for the monthly newsletter of my local dental society, only to be refused publication for the first time in over two decades of submissions. I was told that an official nixed it as a transparent “scheme” to harm managed care dental companies, and was therefore below the standards of ADA publications.

“Image is everything”

-ADA/Intelligent Dental Marketing

Finally, in Part Three, I’ll describe how a good offense is also a handy defense – perhaps even in defense against malpractice litigation. Hopefully, a few sincere readers will consider playing to win rather than playing not to lose. And, for those who still don’t see my point, I will reveal how to play not to lose. Fair is fair.  It costs from $625 to $1995 per year, and in my opinion, is the stupidest thing one can do. Hope you enjoy this three part series. 

Assessment

Editor’s Note: This post was first published on PennWell. Dr. Pruitt blogs here and at others sites. His insights are applicable to most all medical specialties.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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

Our Other Print Books and Related Information Sources:

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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

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About ChainOnLine.org

A New AHRQ Web Site

By Staff Reportersradar1

A new educational Web site offering expert perspectives, advice and guidance on drugs, biological products and medical devices is now operational. The destination site, from the Agency for Healthcare Research and Quality’s [AHRQ] Centers for Education and Research on Therapeutics [CERTs], a federally sponsored network of more than a dozen leading research centers nationwide, was officially launched on January 8, 2009.

CHAIN

The Clinician-Consumer Health Advisory Information Network [CHAIN] http://www.chainonline.org connects clinicians and consumers with therapeutics information to assist in clinical practice and health care decision making in areas where evidence is undergoing significant and rapid changes.

CERTS

The site also provides access to educational and informational resources developed from research conducted by CERTs and intended for use in improving health care quality, safety and effectiveness. Clinical topics included on the CHAIN Web site address the management of blood clot prevention with drug-eluting stents and expert opinions about topics where evidence is uncertain, such as restarting anti-platelet therapy if it has been interrupted. The site’s educational section includes materials to assist consumers with clinician-patient conversations and decision-making as well as an online medication record. Resources for clinicians include a slide library that can be adapted to educate clinical audiences and used for continuing medical education credit.

Goal

The overarching goal is to serve as a trusted national resource for people seeking to improve health through the best use of medical therapies. The CERTs program includes partnerships of public and private organizations, a national steering committee involving multiple sectors and CERTs investigators, a coordinating center and 14 research centers. The CHAIN Web site was designed and developed collaboratively with input from all centers, working under the leadership of the Center for Collaborative and Interactive Technologies at Baylor College of Medicine, Houston.

Assessment

For more information, contact AHRQ Public Affairs: (301) 427-1246 or (301) 427-1998.

Internet Citation: Agency for Healthcare Research and Quality, Rockville, MD. Link: http://www.ahrq.gov/news/press/pr2009/chainpr.htm

From the Press Release: AHRQ Announces New Web Site on Emerging Issues in Medical Therapeutics.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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

Our Other Print Books and 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

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Hospital Cafeteria Plan Elections

Join Our Mailing List

On Health and Dependent Care

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

DEM 2013

I wrote a bit about hospital cafeteria plans in an earlier blog post.

Link: https://healthcarefinancials.wordpress.com/2008/04/02/hospital-cafeteria-plans/

Now, any hospital, or other employee given the opportunity to participate in a cafeteria plan should consider the following important two elections; health and dependent care.

Healthcare [Working Spouse]

If the employee is married and has a spouse who also works, and the employer-provided health benefits are better under the spouse’s plan, then the employee should elect to be covered by the spouse’s plan and choose another nontaxable benefit or a cash benefit that would be taxable under his or her own cafeteria plan, such as dependent-care coverage or group term insurance coverage. Switching health insurance requires planning to eliminate potential gaps in coverage created by insurance enrollment criteria. If the employee does not need the salary or cafeteria-plan benefits to meet current expenses, he or she should consider contributing the cash to a 401(k) plan and defer the tax liability.

Healthcare [Non-Working Souse]

If the employee has no working spouse and the employee’s plan is the only source for certain health benefits, the employee should consider what type of benefits he or she really needs for his or her family. In other words, can the employee get the necessary benefits under the company plan cheaper than he or she could individually, after taking into account that individual coverage will be paid with after-tax dollars, whereas under a cafeteria plan such benefits can be paid with before-tax dollars?

For example, if an employee who is in the 30% tax bracket is provided a $6,000 plan by her employer. He or she would have to be able to get a comparable plan independently for only  $3,741 to be in the same position on an after-tax basis. ($6,000 minus income taxes of $1,800 = $4,200, $4,200  minus $459 of avoided FICA

Dependent-Care

An employee who has a choice of including dependent-care costs may be entitled to an income-tax credit for such expenses if, the employer does not reimburse them. Thus, if a credit is worth the same or more than the payment under the cafeteria plan, the employee may choose to contribute those dollars toward additional health or life insurance.

Assessment

There is no doubt why healthcare and dependent care are the two most important cafeteria plan election determinants that clients seek in our advisory practice. The issues are that vital to all employees.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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Tax Tips for Under or Unemployed Medical Professionals

Status Still Possible for Physicians and Nurses

By Sean G. Todd, Esq., M. Tax, CFP©, CPA

Tax Attorney

Certified Public Accountant
Certified Financial Planner™ practitioner

Terminated, reduced-in-force, or out of work in 2009? As the April 15th tax deadline approaches, medical professionals and all other under/unemployed folks might have questions regarding their tax returns – unchartered waters for many. More people than ever before may be experiencing the effects of losing their jobs for the first time, or receiving unemployment benefits, and are uncertain about the tax consequences that relate to all this. So, in these difficult times, give some consideration to working with a professional to help you make the right decisions.   

Labor Department Reports

The US Labor Department report issued on February 6, 2009 showed that nearly 2.6 million jobs were lost over the course of 2008, the highest yearly job loss total since 1945. The official unemployment rate is at 7.2%, a 16 year high, according to the labor department. For your assistance, I’ve prepared some of the most common questions along with the answers. Here are several questions and answers to help you through this stressful time.

1. Do I have to still pay my taxes if I was out of work in 2008?

More likely than not! The IRS requires anyone who received a W-2 from their employer and made at least $8,950 (if you’re single and under 65 years old), or made at least $400 if you’re self employed, to file a tax return. These are the baseline cutoff numbers. If you’re anticipating a tax refund, you must file – even if you didn’t work at all. The IRS will not just send you a refund – you must file and claim your refund. Despite being unemployed, you still are required to file your taxes – often times a new level of frustration begins during this already confusing and frustrating time.    

2. Will I have a tax liability? 

It depends. It depends on a variety of factors since every taxpayer’s tax situation is unique, based on the facts and circumstances of the taxpayer. Some factors may impact a person’s filing requirement such as: if you only had unemployment compensation throughout the year, you may owe some tax on the checks you received. A severance package could also give you a tax bill, as could dividends and interest from investment income. Other factors which also need to be considered would include tax deductions and other life changes as a result of being unemployed: out-of-pocket medical expenses; sale of your home as a result of downsizing or even independent contractor income you might have received.

3. Do I have to include my unemployment checks in taxable income?

In a word, yes. Unemployment compensation is included as taxable income for federal purposes and most state tax returns. When applying for unemployment, we recommend that you elect tax withholding. You can choose whether you want federal and/or state income taxes automatically taken out of your unemployment benefits. If you choose to withhold, federal income taxes are withheld at a 10% rate, while the state rate varies. But since many cash-strapped Americans opt not to withhold – come April they may have to pay up during an already stressful time when extra cash is often times not available. So if you are not electing any tax withholding, a tax bill may be an unwelcome surprise when you file your 2008 return.

4. What if I “took” money from my 401(k)?

The answer depends on the definition of “took”. If you took a loan from your 401(k), exclude this from taxable income. You may owe taxes if you took money out of a retirement plan or 401(k) to supplement your unemployment checks. That counts as income and is taxable too. The taxes are in addition to a 10% penalty on early withdrawals if you’re below the age of 59-1/2. A special election is available to many taxpayers to avoid this 10% penalty on early withdrawals which many do not know about – costing even more in taxes. 

5. What if I did some supplemental work as an independent contractor?

In the attempt to continue to earn an income after being unemployed, you might have done some freelance or project work. Being unemployed allowed you the flexibility to become self-employed. That is the positive side of things – you earned income. Here is the negative side: if you earned some income doing odd jobs or consulting services while unemployed, you’re subject to income tax AND self-employment tax on that income. To report that supplemental work, taxpayers must include a Schedule C with their income tax return, which details the income and expenses for the year. This is where we see a lot of errors – individuals do not prepare schedule C for this type of earnings. If you earned over $30,000 and are now unemployed – you may go to www.lostmyjobtaxprep.com for an exclusive offer.  If you earned more than $600 during one of the projects, expect to receive tax form 1099 and you must include that as taxable income on your income tax return. Also note that if you made less than $600, then you will not be issued a 1099 but are still required to report this income as well on your tax return.

6. Relocated for the new job?

If the new job required you to relocate for the position, you may be able to deduct the moving expenses not reimbursed by your new employer. But there’s a distance test you must meet to qualify for the deduction. The new job site has to be 50 miles further than the distance from your old residence was from the old job, according to Tom Ochsenschlager, vice president of taxation for the American Institute of Certified Public Accountants [AICPA]. This basically prevents you from trying to deduct a move within the same metropolitan area.

7. Are my job search expenses deductible?

Those who were on the job hunt last year can utilize the tax code to their benefit and qualify for a larger refund. There are a slew of tax deductions available. In fact, many of the expenses incurred while looking for a job can be deducted, which can result in some serious tax savings.

Tax Checklists

As readers and subscribers to the Medical Executive-Post are aware, there is a quality initiative in clinical medicine that promotes the use of checklists. So, here is a good, but partial list of those things you need to keep track of:

  • Anything you spend on creating, printing and mailing your resume is deductible.
  • Anything you spend on a career coach or headhunter.
    Any long distance, cell or fax charges directly associated with your job search.
  • Transportation costs such as a bus, taxi, train or plane to an interview is deductible.
  • Mileage costs accrued when you drive to interviews and even to the unemployment office. [Between Jan. 1, 2008, and June 30, 2008, taxpayers can claim 50.5 cents per mile, between July 1, 2008 and Dec. 31 2008 taxpayers can claim 58.5 cents per mile].
  • All job related parking fees and tolls; and,
  • All meals and lodging if the interview was out of town.

Link: https://healthcarefinancials.wordpress.com/2009/01/20/a-homer-simpson-moment-of-clarity-on-medical-quality

Further Explanations

You cannot deduct the cost of the “new interview suit” as it does not qualify as a uniform. Also forget about deducting the value of your time as the IRS deems it to be worthless for tax deduction purposes. So too, forget about deducting your new Coach “briefcase” and matching “interview” shoes – they too are disallowed.  It’s the responsibility of each taxpayer to keep receipts related to any of these expenses in order to substantiate them when filing. In a self-serving interest, we always recommend consulting a professional tax preparer for help.  

Two New Websites

There are two websites especially beneficial for individuals who have lost their jobs and are concerned about protecting their 401(k) account. Individuals who are still employed can benefit from the information provided on the site as well.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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

Our Other Print Books and 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

Physician Advisors: www.CertifiedMedicalPlanner.com

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Maintenance of Medical Board Certification

Status Growing in Importance – or Sham

Dr. David Edward Marcinko; MBA, CMP™

And Staff Reporters

dr-david-marcinko11Increasingly, efforts to boost quality and gain better value from the world’s most costly healthcare system are including attention to Maintenance of Board Certification [BOBC], a little-understood but rigorous process by which physicians maintain board certification status and then keep it.  

Hillary-Care Redeux

Back in the day, circa late 1970s – early 1980s, medical board certification was indeed a rigorous process; and still is to a very large extent. For example, Democratic presidential candidate Hillary Rodham Clinton, in laying out the quality portion of her three-part healthcare reform plan last year, specifically touted these programs as a key step in enhancing quality. From the presidential campaign trail to hospital and health plan board rooms, Board Certification and the Maintenance of Board Certification is a growing force in the industry.

But, is maintaining recertification status another matter of true quality import?

Major Health Plans On-Board

Several of the nation’s biggest health plans—including Aetna, Cigna, Humana, UnitedHealth Group and national and regional Blue Cross and Blue Shield organizations—are embracing Maintenance of Certification as part of their recognition and reward programs. Physicians who do not participate are not highlighted in plan directories and miss out on higher plan reimbursements.

Yet, why do we have “red flag” issues, “never-events” policies and/or the rise of “checklist-medicine” for risk reduction if these continuing education programs are so effective?

Allow me to cite the raging over-treatment epidemic, especially in specialties like arthroscopic orthopedics, radiology imaging [CT and MRI scans] and invasive cardiology, etc. Not to mention recent, and not so recent, Institute of Medicine [IOM] quality chasm reports for in-hospital patient deaths, complications and infections, etc.   

Assessment

Of course, savvy hospital administrators and physician executives, of all stripes, are examining ways to use elements of board certification maintenance to respond to the Joint Commission’s new requirements for physician credentialing and privileging. Furthermore, the National Quality Forum [NQF] and the AQA quality alliance will be considering Maintenance of Certification for quality measurement endorsement.

Source: Cary Sennett and Christine Cassel, Modern Healthcare

Joint Commission Relevance in Modernity

But, is the Joint Commission itself even as relevant today, as in the past? Or – is its [political, quality and economic] status, might and swagger being reduced in favor of modern new-wave insights from health 2.0 collaboration activities and emerging formal organizations like DNV Healthcare Inc., a division of the Norwegian company.

As subscribers and Medical Executive-Post readers are aware, Det Norske Veritas [DNV] has recently been charged with immediately determining if hospitals are in compliance with the Medicare Conditions of Participation [COP]. The company’s authority to accredit hospitals runs through September 26, 2012. DNV joins the American Osteopathic Association [AOA] as the only other national hospital accrediting agency approved by the Centers for Medicare and Medicaid Servicers [CMS].

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is medical board certification and maintenance status of real value – or just fluff – much like the continuing education and licensure requirements of insurance agents, stock-brokers and financial advisors, etc? Is it less for medical education – and more for liability risk reduction – or PR – you decide? 

Disclosure: I am a reformed insurance agent, stock-broker, board certified quality review physician and Certified Financial Planner®.

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

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Physician Advisors: www.CertifiedMedicalPlanner.org

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Reflections on Legionellosis and the Sweet-Science

Beleaguered Grady Memorial Hospital in the News

By Dr. David Edward Marcinko; MBA, CMP™dr-david-marcinko14

The economically dreadful status of Grady Memorial Hospital Corporation [GMHC], here in Atlanta Georgia, is well known to those in the industry. We personally wish its new CEO, Michael A. Young, of the hospital’s recently privatized BOD much professional success. As the region’s only level-two trauma center – an important public service is provided to us all.

Current Development at GMHC

And now, tests of water samples from varied hospital locations at GMHC have focused a Legionella Pneumonia investigation on upper parts of Water Tower A.

Link: http://www.ajc.com/gwinnett/content/metro/atlanta/stories/2009/02/12/legionnaires_disease_grady.html

As originally suspected, the water source on units 11-A and 12-A tested positive for Legionella bacteria, and were treated with hot water [284 degrees] and heated hyper-chlorination, as inpatients centered on the 11th and 12th floors were temporarily unable use their shower facilities as a precaution.

Link: http://www.gradyhealthsystem.org/lpneu.asp

First Anecdote

I initially learned of Legionnaires’ disease while a medical student at Temple University, in Philadelphia. The community paranoia and patient deaths surprised us all back then, as well as the ultimate general simplicity of treatment with the antibiotic erythromycin. In fact, two incidents quickly come to mind as this story unfolds.

First, I returned to the same hotel about a decade after the incident while serving on the residency selection committee for a local hospital. I was astonished to learn how few of our interviewees knew about the condition; not medically of course, but its rich history in the very same hotel accommodations where we stayed. While having dinner one evening in the hotel’s restaurant, I met former heavy weight boxing champion, Smok’in Joe Frazier, who invited me to his table for a drink. Even he recalled the original Legionnaire’s incident, and hotel venue, just as he regaled me with his nascent training escapades at the Center City Athletic Association on North Broad Street. I regaled him in-turn, with stories of my own dad, an amateur fly-weight Baltimore City boxing champion circa 1945; and stories of my services as boxing-ring physician’s assistant at the old Philadelphia Spectrum. He was a gracious and charming champion, indeed. My dad was thrilled when I recounted this story.

About Legionnaires‘ Disease

Legionnaires’ disease got its name in 1976, when an outbreak occurred in the Bellevue-Stratford, a land-mark Philadelphia hotel during an American Legion convention. Pneumonia-like symptoms include fever, chills, cough, muscle aches and headaches. Chest X-rays, and other tests can be done on sputum, as well as blood or urine to find evidence of the bacteria. The bacteria grows best in warm water, like the kind found in hot tubs, saunas, cooling towers, hot water tanks, large plumbing systems, or parts of the air-conditioning systems of large buildings. Transmission is through mist or vapor-like steam from sources not been properly cleaned and disinfected. The bacteria are not spread from one person to another person. Outbreaks occur when two or more people become ill in the same place at about the same time, such as patients in hospitals. Hospital buildings have complex water systems and many people in hospitals already immune compromised and have illnesses that increase their risk for Legionella infection. Other outbreaks have been linked to aerosol sources in the community, on cruise ships etc, with the most likely sources being whirlpool spas, cooling towers and water used for drinking and bathing.

Unfortunately, Legionnaires’ disease can be very serious and can cause death in up to 5% to 30% of cases. Most cases are successfully treated with antibiotics and healthy folks usually recover from infection. Current antibiotic treatments are with quinolones and macrolides. Those used most frequently are levofloxacin and azithromycin. Macrolides are used in all age groups while tetracyclines are prescribed for children above the age of 12, and quinolones above the age of 18. These antibiotics are effective because they have excellent intracellular penetration and Legionella infects cells.

Second Anecdote

The second incident that comes to mind is my recollection of Dr. Leonard Bachman, the former Pennsylvania Commonwealth Health Secretary at the time of the first Legionaire’s crisis, thirty-three years ago. Dr. Bachman is a former Commanding Officer of the US Public Health Service’s Disaster Response Team, Director of Health Services for the National Oceanic and Atmospheric Administration, and Director of the Public Health Service. During his long and distinguished career, he assisted with the establishment of the National Disaster Medical System (NDMS), coordinated the original investigation into the initial outbreak of Legionnaire’s Disease in Philadelphia, and was responsible for the medical response to Hurricane Andrew. Today, although semi-retired, Dr. Bachman provides consultancy services to the US Marshall Service and numerous other organizations. So, imagine how shocked I was to see him interviewed on TV a few weeks ago! Now, at Emory University, his advice and experience was again sought during the current GMHC incident. What a blast from the past!

Assessment

GMHC is a downtown Atlanta public facility with 950 beds. It normally sees about 2-3 cases of Legionaiire’s disease each year.

Proper antibiotic use: http://www.tufts.edu/med/apua/mrsa/mrsa.html

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Please opine on GMHC, the sweet-science, or related topics of interest. Is this outbreak, for example, related to the Peanut Corporation of America salmonella outbreak in Blakely, GA, in any systemic way? Or, does this state simply lack governmental oversight in multiple areas?

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

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A Review of Elder Housing Protections

Home Equity Resources, Housing and Care Options

Staff Reportersinsurance-book2

According to Stephanie Edelstein JD; Charles P. Sabatino JD and Nancy M. Coleman MSW MA; opining in the ElderLaw Series, until relatively recently most people in this country followed a rather typical housing pattern in their later years. They either rented or owned their homes and lived alone until they were no longer physically or economically able to manage independently, at which time they moved in with family members or into nursing homes or board-and-care homes.

Elderly Housing

Housing, particularly rental housing, provided the proverbial bricks and mortar, and, with the exception of a few facilities that offered meals and some light housekeeping, little opportunity existed for older persons to receive services in their homes. Elderly tenants who were perceived by a landlord or housing manager as unable to manage on their own were evicted, frequently without due process protections, and just as frequently would end up in a nursing home. While disabled tenants in federally assisted housing programs were accorded protections against discrimination on the basis of disability, no such protections existed for residents of private housing. Few members of the legal, healthcare or aging communities, and even fewer among the elderly, were aware of those protections that did exist.

Emerging Changes

Much has changed during the last few years, in large part due to the increasing emphasis on retaining autonomy, the trend towards aging in place, and the passage of civil rights statutes, which have raised public awareness of the legal rights of persons with disabilities.

For example, for frail or disabled older persons, including medical professionals, protection against discrimination in housing can be found in three federal statutes: [1] the Americans with Disabilities Act, [2] the Rehabilitation Act of 1973 and the [3] Fair Housing Amendments Act of 1988. Of the three, only the Fair Housing Amendments Act (FHAA) is targeted exclusively to housing and within the housing area is arguably the most far-reaching.

Rehabilitation Act

The Rehabilitation Act of 1973 (the antidiscrimination provisions of which are commonly referred to as §504) is a general civil rights statute that prohibits discrimination against any “otherwise qualified individual with handicaps” in a wide variety of programs or activities receiving federal financial assistance, including housing.  

FHAA

The scope of the FHAA, as it applies to housing is broader, and it covers virtually any housing activity or transaction, including both private and subsidized, apartments and single family dwellings, and prohibits discrimination against all individuals with handicaps, even if the discrimination cannot be attributed directly to the disability.

ADA

The Americans with Disabilities Act (ADA), which is having a profound effect on all elements of society, can be seen as complementing the other statutes. The ADA extends to all state and local programs the protections of §504, and also prohibits discrimination against people with disabilities in public accommodations.

Disability Defined

All three statutes use virtually the same definition of “handicap” or “disability.” Protection is extended to persons with a “physical or mental impairment which substantially limits one or more major life activities,” such as performing manual tasks, personal care, walking, seeing, hearing, speaking, etc. The definition includes persons “having a record of such an impairment”, whether or not the impairment still exists; and a person “regarded” as having such an impairment,” whether or not the perception is accurate. While age alone does not equate with disability, the symptoms and conditions of the aging process are likely to cause impairments that meet these definitions.

Addition Exempted

“Handicap” or “disability” does not include current illegal use of or addiction to a “controlled substance.” Moreover, none of the statutes require a housing provider to make housing available to an individual “whose presence would constitute a direct threat to the health or safety of other individuals or whose tenancy would result in substantial physical damage to the property of others.”

Legal Purposes

The intent of these laws is to provide persons with disabilities access to and enjoyment of housing and services to the same degree as if they were not disabled. They apply from point of application throughout the tenancy. Housing providers may not maintain separate admissions standards for people who are frail or disabled, nor may they inquire about an applicant’s health or ability to live independently, unless those questions are to establish eligibility for particular programs or services.

For example, the decision to lease to a particular individual must be based on program eligibility (if appropriate) and the ability of the applicant to comply with the terms of the lease, whether independently, with the assistance of a third party, or as a result of a reasonable accommodation by the provider. A prospective property owner may not require an older person to have a “sponsor,” or “guarantor,” a practice common to many senior housing programs.

Assessment

In recent years, courts have found the following policies to be discriminatory: requiring residents who must use walkers or wheelchairs to transfer to regular chairs when eating in the common dining room; failing to provide accessible parking spaces for disabled tenants; and refusing to modify a “no pet” rule for tenants with disabilities who need guide dogs or service animals.

Link: www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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

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Financial Product Sales, Communication and Management

Techniques-of-Art for Financial Advisors

By Robert Ayrer and ME-P Staff Writers

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Before any piece of work that requires communication can be understood, the context must be established.  Without context, words have very little reality; and without reality, there can be no communication. Communication is the “transfer of meaning.”

Introduction

The lack of a definitive role of the marketing function (and the sales function, and the difference between the two) for financial advisors [FAs], has contributed to the lack of clarity required for the achievement of sales targets. The fuzzy line between “targets” and “goals” has left most financial product salesmen, OSJs [Office of Supervisory Jurisdiction] and sales managers without the “tools to manage.” In this context, we will define the financial sales person’s role as the “person responsible for the execution of the corporate, or personal, sales plan, which includes the short term marketing of the company.”

Marketing versus Sales

Long term strategic marketing is a very sophisticated process, requiring highly trained people that are not involved with the mundane, day-to-day activities of the enterprise.  Unfortunately, this type of “marketing” is done by too few businesses, RIAs, BDs, and FAs.

The “marketing plan”, as defined by Malcolm H. B. McDonald, Director of the Cranfield Marketing Planning Centre, of the Cranfield School of Management, is a comprehensive business plan, incorporating and integrating all of the elements of business; the four “P’s” — Product, Price, Place and Promotion. More often than not, financial sales organizations and RIAs are run by people with “Director of Sales & Marketing” titles.  This use of the “marketing” title often confuses the difference between marketing and sales. For our purposes, we will include the very short term marketing function in the sales department’s role.

Dirty Ear Marketing

This “very short term marketing” required of the FA or sales person is what is called “The dirty ear” marketing.  The “dirty ear” comes from “keeping an ear to the ground” to detect changes in the market that would affect the assumptions that support the marketing plan and the company sales plan.

It has been said that the American plains Indians could drive a stick into the ground, put the end of the stick to their ear and tell if the buffalo herd was within twenty miles — and, by bending the stick, tell in which direction.  The more sophisticated tracker could tell whether the herd was approaching or going away.

It is this short term, close in, change in direction of the market (herd) upon which the assumptions of the marketing and sales plan are based, that should be the concern of the sales department or financial advisor and business owners. 

Of Bull and Bear Markets

For example, during times of economic expansion, and bull markets, the purchasing authority for many items is transferred down the reporting chain to the lowest possible responsible level of management. At this level a sales person or FA may only require one or two calls to complete the selling process with a buying authority. This authority level would dictate the activity of sales people in achieving their personal sales plan and achieving their targets and goals. 

During a recession however, as is occurring now, authority to buy may be withdrawn from the customary buying level, designating someone at a higher level as the “buyer.” The financial sales person still must go through the traditional contact at the lower level. These contacts can now only say “no”. They cannot say “yes.” By adding another level of decision making to the buying process, additional activity will be required to make the average sale. You cannot double the activity required to make a sale and make the same number of sales!  Don’t make the mistake of thinking that working harder is the answer, as there is only a finite amount of time available to get to your prospects. Your options are; change the plan; adjust the sales budget; add more sales representatives.

The Sales Cycle

Continuing a sales plan based upon the assumption of a two-call sales cycle when the market requires a three or four call cycle will take your sales plan out of reality.  The key to both a good marketing plan and a good sales plan is “reality.”  It is the FA or sales manager’s prime function to see that the sales organization is working in “reality” by constantly testing the basic assumptions of the sales plan.

The challenge to every financial services business owner, sales manager and every FA sales person is to stay focused on the prime objective of a sales person – processing the sale.  To maintain focus on the sales objective, the activities of a sales person should be looked at in two categories; “tasks” and “selling objectives.”  The tasks are those activities that all sales people are required to do to service clients – handle back-charges, warranty claims, stocking services, point of sale maintenance, etc.  The selling objectives are defined by the sales progression used in the sales strategy.

Processing the Sale

To give better understanding to this concept, consider the following.  If you find a local bank that offers a certificate of deposit that is paying a good return, and you put $10,000 on deposit, you have made an “investment.”  It is an “investment” because you expect your money back with a profit.  To find this investment opportunity you must be focused externally (not within your own business).  And, investments are a source of new capital.

If, on the other hand you take the $10,000 and purchase a car for your business, your focus is internal to your business, solving a problem of transportation, and you will only realize gain by reducing an existing or potential expense. You will not realize any new capital from this expenditure.  This use of the $10,000 is an “expense.”

Internal and External Focus

To generalize, if your focus is external and you are seeking to generate new capital by exploiting new opportunities, this is an investment.  If your focus is internal, and you are solving problems (the activities that come after the sale), the time and money spent is an expense.

Tasks and Objectives

Sales people sometimes lose sight of the difference between the “tasks” (internally focused after sales activities that are expenses to the company) and the sales “objectives” (opportunity seeking activity that will result in generating new capital through sales). Although we must service the task items, we can avoid “buying” the customer’s problem (forgetting that the customer’s problem is our opportunity).  The way we make sure we maintain focus on the opportunity rather than the problem – is to link every task with a sales objective. 

Management Reporting

Historically, we have asked sales people and FAs to report to management through an activity report that usually records the “task” items but ignores the opportunity items. To use the reporting system as a training and management tool, stop requiring the typical activity and expense reports.

Instead, ask your sales people fill out an “Opportunity” report and an “Investment” report.  It is true; “What gets measured gets improved!”  If you want your sales people to be externally focused and seek opportunities, investing in accounts rather than “solving problems” and spending money (“expense” items), measure and report on the opportunities and investments.  It is more positive to run an investment department for your business rather than a cost center.

Managing For Results

Peter Drucker observes that “… there are no profit centers in a business; there are only cost centers.”  The profits centers are external.  Again, quoting Drucker; “Results are obtained by exploiting opportunities, not by solving problems!”

Assessment

The above offering is intended to help financial advisors and sales people “manage” themselves, and for the sales people who have assumed the mantle of OSJ or “manager”, etc

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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

Our Other Print Books and 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

Physician Advisors: www.CertifiedMedicalPlanner.org

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Defining Hospital Competitive Markets

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Clarifying Often Nebulous and Contentious Terminology

[By Staff Reporters]

According to Robert James Cimasi; MHA, CMP™ of Health Capital Consultants LLC in St. Louis, MO; the definition of a hospital’s “market” is often nebulous.

Ambiguous Terms

Some entities are defined by terms as ambiguous as “acute care inpatient hospitals,” “specialty hospitals,” or “anchor hospitals.” This ambiguity occurs because healthcare is increasingly provided on an outpatient basis, and general acute care inpatient hospitals face competition from a range of allied healthcare providers for the medical services they deliver.

Link: www.HealthcareFinancials.com

US Supreme Court Explains

For example, none other than the US Supreme Court has explained that the determination of relevant hospital product and geographic markets is “a necessary predicate” to deciding whether a hospital merger contravenes the Clayton Act (antitrust).

Assessment

For additional information, please see United States v. Marine Ban Corporation Inc., 418 U.S. 602, 618 (1974) (citing United States v. E.I. Du Pont De Nemours & Co., 353 U.S. 586, 593 (1957); Brown Shoe Co. v. United States, 370 U.S. 294, 324 (1962).

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

***

[HEALTH INSURANCE, MANAGED CARE, ECONOMICS, FINANCE AND HEALTH INFORMATION TECHNOLOGY COMPANION DICTIONARY SET]

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[Mike Stahl PhD MBA] *** [Foreword Dr.Mata MD CIS] *** [Dr. Getzen PhD]

***

Medicare Audit Triggers

Understanding Healthcare Fraud and Abuse Complaints

By Staff Reporters

ho-journal7According to Patricia Trites PhD, complaints are the most common way that a Medicare audit can be triggered. Anyone can register a complaint. Physicians can report their colleagues, whether competitors in the same town or partners / associates. The literature mailed by Medicare encourages seniors and their family members to report their healthcare providers, if there is any suggestion of inappropriate billing activities.

Beneficiary Literature

Literature has been sent out in beneficiary information and in their Explanation of Medical Benefits [EOB]. The following is an example of information that patients have access to through the Internet.

Fraud and Abuse

NHIC Medicare is responsible for overseeing how your health care dollars are spent. This involves watching how physicians and suppliers submit bills. NHIC works with the Health Care Financing Administration (HCFA-CMS), Office of Inspector General (OIG), Federal Bureau of Investigation (FBI) and the United States Attorney’s Office, to develop suspected fraud and abuse cases. This team approach has resulted in numerous criminal convictions and civil monetary recoveries.

Patients: We Need Your Help!

While the vast majority of providers are honest, there are some who defraud and abuse the system — misusing money that supports your health care. Fraud adversely affects everyone in the form of higher health care costs. With your help, we can identify abusers and halt this costly waste of your health care dollars.

Fraud can take many forms — some obvious and some not so obvious. Fraudulent acts include, but are not limited to, practices like:

· Billing for services or supplies that are not provided or requested.

· Billing for non-covered services as if they were covered services.

· Misrepresenting a patient’s diagnosis.

· Submitting false claims.

· Paying for referral of patients.

· Altering claim forms and records. 

These are just a few examples of the most obvious forms of fraud. Other activities are not so obvious but are fraudulent acts nonetheless. These include changing the date of service so that it falls within a patient’s coverage period, or billing for services over a period of days when all treatment was given during one visit.

How Patients Can Help Detect Fraud

Patients are in a good position to detect and report Medicare fraud and abuse. Patients should read the Explanation of Medicare Benefits (EOMB) forms carefully. Make sure that the information on their EOMBs matches the services received. For example, patient should:

· Look at the type and number of services provided.

· Look at the dates services were provided.

· Look at the services billed to determine if received. Look at the Medicare payment to the doctor or supplier to determine if he or she was paid for more services than received or was paid for services not needed.

· Do not lend your Medicare card to anyone. If your card is lost or stolen, report it to your nearest Social Security office immediately.

What to Do If You Suspect Fraud (Patients)

If you know or suspect that a physician, supplier or hospital may be committing fraud or abuse, or if you would like someone from Medicare to talk to your group about Medicare fraud and what you can do to help stop it, please write or call your local Medicare carrier.

Assessment

Link: www.HealthcareFinancials.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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

Our Other Print Books and 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

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Free Job Post Sign-Up

ME-P Resume Posting Service

New Beta Feature

Staff Writers

56386942With President Obama’s $790 billion stimulus package being voted on recently, now is the perfect time to post your resume and sign up for job alerts, as Obama says this package could result in the creation of 3.5 million jobs.

Postings – Named or Remain Anonymous

Anonymous or named resume posting and job alerts are just two of the ways we help you find the healthcare administration, economics, HIT or finance position you’re looking for.

Link: https://healthcarefinancials.wordpress.com/category/classified-ads

Special Features

Our job board will enable you to:

  • Search specifically the healthcare industry.
  • Access other positions at providers, payers and vendors.
  • Post an anonymous or named resume.
  • Subscribe and check back with us for all daily content. 

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Now in beta, we are at your service and will grow going forward.  

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

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Some Insight on Medicare Advantage Plans

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Enter the Bounty Hunter Insurance Agents

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[By Dr. David Edward Marcinko; MBA]

[Publisher-in-Chief]

As a health insurance agent and industry insider for more than a decade, I know first hand that the agents and brokers who enroll senior citizens in Medicare Advantage (MA) plans often make more on those members than the health plans themselves. 

Example:

For example, up to $400-600 can be spent on an insurance agent/broker fee by the health plan, contributing to a total member acquisition cost that can exceed 10% of the premium dollar. And, this commission fee or bounty on “grandma” – much like a bulls-eye target on her back – was much higher back in the day. Hence, all the “free” seminars, luncheons, trinkets and other senior citizen freebies cloaked as information dissemination.

Acquisition Costs High

Even if Medicare Advantage plans could deliver the actual health care benefits at a considerably lower cost than traditional Medicare Fee for Service (FFS); it is very possible that the entire savings could be consumed by member acquisition costs.

Assessment

Now, as a doctor, insurance agent, financial advisor, health economist and future MC patient, I believe that traditional Medicare is a very tough act to follow; and is still the best deal around, by far. Now, try to convince my dad.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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PHYSICIANS: www.MedicalBusinessAdvisors.com
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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Welcome Valued Vendors

Dear Colleaguesaward-cup2

Many thanks for reaching out to us.

Advertise with Us

If you want the opportunity to reach a personalized daily/weekly audience of health care industry insiders, innovators and watchers, the Medical Executive-Post may be right for you?

Movers-Shakers

We are discussed, read and viewed by medical students, physicians, dentists, podiatrists, optometrists and industry analysts; as well as healthcare administrators, financial advisors and planners, accountants, lawyers, office managers, CXOs, investors, Wall Street insiders and nurse-executives from health systems around the country.

Advertise with us and you’ll put your brand name in front of a smart & tightly focused Health 2.0 demographic; one at the forefront of our emerging healthcare marketplace of collaboratively informed, thought-leaders and professional “movers and shakers.”

 

Contact Us

And so, please feel free to contact us for additional sponsorship and/or advertising information.

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Ann Miller

Executive Director

Video on Remote Health Data Capture

Oracle’s Next-Gen Electronic Data Capture [EDC]

By Staff Reporters

computer-hardware1

See why Oracle’s RDC [Remote Data Caputer] Onsite is the next generation in electronic health information data capture, with its user-friendly method to collect, clean, review and verify clinical trial data.

Remote Data Capture Onsite

Providing unprecedented performance with real-time data capture, Oracle RDC Onsite simplifies source data verification.

Assessment

With a clear, consistent view of study data across all sites, benefits include reduced monitoring time, decreased queries and discrepancies and less time to database lock. 

Conclusion

Download this free video now, and then please comment and opine.

Link: http://assets.fiercemarkets.com/public/ads/oraclevideo/13634-oracle.swf 

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Health Reform, the Stimulus and Hitler’s Aktion T-4

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Overhauling the American Healthcare Industry

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dr-david-marcinko11

According to the Washington Times on February 11, 2009, a secreted House version of the new economic stimulus bill that President Barack Obama is trying to rush through Congress, may contain the germ of a major overhaul of the American health care system befitting German State of yester-year?

National Coordinator of Health Information Technology

For example, one provision causing much concern is the future role of the National Coordinator of Health Information Technology [NCHIT]. This is the organization that will be in charge of collecting and monitoring the health care being provided to every American. We have already commented, written, posted and warned our readers and subscribers about this item in our ME-P.

Link: https://healthcarefinancials.wordpress.com/2009/02/11/illuminating-the-congressional-federal-health-board

Hitler and Aktion T-4

The notion seems fully in the spirit of the partisans of efficiency, but historically may have originated from a program instituted in Hitler’s Germany – called Aktion T-4; as insinuated in the Time’s article. Under this program, elderly people with incurable diseases, young children who were critically disabled and others who were deemed non-productive, were euthanized. This was the Nazi version of efficiency, a pitiless expulsion of the “unproductive” members of society in the most expeditious way possible.

Link: http://en.wikipedia.org/wiki/T-4_Euthanasia_Program

Assessment

According to blogging tipster Matt Holt, and most right-minded folks, the Washington Times should be very careful before it starts comparing the people who support an improved national health care IT infrastructure to Hitler, and suggesting that they advocate mass slaughter of sick people.

Link: http://www.washingtontimes.com/news/2009/feb/11/health-efficiency-can-be-deadly

Industry Index Indignation Rating: 98

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

 

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NEW: Health Industry Indignation Index

Foibles of Industry Movers-Shakers

New Beta Feature

By Staff Reporterssubmission-frenzy3

What it is – How it works

The Industry Indignation Index [III] is an occasional survey feature of the Medical Executive-Post. Our goal is to chronicle the dubious, ironic or humiliating behavior that we humans in the healthcare industrial, financial and health economics complex are prone to do or say. Related sectors are fertile topics, as well.

Our Industry Indignation Score Card

The mathematical scores measured on a scale of 1 [just smelly and cheesy] – to 100 [utterly indignant and totally shameless] are subjective and not-statistically significant. They are non-representative samples however, of the obnoxious behavior of some in the news and their public foibles. 

User Generated Content

Feel free to send in your items, stories or political gossip for consideration.  We will rate-em, rank-em, post-em, and do the rest for you!

Conclusion

And so, your thoughts and comments on this new Medical Executive-Post feature are appreciated.

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

Our Other Print Books and 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

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AMA Sues to Keeps Medicare Claims Data Private

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AMA Wins Appeal to Blind Consumers’ Checkbook

[By Dr. David Edward Marcinko; MBA]human-drones

The Centers for Medicare and Medicaid Services [CMS] does not have to turn over physician-specific Medicare claims data requested by not-for-profit Consumers’ Checkbook under the Freedom of Information Act, the U.S. Circuit Court of Appeals for the District of Columbia ruled in an opinion delivered January 30th.

AMA and DHHS

According to Gregg Blesch of Modern Healthcare, on 2/2/09, the American Medical Association [AMA] joined the Department of Health and Human Services [DHHS] in appealing a 2007 decision that the data should be subject to disclosure, but the appeals court concluded the physicians’ privacy interest outweighs the consumer group’s assertions that the data would be used in the public interest.

Three Decade DHHS Legal Conundrum

DHHS, meanwhile, was not concerned so much with privacy as with its own legal conundrum involving a 1979 federal injunction barring the release of Medicare data that identifies individual physicians. A 2008 statement explaining the decision to appeal said the department “recognizes and shares the goals of Consumers’ Checkbook” and was seeking a legal way for the government to share Medicare claims data as part of its own quality initiatives.

Link: http://www.ama-assn.org

About Consumer’s Checkbook

Consumers’ Checkbook/The Center for the Study of Services is an independent, nonprofit consumer organization founded in 1974 with the help of funding from the U.S. Office of Consumer Affairs. Its’ purpose is to provide consumers information to help them get high quality services and products at the best possible prices. The organization is supported entirely by subscription payments and donations from individual consumers who subscribe to its magazines, and by fees for surveys, and information services and books. They do not accept donations from businesses and their publications carry no advertising.

Link: http://www.checkbook.org

About the AMA

The home page of the AMA website states the organization is “helping doctors help patients.”  Is this really the case; or mere rhetoric? Is it true that less than 20% of the nations MDs are members?

Assessment

Consumers’ Checkbook said it would use the data to show the frequency with which physicians performed certain procedures; expose how much Medicare pays physicians who have disciplinary histories or poor evaluations; and determine whether they were fulfilling standards of recommended care. The court found each argument wanting.

Industry Indignation Index Rating: 85

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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About XYZmoAmerica.com

Digital Solutions for Healthcare

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By Jared Sayovitz

XYZmo digital signature solutions is a leading technology provider for universal, digital signature solutions, which secure and optimize your healthcare administration and business documents.

The Urgent Need

Paper-based processes are rapidly being replaced by electronic workflows. Whenever paper is involved, a large amount of time and money is wasted and security risks increase. Most companies today automate their business process and document workflow procedures, leaving the approval stage the only component that requires the use of paper. Signing the original electronic document saves companies on labor, faxing and mailing costs. Additionally, digital signatures safeguard electronic documents and files by allowing the authentication of the signatory and verification of the original document content.

Healthcare Space Solutions

XYZmo provides medical e-Signature, e-Sealing & healthcare e-Verification solutions for:

  • e-Prescriptions.
  • e-Patient registration.
  • Integration into Electronic Health Records (eHRs).
  • Physician orders.
  • Mobile signing.
  • Informed consent.
  • Business to business processes.
  • Purchase order approvals.

Contact Info

Jared Sayovitz

Xyzmo – 5909 West Loop South

Suite 555 – Bellaire, TX 77401

Phone: 713.482-6793 and e-Mail: jared@xyzmoamerica.com

website: www.xyzmo.com

Assessment

Digital white-papers:

http://www.xyzmo.com/en/resource-center/Pages/digital-signature-white-papers.aspx

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated; especially from any early HIT adopters.

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Illuminating the Congressional Federal Health Board

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A Next-Gen -or- Last-Gen National Model  

[By Dr. David Edward Marcinko; MBA, CMP™]

[By Staff Reporters]

 

 

 

 

 

 

Beware; all Medicare and other private health insurance recipients.

Why?

On December 4, 2008, and according to Robert E. Moffit PhD, the Director of the Center for Health Policy Studies [CHPS] at The Heritage Foundation, Presidential Obama proposed the creation of an institute that would judge the “comparative effectiveness” of medical treatments, procedures, and therapies, as well as drugs, devices, and technologies.

Congressional FRB Model

This Congressional Federal Health Board [FHB] would be modeled on the Federal Reserve Board [FRB] with a governing body of politically appointed experts, but “insulated from politics” and  possess many powers similar to the proposed National Health Board [NHB], a key feature of the ill-fated Health Security Act [HSA] of 1993.

New Health Board

This new health board would also:

  • Set the rules for health insurers who would participate in a national health insurance exchange and recommend benefits coverage, including drugs and medical procedures backed by “solid evidence”;
  • “Rank” therapies and medical services based on their cost effectiveness;
  • Suggest priorities for medical research; and
  • “Align incentives with the provision of quality care,” as defined by the health board, through Medicare-style “pay for performance” rules for doctors and other medical professionals who comply with government practice guidelines.

Assessment

For ordinary Americans unsatisfied with the new Federal Health Board, there would be little recourse since it would likely be independent of Congress and the White House. For medical providers, according to Hope Hetico; RN, MHA of this Medical Executive-Post, it would be an operational nightmare that makes the managed care logistical problems of condition coverage, pre-certifications and pre-treatment authorizations, etc., seem a non-issue.

In other words, is this new FHB really the next-generation of medical collaboration and communication vis-a-vie health 2.0; or just another bloated last-generation command control model?   

Link: http://www.heritage.org/research/healthcare/wm2155.cfm

Conclusion

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About FDIC.gov

What it is – How it works

Staff Reporters

handcuffsThe Federal Deposit Insurance Corporation (FDIC) preserves and promotes public confidence in the US financial system by insuring deposits in banks and thrift institutions for up to $250,000 (through December 31, 2009); and by identifying, monitoring and addressing risks to the deposit insurance funds; and by limiting the effect on the economy and the financial system when a bank or thrift institution fails

Mission

The FDIC is an independent agency created by the Congress that maintains the stability and public confidence in the nation’s financial system by insuring deposits, examining and supervising financial institutions, and managing receiverships.

Vision

The FDIC is a leader in developing and implementing sound public policies, identifying and addressing new and existing risks in the nation’s financial system, and effectively and efficiently carrying out its insurance, supervisory, and receivership management responsibilities.

The Website

The website www.FDIC.gov has these tabs-of-interest:

  • Deposit Insurance
  • Consumer Protections
  • Industry Analysis and Analysis
  • Regulations and Examinations
  • Failed Bank Information
  • Institutional Asset Sales
  • Breaking News and Events

Assessment

This site is an excellent resource for physicians, financial advisors, medical executives and all investors in this time of national economic crisis:

For more information:

Federal Deposit Insurance Corporation
Consumer Response Center
2345 Grand Boulevard, Suite 100
Kansas City, MO 64108-2638
Fax Number (703) 812-1020

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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

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A Six Sigma Emergency Department Case Report

Emergency Department Diversions

By Staff Writersbiz-book1

According to Daniel L. Gee MD MBA, Scottsdale Healthcare in Arizona used consultants from Creative Healthcare USA on a recent project, rather than doing a full deployment of Six Sigma in its organization, to analyze its problem of emergency department (ED) “diversions.”

Emergency Department Diversions

Diversions happen when emergency departments are too full in capacity to handle acute emergencies and a decision is made to close its doors to patients and ambulances are diverted elsewhere. The issue of closed and diverted emergency rooms is a growing nationwide phenomenon because of fewer EDs and a growing aged and uninsured population. The consultants, using Six Sigma principles, mapped the ED process and found multiple bottlenecks that have a direct effect on the probability of evoking a “diversionary” status in the emergency room.

Out of Control Bottlenecks

One bottleneck process deemed “out of control,” in Six Sigma jargon, was the issue of bed control. A process is considered “in control” when operating within acceptable specification limits. It was found that the average transfer time for a patient admitted to a hospital bed from the emergency department was 80 minutes, of which half of this time, a bed is available and waiting. The process was a significant “waste of time” and, moreover, complicated by an Administrative Nurse “inspector” locating beds on different floors.

Sig Sigma Tenants

Two tenements of Six Sigma level of quality were violated: one is that having an inspection is a correction for an inefficient process and two, the more steps involved the less is the potential yield of a process. Through this revelation, the hospital eliminated the Administrative Nurse, reduced cycle time by 10% in bed control, and improvement ED throughput with greater turnover thereby, improving revenue by nearly $600,000.

Little’s Law

The addition of a nurse inspector and waiting patients in a busy ED is an example of “Little’s Law” or sometimes referred to as the first fundamental law of system behavior. When more and more inputs are put into a system, such as more ED patients and an additional nurse employee, and when there is variation in their arrival time (no control over patient arrivals) or process variation (different people doing the same things differently), there becomes an exponential rise in “cycle time.” Productivity of the system begins to fall and inefficiency and variation creeps in.

Assessment

An examination of the project types to which health care provider organizations have utilized Six Sigma methodology reveals almost any hospital or medical clinic process is a candidate.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is Six Sigma a real medical quality control initiative that’s here to stay; or just another passing fad?

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

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A Due-Diligence ‘Condom’ for Physician Investors

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Using Financial Advisors with Increased Safety

[By Dr. David Edward Marcinko; MBA, CMP™]dr-david-marcinko8

Following the Bernie Madoff investment scheme, and related financial industry scandals, here are seven “red-flags” that should have alerted physician-investors to proceed with extreme caution. Always consider them before making an investment with any financial advisor [FA], registered representative [RR] or financial advisory firm, regardless of reputation, size, referral recommendation or so-called industry certifications and designations. In other words, according to Robert James Cimasi; MHA, AVA, and a Certified Medical Planner™ from Health Capital Consultants LLC, of St. Louis, MO;” trust no one and paddle your own canoe.”

Red Flags of Cautious Investing

As a former insurance agent, financial advisor, registered representative, investment advisor and Certified Financial Planner™ for more than a decade, the existence of any one of the following items may be a “red-flag” of caution to any investor:

  • Acting as its’ own custodian, clearance firm or broker-dealer, etc.
  • Lack of a well-known accounting firm review with regular reporting.
  • Unreliable or sporadic written performance reports.
  • Rates-of-return that don’t seem to track industry benchmarks.
  • Seeming avoidance of regulatory oversight, transparency or review.
  • Lack of recognized written fiduciary accountability in favor of lower brokerage “sales suitability” standards.
  • No Investment Policy Statement [IPS]. 

Assessment

Let a word to the wise be sufficient going forward. But, in hindsight, a healthy dose of skepticism might have prevented this situation in the first place. As is the usual case, fear and greed often seem to rule the day. Just as there is no such thing as safe sex – just safer sex – there is no thing as safe intermediary investing. But, exercising some common sense will surely make investing with any financial advisor much safer. It’s like a condom for your money. 

For more information on the topic of fiduciary standards – which we have championed for the last ten years in our books, texts, white-papers, journal and online educational Certified Medical Planner™ program for FAs – watch out for our exclusive Medical Executive-Post interview with Bennett Aikin AIF®, Communications Coordinator of www.fi360.com coming in March. Ben, an Accredited Investment Fiduciary® did a great job with the tough questions submitted by our own Ann Miller; RN, MHA and Hope Hetico; RN, MHA, CMP™. Don’t miss it!

Disclaimer

I am the Managing Partner for http://www.CertifiedMedicalPlanner.org and I agree with this message.

Conclusion

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Tragedy at William Beaumont Army Medical Center

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Thousands at Risk from Needle Contamination

[By Staff Reporters]

56372274

According to Derek Shore of Veterans Today, on February 7, 2009, the Army Medical Center announced that 2,114 diabetic patients treated at the hospital may be at risk for contracting blood-borne illnesses.

Improper Insulin Injections

Hospital administrators reported to local station, KFOX, that diabetic patients at the hospital were being injected with insulin improperly. A medical injection pen was being used on more than one patient. Even though the needle was changed with each patient, there are fears the insulin reservoir may have contained diseases from past patients, which has sparked the fear of contamination.

Assessment

Doctors said the patients could be at risk of being given blood-borne diseases from August 2007 until Friday, February 6, 2009.

William Beaumont Army Medical Center has set up a toll-free hotline at 1-866-770-0194.

Link: http://www.veteranstoday.com/modules.php?name=News&file=article&sid=4726

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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IBM and Google Health

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[Partners for Online Personal Health Records

By Staff Reporters]

computer-hardwareAccording to MarketWire, February 5, 2009, IBM, Google and the Continua Health Alliance [CHA] announced new software that will enable personal medical devices used for patient monitoring, screening and routine evaluation to automatically stream data results into a patient’s Google Health Account [GHA] or other Personal Health Records [PHR].

PHR Value Extension

This breakthrough extends the value of PHRs to patients and also helps to ensure that such records are current and accurate at all times. Once stored in a PHR, the data can also be shared with physicians and other members of the extended care network at a user’s discretion.

Daschle and e-Health Reform

Of course,Tom Daschle’s recent decision to withdraw his nomination as the Department of Health and Human Services [DHHS] secretary clouds hopes that President Obama will make significant progress on health-care reform in his first 100 days in the White House. But the problems of unaffordable medical bills and millions of uninsured are not going away, and a deepening recession has more Americans feeling worried about their jobs and insecure about their health benefits.

Assessment

The breakthrough of this triumvirate extends the value of PHRs to consumers and also helps to ensure that such records are current and accurate at all times. Once stored in a PHR, the data can also be shared with physicians and other members of the extended care network at a user’s discretion.

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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Hospital Financial Capital Capacity

An Economic Risk Measurement

By Calvin Weise; MBA, CPAho-journal5

Hospital capital capacity is all about risk.

A Risk Measurement

Since capital investments have risks associated with them, capital capacity is a measurement of how much risk a hospital can bear. Capital capacity is not simple to determine. Capital investments introduce varying levels of risk, depending on the relative uncertainty of the benefits to be derived.

For example, one million dollars invested in an MRI at a hospital that has a two-month backlog for scheduling MRIs has much lower risk than $1 million invested in a new service like a PET scanner.

Profit Margins

Profit margins affect capital capacity. Larger profit margins create larger capacity for uncertainty which implies more risk and that means more capital capacity. Higher liquidity means more capital capacity. Lower debt leverage means more capital capacity. Liquidity and leverage are balance sheet ratios. Both imply capacity to absorb uncertain outcomes; both affect capital capacity.

Capital Determinations

Determining capital capacity is more art than science because of the variability in risk presented by various capital investments and the subjectivity associated with trying to measure that uncertainty.

That having been said, it is important to build models that estimate capital capacity. Most capital capacity models ignore the variability in risk presented by capital investments. They are typically built from published rating agency financial ratio medians. These models are based on the view that financial ratios of similar rating categories represent equivalent risks.

Of course, this is a simplistic view as it suggests that credit analysts simply categorize risk on the basis of financial ratios. It is not the case as the recent financial meltdown has demonstrated. Even the major credit rating agencies have been implicated as suspect; of late

Assessment

Published medians are the result of credit analysis, not the basis for credit analysis. Importantly, what is not usually published is the range or distribution around these medians. Models that estimate risk need to differentiate among risks presented by capital investments. Capital investments with little risk should consume less capital capacity than capital investments with a lot of risk.

Link: www.HealthcareFinancials.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How does your practice, medical clinic or hospital measure and report capital risk; does it?

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

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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

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Wi-Max 2 the Medical-Max

An HIT Report from the Inner City Trenches

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dr-david-marcinko4

While not an IT guru by any means, I am a prudent fan of health IT where appropriate, and have always been a bit on the curious side.

A Bit about Me

OK; I am a member of the American Health Information Management Association (AHIMA) and the Healthcare Information and Management Systems Society (HIMSS). I am also a beta-tester for the Microsoft Corporation, a member of the Microsoft Health User’s Group (MS-HUG) and the Sun Executive Boardroom program sponsored by CEO Jonathan Schwartz; as well as SUNSHINE [Solutions for Healthcare Information, Networking and Education [NASD/FINRA-JAVA]. I also was fortunate to just finish editing the Dictionary of Health Information Technology and Security, with Foreword by Chief Medical Information Officer Richard J. Mata; MD MS MS-CIS of Johns Hopkins University.

And, I was incredibly lucky to have  my colleague Ahmad Hashem; MD PhD, who was the Global Productivity Manager for the Microsoft Healthcare Solutions Group at the time, to pen the Foreword to the second edition of my book, the Business of Medical Practice

And so, it was with the pleasure of potential intellectual satiety that goaded me into testing the airwaves, so to speak, on my recent visit to my home town of Bal’more. Thus, this exclusive ME-P report follows.

Location … Location … Location

If you lived in San Francisco a few years ago, during the ill-fated and costly WiFi experiment, you have my sincere condolences. If you live in Baltimore however, and want to have fast, wireless Internet speeds, then congratulations because you’ve chosen your place of residence wisely. Me, I’m an ex-patriot who was ecstatic when Sprint announced in October 2008, that Baltimore would be the first US city to have access to its new Wi-Max mobile data network; known as Xohm. I visit my home town 3-4 times, annually.

About the Wireless Xohm Data Network

Xohm is a wireless data service which, thanks to its WiMax capability, reportedly provides broadband-like speeds on a wireless PC. With this, as long as you have a WiMAX adapter and can pay for the service, the Internet should be available anywhere within the city. For home use, service for WiMAX costs $25 per month for six months, and $35 per month after that. Laptop access was to be $30 per month for the first six months. If you’re just visiting the city, single day access will cost $10, which is a bit steep, but not bad compared to the price of Wi-Fi access in some airports. Or, their unsecure networks were purported free; anywhere in the city. This was the object of my informal beta-testing activities.

computer-hardware2

City of Baltimore

My neighborhood, in Baltimore, is known as the historic Fell’s Point District. It was founded in 1670 by William Cole who bought 550 acres on the Inner Harbor, downtown. English Quaker, William Fell then bought land he named “Fell’s Prospect”. The land was also known as “Long Island Point” and “Copus Harbor”.

This area was the ideal hostile site for the Wi-Max experiment. The surrounding neighborhoods are composed of many dense, old-brick and stone-masonry buildings, with abundant large expanses of Chesapeake Bay with its related estuaries and inlets. Local gossip about the experiment suggested that if it was successful in this hostile Baltimore environment, it would like be successful in more modern American cities.

Link: http://www.fellspoint.us/history.html

Test-Laptop Specifications

I used my daughter’s [age 12, eighth-grade] Dell Latitude D600 laptop PC, running a Windows XP professional downgrade, with an Intel® P4 micro-processor [1.4 GHZ, 512 MB, 30 GIG CD with 24X CD-RW/DVD] for data only. It was originally purchased used – not new – for a few hundred bucks and badly in need of some upgrades. For the test, we added 512 MB LT DDR PC-3200, and a wireless LINKSYS PCMCIA card [WPC54GX].

Network Results

First, set up was a snap. While the network is expansive, it was not exactly blazingly fast, at least not for unsecure roaming access. The network can provide “download speeds of 2 to 4 megabits per second“. While, it is faster than most cellular networks, the service is nothing compared to some home internet connections. Although, the option to use it on a laptop is useful, the 4 Mbps is good enough for checking email or other smaller, lower bandwidth internet surfing usages. It’s hard to say if these estimates actually hold up with a lot of people using the network at once, especially if you are far from a broadcast tower – or in a funky part of the city – which is everywhere. But, they seemed to work quite well. My daughter, wife and I were suitably impressed.

Of Medical PACS

Of course, we also talked to local town folk about their free unsecured use. All were pleased with the Baltimore experience. We found business, law, nursing and graduate school students who were ferocious users. We even found medical students using open network wireless PCAS. To the uninitiated, picture archiving and communication systems (PACS) are computers or networks dedicated to the storage, retrieval, distribution and presentation of digital radiology images. The medical images are stored in an independent format. The most common format for image storage is Digital Imaging and Communications in Medicine [DICOM].

Roll-Put in Other Cities

Apparently, Sprint plans on releasing Xohm WiMAX networks in Chicago and Washington DC, this year.  While they are both major cities, it is hard to speak for just how well the WiMAX works when you’re sitting in Atlanta, GA. Should these networks actually get some decent use, perhaps the service will be released in more markets. I just don’t know.

About NETGEAR

Local Baltimore provider NETGEAR has been a worldwide leader of technologically advanced, branded networking products since 1996. Their mission is to be the preferred customer-driven provider of innovative networking solutions for small businesses and homes.

Link: federal@netgear.com

Assessment

As an old city, Baltimore has a rich medical heritage. There is the University of Maryland School of Medicine, Dentistry, Nursing and Pharmacy. Up the street from the Inner Harbor are the famed Johns Hospital School of Medicine and the Kennedy School of Public Health. It is here where I played stickball, as a child, in the parking lot. Nevertheless, given the high demands of business networking security and emerging network management in the local, State and Federal space today, NETGEAR is reported to have an end-to-end solution to meet most agency needs. This did seem to be the case in my ad-hoc experiment. We always found an open channel, and dropped links were few and far between; usually while mobile or riding in an automobile, bus, train or high-rail transportation system.

Link: http://www.freewimaxservice.net

Conclusion

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About Free-Labor Contributing Authors

The Most Important Medical Executive-Post Asset

By Hope Rachel Hetico; RN, MHA

Managing Editorhetico4

The Medical Executive-Post is a knowledge aggregator of user-generated content. It is a network where users share, recommend, rank and comment on professional submissions by experts and thought-leaders. We believe that better submissions, lead to better actionable knowledge and professional lives.

Great information can also help us do, become and experience the professional goals and accomplishments that make us happy and more successful. Our mission is to help people discover and use this deeply gratifying electronic and/or print content.

Content Broadcasting

Every Medical Executive-Post is submitted by members of our community. You send-in content and comments, and we rate the clicks as recommendations on this blog. We call this ranking process “content-broadcasting.” It increases your exposure and helps to establish and disseminate your uniquely professional brand-image. Your submit content, and we do the rest.

A Niche Industry

When you make a submission, click-on a post or make a comment, you are in-effect saying that you think the content is worth reading and spending time to review. You are answering the question, “What do I need to know and where can I find the answer“, for people who share your interests and passion in the healthcare industrial complex and related health economics and nice practice management space.

Built by Free-Labor Entrepreneurs

The Medical Executive-Post is a privately-funded Web 2.0 company. We are committed to improving the overall quality of deeply specific Internet content search experiences by offering this utility platform for professional user-generated content and recommendations. The Medical Executive-Post was initially built by a team of seasoned Internet entrepreneurs, editors, and bloggers. But you, our free-labor entrepreneurs and contributing authors are now our most important long-term survival asset. Thank you.submission-frenzy

Assessment

To see what else we are up to; please visit our related websites, links, books and products on each side-bar. Learn how your bottom-up efforts – become valuable real-world print content.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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

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Health Administration Terms: www.HealthDictionarySeries.com

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Kahn-Bahn and Patient Focused Healthcare

What it is – How it works?

Staff Writersaward-cup1

 

One competitive trend currently emerging is patient-focused healthcare, which focuses on patient needs and attempts to humanize patient care. Patient-focused healthcare therefore incorporates the following:

· patient education;

· active participation of the patient;

· involvement of the family;

· nutrition;

· art; and

· music. 

Improving Patients Outcomes

The above, of course, are thought to improve patient outcomes. Furthermore, some think that patients will benefit from learning how to cope with healthcare processes before they enter into those processes and that this knowledge will result in better outcomes.

An example of this would be classes to prepare couples for childbirth. These classes teach prospective parents the different stages of labor and strategies for dealing with the challenges associated with each stage. They cover options for pain management such as breathing and relaxation techniques and/or analgesics. The classes also provide education about clinical options such as induced labor and caesarian sections, and they cover practical issues such as what to wear and what kind of car seat to buy to transport the newborn home.

***

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Business Processes Re-Engineering

As a result of this movement, some healthcare organizations have tried to re-engineer the processes by which care is delivered in order to make it more patient focused. This is accomplished, in large part, by bringing the therapy to the patient rather than bringing the patient to the therapy.

For example, storing more supplies and equipment in the patient’s hospital room means that more services can be performed in the room. Obviously, this trend has significant implications for the operations management function in healthcare organizations in the areas of layout and human resources management. Supplies and equipment may be arranged differently to facilitate patient-focused care. Considerable staffing changes and cross training may be in order, to provide this type of service. Changes in facility layout to implement patient-focused care and reduce nonproductive movement of patients and personnel should be considered, especially when a facility is contemplating expansion or renovation of facilities.

Assessment

Kanban (kahnbahn) is the Japanese word that when translated literally means “visible record” or “visible part”. In general context, it refers to a signal of some kind.  Thus, in the business process manufacturing and re-engineering environment, kanbans are signals used to replenish the inventory of items used repetitively within a facility. The kanban system is based on a customer of a part pulling the part from the supplier of that part. The customer of the part can be an actual consumer of a finished product (external) or the production personnel at the succeeding station in a manufacturing facility (internal). Likewise, the supplier could be the person at the preceding station in a manufacturing facility. The premise of kanbans is that material will not be produced or moved until a customer sends the signal to do so.

The leap to hospital and healthcare organization re-engineering is thus not a great one.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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Health Insurance versus Mental Health Parity

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Understanding Physical Health and Mental Health Insurance

By Carol Miller; RN, MBA

Carol S. Miller

There is a difference between the benefits covered under medical insurance compared to those covered under mental health benefits.

Mental Health Parity Act

There has always been a disparity resulting in caps on the annual number of visits allowed, higher co-pays, higher deductibles, and reduction of covered benefits such as partial hospitalization and number-of-treatment limits for mental health. Congress touched on this issue in 1996 with the Mental Health Parity Act. This federal law prevented group health plans from placing annual or lifetime dollar limits on mental health benefits that are lower¾less favorable¾than annual or lifetime dollar limits for medical and surgical benefits.

Group Health Plan Exclusions

However, the law did not require group health plans and their health insurance issuers to include mental health coverage in their benefits package¾it only applied to group health plan insurances that already did include mental health benefits in their benefit package.

MHETA Attempts at Correction

In 2003, Senators Pete Domenici, Edward Kennedy, and Representatives Patrick Kennedy and Jim Ramstad introduced S. 486 and H.R. 953, called the Mental Health Equitable Treatment Act. In March 2005, the Mental Health Equitable Treatment Act [MHETA] was passed and with the passage of this bill a loophole – insurers may no longer arbitrarily limit the number of hospital days or outpatient treatment sessions for people in need of mental health care – was closed.

Assessment

Nevertheless, even though states are encouraged by the government with this new bill to enact stronger parity laws, the final decision of parity still rests with the states.  Many states have not enforced the law and therefore, insurers may still be inclined to limit

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Why the mental versus medical health care insurance disparities?

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