Do Prices Drive Regional Medicare Spending Variations?

A New Study Says – Apparently Not

By ME-P Staff Reporters

Per capita Medicare spending is more than twice as high in New York City and Miami than in places like Salem, Oregon.

How much of these differences can be explained by Medicare’s paying more to compensate for the higher cost of goods and services in such areas?

The Study

According to Daniel J. Gottlieb, Weiping Zhou, Yunjie Song, Kathryn Gilman Andrews, Jonathan S. Skinner and Jason M. Sutherland – not much!

The Answer

The authors analyzed Medicare spending after adjusting for local price differences in 306 Hospital Referral Regions. The price-adjustment analysis resulted in less variation in what Medicare pays regionally, but not much.

The findings suggest that utilization—not local price differences—drives Medicare regional payment variations, along with special payments for medical education and care for the poor.

Assessment

http://content.healthaffairs.org/cgi/content/full/hlthaff.2009.0609v1

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Submitting a Guest Post to the ME-P

Make your Voice Heard

By Hope Rachel Hetico; RN, MHA

[Managing Editor]

The Medical Executive-Post is a growing and influential media voice with over 150,000 readers, and followers.

Out Reach Efforts

You can reach this influential audience by submitting a guest opinion piece on anything related to non-clinical health care. Newspaper reporters and editors read the ME-P regularly, so this is always an opportunity to expose your writing to major media outlets.

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Assessment

Articles for consideration can be emailed directly to us at any time: MarcinkoAdvisors@msn.com

Conclusion

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Questioning [Physician’s] Upward Social Mobility and the State of the Union Address

Broad Consensus Seems Impossible for Medical Professionals – and Everyman

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

While an undergraduate student at Loyola University in Maryland, I learned from my Jesuit teachers and philosophers that a couple of centuries ago, the decider of all matters of importance in Jerusalem was the Great Sanhedrin, or a council of 71 judges. The council met most every day except on festivals and the Sabbath. It functioned as sort of a combination of the Supreme Court, Congress and a political debate boiler room.

Incorrect Unanimity

As one might imagine, the Sanhedrin’s members normally disagreed as they hammered out their daily opinions; much like today’s political debates over healthcare reform. But occasionally they came to a unanimous decision, and they had an amazing and very wise rule when that occurred: The decision was immediately overturned because the sages believed that a unanimous conclusion among so many individuals just had to be wrong.

THINK: The US Senate and Congress

Rules for Upward Mobility

Anyway, I was thinking about the Sanhedrin’s rule after last night’s 2010 State of the Union address by President Barrack H. Obama while I was considering the current state of the economic union for doctors – specifically. The translation is easy for non-physicians [everyman] as well; so bear with me.

Anyway, I was struck by the fact that if there was one grand unified theory which gets at least 90-100% agreement from current generations of America’s medical and lay punditocracy – it is the rules for upward [medical professional] mobility.

These rules, especially for second generation Americans like me, were:

  • A medical degree [college education] leads to a lucrative profession [job] and a satisfying lifestyle.
  • [Working hard], or practicing long hours, means your income will grow.
  • Devotion to medicine, or your job, will produce a comfortable retirement.
  • Your children will follow your career path [job] and create a lasting legacy

The Paradigm Shift

Today, with a national unemployment rate hovering around 10%, doctors and everyman may need to reconsider the above unwritten rules that have governed our upward mobility since the end of World War II. As the son of a GM auto worker – I did decades ago – and still do.

For example, from 1945 to 2000, various private and public health insurance mechanisms were developed, along with the idea that health insurance was a fringe benefit in lieu of the wage and price controls instituted after the war. Today it is even considered a “right” by some.

Nevertheless, the doctor-class was a surrogate for the affluent American upper middle class lifestyle, and a type of perpetual prosperity machine that created wealth.

There were periodic general economic dislocations of course, like the recessions of the mid-1970s and early 1980s, and the rise of managed care in the early 1990s. But, wealth seemed to compound for physicians, and progress always resumed its upward trajectory. This was especially true for all medical professional during the “golden age of medicine” [circa 1965-1990, approx].

After all, wasn’t [isn’t] healthcare considered a recession proof business? Perhaps no more!

The Physician Net-Worth Numbers

Then: I was involved in study a few years ago [September 16, 2008] which determined that the average 47 year-old physician, earning $180,000 annually, needed to amass a net-worth of about $5.5-M in order to maintain the same lifestyle throughout retirement at age 65.

Link: http://www.hcplive.com/finance/publications/pmd/2005/92/3951

Link: www.CertifiedMedicalPlanner.com

Now: Today, with the DJIA down about 30% from its’ October 2008 high, is this retirement / employment scenario still possible? Are our opinions Sanhedrin-like?

And remember, the estate tax laws sunset back to their original rates in 2011. Moreover, many financial advisors, like me, believe income tax rates and brackets will increase going forward; along with increasingly onerous regulations for small businessmen and women like physicians and private medical practitioners. New business innovations of all stripes will also be adversely affected.

Full Disclosure: I am founder of the Certified Medical Planner™ online education program for financial advisors and medical management consultants.

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Assessment

And so, I ask, do the rules of upward mobility for physicians or everyman still apply; or have they changed?  Why or why not? If so, is the change permanent or temporary, and is it for the positive or negative. Please consider financial, societal and/or generational implications.

IOW: Is President Barack H. Obama correct?

Conclusion

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About the Cisco HealthPresence Medical Delivery Model

What it is – How it works

By Staff Reporters

Cisco HealthPresence is a new concept developed by the Cisco Internet Business Solutions Group (IBSG) and prototyped at the Cisco Technology Centre. Cisco HealthPresence is based on market-ready Advanced Technologies. It is led by Dr. T. Warner Hudson.

A Multi-Media Platform

Using the network as a platform, Cisco HealthPresence combines state-of-the-art video, audio, and medical information to create an environment similar to what most people experience when they visit their doctor or health specialist.

Healthcare services include:

  • Primary medical care (family medicine, internal medicine, women’s health)
  • Pediatric care
  • Digital x-ray
  • Laboratory services
  • Pharmacy services
  • Physical therapy
  • Condition management and health coaching
  • Travel immunizations and prescriptions
  • Chiropractic medicine
  • Acupuncture
  • Executive physicals
  • EAP/Behavioral health
  • Assessment

    http://www.cisco.com/web/about/ac79/health/hp/index.html

    Currently for employees only, each has a personal account at: www.ciscolifeconnections.com where they can view their eMRs and message physicians.   

    Conclusion

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    Apple Tablet PC Poll for Medical Professionals

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    About Ambulatory Gadgets in Medicine

    By Chris Thorman
    Chris@softwareadvice.com


    Hello Dr. Marcinko and all Medical Executive-Post readers. I hope you’re doing well.

    The Big-Breaking News from Apple

    You’ve probably heard the news that Apple is set to release a new tablet PC today. That got us thinking here at Medical Software Advice about whether or not this new device will be the first tablet PC to break through in the healthcare industry.

    A Short Survey

    So, we’ve created a short survey (8 multiple choice questions) about what tablet PC features are important to healthcare professionals. I’ll use the results from the survey to determine which tablet PC is best positioned to rule the halls of healthcare. Even if you’ve never used a tablet PC, we’d love to get your opinion on what features are important.

    Link:
    http://www.softwareadvice.com/articles/uncategorized/which-tablet-pc-will-rule-the-halls-of-healthcare-1012610/

    Assessment

    Thank you in advance for your survey participation.

    Medical Software Advice [512.364.0118]

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    Why Health Savings Accounts are No Longer a Banking Industry Pariah

    The High Deductible Insurance Competition Heats Up

    By Dr. David Edward Marcinko; MBA

    [Editor-in-Chief]

    As ME-P readers are aware, I’ve had a High Deductible Healthcare Plan [HDHP] coupled with a Health Savings Account [HSA] for my family, and consulting firm, for more than a decade. We’ve been very pleased with it thus far. No significant health problems along the way; just a few scares that proved costly, but benign, because of physician over-protection, over-reaction, or liability phobia; i.e., its better to be safe, than sorry!.

    Still, having some economic skin in the insurance game because of the high-deductible feature, makes one an informed consumer. It also provides a sense of empowerment which, while ultimately illusionary for mortals, does offer a bit of self-control. After all, while we can’t mitigate against drunk-drivers and catastrophic diseases, we can live a healthy lifestyle and pay out of pocket for true health “maintenance” … much as we self-pay to maintain our cars and homes, etc. We can do our best … and hope for the rest.

    Of course, the savings portion [HSA] has always been a secondary after-thought relative to the actual re-insurance coverage terms, exclusions and conditions. I personally remain focused on the indemnity or PPO type with full coverage, no co-payments and few restrictions. After all, if I use up my high-deductible for an adverse health incident, I figure I have far more problems to worry about than economic. My health, well-being and probably life are significantly in peril.

    Nevertheless, as a health economist, I have always appreciated the above market rates given to my cash HSA account; 5% to 4.0% historically; and now 2.5% even after the domestic implosion thru 2010. Compared to the paltry 0.19% in my FDIC protected Wachovia money market deposit account, or the 0.5% in my non-FDIC protected money market mutual fund [brokerage] account; this is a great deal. And, it is tax exempt.

    Oh the Irony! 

    So, it comes as some surprise that after more than a decade, and the recent health insurance reform political debacle, that there is a surge of interest in the HSA companion. This time however, interest comes not from the insured’s – but the insurers. And, not from the health insurance industry, but rather from the affiliated [and desperate] banking industry.

    How so – and why?

    Well, it now seems some insurance companies actually desire the business of folks like me who are willing to bear a higher deductible in return for lower premiums, or who are willing to research CPT® code prices and question the efficacy of the procedures they negotiate with physicians in a collaborative fashion; or who are willing to watch their weights and abstain from over-indulgences for their own good. How novel; and again, why?

    It’s the HSA pot-o-gold; Duh!

    The Proof

    Below, is a copy of an email I personally received from eHealthInsurance soliciting my separate health savings account [HSA] business; not my health insurance coverage business:

    Dear David,

    Did you know that your health insurance plan can be complemented by a Health Savings Account (HSA)? If you haven’t opened an HSA yet, it’s not too late! An HSA allows you to:

    • Use funds to pay for copays, deductibles, prescription drugs, dental services, vision care and more
    • Save money by deducting 100% of your HSA contributions from your taxable income
    • Earn tax-free interest on the funds that accrue in your account over time
    • Grow your account from year to year – the money you contribute won’t expire; you can even use an HSA as a secondary retirement savings account

    There are no penalties or taxes when you use your HSA funds to pay for qualified medical expenses. Take advantage of your health plan’s benefits and open an HSA today! eHealthInsurance has partnered with nationally recognized, highly-rated HSA banks to offer you industry leading choices:

    • The Bancorp Bank
    • HSA Bank
    • JPMorgan Chase Bank
    • OptumHealth Bank
    • Sovereign Bank
    • Wells Fargo Bank

    We’re with you every step of the way

    Our representatives are also available for online chat 24 hours day.

    Gary Matalucci
    Vice President of Customer Care

    The Question Is?

    Such the deal; NOT!

    So, any thinking HDHP participant [like me] must logically ask why such “nationally recognized, highly-rated HSA banks” would offer above market rates during these times of essentially zero interest rate levels.  Why the interest at all? Are they trying to loose money; or are they just befriending me?

    As tennis player John McEnroe might say: are you serious!

    Assessment

    Yes John, the high rates are a serious loss-leader for more expensive products.

    These banks want to make money; not from the non-existent interest rate spread on your HSA cash, but by enticing us to place this growing cash horde into their “investment vehicles.”  In the recent past, some of us mortgaged our homes chasing the stock market or were goaded into flipping houses. And now, these same bankers are encouraging us to mortgage our health insurance on whatever high-priced, low-quality, fee-ridden, load bearing, snarky “investment vehicles” they can pawn off on us.

    Of course, the health insurance companies get a fat sales commission or percentage cut, as well. A win-win situation for all but us – the insured.

    Think AARP.

    My Personal Advice

    Do not do it. Do not take the bait.

    The HSA portion of your HDHP is for paying premiums and future medical care in the event of a health catastrophe. It is for savings, not for investing in a risk-bearing vehicle. Far too many of us realized too late that a home is a place to live – not an investment. Likewise, a health savings account is for your health, and health insurance – not risky investing.

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    Assessment

    Well, that’s my opinion as a retired surgeon, former insurance agent and financial advisor.

    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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    Capital Formation for Hospitals

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    Understanding Strategic Expenditures

    [By Calvin W. Wiese; MBA, CMA, CPA]

    [By Dr. David E. Marcinko MBA CMP]

    Some of the most important strategic decisions hospital executives make are related to capital expenditures. Almost every hospital has capital investment opportunities that are far in excess of their capital capacity. Capital investments are bets on the future. How these capital bets are placed has long-lasting implications. It is of utmost importance that hospitals bet right.

    Strategic Importance of Capital Investing

    Hospitals are capital intensive businesses. Hospital buildings are unique structures that require large amounts of capital to construct and maintain. Inside these buildings are pieces of expensive equipment that have fairly short lives. Technological innovations continually drive demand for new and more expensive equipment and facilities. The ability to continually generate capital is the lifeblood of hospitals. In order to compete and succeed, it’s imperative for hospitals to continually invest in large amounts of capital equipment and expensive facilities.

    Profit Driven

    Capital investment is fueled by profit. In order to continually make the necessary capital investments, hospitals must be profitable. Hospitals unable to generate sufficient profit will fail to make important capital investments, weakening their ability to compete and survive.

    Capital Opportunity Selection

    Hospital managers bear important responsibility in choosing which capital investments to make. There are always more capital opportunities than capital capacity. In many cases, capital opportunities not taken by hospitals create openings for others with capital capacity to fill the vacuum. By not taking such opportunities, hospitals are weakened, and their operating risk increases.

    Stewardship

    Stewardship is a term that aptly describes the responsibility borne by hospital managers in making capital investments. The New Testament parable of the talents describes this kind of stewardship. In this story, a merchant entrusted three managers with money to invest. One manager was given five units, another two, and a third one. At the end of the investment period, the two managers given five units and two units reported a 100% return. The manager given one unit reported zero return — he was fired and his unit was given to the first manager.

    This is stewardship — and hospital managers are stewards of their organizations’ assets. Too often, not-for-profit hospital managers hold an erroneous view of the returns expected of them. Like the third manager in the parable, they think zero return on equity is acceptable. They understand capital investment funded by debt needs to cover the interest on the debt, but they view capital investments funded by equity as having no cost associated with the equity. From an accounting perspective, they are right. From a stewardship perspective they are dead wrong — just like the third manager in the parable.

    Here’s why: as stewards, they are responsible for managing the entrusted assets. They can either put these assets at risk themselves, or they can put those assets in the market and let other managers put them at risk. If they choose to put them at risk themselves, and then they have the mandate of creating as much value from putting them at risk as they would realize if they put them in the market for other managers to put at risk. They have the duty to realize returns that are equivalent to the returns they could realize in the market; otherwise, they should just put them in the market. They can either invest in hospital assets or work the assets themselves, or they can invest in financial market assets so others can work the assets. When they choose to invest in hospital assets, the required return is not zero. That’s the return they get fired for. The required return is equivalent to market returns.

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    Assessment

    Thus, when evaluating performance of hospital management teams, the minimum acceptable performance level is return on equity that is equivalent to the return that could be realized by investing the hospital assets in the market. And when evaluating a capital investment opportunity, it is important to apply a capital charge equivalent to the hospital’s weighted cost of capital — a measure that imputes an appropriate cost to the equity portion of the capital along with the stated interest rate for the debt portion of the capital structure.

    CASE MODEL: CASE MODEL

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    Is the HITECH Act Unconstitutional?

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    Parts 1 and 2

    [By Alberto Borges; MD]

    Is the HITECH Act Unconstitutional? – PART 2

    Is the HITECH Act Unconstitutional? – PART 1

    Dr. Borges is a ME-P thought-leader in private practice. He is an associate clinical professor of medicine at the George Washington University in Washington, DC.

    Assessment

    Check out his website at http://msofficeemrproject.com

    Conclusion

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    I Want Obama Transparency for the ADA

    No More Hiding Places

    By D. Kellus Pruitt; DDS

    Today, Ed O’Keefe of the Washington Post posted “New Obama Orders on Transparency, FOIA Requests.”

    http://voices.washingtonpost.com/federal-eye/2009/01/_in_a_move_that.html

    O’Keefe writes:

    “In a move that pleased good government groups and some journalists, President Obama issued new orders today designed to improve the federal government’s openness and transparency. The first memo instructs all agencies and departments to ‘adopt a presumption in favor’ of Freedom of Information Act requests, while the second memo orders the director of the Office of Management and Budget to issue recommendations on making the federal government more transparent.”

    Soon, other ADA members are going to bluntly ask Pres Dr. Ron Tankersley:

    “If the President of the United States has the courage to face those whom his actions affect, why oh why doesn’t the President of the American Dental Association support transparency in the non-profit organization that belongs to dues-paying members?” After all, ADA members pay more than $1000 per year for ADA services.”

    “If you are an ADA leader, pay close attention. This is the future I warned you about that far too many of you avoided out of convenience. As you can read below in his memos, Obama promises, “The Government should not keep information confidential merely because public officials might be embarrassed by disclosure, because errors and failures might be revealed, or because of speculative or abstract fears.”

    Who will be held accountable for the ADA/IDM blunder… among other bone-head ideas?

    Obama promises that his administration:

    “Will work together to ensure the public trust and establish a system of transparency, public participation, and collaboration. Openness will strengthen our democracy and promote efficiency and effectiveness in Government.”

    I think openness will do the same in healthcare if we can move a handful of entrenched ADA leaders on down the road. They are weighing us down with their selfish special interests.

    Assessment 

    Did you hear that, Dr. Ron Tankersley, President of the American Dental Association? There are simply no more hiding places for the anonymous ADA hobbyists who elected you. I’m sure the long run of irrelevant ADA Presidents was fun before electricity and social networks, though.

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    Conclusion

    And so, 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, be sure to subscribe to the ME-P. It is fast, free and secure.

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

    OSHA Financial Cost Analysis Software

    About the “Safety Pays” Program

    By Staff Reporters

    A financial cost analysis can be performed by anyone using the OSHA software program, Safety Pays. This software can be found and downloaded at no cost by accessing the website: http://www.osha.gov/pls/oshaweb/searchresults.category?p_text=safety%20pays&p_title=&p_status=CURRENT

    A Free Software Program  

    The program was developed to assist employers in assessing the impact of occupational illness and injuries on their profitability. Utilizing this software program and profit/loss data from the www.bizstats.com website on physician practices – reveals a number of startling statistics that illustrate how cost effective implementing an OSHA safety program can be for a medical practice, clinic, hospital or emerging healthcare organization (EHO).

    Assessment

    Conclusion

    And so, 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, be sure to 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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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    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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    The Scott Brown versus Healthcare Reform Poll

    The Sott Brown Opinion Poll

    By Staff Writers

    In what some pundits are calling the “Boston Massacre” in liberal Massachusetts, Republican Scott Brown rode a wave of voter anger to win the US Senate seat held by the late Edward M. Kennedy for nearly half a century, leaving President Barack Obama’s health care overhaul in doubt and marring the end of his first year in office.

    Our ME-P Audience

    As a financial advisor, we know you are aware of the rise in healthcare stocks yesterday. And, as a medical executive or healthcare professional, we know you have been against the public option, and healthcare reform, in its current version.  The AMA is not your friend – nor does it represent you.

    The Question Is?

    And so, do you believe that last Tuesday’s Republican victory in Massachusetts means the current Democratic health care bill will not be on the President’s desk in 2010?

    Please VOTE:

    US Navy Ship Comfort Heads to Haiti

    More on the Hatian Military Sealift Command Operations

    By Dr. David Edward Marcinko; MBA

    [Publisher-in-Chief]

    According to www.USNavySeals.org, the Military Sealift Command hospital ship Comfort just sailed from its pier home-port in Baltimore Maryland and is now on its way to Haiti to assist in relief operations.

    On board are 550 doctors, nurses, technicians and support staff who, according to the Bureau of Medicine and Surgery of the United States Navy, will give a variety of medical services, among them primary care, trauma care, pediatric care and orthopedic care. 

    Assessment

    I was privileged to visit the big ship last summer [2009] while on speaking tour. It is a sight to behold:

     For more info, I encourage all ME-P readers and subscribers to lean more about her:

    Channel Surfing

    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. 

    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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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    Sponsors Welcomed

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    Product DetailsProduct DetailsProduct Details       

    Product Details  Product Details

       Product Details 

    Healthcare Reform and the US Constitution

    Consider this Proposed 28th Amendment

    Submitted by Cecelia T. Perez; RN

    Author Unknown

    For too long we have been too complacent about the workings of Congress. Many citizens have no idea that Congress members can retire with the same pay after only one term, that they didn’t pay into Social Security, and that they specifically exempted themselves from many of the laws they have passed (such as being exempt from any fear of prosecution for sexual harassment); while ordinary citizens must live under those laws. 

    The Healthcare Reform Exemption

    The latest is to exempt themselves from the Healthcare Reform that is being considered … in all of its forms.  Somehow, that doesn’t seem logical.  We do not have an elite class that is above the law.  I truly don’t care if they are Democrat, Republican, Independent or whatever. The self-serving must stop. This is a good way to do that.  It is an idea whose time has come.

    Proposed 28th Amendment to the United States Constitution:

    “Congress shall make no law that applies to the citizens of the United States that does not apply equally to the Senators and Representatives; and, Congress shall make no law that applies  to the Senators and Representatives that does not apply equally to the citizens of the United States.”

    Assessment

    Each person contact a minimum of twenty people on their address list, in turn ask each of those to do  likewise. Then in three days, all people in The United States of America will have the Message. We ask you to pass this idea to your friends for their consideration.

    Channel Surfing

    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. 

    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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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    Healthcare Organizations: www.HealthcareFinancials.com

    Health Administration Terms: www.HealthDictionarySeries.com

    Physician Advisors: www.CertifiedMedicalPlanner.com

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    Desperately Seeking Medical Professionals in Haiti

    The Catastrophe in Port-au-Prince

    By Dr. David Edward Marcinko; MBA

    [Publisher-in-Chief]

    The ME-P is attempting to assist those in need in Haiti. So, if you are a healthcare professional interested in volunteering, please send an email to volunteer@pih.org with information on your credentials, language capabilities (Haitian Creole or French desired), availability and contact information; etc.

    Acute Medical Needs

    Orthopedic and trauma surgeons and related specialists are especially desired. In particular, ER doctors and nurses – and full surgical teams (including anesthesiologists, scrub and post-op nurses, and nurse anesthetists) – are in short supply.

    Chronic Medical Needs

    Down line, primary care doctors, infectious disease specialists, nurses, dentists and internists will be needed once the acute situation has been controlled.

    Assessment

    We at the ME-P would be very grateful if you are able to contact them, or the Red Cross, and provide medical assistance. As patients flood from Port-au-Prince, they are also finding themselves in need of both personnel and medical supplies, as well.

    In other words, any help is much appreciated [time, talent and money].

    Conclusion

    And so, your thoughts and comments on this ME-P are appreciated. If confirmed, we will laud your humanitarian efforts in an upcoming edition of the ME-P.

    Join Our Mailing List

    Godspeed!  

    Who Admires the EU Healthcare Model?

    Not so Fast – Old Man 

    By Darrell K. Pruitt; DDS – el Viejo

    Here’s something interesting I found on Courthouse News.com about Germany’s mandatory retirement age for dentists.

    “EU Court OK’s Age Limits for Firefighters, Dentists” (no byline).

    http://www.courthousenews.com/2010/01/14/European_Courts.htm

    European Court of Justice  

    “The European Court of Justice released a ruling reconciling a ban on age discrimination with German age limits for firefighting and dentistry.”  

    The article continues:

    “For dentists, the high court agreed with the national court that an age limit is justified by the need to protect patients from declining performance.”

    As we wait for octogenarian Gordon Christensen DDS to discover and describe the lame “declining performance” claim in that statement, let me focus on the rest of the paragraph:

    “But it said that such a limit must apply across the board, not only for panel-certified dentists within the public sector, but also for private practitioners.”

    Touting the Next Generation of Dentists  

    It gets worse. The EU openly states that it intends to hand young dentists (and mid-level providers?) an immediate chance at making swell money with a huge demand for dental care that will arise when thousands of thriving dental practices across Europe close.

    “The Court of Justice also agreed that such a limit is reasonable to provide work positions for young dentists, but only if it can be proven to fulfill this purpose.”

    Assessment 

    Hell, I’ll probably still have kids in college if US HIT stakeholders fall in love with this plan. Not only that, but since thousands of dental practices like mine will be up for sale at the same time, the business I’ve built over the last 27 years will be worthless on the open market. 

    So what are my plans? I hope the ADA is adequately protecting Americans from such folly.

    And – if not?

    Porque hablo español, tengo la intención de mover el culo viejo a una ciudad en la costa en México y sacar dientes a los extranjeros ilegales a su regreso desde el norte. ¡Viva el NAFTA!

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    Conclusion

    And so, your thoughts and comments on this ME-P are appreciated. Who agrees with the EU; why or why not? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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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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    Understanding Hospital Community Essentiality

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    Views Differ on this Important Concept

    [By Calvin W. Wiese; CPA, CMA, MBA]

    An important component of hospital financial analysis is essentiality. Hospitals are unusual businesses that many times possess some form of essentiality to their communities. Healthcare is important to the economic vitality of every community. Many hospitals have served their communities for many years; it is not uncommon to find hospitals that have been continuously operating for more than 100 years in the same community.

    Many Hospital Types

    As we have discussed here and elsewhere, most hospitals are not-for-profit. In not-for-profit hospitals, no private party actually “owns” the hospital; control is vested in various boards, but no one explicitly “owns” a not-for-profit hospital. In a broad sense, communities own not-for-profit hospitals. They are considered “charities” with a “charitable purpose.” Though a not-for profit hospital may not have owners, it has many” stakeholders,” parties that have vested interests in the continuing success of the hospital.

    Many Diverse Stakeholders

    Many hospitals have broad and vast webs of stakeholders. Stakeholders are why hospitals rarely close or are shut down. Too many stakeholders have interests in the continuing successful operation of hospitals.

    Hospital stakeholder relationships need to be considered in the analysis of essentiality. How strong are these relations? How many are there? How important is the continuing success of this hospital to these stakeholders?

    Health Services Analysis

    Another dimension of the essentiality is medical service analysis. For examples, how significant are the hospital’s services? If the hospital shuts down, what population segments would suffer? How significant is the population that would suffer? How much would they suffer?

    Assessment

    Analysis of hospital’s stakeholders and services should provide a credible view of the degree of essentiality associated with a hospital. Higher degrees of essentiality suggest higher likelihoods that hospitals, one way or another, will meet their commitments, particularly their payment commitments.

    Conclusion

    So, tell us what you think about your hospital’s essentiality? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to 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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    Asking Uncle Sam – Why Health IT?

    Let ONC and CMS Explain

    By Staff Reporters

    On December 30, 2009, CMS and ONC issued proposed regulations on the definition of meaningful use and the initial set of standards, implementation specifications, and certification criteria for EHR technology.

    According to the DDHS

    Health information technology (health IT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. Broad use of HIT has the potential to improve health care quality, prevent medical errors, increase the efficiency of care provision and reduce unnecessary health care costs, increase administrative efficiencies, decrease paperwork, expand access to affordable care, and improve population health.

    Improving Patient Care

    Furthermore, according to the DHHS, interoperable health IT can improve individual patient care in numerous ways, including:

    • Complete, accurate, and searchable health information, available at the point of diagnosis and care, allowing for more informed decision making to enhance the quality and reliability of health care delivery.
    • More efficient and convenient delivery of care, without having to wait for the exchange of records or paperwork and without requiring unnecessary or repetitive tests or procedures.
    • Earlier diagnosis and characterization of disease, with the potential to thereby improve outcomes and reduce costs.
    • Reductions in adverse events through an improved understanding of each patient’s particular medical history, potential for drug-drug interactions, or (eventually) enhanced understanding of a patient’s metabolism or even genetic profile and likelihood of a positive or potentially harmful response to a course of treatment.
    • Increased efficiencies related to administrative tasks, allowing for more interaction with and transfer of information to patients, caregivers, and clinical care coordinators, and monitoring of patient care.

    Assessment

    Is the above really true in light of these two recently released reports on meaningful use?

    More information is available at http://healthit.hhs.gov

    Conclusion

    And so, 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, be sure to subscribe to the ME-P. It is fast, free and secure.

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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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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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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    Webinar on Doctors and the Economic Stimulus Package

    An ME-P TV First

    By Ann Miller; RN, MHA

    [Executive-Director]

    Recently, we caught up with Houston Neal – of Software Advice – who thought our ME-P readers would like to see their new podcast on eHR stimulus funds. In-as-much as they are still hearing from doctors who want to know how to take advantage of the stimulus, they’ve teamed up with the Chairman of HIMSS to help answer questions via webinar. The final clip is now live on the blog.

    And the Question … Is?

    After talking with hundreds of physician practices each month, their biggest question seems to be: “What does the economic stimulus package mean for me?”  

    Of course, practices understand that up to $45 billion is allocated to provide incentive for physicians to adopt eHRs. However, many questions remain about how and when providers will receive stimulus funds.

    ME-P TV

    The podcast, with Justin Barnes Chairman of the HIMSS Electronic Health Record Association and Vice President of Greenway Medical Technologies, seeks to answer these questions. The original presentation was delivered last week; however you can view the entire webinar here, as well.

    In this hour webinar, we hope you’ll learn:

    • How the stimulus money will be paid out
    • What it takes to qualify for funding
    • Which specialties qualify for funding
    • How “meaningful use” is defined
    • What constitutes a “qualified EHR”

    Assessment

    There’s some great content here, so be sure to check it out.

    http://www.softwareadvice.com/articles/medical/what-does-it-take-to-qualify-for-ehr-stimulus-funds-1122209/

    Join Our Mailing List

    Further Contact

    512.364.0117
    www.SoftwareAdvice.com
    houston@softwareadvice.com

    Conclusion

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

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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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    What is a HIT Security Firewall?

    Understanding Concepts and Terms

    By Dr. Richard J. Mata; MIS

    www.HealthcareFinancials.com

    Firewalls are devices or systems that control the flow of health information network traffic between networks or between a host and a network. A firewall acts as a protective barrier because it is the single point through which communications pass. Internal information that is being sent can be forced to pass through a firewall as it leaves a network or host. Incoming data can enter only through the firewall.

    www.HealthDictionarySeries.com

    The Federal publication NIST Special Publication 800-41, Guidelines on Firewalls and Firewall Policy provides details of firewalls and firewall product selection that are beyond the scope of this post.

    Implications Beyond Internet Connectivity

    While firewalls and firewall environments are often discussed in the context of Internet connectivity, firewalls have applicability in network environments beyond Internet connectivity.

    For example, many corporate healthcare enterprise intranets employ firewalls to restrict connectivity to and from internal networks servicing more sensitive functions, such as the accounting or personnel department. By employing firewalls to control connectivity to these areas, an organization can prevent unauthorized access to the respective systems and resources within the more sensitive areas. The inclusion of an internal firewall environment can therefore provide an additional layer of security that would not otherwise be available.

    Imperfect Security

    Although firewalls afford protection of certain resources within an organization, there are some threats that firewalls cannot protect against: connections that bypass the firewall, new threats that have not yet been identified, and viruses that have been injected into the internal network.

    Assessment

    It is important to remember these shortcomings because considerations will have to be made in addition to the firewall in order to counter these additional threats and provide a more comprehensive security solution.

    Conclusion

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    So, tell us what you think about this information. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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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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    Sponsors Welcomed

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

    Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

    A Quality Story all Doctors and Patients Should Re-Read

    [Mis] Adventures in Cardiology

    Reposted by Ann Miller RN MHA

    [Executive Director]

    According to the author of this re-posted e-journal, Johns Hopkins Medicine has a long tradition of prioritizing patients, and striving for the bottom rung that are the anonymous poor.

    And, many agree this is true. In fact, our Publisher-in-Chief grew up in Baltimore Maryland and has written about this venerable institution on the ME-P before.

    Outliers

    If, for example, you catch a bullet on a Baltimore street corner, or your mother presents you at the ER as a feverish welfare child, then it us open season for the medical students, well meaning as they may be. They can practice on you because if  their actions result in an adverse outcome—which is to say that if you are mangled or killed—nobody will question said outcome, precisely because … you are a nobody.

    At the other end of the spectrum are wealthy and prominent patients, who get treated by doctors who have already learned what not to do from the mistakes inflicted upon the lower classes.

    Of … Quality Medical Care

    However, sometimes mistakes happen, and medical errors do occur as we all are human. But, what is reported to have happened to one journalists’ wife – Pam – at Johns Hopkins Hospital in March of 2002 is beyond the pale.

    As a middle class citizen, she landed somewhere in the middle of the bell shaped curve. Maybe she got snookered by all the hype from US News into thinking that she was going to be treated by the best doctor at “The Best Hospital in America” … You decide.

    Assessment

    This is the story of what happened to Pam; as reported by her journalist husband Don.

    Link: http://adventuresincardiology.com/

    Conclusion

    Indignation Index: 96

    We trust medical quality guru Bob Wachter MD will opine. And so, your additional thoughts and comments on this ME-Pare also appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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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

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    Introducing our New Name

    Or … What’s in a Formal Name?

    By Ann Miller; RN, MHA

    [Executive-Director]

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    Some ME-P readers have already noted our new moniker so it seems appropriate to formally announce our new name … domain name that is.

    The Complete Migration

    We’ve migrated from the rather unwieldy www.HealthcareFinancials.wordpress.com extension to the more facile and relevant www.MedicalExecutivePost.com

    The first domain name refers to our companion institutional journal: Healthcare Organizations [Financial Management Strategies], located at www.HealthcareFinancials.com. Of course, the synergy there is perfect.

    But, we were searching for something more expansive for the entire healthcare 2.0 universe for this rapidly growing blog, and had the epiphany to simply rename the site using our existing MEP tagline; and voila www.MedicalExecutivePost.com was born.

    Confusing?

    Not at all, since either name will get you to the same place via “domain sub-name pointing” technology.

    What’s a Reader to Do?

    So, what’s a reader to do about this name change; nothing! Just be aware and join us by reading and subscribing as you have always done … and we’ll do the rest. Fast, free and secure. Oh, and be sure to comment, too. Your opinion counts!

    Conclusion

    So, tell us what you think about our new name. Then, be sure to subscribe to the MEP. A rose by any other name … smells as sweet.

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    Healthcare Organizations: www.HealthcareFinancials.com

    Health Administration Terms: www.HealthDictionarySeries.com

    Physician Advisors: www.CertifiedMedicalPlanner.com

    Hospital Materials Management Information Systems [Part 2]

    Fundamentals of Software Implementation

    By David J. Piasecki; CPIM

    By Hope Rachel Hetico; RN, MHA

    Dr. David Edward Marcinko; MBA

    www.HealthcareFinancials.com

    The singular focus of any Hospital Materials Management Information System (HMMIS) is to deliver significant improvements in the ability of hospital facilities, networks, and other healthcare organizations to optimize the processes and work flows associated with materials management systems and reduce the costs related to inventory, durable medical equipment, pharmaceuticals and supply chain management (SCM).

    Understanding Strategies

    Strategically, hospitals must exploit contemporary technologies and connectivity with suppliers and trading partners to:

    • improve patient care and safety,
    • increase efficiency,
    • drive down costs, and
    • optimize inventory levels.

    Software Implementation

    As with the selection process written about previously, ERP software implementation may also require outside assistance.  Whether you use consultants from the software vendor, a business partner, or an independent firm, the implementation plan will likely be the same.  It’s very important to listen to consultants and be prepared to dedicate the resources outlined in the implementation plan.  A common mistake made by healthcare entities going through their first major implementation is to underestimate the complexity of their operations, the extent of system setup and testing, and the impact the implementation will have on their operation.

    ERP Implementation

    Here is an outline of a common scenario in single-hospital ERP implementations.

    • The consultants warn of the consequences of not dedicating adequate resources.
    • Management publicly agrees but privately thinks the consultants are crying wolf.
    • Implementation fails or goes poorly.
    • Management claims “how could we have known?”

    Don’t let this be you.  The only thing to assume about the implementation is that it that it will be much more difficult than expected, it will take longer than you expected, and it will cost more than expected.

    Like most other projects, the success of a software implementation will be based upon the skill of the people involved, training, planning, and the effort put forth.  Plan to have the most knowledgeable employees heavily involved in the system setup and testing.  

    Testing Programs

    Adequate time should be dedicated to make sure every aspect of every process is thoroughly tested.  An example of a detailed testing program is listed below:

    • Does the purchase order [PO] receipt screen have all the information needed to perform the receipt such as vendor item number, item description, unit of measure?
    • What happens when we receive more than the PO quantity?
    • What happens when we receive less than the PO quantity?
    • What happens when we enter multiple receipts against the same line?
    • What happens if someone tries to change the PO quantity after we have entered a receipt?
    • What happens if one changes the PO quantity at the same time we are entering a receipt?
    • What happens when we reverse a receipt?
    • What happens when we reverse a receipt after it has been paid?
    • What happens if the ordered unit of measure is different from the stocking unit of measure?
    • What happens when we receive an early shipment?
    • What happens when we try to receive against a cancelled PO?
    • What happens when we change the receipt location?

    After the system has been thoroughly tested, employee training begins. Remember, dealing with unexpected issues is the norm; you don’t also need to be training employees after the system is supposed to be operating.

    Hands-On Training

    The training should consist of hands-on training and include written procedures for the tasks performed.  For most positions, make sure that each employee has entered the equivalent of at least a full day’s transactions during the training.  Using an actual day’s transactions is a good way to make sure the variety of transactions an employee is likely to encounter have been experienced. The most common mistake made in training is a lack of adequate repetition. Just because someone was able to perform the task once, during a training session on a Saturday three weeks prior to “going-live” does not mean they will be able to perform the task with system start-up. If they have repeated the task many times over a series of training sessions, they are much more likely to remember how to do it. 

    Assessment

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    Watch the data. During and immediately after the implementation it is incredibly important to watch the data and make sure everything is working as planned. Monitor the status of orders, purchase orders, and delivery orders paying specific attention to “stuck orders” or other exceptions. Conduct some aggressive cycle counting of fast-moving items to make sure transactions are working correctly. 

    Conclusion

    So, tell us what you think about your hospital’s SCM software implementation? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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    Healthcare Organizations: www.HealthcareFinancials.com

    Health Administration Terms: www.HealthDictionarySeries.com

    Physician Advisors: www.CertifiedMedicalPlanner.com

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    Hospital Materials Management Information Systems [Part 1]

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    Fundamentals of Inventory Software Selection

    By David J. Piasecki; CPIM

    By Hope Rachel Hetico; RN, MHA

    By Dr. David Edward Marcinko; MBA

    The singular focus of any Hospital Materials Management Information System (HMMIS) is to deliver significant improvements in the ability of hospital facilities, networks, and other healthcare organizations to optimize the processes and work flows associated with materials management systems and reduce the costs related to inventory, durable medical equipment, pharmaceuticals and supply chain management (SCM).

    Understanding Strategies

    Strategically, hospitals must exploit contemporary technologies and connectivity with suppliers and trading partners to:

    •  improve patient care and safety,
    •  increase efficiency,
    •  drive down costs, and
    •  optimize inventory levels.

    Software Selection

    Software selection and implementation services have become big business for consulting firms as well as the software vendors themselves.  Even with outside assistance, selecting the right software for hospital operations and having a successful implementation can be an extremely difficult undertaking. Horror stories of failed enterprise resource planning (ERP) system implementations are unfortunately very common.  Anyone who frequently reads business publications have read stories where large healthcare corporations, posting smaller than forecasted profits, cite problems associated with the implementation of a new software system as one of the causes.  Whether these claims are legitimate or not is up to debate. What is true is that hospitals are highly dependent on information systems and failures in the selection and implementations of systems can result in anything from a minor nuisance to a complete operational shutdown.

    Those unfamiliar with business inventory management software should be prepared to be bombarded with acronyms and buzz words.  E-business, web-enabled, E-procurement, E-fulfillment, E-manufacturing, collaborative, modular, and scaleable are just a sampling of the terms used to describe (sell) hospital software inventory products.

    Inventory Tracking Software

    Healthcare enterprise inventory tracking software with implementation ranges in price from a few thousand dollars to millions.  In fact, up until recently, if you were a medical clinic with annual revenues of less than $200 million, many of the top enterprise software vendors didn’t even consider you a potential customer.  Fortunately, this arrogance has been tempered recently due to economic conditions (primarily the software vendors’ cash flow). Unlike five years ago, when the software vendors felt they held all the cards, today it is truly a buyer’s market. No matter how big or small an entity, many vendors will be vying for software dollars. That’s the good news. The bad news is that you must sift through all these products to find the one that best meets your business needs.

    Process Definition

    The most important part of the software selection process is defining the processes within your health organization and determining functionality that is critical to your medical operation.  Many times clients get distracted by the bells and whistles and forget about their core healthcare business functions.  As a healthcare entity in the DME distribution fulfillment business – focus on functionality related to order processing, as well as warehouse and transportation management. Be wary of the software vendor that claims packages that work equally well in all environments.  Most software packages are initially designed with specific situations in mind; asking the vendor about their biggest customers will often give you an idea as to the type of operation the software was designed to work in.

    Product Functionality

    When you look at the detailed functionality of a product it will be important to have listed detailed functionality requirements of your healthcare operation.  This is where hospitals often make mistakes by emphasizing functionality that they currently don’t have, but would like, and overlooking core healthcare processes that their current system handles well.

    Example:

    For example, if you are awestruck with functionality that allows remote access to a medical charting system from an Internet browser on an ambulatory device – and as a result – overlook critical functionality related to order entry or demand planning, you may end up with a system that provides great visibility to the fact that patient revenues are failing. Never assume a software package “must” be capable of handling something considered a standard function.  Some examples of detailed functional requirements are as follows:

    • E-commerce capabilities
    • Multi-facility demand planning
    • Postponement and configure-to-order functionality
    • Forecasting and demand planning
    • Back-order processing
    • Lot or serial number tracking
    • Forward pick location replenishment
    • Batch or wave order picking
    • Returns processing
    • Back flushing DME inventory
    • Co-product processing
    • Outsourcing specific operations
    • Multiple stocking units of measure
    • Product substitutions
    • Blanket orders
    • Shipment consolidation
    • Multi-carrier rate shopping and manifesting
    • First-in first-out processing

    documents

    Assessment

    Don’t settle for “yes, we can do that” responses from the software vendor. It’s your responsibility to verify that not only can they do it, but also that they can do it to the level required. Ask detailed questions as to exactly how it works in their system. Look at the specific programs used to achieve the task and verify that the data elements required to achieve the task are present. Don’t allow the software vendor to sidestep your questions by retreating into obfuscating technical jargon

    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:

    Product DetailsProduct DetailsProduct Details

    Product DetailsProduct Details

    Meet Shahid N. Shah MS [Our Newest IT Thought-Leader]

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    And Textbook Contributor, Too!

    By Ann Miller; RN, MHA

    [Executive Director]

    Shahid N. Shah is an internationally recognized healthcare thought-leader across the Internet. He is a consultant to various federal agencies on technology matters and winner of Federal Computer Week’s coveted “Fed 100” Award, in 2009.

    Professional Career

    Over a twenty year career, Shahid built multiple clinical solutions and helped design-deploy an electronic health record solution for the American Red Cross and two web-based eMRs used by hundreds of physicians with many large groupware and collaboration sites. As ex-CTO for a billion dollar division of CardinalHealth, he helped design advanced clinical interfaces for medical devices and hospitals. Mr. Shah is senior technology strategy advisor to NIH’s SBIR/STTR program helping small businesses commercialize healthcare applications.

    He runs four successful blogs: At http://shahid.shah.org he writes about architecture issues; at http://www.healthcareguy.com he provides valuable insights on applying technology in health care; at http://www.federalarchitect.com he advises senior federal technologists; and at http://www.hitsphere.com he gives a glimpse of HIT as an aggregator.

    Industry Awards

    Mr. Shah is a Microsoft MVP (Solutions Architect) Award Winner for 2007, and a Microsoft MVP (Solutions Architect) Award Winner for 2006. He also served as a HIMSS Enterprise IT Committee Member. Mr. Shah received a BS in computer science from the Pennsylvania State University and MS in Technology Management from the University of Maryland.

    Assessment

    Shahid is also contributing the chapter on HIT in the third edition of our book “Business of Medical Practice” [Transformational Health 2.0 Profit Maximization for Savvy Doctors], now in-progress www.BusinessofMedicalPractice.com

    Channel Surfing

    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.

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

    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:

    Product Details

    Stuff that Still Floats to the Top on the ME-P

    Interesting Articles of Yore

    By Darrell K. Pruitt: DDS

    I’ve posted hundreds of articles on the Medical Executive-Post over the last year, and it always surprises me when something I long ago forgot rises to the top of their popularity scale.

    The Run-Down

    Earlier today, a comment I posted on March 30 titled “Usual and Customary UnitedHealthcare” was the most popular article out of thousands (?).

    https://healthcarefinancials.wordpress.com/2009/03/30/usual-and-customary-unitedhealthcare/

    Why the sudden interest in UnitedHealth? Where is it coming from? 

    At the same time, an article I posted on June 17 titled, “GM Bankruptcy Hits Delta Dental Hard,” had just showed up at 11th of the top dozen most popular articles. Why?  

    https://healthcarefinancials.wordpress.com/2009/06/17/gm-bankruptcy-hits-delta-dental-hard/

    Now, the UnitedHealthcare has dropped off the top dozen, and GM Bankruptcy has moved up to number 6.

    Assessment 

    Do you find that interesting? What do you think happened in the dental insurance market that has ME-P juggling my articles?

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    Conclusion

    And so, 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, be sure to subscribe to the ME-P. It is fast, free and secure.

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    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

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

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    Sponsors Welcomed

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

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    Guidelines for Using an Equity Analyst’s Report

    Trusting and Testing Fundamental Research

    By Dr. David Edward Marcinko; MBA, CMP

    [Publisher-in-Chief]

    It is not unreasonable to doubt the research of some security analysts; as evidenced by Wall Street’s recent implosion.

    And so, trust but verify with your on research is always a good idea for the physician or lay investor.

    25 Questions to Ask and Answer

    Now, as a former certified financial planner, and professional investment advisor, please allow me to suggest the following before purchasing any equity:

    • How recent is the stock price on the report? If it is not recent, what is the current price? What is the current price relative to the 52-week high and low?
    • What is the P/E on trailing earnings per share? What is the stock’s projected price, based on estimated earnings for the periods shown?
    • What is the cash flow per share and the price-to-cash-flow ratio?
    • What is the book value? Price to book?
    • What is the trading volume relative to the number of shares outstanding?
    • How many shares are outstanding? What is the market capitalization based on current stock price and current shares outstanding? Is it a small, medium, or large-cap company?
    • Is the number of shares on a fully diluted basis shown? Is the fully diluted P/E shown? If there is a significant difference, read the report to find out where the extra shares will come from (convertible stock, a new or re-issue) and what the likelihood is that a conversion or a new issue or re-issue will occur.
    • What is the company’s earnings growth history? Is it a growth company or a cyclical company?
    • Does the company pay a dividend? If so, what is the dividend history and the payout ratio?
    • What is the debt-to-equity ratio? What kind of debt is it (publicly owned bonds, loans, etc.), and when does it have to be paid? What is the annual interest expense?
    • What are the cash ratios? Can the company cover its current liabilities easily? What is the ratio of annual earnings to interest expense?
    • What business is the company in? Are there comparisons to other companies in the same business? Are they similar in size? What is the outlook for the industry?
    • What is the company’s share of the market for its product? Does it have a particular niche? Does it have patents or protected rights on a special product? When do they expire?
    • How do the company’s financial ratios compare to those of other companies in its industry? How do the company’s ratios compare to those of the market as a whole or to narrower industry indexes?
    • Who are the company’s competitors? What advantages does the company have over its competitors?
    • How old is the company? How long has it been public? How long has the current management been running it? Who is the current management, and have there been significant management changes in the recent past?
    • How much of the company’s stock is owned by management? How much is owned by large institutional investors?
    • What kind of labor force does the company rely on? Where is it located?
    • Who are the company’s major customers? Is one customer very important?
    • Who are the company’s major suppliers? Is the company very dependent on one supplier?
    • How is the product distributed? Are there important relationships with distributors? How many different distributors are there?
    • What are the profit margins of the company? Where do they come from (incremental sales over break-even, or are they directly related to sales, no matter what level)?
    • What is the inventory turnover? Is there a lot of old, highly valued (on-the-books) inventory?
    • What is the history of sales revenue growth? What is the history of product mix in sales revenue?
    • Did the company issuing the research report also serve as investment banker?

    Assessment

    What did we miss – please advise?

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    Conclusion

    And so, 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, be sure to subscribe to the ME-P. It is fast, free and secure.

    Get our Widget: Get this widget!

    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

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

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    Sponsors Welcomed

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

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    Understanding the Healthcare Integrity and Protection Data Bank

    Healthcare Fraud and Abuse Data Collection Program

    By Patricia Trites; MPA, CHBC, CPC

    The Healthcare Integrity and Protection Data Bank (HIPDB) were created to coordinate information with the National Practitioner Data Bank (NPDB). Currently, health plans, health maintenance organizations, and federal and state agencies are required to report final adverse actions taken against healthcare providers on a monthly basis.

    The NP Database

    The database operates under the auspices of DHHS, the Health Resources and Services Administration, and the Bureau of Health Professions. The Secretary of DHHS is responsible for operating this data bank in the same fashion as the NPDB.

    Adverse Actions

    Five types of final adverse actions against a healthcare provider, supplier, or practitioner are reported into this data bank:

    1. civil judgments in federal or state court related to the delivery of a healthcare item or service;

    2. federal or state criminal convictions related to the delivery of a healthcare item or service;

    3. actions by federal or state agencies responsible for licensing and certification;

    4. exclusions from participation in a federal or state healthcare program; and

    5. any other adjudicated actions or decisions that the secretary of DHHS establishes by regulations.

    Assessment

    These actions must be reported, regardless of whether the subject of the report is appealing the action. Federal and state agencies, hospitals, and health plans are permitted to query the HIPDB. This will also lead to increased activities by other federal agencies, including the Internal Revenue Service and the Federal Trade Commission, which can lead to civil and criminal penalties.

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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.

    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

    Product DetailsProduct DetailsProduct Details

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    Secure e-mail Delivery with a Widget for your Website

    By Ann Miller; RN, MHA

    [Executive-Director]

    Join Our Mailing List

    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, voting polls, surveys and much more!

    Many Related Topic Channels

    With more than 50 topic channels to select, the ME-P is sure to professionally inform and illuminate your day; almost each and every day. So, also feel free to review our top-left column, and top-right sidebar materials, links, URLs and related sites.

    And, get a free ME-P widget for your website, too!

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    Sponsors Welcomed

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

    Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

    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

    Announcing ME-P TV

    What it is – How it works [beta]

    By Ann Miller; RN, MHA

    [Executive Director]

    What is ME-P TV?

    The emergence of Internet video is creating new opportunities to provide richer, more effective information on our core subject areas and more than 50 related topical channels. Internet video gives anyone the ability to create a personal TV channel to distribute information on demand. We are creating the opportunity for you to participate in the Internet video revolution. ME-P TV opens the door to real financial advisors, medical management consultants and health care providers to share their views and opinions with us; each and every day.

    Why would I want to be on ME-P TV?

    By participating in ME-P TV, you help us create a useful resource for readers and subscribers, and thereby enhance our product. At the same time, we share these video materials with you to market your ideas, products or services. You are free to use these video materials in any way that you want, including on your own website, mobile device, wiki or blog; or on a DVD to distribute to your referring clients, advertisers and patients, or on your local news station. It’s your choice.

    Multiple Formats Available

    One format is the simple one-on-one interview between a host [Dr. David Edward Marcinko or Hope Rachel Hetico; RN, MHA] and the guest. We use a format similar to the “Charlie Rose” style – two participants sitting across from one another at a table. Generally, each interview focuses on a single topic area. Each informal interview lasts about 15 to 20 minutes. The structure of each interview is not necessarily consistent to keep interest high and energetic.

    You may also send in video material that you have previously recorded for your own purpose. Whatever you would like to get on file, send it in and we will post for free. We do reserve the right of refusal, of course. Once published, the video is available to incorporate into your own website and/or for syndication to any other websites.

    Syndication

    The dynamic of syndication makes the Internet and the World Wide Web the most powerful media distribution engine the world has ever known. This dynamic is fueling the transition of broadcast television into a new entity that combines the richness of video media with the convenience of “download on demand” to create a new way of accessing and distributing information. The Internet video revolution is creating the mechanism for anyone to create and distribute video information to as wide – or as narrow – an audience as necessary to accomplish your professional goals.

    The concept is simple:

    • Create your message
    • Make it accessible on the Internet
    • Enable others to find it

    ME-P TV Helps you accomplish these Tasks

    • You provide the message.
    • We produce the channel of Internet distribution.
    • We provide a portal on the Internet to initialize distribution of your message to the target audience.

    ME-P TV is the “contextual” portion of solving the distribution equation. Successful Internet distribution requires both content and context. Content is a critical “necessary but not sufficient” element. Providing an appropriate context to serve as a “container” to aggregate and increase the value of the content is also necessary. A growing collection, or library, of similar content is more valuable than isolated, individual offerings. ME-P TV is the container for your content with a “home” on the Internet from which to begin the syndication process. We represent a niche portal that gives us the ability to aggregate an audience to generate the attention necessary to be able to offer this service to you.

    A Partnership

    ME-P TV is a partnership between you and us. Once your message is produced and available on the Internet for distribution, this message is your asset to use as you like. Embed that message on your financial advisory website, your hospital or medical practice website, burn it on a DVD for physical distribution, send it to your friends, colleagues, clients, prospects and patients via email, or make it available on your local news. We will be hard at work making the message available to other health economics and medical management portals, as well. In addition, we will continue to build a portal devoted to integrating financial planning with medical practice management for all physicians and advisors.

    Assessment

    Join Our Mailing List

    Send in your video files or video links here: MarcinkoAdvisors@msn.com

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    Channel Surfing

    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. 

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

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

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    Events Planner: January 2010

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    Events-Planner: JANUARY 2010

    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 relative 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

    January 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:

    Jan 10-14: Arizona Financial Services Society, Phoenix, AZ

    Jan 11-12: Kinder Institute of Life Planning, Houston, TX

    Jan 11-12: Investment Management Consultants Association, New York, NY

    Jan 17-20: AICPA Advanced Personal Financial Planning Conference, Orlando, FLA

    Jan 21-23: Symposium on Healthcare Payers and Providers, Las Vegas, NV.

    Jan 25-27: EBM Leadership Conference, National Harbor, MD

    Jan 25-28: Healthcare Leadership Summit, Dallas, TX

    Jan 28-29: Money Management Institute, Bonita Springs, FLA

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

    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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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

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