July | 2009 | The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants

Hand Washing for Healthcare Facilities

Posted on July 31, 2009 by Dr. David Edward Marcinko MBA

Understanding OSHA Standards

[By Dr. David E. Marcinko; FACFAS, MBA, CPHQ, CMP™]

[By Patricia A. Trites; MPA, CHBC, CHCC, CMP™ (Hon)]

The OSHA Standards for healthcare require that hand washing facilities be readily available to employees.

Definition

Hand washing facilities are defined as a facility providing an adequate supply of:

running potable water;
antiseptic soap; and
single-use disposable towels or hot air drying machines.

Location

The hand washing facilities must be located where the employee will have easy access. This will ensure that the employee will be likely to use the hand washing facility and will minimize the time that the contamination will remain in contact with the employee. In those instances where the provision of hand washing facilities is not feasible, either an appropriate antiseptic hand cleaner (e.g., alcohol-based rinse, antiseptic foam, or antiseptic-impregnated paper wipes) in conjunction with clean cloth or paper towels, or antiseptic towelettes, must be provided.

Soap and Running Water

When using antiseptic hand cleansers or towelettes, the hands must be washed with soap and running water as soon as feasible. Not only must the employer provide the hand washing facilities, he or she must also ensure that employees in fact do wash their hands immediately or as soon as feasible following contact with blood or other potentially infectious material [OPIM].

The employee must also wash his or her hands immediately after removal of gloves or other personal protective equipment [PPE]. It is the employer’s responsibility to ensure that hand washing occurs. OSHA states that hand washing must be strictly enforced by the employer.

***

Assessment

How has OSHA affected your hospital, medical practice or healthcare facility?

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Conclusion

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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:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: "Doctors Only", Career Development, Glossary Terms, Health Law & Policy, Practice Management, Quality Initiatives, Recommended Books, Risk Management | Tagged: Charles Fenton, hand washng, OPIM, OSHA, other potentially infectious material, Pati Trites, personal protective equipment, PPE | 8 Comments »

About EHRWatch.com

Posted on July 30, 2009 by Dr. David Edward Marcinko MBA

A New Online Virtual Collaborative

By Staff Reporters

www.EHRWatch.com is a new online community dedicated to developments in electronic health records [eHRs], including practice, funding, product integration, standards developments and trends in implementation. The new site features blog posts, polling, commenting and a weekly e-newsletter.

A Collaborative

www.EHRWatch.com is designed to encourage community participation, interaction, collaboration and reaction. Whether you need to select and implement an EHR solution or make sure your current system meets the requirements and timeline necessary to receive the Obama Administration’s ARRA, and HITECCH, stimulus incentives, the site may offer the products, information, services and expertise to help.

Assessment

Visit www.EHRWatch.com to read the latest posts and join the virtual community. Just give em’ a click, today!

Conclusion

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Healthcare Organizations: www.HealthcareFinancials.com

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Filed under: Breaking News, Information Technology, Practice Management | Tagged: ARRA, CCHIT, EHRs, electronic health records, electronic medical records, EMRs, healthcare reform, HITECH, obama | 2 Comments »

Understanding Universal Healthcare Precautions

Posted on July 29, 2009 by Dr. David Edward Marcinko MBA

The OSHA Definition for Medicine

By Patricia A. Trites; MPA, CHBC, CHCC, CMP™ (Hon)
Dr. Charles F. Fenton, III; JD, FACFAS
Hope Rachel Hetico; RN, MHA, CMP™

www.HealthcareFinancials.com

OSHA defines universal precautions (sometimes referred to as “normal precautions”) as an approach to infection control whereby all human blood and certain human body fluids are treated as if known to be infected by HIV, HBV [hepatitis], or other blood borne pathogens.

Assessment

Universal precautions must be observed to prevent contact with blood; or; Other Potentially Infectious Materials [OPIM]. Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids should be considered potentially infectious.

Conclusion

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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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Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

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Filed under: Health Law & Policy, Practice Management, Quality Initiatives, Risk Management | Tagged: blood borne pathogens, Charles F. Fenton, HBV, HIV, Hope Rachel Hetico, OPIM, OSHA, Other Potentially Infectious Materials, Patricia A. Trites, universal infection precautions | Leave a comment »

Journal of the American Dental Association [Letter to the Editor]

Posted on July 28, 2009 by Dr. David Edward Marcinko MBA

ADA Image Tarnished?

[By Darrell K. Pruitt; DDS]

Dear Editor,

This is a sincere letter which I am sure you will agree should be published in the October 2009 edition of the JADA. Today is July 19, 2009. I am allowing for the six weeks minimum time it requires for letters to appear in print following their selection for publication. It will be posted on the Internet immediately. In spite of this, I trust you will eventually agree to publish it in spite of your archaic rules. Otherwise, by November, history could show that the editor of the JADA arguably denied representation of dental patients’ interests at a most critical time in the history of the profession. That would be regrettable for your own professional reputation as well as for the JADA’s. As an ADA member, if my concerns are ignored, I will hold you publicly accountable for an explanation for a long time.

Public Laundry

From now on, we will agree to wash our laundry in public because otherwise it doesn’t always come clean. You can call the pressure I bring unprofessional if you want, but following the ADA News’ public exhibition of their shoddy ethics this week, it would be foolish to use my methods as an excuse to deny my access to membership. As I am certain you are aware, there were three revisions of “ADA/idm to phase out service” on ADA News Online (7/10, 7/13 and 7/16). I not only welcome a wide-open public discussion about ethics in journalism with representatives of the JADA, but I encourage it. We both know that the ADA needs clean laundry now more than ever before in its history.

ADA Business Enterprises, Inc.

For members who haven’t heard, the 2 ½ year old joint venture of our ADA Business Enterprises, Inc. (ADABEI) with Intelligent Dental Marketing – a Utah-based private business – fell apart in late spring of this year. Months later, our ADA leaders are still less than transparent with membership about what went wrong. I’ve been in business long enough to know that if mistakes by employees are not revealed and discussed, they are bound to happen again and again. And, it’s not like the leaders of the ADA were not warned. They just didn’t take heed. By late 2007, many knowledgeable people involved in the dental industry easily recognized the faults in the partnership between our non-profit professional organization and a for-profit Utah advertising company. In hindsight, anyone can see that ADA/IDM’s slogan, “Image is everything,” clearly betrays an attitude inconsistent with both the mission of the ADA and the Hippocratic Oath. Nevertheless, even the spirit of the slogan was regretfully adopted by the leaders of the ADA’s Business Enterprises, Inc. Now it is the image of the entire ADA that is suffering the damage.

ADABEI

I personally began questioning the accountability of the tricky ADA/IDM business model over two years ago when the profits from ADABEI had officials excited about avoiding the need to raise membership dues last year. Not unexpectedly, in the atmosphere of euphoria, nobody in Chicago wanted to acknowledge the concerns of a handful of alert members. We were cast aside as troublemakers. So how critical is the risk? With massive, unprecedented health care legislation imminent, this is the worst time imaginable for our stoic, image-conscious officers to lead us to nation-wide embarrassment.

Following the Money

The surrender to such temptations for leaders of non-profit organizations is not unprecedented. Do you know why the dues for the American Association of Retired People (AARP) have been kept so low? Not unlike the ADA, the non-profit AARP reaps profits from insurance policies and other products that its leaders sell to membership – even using misleading ads in AARP dues-supported publications. However, unlike dues money, vendor “kickbacks” don’t depend on accountability to members. A few years ago, the profits derived from agreements with vendors predictably became the lifeblood for AARP’s self-perpetuating bureaucracy – eventually influencing their lobbying efforts. Since non-profits like the AARP and the ADA are traditionally respected by lawmakers who like huge campaign donations, a non-profit entity’s lobbyists can be tempted to quietly represent vendors’ interests at members’ expense. Sometimes they get caught.

Lost Confidence

Almost a year ago, the AARP lost valuable member confidence when the organization was forced to suspend sales of “limited benefit” health plans backed by UnitedHealth Group (of Ingenix fame). Sen. Chuck Grassley said the plans which leave policyholders vulnerable to tens of thousands of dollars in costs were sold by the AARP to naïve and trusting members using misleading marketing tricks – not unlike those used in the ADA’s promotion of ADA/IDM. Sen. Grassley sent a detailed letter to CEO Bill Novelli demanding answers to questions about health insurance plans promoted to over a million dues-paying AARP members. Grassley told USA Today reporter Julie Appleby that “Insurance is supposed to limit your exposure to the potentially high cost of a serious illness and these plans do the opposite.” (Nov 7 2008).

http://www.usatoday.com/news/health/2008-11-07-aarp-insurance_N.htm

Is AARP-level accountability as good as it gets?

I say no. Attention ADA members – It is my opinion that our leaders are losing the control of our professional organization. The recent failure of ADA/IDM isn’t the first glaring sign of trouble in Headquarters. Over a year ago, the executive director, Dr. James Bramson, was suddenly fired with no explanation. In fact, then President Dr. Mark Feldman commanded that the reasons for the firing will not be disclosed. Obediently, ADA leaders have so far maintained firm control of the top secret information which if released could somehow endanger dental patients (?). Because Bramson’s severance pay came from my dues and not out of Dr. Feldman’s pocket, I think I deserve to know more details. Otherwise, this mistake could happen again and again.

The ADA/IDM disaster is also not the only ADABEI embarrassment I see on the horizon. It is my opinion that CareCredit is also showing signs of silent desperation. On July 9, the officials of the wholly-owned ADA subsidiary purchased an ad on dentalblogs.com titled “Press Release: CareCredit Adds 24-Month, No-Interest [sic] Payment Plan” (no byline).

http://www.dentalblogs.com/archives/administrator/press-release-carecredit-adds-24-month-no-interst-payment-plan/

Even though I approve of the benevolence in the idea of extending credit to those with worsening dental problems – especially during these hard financial times for patients – the anonymous CareCredit (ADA) representative who posted the ad failed to respond to my timely and important question: “If the Red Flags Rule is not delayed for the third time in three weeks, how will it affect those who offer Care Credit?”

Assessment

Nor did he or she respond to my follow up response on July 13. “On July 9 at 4:54 pm, I submitted a sincere question concerning how the Red Flags Rules will affect ADA members who sign up for CareCredit. Instead of posting it with the promise of an answer, you regretfully chose to censor an ADA member. Today, July 13, I have a second and third question: Why did you ignore my first one and who is your boss?”

Conclusion

So far, I’m still waiting for responses to all three questions. I trust you will treat my concerns with more respect, Editor.

Conclusion

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Filed under: Breaking News, Career Development, Ethics, Health Insurance, Managed Care, Op-Editorials, Pruitt's Platform, Research & Development | Tagged: AARP, ADA, ADA Business Enterprises, ADA News, ADA News Online, ADA/IDM, ADABEI, American Association of Retired People, American Dental Association, Bill Novelli, CareCredit, Chuck Grassley, Darell Pruitt, DDS, denturist, DMD, Dr. James Bramson, Dr. Mark Feldman, Hippocratic Oath, Inc., Ingenix, Intelligent Dental Marketing, JADA, Journal American Dental Association, Julie Appleby, LD, red flags, red flags dentistry, UHG, UnitedHealth Group, USA Today | 4 Comments »

OSHA and Workplace Pathogen Control

Posted on July 26, 2009 by Dr. David Edward Marcinko MBA

Engineering and Medical Work Practice Controls

By Patricia A. Trites; MPA, CHBC, CHCC, CMP™ (Hon)
Dr. Charles F. Fenton, III; JD, FACFAS
Hope Rachel Hetico; RN, MHA, CMP™

Engineering and medical practice controls are methods used to isolate or remove bloodborne pathogen hazards from the workplace. These practices should be used to eliminate or minimize employee exposure by removing the hazard or isolating the employee from the exposure. However, where occupational exposure remains after institution of these controls, personal protective equipment [PPE] must be employed, as described below.

Engineering Controls

Engineering controls can be described as those an employer purchases and makes available to protect his or her employees. Examples are sharps containers, eye-wash stations, spill-kits, and safer needle systems. It is the employer’s responsibility to implement and maintain a system for ensuring engineering that controls are used. The engineering controls must be examined and maintained or replaced on a regular schedule to ensure their effectiveness. Conducting only an annual review of the engineering controls is inappropriate under the OSHA Standard.

Healthcare Work Practice Controls

Unlike engineering controls, healthcare work practice controls depend upon the behavior of the employee to reduce exposure. Examples are hand washing, utilizing universal precautions, and wearing appropriate PPE. Even with properly implemented work practice controls, exposure can still occur. Some of the engineering and work practice controls that must be addressed (if applicable to the specific healthcare organization) within the employee control plan [ECP] include:

hand washing facilities and practices,
treatment of sharp instruments,
separation of food from contamination,
certain procedures in the treatment of contamination,
sterilization, and
care of equipment.

Assessment

These engineering controls must be examined and maintained or replaced on a regular schedule to ensure their effectiveness. Conducting only an annual review of the engineering controls is inappropriate under the OSHA Standard.

Conclusion

How has OSHA affected your practice? Or, is it so 1999?

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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CLINICS: http://www.crcpress.com/product/isbn/9781439879900
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FINANCE: Financial Planning for Physicians and Advisors
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Filed under: "Doctors Only", Glossary Terms, Health Law & Policy, Practice Management, Quality Initiatives, Risk Management | Tagged: bloodborne pathogens, Charles Fenton, ECP, eye-wash stations, hand washing, hope hetico, OSHA, Patricia Trites, personal protective equipment, PPE, safe needle, sharps containers, spill-kits | 3 Comments »

Physicians and Money

Posted on July 25, 2009 by Dr. David Edward Marcinko MBA

A Commencement Address on “Positive Deviancy”

Staff Reporters

One June 12^th, 2009, New Yorker staff writer Atul Gawande MD delivered this commencement address, titled “Money,” to the graduates of the University of Chicago; Pritzker School of Medicine. It expands on the themes he touched on in his recent article about health-care costs in McAllen, Texas, which figures in President Obama’s vision on health care reform.

Link: http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html

Off-Road Touring with Dr. Marcinko [Part III]

Posted on July 24, 2009 by Dr. David Edward Marcinko MBA

I Dislocate a Finger

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Dateline: Sunday June 28, 2009

Fresh off my “runner’s” high from meeting Olympians Shani Davis and Apolo Ohno, the other day, I easily ran an extra couple of miles during my daily training run to stay in shape during my arduous speaking and book signing tour. Thus, invigorated in mind and body, and flushed with surging natural endomorphins, I decided to spend the afternoon at Marquette Mountain watching the downhill mountain bike races.

After introducing myself to Bruce Gustafson, the ambulance driver there on professional standby from the local Marquette General Hospital EMT service, I spent an hour or so marveling at how the racers survived the rocky and treacherous down-hill course. Unfortunately, I was not so lucky, and came very close to requiring Bruce’s expert services.

Taking a Tumble

While climbing down the mounting, running actually, I tripped head-over-heels and commenced wildly flailing and rolling down the rocky terrain, stopping just short of smashing into a large birch tree after 50 feet or so. Bouncing straight back up in an instant, I doubt if nearby spectators even noticed what had happened. Nevertheless, I was most pleased at my adroit body and still youthful ability to assume a dolphin like roll into the fall, dissipating kinetic energy and avoiding injury. Or, so I thought.

Dislocating a Finger

Unfortunately, my fourth right finger began to throb a few seconds later; and then scream at me. Not much medical acumen was needed to note that something was wrong, as the proximal-inter-phalangeal-joint [PIPJ] appeared laterally deviated forty-five degrees, just as the digital apex was turning blue and the joint began swelling before my eyes. Appreciating the impending neurovascular compromise potential, I grabbed the finger, distracted it, reversed the mechanism of injury, let go, and felt it snap back into place. I promptly sat down as a diaphoretic wave of cold sweat broke out on my forehead, chest, shoulders and arms. Fortunately, the hypo-tensive episode lasted only a few minutes, and I did not go into shock. A visiting nurse came to the rescue, elevating my feet, monitoring vital signs and offering fluids as I recovered quickly. She was indeed my Florence Nightingale and, as I later learned, a Master’s prepared nurse-executive. I was gratefully taken back to my hotel after refusing further medical assistance or X-rays. The finger was grotesquely swollen the next few days but did not hurt much. Simple contrast baths, passive and active ROM exercises, along with the “tincture of time” which I estimate to be 6-8 weeks based on clinical experience, will hopefully be all that is required for complete recovery. Although, it may be some time before full typing flexibility is returned; assuming a “button-hole” extensor tendon rupture incarcerating, strangling or imbricating the phalangeal head, did not occur.

Assessment

In my former clinical medical career, I diagnosed, treated and operated on hundreds of injured fingers and toes; for various acute and chronic conditions, fractures, dislocations and related digital anomalies. I even published several peer reviewed papers on same. Still, my course of action may be considered reckless, by some, and should not be repeated. Always seek medical advice.

References:

1. Digital Fractures and Dislocations [Diagnosis and Treatment]. Author: DH Elleby, and DE Marcinko [Clinics in Podiatry. 05/1985; 2(2):233-45].

2. Marcinko DE, and Elleby DH. Digital Fractures and Dislocations; In: Scurran BL, ed. Foot and Ankle Trauma, 2nd ed; Church-Hill-Livingston, Boston, MA.

About Off Road with Dr. Marcinko

These sporadic off-road segments will continue through-out my 2009 summer promotional tour. On the one hand, formal attendance at several engagements was a bit sparse because of the death of several recent celebrities and entertainer types. On the other hand, local book stores and sponsors noted a spike in our CD and book sales, as well as interest in our online www.CertifiedMedicalPlanner.com program as well as our quarterly institutional premium guide; Healthcare Organizations [Journal of Financial Management Strategies] www.HealthcareFinancials.com

Part I: https://healthcarefinancials.wordpress.com/2009/07/20/off-road-touring-with-dr-marcinko-part-i/

Part II: https://healthcarefinancials.wordpress.com/2009/07/22/off-road-touring-with-dr-marcinko-part-ii/

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
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HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Book Reviews, iMBA, Inc., Marketing & Advertising, Media Mentions and PR, Op-Editorials, Sponsors, Touring with Marcinko | Tagged: ambulance, Apolo Ohno, barry scurran, Bruce Gustafson, churchill-livingston, david marcinko, DH Elleby, douglas elleby, Elleby, EMT, finger dislocation, finger fracture, Florence Nightingale, marquette general hospital, Marquette Mountain, nurse, PIPJ, podiatry, ROM, Shani Davis, shock, X-ray | 1 Comment »

About MeaningfulUse.org

Posted on July 23, 2009 by Dr. David Edward Marcinko MBA

A Dedicated Terminology Website

By Staff Reporters

Understanding and defining the new era of healthcare information technology in America.

The ARRA and HITECH concept of “meaningful use” for e-MRs is nebulous and ill defined. This new website is intended to be a collaborative destination site in order to promote the national dialogue and education around the term, “meaningful use”, by providing the HIT community a single-central location to access resources, influence and discuss the definition of “meaningful use” and learn how to take advantage of the HITECH stimulus funds.

Assessment

According to the site, registration for the www.MeaningfulUse.org discussion board is only used for the purpose of posting and will not be used for any marketing purposes. The site is supported by the Association of Medical Directors of Information Systems (AMDIS) and sponsored by Compuware Corporation.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Breaking News, Career Development, Glossary Terms, Health Economics, Information Technology | Tagged: AMDIS, ARRA, Association of Medical Directors of Information Systems, CCHIT, Compuware Corporation., economic stimulus funds, HIT, HITECH, IT, Mark Leavitt, meaningful use, www.healthcarefinancials.com, www.healthdictionaryseries.com, www.MeaningfulUse.org | 13 Comments »

Off-Road Touring with Dr. Marcinko [Part II]

Posted on July 22, 2009 by Dr. David Edward Marcinko MBA

Meeting Olympic Champions

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Dateline: Saturday June 27, 2009

I attended the Superior BMX Bike Fest today, sponsored in-part by Marquette General Hospital [MGH] and held for amateur and professional cyclists, alike. These brave riders in downtown Marquette MI; segregated by gender and age groups, rode mostly carbon bicycles. Female winner of the Twilight Criterium was 22 year old Sarah Maguire, of Team Priority Health, and the defending state champion. Her time was 33:14.6 for the urban and very hilly short course. The first place male winner was Derek Graham at 28:15.5, and the second place winner was Graham Howard, a former pharmacy graduate student, also from powerhouse Team Priority Health. All were given a hearty ME-P congratulatory “shout-out”, as my services in the medical-tent went un-needed for the entire event.

Apolo, Shani and Ryan

Shani Davis, of Marquette High School, is a former US Olympic Education Center [USOEC] ice skater and 1,000 meter Olympic gold medalist at the 2006 Winter Games in Torino, Italy. He is also a close friend of Apolo Anton Ohno who was here to participate in the US Short Track National Speed Skating Trials. Fans of the sport may recall that Apolo is a five time Olympian speed ice-skating medalist and most recent “Dancing with the Star’s” winner. So, he took a celebratory bike ride through the city while in town practicing with the US Olympic team at the nearby Berry Events Center. Both Shani and Apolo cheered for former USOEC speed skater Ryan Bedford, while remaining very approachable to their considerable fan base. I was lucky enough to briefly chat-them-up at the races. All young men are fine examples of amateur athletics in the truest Olympic tradition.

About Off Road with Dr. Marcinko

These sporadic off-road segments will continue through-out my 2009 summer promotional tour. On the one hand, formal attendance at several engagements was a bit sparse because of the death of several recent celebrities and entertainer types. On the other hand, local book stores and sponsors noted a spike in our CD and book sales, as well as interest in our online www.CertifiedMedicalPlanner.com program and premier quarterly guide: Healthcare Organizations [Journal of Financial Management Strategies] www.HealthcareFinancials.com

Part I: https://healthcarefinancials.wordpress.com/2009/07/20/off-road-touring-with-dr-marcinko-part-i/

Conclusion

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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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Sponsors Welcomed

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Filed under: Breaking News, iMBA, Inc., Media Mentions and PR, Op-Editorials, Sponsors, Touring with Marcinko | Tagged: Apolo Anton Ohno, Berry Events Center, Dancing with the Star’s, david marcinko, Derek Graham, Graham Howard, Marquette, marquette general hospital, Marquette Michigan, Ryan Bedford, Sarah Maguire, Shani Davis, speed skating, Superior BMX Bike Fest, Team Priority Health, Twilight Criterium, US Olympic Education Center, US Olympic Education Center [USOEC], US Short Track National Speed Skating Trials, USOEC | 5 Comments »

Off-Road Touring with Dr. Marcinko [Part I]

Posted on July 20, 2009 by Dr. David Edward Marcinko MBA

“Using-Up” Health Insurance

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Dateline: June 18-19th, 2009

I flew into Marquette Michigan last night on a puddle jumper from Chicago, Illinois. Marquette will be the home base on my current book promotion and public/private speaking tour. This second leg of our trip, from Atlanta, was delayed for mechanical reasons. So, rather than follow directions from American Airlines regarding new arrangements, and rushing to wait in a long line of humanity for a new boarding pass on a much later flight, I simply called the travel assistance number on my cell phone. We were re-routed by computer from American, to a Delta Airlines flight, that caused no additional time lag as we later learned the other passengers boarded their American flight three hours late. Many of the elderly and slower moving folks even missed connecting flights which necessitated overnight hotel stays, in some cases.

THINK: outside the box independently, and don’t follow directions mindlessly.

About Marquette, Michigan

The City of Marquette is located in the central region of Michigan’s Upper Peninsula. With a population of 20,714, it is the UP’s largest community. In addition to being a population center, it serves as the regional center for education, health care, recreation, and retail. This regional draw is particularly evident due to Northern Michigan University and Marquette General Hospital, both of which are located in the City of Marquette. Of course, I visited both.

Quality Healthcare for the Upper Peninsula

So, the next morning I called some friends who suggested we head over to the Marquette Upper Peninsula Healthcare Network System, on Washington Street, for an unplanned and unofficial stop on our current “signing and opining” tour. It seemed very busy for a Friday morning; so we gathered some colleagues and ambled over to Viering’s Restaurant where we discussed the local economy, current state of the healthcare industry and the Obama Administration’s ideas for healthcare reform. When I expressed my surprise at the number of patients in the clinic waiting room areas, I was informed that an unexpected corporate layoff resulted in patients “wanting to use their health insurance, before being RIFed [Reduced-in-Force].” Now, as a doctor, and insurance agent, I find this attitude both very strange; yet not uncommon.

“Using-Up” Health Insurance

I can honestly say that after more than three-decades in the business, I have never heard a single soon-to-be unemployed client say,” I need to use up my life insurance”, or “auto insurance”, or “homeowner’s insurance”, etc. So, what gives with health insurance?

Health Insurance IS Different

Insurance of all types is sold to economically protect against catastrophic events like pre-mature death, auto accidents, or home destruction. But life insurance doesn’t pay for non-lethal issues; auto insurance doesn’t pay for new tires, tune-ups or oil changes; and home owner’s insurance doesn’t pay for regular upkeep and maintenance, etc. So, why do some patients believe that health insurance necessarily needs to be used-up? Were they not healthy before the lay-off announcement; or did they suddenly become ill, thereafter? What do you think? Is this just a local phenomenon, or would it be [is it] pandemic in any community given the same or similar circumstances?

Assessment

For me, this scenario clearly demonstrates two things. First, that Health Insurance is thought of as a personal right and/or corporate fringe-benefit; rather than true financial indemnification. Second, it demonstrates the ability of patients to think ahead; unlike the airline customers on my initial trip here. So, if patients can be forward thinking about their health insurance needs, why don’t they think ahead about their personal health care needs? Why don’t more of us exercise regularly, watch our blood pressure and weight, and/or avoid drugs, alcohol and promiscuous sex, etc. If we can monitor and pay for routine auto and home maintenance ourselves; why not our routine health needs? Isn’t good health our most important personal asset? Aren’t we worth it? Do we really want to abrogate our very lives to others? Do we want to concede our responsibilities to a third party, ie, a national [single-payer] governmental controlled healthcare? Those patients wanting to “use their health insurance”, before unemployment, certainly seem to think so.

About Off Road with Dr. Marcinko

These sporadic off-road segments will continue through-out my 2009 summer promotional tour. On the one hand, formal attendance at several engagements was initially a bit sparse because of the death of several recent celebrities and entertainer types. On the other hand, local book stores and sponsors noted a spike in our CD and book sales, as well as interest in our online www.CertifiedMedicalPlanner.com program and premier quarterly guide: Healthcare Organizations [Journal of Financial Management Strategies] www.HealthcareFinancials.com

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Filed under: Health Economics, Health Insurance, iMBA, Inc., Marketing & Advertising, Media Mentions and PR, Op-Editorials, Sponsors, Touring with Marcinko | Tagged: American Airlines, auto insurance, certified medical planner, CMP, david marcinko, Delta Airlines, doctor, Health Insurance, healthcare, healthcare reform, insurance agent, marquette general hospital, marquette MI, Marquette Upper Peninsula Healthcare System, Michigan, Northern Michigan University, obama, RIF, Upper Peninsula, Viering’s Restaurant, www.certifiedmedicalplanner.com | 1 Comment »

We Love ME-P Kudos

Posted on July 19, 2009 by Dr. David Edward Marcinko MBA

And Suggestions for Improvement, Too!

By Ann Miller; RN, MHA

[Executive Director]

We love accolades at the ME-P, but we also love your suggestions for improvement, too. So, talk to us! If you participate, you can win a chance to receive a signed first-edition copy of the best-selling textbook: Business of Medical Practice.

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Channel Surfing

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Filed under: "Advisors Only", "Doctors Only", Alerts Sign-Up, Marketing & Advertising, Media Mentions and PR | Tagged: An Miller, Business of Medical Practice, david marcinko, hope hetico, medical executive post | 1 Comment »

Sign-Up for the ME-P

Posted on July 18, 2009 by Dr. David Edward Marcinko MBA

Get Direct Delivery to your Private e-mail Box

By Ann Miller; RN, MHA

If you haven’t had a chance to sign up for the Medical Executive-Post yet, you really should. You’ll get a helpful daily email reminder when breaking news occurs, or when important posts go up on the site. Plus; recently added new features like classified ads, job posts, “ask-the-advisor”, videos, and much more!

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Filed under: Alerts Sign-Up, Breaking News, Career Development, Practice Management, Sponsors | Leave a comment »

Medicare Scam Alert Notice

Posted on July 17, 2009 by Dr. David Edward Marcinko MBA

Fearing Medicare Payment Gaps

By Staff Reporters

June 18, 2009

The Centers for Medicare and Medicaid Services (CMS) issued the following “Scam Alert Notice”

“CMS has become aware of a scam where perpetrators are sending faxes to physician offices posing as the Medicare carrier or Medicare Administrative Contractor (MAC). The fax instructs physician staff to respond to a questionnaire to provide an account information update within 48 hours in order to prevent a gap in Medicare payments. The fax may have the CMS logo and/or the contractor logo to enhance the appearance of authenticity.”

Medicare Contractors

Furthermore, CMS said that “Medicare FFS providers, including physicians, non-physician practitioners, should be wary of this type of request. If you receive a request for information in the manner described above, please check with your contractor before submitting any information. Medicare providers should only send information to a Medicare contractor using the address found in the download section of the CMS.gov website” found at:

Link: http://www.cms.hhs.gov/MLNGenInfo/

Link: http://www.cms.hhs.gov/MedicareProviderSupEnroll.

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Filed under: Alerts Sign-Up, Breaking News, Career Development, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Research & Development | Tagged: CMS, CMS Scam Alert Notice, FFS, MAC, MC, medicare, Medicare Administrative Contractor, Medicare FFS, medicare paymenhjt gaps, Medicare Scam Alerts | Leave a comment »

Janis Oshensky Lobbies Congress – Not Dentists

Posted on July 16, 2009 by Dr. David Edward Marcinko MBA

Show Me the Math

By Darrell K. Pruitt; DDS

I have noted here far too many times how it disappoints me that Delta Dental Plans Association vice president Janis Oshensky repeatedly chooses to turn to politicians rather than discuss Delta Dental’s arguably egregious and harmful policies with me, a dentist. I intend to put a stop to such disrespect one PR expert at a time if necessary.

Long ago I warned Oshensky that if she didn’t talk to me, she should probably just shut up in order to preserve what’s left of her Internet reputation. Since by posting her Letter to the Editor on POLITICO.com today, she obviously ignored my advice, this highly critical comment will reliably join three others of mine on her first page soon enough. Her employer is sacrificing her like a pawn.

The following comment is the one I posted on POLITICO.com in response to Oshensky’s letter. It might just help the vice president to finally come to a decision on this issue one way or the other. Either way, marketplace conversation like this cannot help but lead to safer air for the community … My pleasure.

http://www.politico.com/news/stories/0709/24873.html

Dear POLITICO.com Editor:

This comment and subsequent invitation to Janis Oshensky is in response to the Delta Dental Plans Association vice president’s July 14, 2009 letter to you. Her letter is the most recent message she successfully sent Congress using a political news Website. Even though Ms. Oshensky holds the position of VP of dental relations as well as public policy, she has avoided answering this dentist’s questions about Delta Dental’s policies for months. If Ms. Oshensky is willing to do so, I would love for her to join me in discussion of Delta Dental’s taxation subsidy right here on POLITICO.com so that our lawmakers can witness a more balanced view of the issues.

Hello – It’s Me

Hello. My name is D. Kellus; Pruitt DDS, and I’m a practicing dentist in Fort Worth, Texas. It is my professional opinion that my patients are harmed by the policies of managed care dental plans like that sold by DDPA because there is no accountability to their clients or dentists. There is barely any accountability to those who select and pay for Delta’s products – dental patients’ naive bosses.

Like virtually every US citizen, your readers probably couldn’t care less about the dental industry. It is precisely because dentistry has been uninteresting for decades that make the microcosm of health care incredibly interesting to me. Let me uncover for your appreciation the event horizon in dental history. You could learn about more than just dentistry.

If left to natural forces of human nature, what happens to value when there is no accountability? For example, what do the 1975 East German Trabant and the 1979 Ford Pinto have in common? By popular vote, those products not only represent the two worst automobiles ever made, but the state shielded both manufacturers from accountability to consumers. Poor quality happens.

Oshensky argues against the taxation of managed care dental benefits like those sold to employers by Delta Dental. Let me offer that if Delta’s product were taxed like income, its value would quickly dive below the market threshold that attracts purchasers’ consideration.

Allow Me to Show-You the Math

Recently, Delta Dental of Michigan lost the accounts of thousands of GM retirees when their group dental benefits were cut in bankruptcy negotiations with UAW. Suddenly, Delta found itself forced to market their product to individuals who for once have the choice to keep their money. Faced with true competition for healthcare dollars, Delta leaders desperately cobbled together individual policies for the retirees who want to continue with their coverage. Even though Delta did everything possible to lower the cost of their coverage, the cheapest of the plans they offered still runs about $30 per person per month, and covers only 50% of everything, including preventive. So for premiums of $360 per year plus half the preferred providers’ 20% to 30% discounted fees, is this a bargain for Michigan retirees?

Free Markets

In my free-market, fee-for-service practice, if a patient comes in for two cleanings and routine x-rays during a year, 100% of my bill is $208. This is the market price in my neighborhood that is continually challenged by lively competition with other dentists for new patients who may not even have dental benefits. Those customers pay in full at the time of visit, just like most people whose bosses purchased Delta Dental Plans.

Value Comparisons

So let’s compare value of Delta Dental’s product with cash. If I were a Delta Dental preferred provider, my fee of $208, less Delta’s 25% discount would be $156. Never mind that my wife has problems with my 70% cut in pay, let’s move on.

The patient’s half of the $156 I earned is $78. $360 + $78 = $438. So for one uneventful year of discounted dental services with a dentist chosen from a list of names, a patient can expect to spend more than twice as much than if they paid the free-market price at the point of service.

Assessment

Not only is that hardly a bargain, but it is my opinion that managed care dentistry is dentistry by the lowest bidder with no quality control. That should be enough meat to get this conversation rolling. Now it’s your turn Ms. Oshensky. I think you have to admit that you’ve got holes to mend in the dental relations part of your job.

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Filed under: "Doctors Only", Career Development, Ethics, Health Insurance, Managed Care, Practice Management, Pruitt's Platform | Tagged: ADA, Darrell Pruitt, DDPA, DDS, delta dental, Delta Dental Michigan, dentists, DMD, GM, HMO, Janis Oshensky, managed dental care, POLITICO, PPO, UAW | 3 Comments »

Health Plan Management Navigator

Posted on July 15, 2009 by Dr. David Edward Marcinko MBA

July 2009 Edition

By Douglas B. Sherlock; CFA, MBA

Attached below, find the July 2009 Edition of Plan Management Navigator. In this month’s edition, we summarize the results of Independent / Provider-Sponsored Healthcare Plans. The 16 plans collectively serve 5.7 million members and are leaders in their communities.

Link: Navigator_07-09

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Filed under: Health Economics, Health Insurance, Healthcare Finance, Managed Care, Monthly Reports, Research & Development | Tagged: douglas sherlock, Health Insurance, health plan, healthcare plans, managed care plans, Plan Management Navigator, Sherlock Company | 1 Comment »

ADA / IDM Breakup – You Heard it Here First

Posted on July 14, 2009 by Dr. David Edward Marcinko MBA

Will CareCredit be the Next ADA Subsidiary to Fail?

I saw a warning sign last week.

By Darrell K. Pruitt; DDS

My aggressive writing hobby has understandably brought me in hard contact with public relations people whose job is to insulate good ol’ boys from accountability – even if it means taking hits for the team and staining their reputations. Let’s face the fact we all of us involved in public relations know but don’t dare discuss: Depending on the ethics of one’s employer, PR professionals are sometimes used up like expendable pawns. And avoiding bylines for press releases no longer shields anyone from accountability.

I often silently stalk PR employees (Gasp!) on the Internet who work for sleazy companies just to better understand them. I’ve discovered that it is not hard to find and exploit the weaknesses of those whose heart isn’t behind selling their employer’s product. Sometimes all it takes is a fistful of transparency to cause defenseless representatives to completely shut up, and that alone makes our neighborhood safer. Committee-approved methods of evasion are as simple-minded as committees, so it doesn’t take long to figure them out – exposing the shameful ethics of those who sign off on the use of lame, institutional trickery.

For example, here’s a very popular, traditional PR trick: If a huge business entity such as the ADA has bad news they can no longer keep secret from customers, professional PR-types will advise their bosses to post bad news on a Friday to soften the blow. When traditional leaders find that they can no longer sidestep accountability, delaying accountability until a busy news day is the next best thing one can purchase. Even though the tricks seem simple, there are people who study evasion science as part of obtaining a degree in marketing.

So how good is the ADA’s PR team? How much time did ADA members’ employees buy for leaders before they had to quietly acknowledge an expensive failure?

On July 10, a Friday, “ADA/idm to phase out service” was posted on ADA News Online without a byline. (Another PR trick: When the ADA posts an orphan without a name, it means someone is ashamed of the bastard.)

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3655

“ADA Business Enterprises, Inc. (ADABEI), a wholly owned ADA subsidiary, announced today that ADA Intelligent Dental Marketing (ADAidm) of Salt Lake City, one of its joint venture companies, is no longer able to provide marketing services to its customers due to significant production and operational difficulties.”

Now the ADA must refund money to members in a depressed market. Could this embarrassment for our professional organization have been quietly avoided instead of delayed and magnified? I personally started seeing clues of CEO Trajan King’s reticence long ago, and warned ADA leaders in Chicago about my concerns. Nobody ever responded to my numerous, sincere warnings.

These are highly critical times on Capitol Hill and our patients trust us to represent their welfare. Dentists are their last hope, because there is nobody else who cares. Practicing dentists are solely responsible for assuring the benevolence of our niche market, and we are losing control publicly. Disasters like the ADA/IDM make the ADA look foolish to Congress, and word gets around fast on the Internet.

This morning, I read an article posted on The NY Times titled “Study Measures the Chatter of the News Cycle, “ written by Steve Lohr.

http://www.nytimes.com/2009/07/13/technology/internet/13influence.html?_r=1

Researchers at Cornell used powerful computers and sophisticated algorithms to accomplish an unprecedented analysis of news articles and comments on the Web during the 2008 presidential campaign. They studied the characteristics of the news cycle by scanning 1.6 million mainstream media sites and blogs for repeated phrases and tracking the history of their appearances.

Lohr writes: “The researchers’ data points to an evolving model of news media. While most news flowed from the traditional media to the blogs, the study found that 3.5 percent of story lines originated in the blogs and later made their way to traditional media.”

The study also shows that traditional news outlets are still quicker than blogs by 2.5 hours. I should now point out that the Cornell study was performed using data from very popular, huge news items collected during a presidential election – not hidden, niche news like dentistry’s.

If you are involved in the dental industry, where are you more likely to read time-sensitive news about our profession first? In an ADA publication, or from D. Kellus Pruitt; DDS?

Whereas traditional media is 2.5 hours quicker with popular topics, I scooped traditional ADA News Online by three weeks when I posted “ADA/idm – A bad union after all?” on the PennWell forum.

http://community.pennwelldentalgroup.com/forum/topics/adaidm-a-bad-union-after-all

So what about the warning sign I saw concerning CareCredit – a wholly-owned subsidiary of the ADA?

When Trajan King, former CEO of the defunct ADA/IDM partnership refused to acknowledge my questions, I immediately suspected something was terribly wrong with the union of my non-profit professional organization and his for-profit Utah advertisement company. Six months later, my fears were confirmed. Now then, I hope it grabs someone’s attention that I see the same warning signs coming from the ADA’s CareCredit business. Note this date: July 13, 2009.

On Thursday, July 9, CareCredit purchased a press release on dentalblogs.com: “CareCredit Adds 24-Month, No-Interst [sic] Payment Plan” (no byline).

http://www.dentalblogs.com

Since dental problems only get worse, I consider the idea of extending credit to dental patients is a benevolent thought during these hard financial times. I also say that the offer appears to have been put together out of generosity and not greed like the ADA/IDM disaster. However, at 4:54 pm on the same day that CareCredit’s press release was posted, I submitted a difficult question for the anonymous author of the piece who works PR for CareCredit – and is an ADA employee.

“If the Red Flags Rule is not delayed for the third time in three weeks, how will it affect those who offer Care Credit?”

I was given the hopeful response “Your comment is awaiting moderation,” but days later there is no sign that my question is being considered at all. Please, oh please ask yourself: What could CareCredit leaders be hiding and how much will it end up costing ADA membership?

I will not be ignored by anyone. Today, I submitted two follow-up questions on dentalblogs.com. I considered warning the anonymous moderator that this is being simulposted on other blogs, as well as described on Twitter, but then I thought, why spoil the fun? Let the leaders of the ADA Business Enterprises, Inc. (ADABEI) get word of my e-Attack from their colleagues. Won’t they be surprised!

Oh, and for those who are wondering what happened to ADA/IDM CEO Trajan King – he quit.

Dear Dentalblogs.com moderator:

On July 9 at 4:54 pm, I submitted a sincere question concerning how the Red Flags Rule will affect ADA members who sign up for CareCredit. Instead of posting it with the promise of an answer, you regretfully chose to censor an ADA member. Today, July 13, I have a second and third question: Why did you ignore my first one and who is your boss?

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Filed under: "Doctors Only", Breaking News, Career Development, Ethics, Health Insurance, Information Technology, Marketing & Advertising, Media Mentions and PR, Pruitt's Platform, Research & Development | Tagged: ADA, ADA Business Enterprises, ADA/IDM, ADABEI, American Dental Association, CareCredit, Darrell Pruitt, dentists, IDM, Intellignet Dental Marketing, red flag rules, Steve Lohr, Trajan King | 12 Comments »

Financial Accounting Concepts for Medical Practice Management

Posted on July 13, 2009 by Dr. David Edward Marcinko MBA

Your Top 25 Most Urgent Questions Answered by iMBA, Inc.

By Dr. David Edward Marcinko; MBA, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™

www.CertifiedMedicalPlanner.com

The modern medical practice is both similar, and unlike, other businesses today. This disparity often adds to confusion for the private practitioner. And so, the experts at iMBA Inc, list the top 25 most urgent questions in practice financial management, asked by clients to date.

Assessment

Since inception in 2000, the Institute of Medical Business Advisors Inc., has become one of North America’s leading professional health consulting and valuation firms; and focused provider of textbooks, CDs, tools, templates, onsite and distance education for the health economics, administration and financial management policy space. As competition and litigation support activities increase and the cognitive demands of the global marketplace change, iMBA Inc is well positioned with offices in five states and Europe, to meet the needs of medical colleagues, related advisory clients and corporate customers today; and into the future.

Link: iMBA Inc Q and As

Website: www.MedicalBusinessAdvisors.com

Conclusion

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Filed under: Accounting, CMP Program, Health Economics, Health Insurance, Healthcare Finance, iMBA, Inc., Managed Care, Media Mentions and PR, Practice Management, Recommended Books | Tagged: certified medical planner, CMP, CPA, david marcinko, financial accounting, financial management medical practice, healthcare acounting, healthcare CPAs, hope hetico, iMBA, Inc., Institute Medical Business Advisors, medical financial acounting, medical practice financial management, medical practice management, www.certifiedmedicalplanner.com, www.HealthDictionaySeries.com, www.medicalbusinessadvisors.com | 1 Comment »

Sponsorship Opportunities

Posted on July 11, 2009 by Dr. David Edward Marcinko MBA

Advertise on the Medical Executive-Post

Reach out and impress more than 100,000 physician and nurse-executives, financial advisors, CEOs and medical management consultants in the health 2.0 space. Our premium institutional e-journal: www.HealthcareFinancials.com and complimentary companion newsletter blog: www.HealthcareFinancials.wordpress.com has limited sponsorship and advertising opportunities available; So, act now!?

Advertise with us!

Reserve your space today.

For more information please contact: Edward

MarcinkoAdvisors@msn.com

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.

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Boosting Medical Practice Goodwill Value

Posted on July 10, 2009 by Dr. David Edward Marcinko MBA

Goodwill Hunting

What’s your Office Really Worth?

[By Dr. David E. Marcinko; MBA]

There are several measures a physician can take to increase the value of medical practice goodwill, which in turn will make the practice more desirable, and profitable, when selling or taking on a partner.

These are listed below for your consideration:

Keep good financial records. Know your capital purchases, and have your balance sheet, statement of cash flow and net income statement up to date.
Continually monitor key financial ratios, such as profitability, creditors, long-term debt management and medical equity value-added.
Have adequate practice insurance, including property liability coverage, plus have workers’ compensation for staff and life and disability insurance on the key doctors.
Build a brand identity for the practice rather than an individual brand identity for you as a physician. This helps in developing a business that others could assume and operate.
Have a practice continuation plan that stipulates how the practice will be sold or continued in the event of a physician’s death or disability. Specify who will buy the practice and for how much. And specify whether the purchase will include land, buildings, inventory, licenses and goodwill. Have a covenant that specifies the procedures to follow when a physician leaves the practice.
Have strong relationships with everyone who does business with your practice, including supply vendors as well as referring doctors and fellow physicians.
Be organized when it comes time to present the supporting information. Don’t accept the first valuation given. Numbers can be changed, if you can present substantive reasons.

MORE: AMA News Interviews Dr. Marcinko

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How have you reacted to the recent declines in both medical practice [business] and personal [doctor] goodwill?

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Filed under: Career Development, Glossary Terms, Health Economics, iMBA, Inc., Practice Management, Practice Worth, Research & Development | Tagged: accounting value, book value, business goodwill, david marcinko, goodwill, goodwill valuation, medical practice value, personal goodwill, practice appraisal, Practice Worth | 1 Comment »

Essay of Atul Gawande MD in the New Yorker

Posted on July 9, 2009 by Dr. David Edward Marcinko MBA

The McAllen Redux

We urge all ME-P subscribers and followers to read Atul Gawande’s piece in the New Yorker that appeared as an essay on McAllen, Texas – the little Texas town with the dubious honor of being one of the most expensive health care markets in the country, today.

Link: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

As Dr. Gawande noted, in 2006, Medicare spent about $15,000 per enrollee there – close to twice the national average, and three thousand dollars more per person than McAllen’s per capita income of $12,000.

Commentary

Then, take at look at the comment by OMB Director Peter R. Orszag, posted on Thursday, June 4th, 2009 at 10:50 am; entitled the McAllen Redux

http://www.whitehouse.gov/omb/blog/09/06/04/McAllenRedux/

Assessment

Who says bloggers, and citizen journalists, get no respect?

Conclusion

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Selecting Financial Advisors the Risky Way

Posted on July 8, 2009 by Dr. David Edward Marcinko MBA

Physician Due Diligence is Important

[By Daniel B. Moisand; CFP®, and the ME-P Staff]

While the merits of hiring the right financial advisor [FA] may be clear, hiring the wrong one can be devastating. Medical professionals still tend to have higher incomes and are an attractive target for most financial institutions and scam artists. This fear is a poor excuse for not getting the assistance necessary. Advice about who to engage for financial assistance comes from a hodge-podge of disjointed sources. This leads to good intentions and bad results. Take caution when using the following as sources of advice.

Relying on Family and Friends

By far more people seek financial advice from trusted family members and friends than any other source. This is only natural. It is essential to trust that you are getting advice from a source that means well. It is also important that you get along well with your advisors. Hesitating to communicate with your advisor, even a great advisor, can cause problems even more problematic that getting bad advice from someone you like. While these sources have a good handle on the essential elements of trust and rapport, it is the competence of the advice that is most often the issue. The life and money experiences of those who are close to you certainly have value, but they are not necessarily relevant to your unique goals and circumstances. THINK: Bernie Madoff.

Media

A few years ago, the dominant media force in consumer oriented financial matters was the print media. Magazines and newsletters proliferated with the bull market. More recently however, television has supplanted print even in the bear market. For example, a study now estimates that 80 percent of what the average American knows about current events comes from TV. Why wait three weeks for the next issue when you can get a commentary instantly on the television? There is nothing wrong with watching shows that cover the markets or subscribing to a consumer finance magazine. It is certainly a good idea to be informed. However, be wary of the quality and applicability of information put out by the media.

The Internet

It is easy to run across an ad for prescriptions drugs on television. Images prance across the screen followed by a litany of potential side effects and the obligatory, “Ask your doctor about”. With the expansion of the information superhighway, more and more companies are going direct to the consumer in some manner or another.

Financially speaking this information can be of great benefit but should also generate more concern. It is very easy to project a particular image via the web. The webmaster controls the interaction from what you see to what you hear. One of the results of this is that the Internet has already garnered a reputation as a breeding ground for new scams. More prevalent, however, is the presentation of information meant to be useful that is simply wrong, misinterpreted, or misapplied. The most terrifying source of misinformation on the net is the chat rooms. Here the entire interaction is clouded by anonymity. Some people enter chat rooms because there is a comfort in anonymity when asking a question. There is also a danger in an anonymous answer. When it comes to something as important as your finances or your health, the prudent course should be to take all the advice with a grain of salt. A great deal of consideration to the quality of the source is in order. It is also essential that one understand the level of accountability a source may possess.

Assessment

Much has been written on financial advisor selection, here on the ME-P and elsewhere; but little on how not to select an advisor. We trust this information will be of assistance to the medical professional in some small increment. Send in your FA stories; both good and bad.

Channel Surfing the ME-P

Conclusion

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Filed under: "Doctors Only", Book Reviews, Career Development, Financial Planning, Portfolio Management, Recommended Books, Research & Development, Risk Management | Tagged: bear market, bull market, certified financial planner, certified medical planner, CFP, CMP, Dan Moisand, david marcinko, financial advisors, Financial Planning, Wall Street, www.certifiedmedicalplanner.com | 5 Comments »

Concierge Medicine and the “Zombie” Medical Practices

Posted on July 7, 2009 by Dr. David Edward Marcinko MBA

Continued Growth of Boutique Medical Practices Today

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

The boutique, or direct reimbursement, or cash based medicine, or concierge medical practice business model requires an annual fee for personalized treatment that includes amenities far beyond those offered in the typical practice, or suggested by physician medical unions. Patients pay annual out-of-pocket fees for top tier service, but also use traditional health insurance to cover allowable expenses, such as inpatient hospital stays, outpatient diagnostics and care, and basic tests and physician exams. Typical annual fees can range from $1,500 to $ 5,000 per patient, to family fees that top $25,000 a year, or more. The concept, initially developed for busy corporate executives, has now made its way to others desiring such service.

A Higher Level of Care

Medical providers get to provide a much higher level of care and get to know their patients as they enjoy the incentive to spend appropriate time with them, and over time, get to know them within their unique social/cultural context as well (hence the house calls become important). Patients enjoy the access, the attentiveness, and are willing to spend cash to have the type of unhurried, contemplative time with physicians that is required to develop a trusted relationship and deliver high quality care. The financial remuneration potential is compelling as well.

Now, let us compare and contrast various parameters of traditional medical practice [third party reimbursement] with the same parameters of so-called “new-wave” concierge medicine. Then, let the next-generation of doctors decide.

Current Traditional Model

patients seen at 15-20 min increments
2,000 – 3,000 patients
Paperwork, administrative burdens, frustrations, and lack coordinated care
Impersonal experience (long waits, un-intelligible interactions with health care system)
Average Salary = $150,000-250,000

Concierge Practice Model Potential

direct relationship with patients
300-500 patients
$1,500 – $3,000 access/retainer fee
Reduced overhead, positive interactions, care coordination and increased quality
Personalized experience (reduced headaches and paperwork with transparent pricing)
24/7 access, same day appointments with multiple other amenities
Average Salary = $100,000 – $500,000

Enter the Franchisors

Concierge medical practices can be developed organically, or use a franchise business model [personal communication, Suzanne R. Dewey, Forté Partners, LLC, Williamstown, MA]. Examples of franchisors include:

Elite Health: http://elitehealth.com
Health Advocate: http://healthadvocate.com National organization with over 4,300 client relationships.
MD2 International: http://www.md2.com/home.php
MDVIP: http://www.mdvip.com
ModernMed: http://www.modernmed.com

Opponents and Pessimists

There have been plenty of opponents, within medicine and outside, to the idea of concierge practices almost from the first day. For example,

”The state of Washington’s insurance commissioner attacked the concept of practices offering all the primary care patients needed for a prepaid fee or retainer, arguing that such practices amounted to the business of underwriting health insurance. He said that the practices would have to meet all the regulatory requirements for such an insurance business, including establishing capital reserves and maintaining loss reserves for the payment of claims. It didn’t work, and besides, few concierge practices offer free traditional medical care once retainers are paid–most concierge physician’s bill insurance plans for all the services covered under their patients’ coverage. The Medicare folks chimed in and managed to drive one physician out of business, arguing that he had tried to charge Medicare patients an extra $600 a year for services already covered by Medicare, hence he was guilty of illegal “balance billing.” Rather than fight Medicare over the issue, the doctor gave up and closed his practice. [C. Davis, “Big Problems for Medicare and Concierge Medicine,” Sierra Sacramento Valley Medicine, 55:3, May/June, 2004 (www.ssvms.org)]”

Attacking ME?

Objections to concierge medicine focus on both its causes and its effects, and some critics have even attack me, personally. For example, just look what “they” said in the online journal: “Health Care Strategic Management.”

”Many critics argue that concierge medicine merely reflects physician greed and unconcern over the needs of the community. Indeed, a recent book by David Marcinko, Business of Medical Practice [Advanced Profit Maximization Techniques for Savvy Doctors], includes a chapter on “The Case for Concierge Medicine” (Ch. 24) as one of the ways ‘savvy’ physicians can maximize their profit, as if that is what medicine is all about. While the image of physicians may retain some Marcus Welby elements of their rushing to the hospital or a patient’s home in the middle of the night, most physicians would rather stay home and leave the job to someone else, it is argued”.

Nicht Schadenfreude

Just think! My mother always feared I’d be a no-body. Good publicity – bad publicity – just spell the name correctly. Schadenfreude may be defined as a “largely unanticipated delight in the suffering of another which is cognized as trivial “ and I take no delight in the slow collapse of traditional medical practice models; or the economic, professional or personal pain of colleagues. But, I also often tell my critics – and clients – that although it’s awfully nice to be altruistic; I am always mindful of the competitive business adage: “no margin-no mission.” And, in as much as this attack was written in July 2005, I can only wonder if I was prescient, or just lucky? With all due respect, I believe it was the former, rather than the later. Why so? Well, just consider how fast www.ChoiceMed.com is growing. This stuff is not rocket-science.

www.MedicalBusinessAdvisors.com

About Concierge Choice Physicians

Concierge Choice Physicians: http://choice.md is a national organization offering a hybrid business model. Physicians divide their practice between a traditional practice and a retainer practice. The retainer practice is limited to approximately 150 patients. A typical concierge practitioner may have 300-500 patients, while the norm for a traditionalist is about 2,000-3,000 patients.

Assessment – Whither the “Zombies”

I, also ruefully wonder how many “zombie” medical practices [practitioners] are out there? You know the kind – a medical practice with neither a good/bad balance sheet. One with only subsistence level operating performance; a practice that is not growing organically or thru merger activity. It is just barely existing as the doctor-in-charge slowly, agonizingly, milks it to death; or retires, whichever comes first.

Conclusion

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Filed under: Career Development, CMP Program, Ethics, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Practice Management, Professional Liability, Research & Development, Risk Management, Sponsors | Tagged: boutique medical practice, Business Medical Practice, c Davis, cash based medicine, choice.md, ChoiceMed, concierge medicine, david marcinko, direct reimbursement medicine, elite health, health advocate, Health Care Strategic Management, MD2 International, MDVIP, ModernMed, zombie medical practices | 11 Comments »

Blue Cross/Blue Shield of Texas on Facebook

Posted on July 6, 2009 by Dr. David Edward Marcinko MBA

Let’s Have Some Fun!

[By Darrell K. Pruitt; DDS]

Hello, sports fans. Have you missed me? It’s been about five days since I posted a comment that didn’t follow an article authored by someone else.

My last one was “Pruitt’s Platform – Introduction to an Adventure.” It’s unusual for me to go so long between posting stand-alone pieces, but after putting that title to my introduction, and compounding the challenge by promising to never push out bland stuff, I set my standard high. It took me a few days, but I finally found a deserving old target on a brand new venue that I think will hold your interest. BCBSTX and I have an intense history, so I assume they charged someone anonymous and shy to follow everything I write. I welcome you, whoever you are. Yea, you. The one hiding in the dark corner, justifiably afraid to utter a peep. Keep your pointed head down, friend, and try not to wet your nice pants.

BCBSTX, you should be disappointed to learn that I found your Facebook account. Even for a fat dinosaur, you are an especially thick and slow-moving easy target. I recommend you just surrender now to transparency and start the confessions and reparations before the lawsuits become huge and the lawyers profit more from your collapse than the Texan dental patients you’ve harmed. Let me remind you that the repeal of the McCarran-Ferguson Act is just around the corner, and we all know about the rumor (started by me) that there are attorneys across the nation just waiting to file class-action lawsuits against BCBS for unfair business practices, including restraint of trade for using the NPI number to drive satisfied patients from dental homes they preferred. Finally, BCBSTX will be subject to the same anti-trust laws as the doctors they fear, and I am here to make sure BCBSTX feels the pain. Look what happened to Dell Computer when that huge dinosaur was surrounded by Jeff Jarvis and Dell Hell. The game I’m playing with you is a more nimble, improved variation of Dell Hell, using fewer vulgar words.

You should know by now you are too fat and too slow to hide from me and the sports fans I bring. Nevertheless, I am always fair in telling my targets my goals before I go on to accomplish them. Here is what I am going to do to you, BCBSTX: I intend to pull your anonymous, unaccountable butt out into the wide open for everyone to see – especially the lawmakers you lobby and support with generous donations. Did you know that there is a rumor (also started by me) that some of those same lawmakers you consider friends are aware of most of what I write on the same day I post it? The transparency I bring will eventually trap and crush you, BCBSTX. Or, you can immediately come out and meet me for an open discussion about the inevitable reformation of dental insurance in Texas – putting humble, obedient bureaucrats with names under the direct control of dentists and patients. And of course, it is understood that in order to save Texas citizens millions of dollars in healthcare expense, there will be drastic downsizing of BCBSTX Dental, just like Delta Dental and ADA/IDM are experiencing right now. That means no more bonuses and no more frivolous pursuits like publishing, printing and mailing to Texas dentists those expensive self-serving brochures joyfully titled “NPI Times.” I suggest you get your resumes in order, BCBSTX employees. I’m very good at having my way with archaic business models. Others I have attacked, such as ADA/IDM and Delta Dental, are clearly failing. Coincidence? Perhaps you’d like to tell yourself that when I undermine your support every time you come up for air. Why not send out your sharpest PR specialists? Oh please, would you? Also, equip them with committee-approved talking points that I’ll hang around their necks for a long time.

When I discovered that BCBSTX had a Twitter account, I started asking anonymous employees of BCBSTX about their new NPI number requirement for processing dental claims – even for dentists who have no contractual relationship with the company. But rather than answer a dentist’s questions about their dental policy (incredibly stupid, BCBSTX), the leaders of the command and control company who can no longer command or control their own socks, responded by blocking me from following them. That was irresponsible, childish behavior from one of the largest and most powerful dental insurance companies in the state. Shouldn’t it be important for BCBSTX to respect dentists who must deal with their cumbersome rules?

At a time when managed care dental companies like BCBSTX are lobbying Congress hard to preserve their taxation subsidy, I think it is important for lawmakers to recognize that these huge stakeholders neglect the welfare of those they serve: the principles – dentists and their patients. We are your constituents who count, Congress. Not discount dentistry brokers whose products will not sell in the free market without mandates and taxpayer assistance – simply because they are lousy products.

If BCBSTX had not opened a Facebook account, I would not have opened one myself. I discovered my fat, defenseless opponent when I googlesearched “BCBSTX” the other day. On their first page was the link “What is the NPI number of BCBSTX? – Facebook.” It features a client’s naïve, insignificant question about the NPI number, and it opened the door for my informed, significant one which I copied below, as well as posted on Twitter.

http://www.facebook.com/topic.php?uid=93487018652&topic=8926

By the way, I was disappointed to see that my comment “BCBS-TX Dental Insurance is Rude to everyone,” which I posted on the Medical Executive-Post over three months ago, was no longer on BCBSTX’s first page. It was their third hit for weeks. But since I hadn’t given the comment a bump lately, it has dropped down to the bottom of their second page. Can’t have that! If you don’t mind, please click once or more on the following link and stay there a few minutes. That way, it will push the blunt criticism back up onto BCBSTX’s first page and will once again warn potential clients of BCBSTX’s poor business ethics. If you’re going to be there anyway, why not go ahead and read the sucker? You could find it interesting. Lots of people do.

https://healthcarefinancials.wordpress.com/2009/03/27/bcbs-tx-dental-insurance-is-rude-to-everyone/

As I wrap up this comment, I’ll share with you with the question I left BCBSTX on Facebook almost 6 hours ago concerning their NPI policy. I don’t think Facebook was a good idea for BCBSTX leaders. Sit back and watch me get someone fired today.

Dear BCBSTX:

I would like to point out to readers more information about the NPI number which you are not likely to share. If you have BCBSTX dental insurance, and your dentist does not have an NPI number, BCBSTX will not process your dental claim and the premiums you will have paid to BCBSTX will become unearned profit for BCBSTX.

Is that true, BCBS-TX? Yes or no?

Conclusion

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Filed under: Career Development, Health Insurance, Information Technology, Pruitt's Platform | Tagged: ADA, ADA/IDN, BCBS, BCBSTX, Darrell Pruitt, DDS, Dell, delta dental, dentist, Facebook, Jeff Jarvis, McCarran-Fergusan Act, NPI, NPI Number, twitter | 19 Comments »

Events Planner: July 2009

Posted on July 2, 2009 by Dr. David Edward Marcinko MBA

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Events-Planner: JULY 2009

Staff Writers

“Keeping track of important health economics and financial industry meetings, conferences and summits”

Welcome to this issue of the Medical Executive-Post and our Events-Planner. It contains the latest information on conferences, news, and relevant resources in healthcare finance, economics, research and development, business management, pharmaceutical pricing, and physician/entity reimbursement! Watch for a new Events-Planner each month.

First, a little about us! The Medical Executive-Post is still a newcomer. But today, we have almost 25,000 visitors and readers each month from all over the country, in addition to our growing subscriber base. We have been a successful collaborative effort, thanks to your contributions. As a result, we are adding new resources daily. And, we hope the website continues to provide the best place to go for journals, books, conferences, educational resources, tools, and other things you need to establish the value your healthcare consulting and financial advisory intervention. And so, enjoy the Medical Executive-Post and our monthly Events-Planner with our compliments.

A Look Ahead this Month

July 1: Print Edition Healthcare Journalism: If you would like to “step-up-your-game” and be considered as a peer-reviewed contributor to the third print edition of: The Business of Medical Practice [Health 2.0 Profit Maximizing Techniques for Savvy Doctors]; contact Ann at: MarcinkoAdvisors@msn.com. There are several chapter topics still available. Now, the important dates:

July 1-12: Dr. David E. Marcinko speaking, interviews and book signing tour, Upper Michigan: MarcinkoAdvisors@msn.com

July 6-10: Investment Management Workshop. CFA Institute, Boston, MA.

July 13: World Congress Medicare Leadership Summit, Washington, DC.

July 13: World Congress Behavioral Health Leadership Summit, Phila, PA.

July 14: Drug Benefit Management Forum, World Congress, Boston, MA.

July 16: Small Firm FINRA Conference Series, Chicago, Ill.

July 16: Pharmaceutical Pricing Conference, Bridgewater, NJ.

July 19-24: Financial Analysts Seminar, Chicago, Ill.

July 20-21: IMCA Advanced Workshop; Phila, PA www.IMCA.org

July 27: Leadership Summit on Wireless Health, Boston, MA.

July 28: Leadership Summit on Process Improvement and Business Excellence in Health Care, Chicago, Illinois.

July 30: Private Wealth Management, Singapore. CFA Institute.

Please send in your meetings and dates for listing in the next issue of our Events-Planner.

MarcinkoAdvisors@msn.com

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Filed under: Alerts Sign-Up, Events-Planner | Tagged: book signing tour, david marcinko, events, financial services organizations, medical societies, meetings, speaking tour | 1 Comment »

Introducing Darrell Pruitt’s Platform

Posted on July 1, 2009 by Dr. David Edward Marcinko MBA

Pruitt’s Platform – Introduction to an Adventure

By Darrell Kellus Pruitt; DDS

I’d like to take this opportunity to thank Managing Editor Hope R. Hetico RN, MHA and the ME-P staff, as well as loyal readers, for providing me a featured spot on this unprecedented free forum – which is rumored to be even monitored by a few in Congress. I do hope so. If we are to cultivate fresh ideas, we’ve got to do some groundwork to clear some weeds.

Let me say that I am flattered and excited that you believe in me enough to offer such a tremendous blog opportunity. I consider it a popular mandate and a responsibility to continue on my path of straightforward, intrusive discovery – bringing you along every step of the way to share in the excitement of accelerated social evolution. I find it fun to undermine traditional bureaucratic bozos who think they are too good to wrestle in the dirt. The fact that our neighborhood entertainment is still under the surface makes it seem sort of like ornery-fun as well.

The World is Flat

Five years ago, New York Times foreign affairs columnist Thomas Friedman, in his national bestseller “The World is Flat,” predicted that “Individuals from every corner of the flat world are being empowered.” He had no idea he was talking about a dentist in Fort Worth, Texas.

Hang on tight, everyone, because I will take this blog on a fast-moving, multi-pronged adventure of a kind never before witnessed on any media venue. What’s more, I will continue to probe for weak, deceptive links in our neighborhood – and I’ll do it between checking my hygiene patients, and just for grins. I would warn newcomers as well as future targets that I don’t avoid hurting feelings if it speeds progress to a better democracy – including, of course, better state and national representation for my dental patients. They trust me to watch after their welfare. And as far as I can tell, I’m their last hope. Besides, since I hold myself accountable for what I post on the Internet, I see not a single reason why everyone else shouldn’t be held to the same standard, or to simply shut the hell up.

Assessment

I know it took work to put together “Pruitt’s Platform.” I promise I will never make you ashamed of giving me such esteemed consideration, and I won’t let you down by pushing out boring, pointless, superficial content. Get ready to plow new ground deep, friends. Once we break up the fallow impenetrable crust, soon it will be time to plant new ideas for fresh leadership. Hey, lawmakers – you’re next: Deep renewal isn’t limited to the field of dentistry. It was just close by, mostly vacated and has been hidden from view for years.

Conclusion

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Filed under: Alerts Sign-Up, Breaking News, Media Mentions and PR, Pruitt's Platform | Tagged: ADA, ADA News, congress, Darrell Pruitt, DDS, dental economics, DMD, hope hetico, medical executive post, PennWell, Pruitt's Platform, The World is Flat, Thomas Friedman | 5 Comments »

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