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Has the ADA Ever Mentioned Quality Control?

About My Tell-All Book?

By D. Kellus Pruitt DDS

One day, I’m going to write a tell-all book about quality control dentistry …  But, for all I’ve been told, it might be fiction.

The Quality Mandate 

Here’s something I find entertaining about the “quality” reporting mandate that was quietly written into HIPAA about the time President Clinton amended the 1966 Freedom of Information Act – making doctors’ records no longer proprietary business information. The 1996 HIPAA Rule is modular, and around every corner, we’ve learned there is an exploding surprise that was slipped into a thick bill long ago. The bolus technique of passing difficult legislation is not unlike the way the 2000 page healthcare reform bill was handled. It gets crap through the system too quick to be read, understood and debated by principals in healthcare who aren’t paying attention anyway. It’s a rule-making policy that simply favors stakeholders rather than doctors and patients. Depending on the campaign contributions, silliness can catch fire like a Madoff investment.

Dental Quality Compliance 

I don’t know about physicians, but dentists have never been warned about the quality control part of compliance. Now that it’s an integral part of healthcare reform’s imaginary funding, it’s a sure bet that no ADA official is willing to discuss the egregious blunder even anonymously.

ADA Department of Informatics

Soon enough, ADA members will learn about the clandestine quality control efforts of the ADA Department of Informatics – the brainchild of former ADA Sr. Vice President Dr. John Luther, who I hear is no longer part of the organization. Although I’m a persistent, nosey outsider peeking into a secretive not-for-profit organization (?), from what I can tell, the ADA’s interest in quality control began about 6 years ago following a visit to the ADA Headquarters by Newt Gingrich – which evidently favored the ADA Department of Dental Informatics with federal funding to replace dependence on finicky members’ dues. Had ADA members who were busy treating dental patients actually known the directions the ADA took the ADA’s mission statement for easy money, Dr. Luther’s career with the organization would have been even shorter.

Anonymous ADA Leaders 

Knowing that anonymous ADA leaders’ blunders no longer stay hidden forever, don’t you find the shyness of today’s dental leaders amusing? Don’t you just know the trusting early-adopters of interoperable eDRs will be pissed off when they discover that long ago, the ADA could have warned them about ambitious stakeholders’ plans for the profession?

Assessment

Who’s going to break the sweet news to dues-paying members before CMS, insurers, and quality control consultants (today’s dental insurance consultants), are granted a back door to HIPAA-compliant dentists’ interoperable computers allowing access for real-time quality control authorities, as well as fraud, HIPAA, FTC and other inspectors working on commission? It’s a dark tale.

Conclusion

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David B. Nash MD MBA FACP

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Hospitals & Healthcare Organizations

FOREWORD 

It should come as no surprise to our readers that the nation faces a financial crisis in healthcare. 

Currently, the United States spends nearly 16% of the world’s largest economy on providing healthcare services to its citizens.  Another way of looking at this same information is to realize that we spend nearly $6,500 per man, woman, and child per year to deliver health services.  And, what do we get for the money we spend?  

This is an important policy question and the answer is disquieting.  Although the man and woman on the street may believe we have the best health system in the world, on an international basis, using well-accepted epidemiologic outcome measures, our investment does not yield much!  

According to information from the World Health Organization and other international bodies, the United States of America ranks somewhere towards the bottom of the top fifteen developed nations in the world, regarding the outcome in terms of improved health for the monies we spend on healthcare. 

From a financial and economic perspective then, it appears as though the 16% of the GDP going to healthcare may not represent a solid investment with a good return. 

It is then timely that our colleagues at the Institute of Medical Business Advisors, Inc. have brought us their greatest work: Healthcare Organizations: [Financial Management Strategies]; a two-volume set of nearly 1,200 pages.  

Certainly, this comprehensive manual, and its quarterly updates, is not for everyone. It is intended only for those executives and administrators who understand that clinics, hospitals and healthcare organizations are complex businesses, with advances in science, technology, management principles and patient/consumer awareness often eclipsed by regulations, rights, and economic restrictions.  Navigating a course where sound organizational management is intertwined with financial acumen requires a strategy designed by subject matter experts. Fortunately, Healthcare Organizations: [Financial Management Strategies] provides that blueprint.

Allow me to outline its strengths and put it into context relative to other policy works around the nation. 

For nearly two years, the research team at iMBA, Inc., has sought out the best minds in the healthcare industrial complex to organize the seemingly impossible-to-understand strategic financial backbone of the domestic healthcare system.   

The periodical print-guide is organized into two volumes in order to appropriately cover many of the key topics at hand.  It has a natural flow, starting with Competitive Strategy and moving through Asset Management, Cost Management, and Claims Management.  

Volume 1, most especially the Competitive Strategy section, has broad appeal and would be of interest to most people in the health insurance industry, including managed care, hospitals, third party benefit managers and the pharmaceutical industry. 

Volume 2 continues in a well-organized theme, progressing from Risk Management and Compliance to Health Policy, Information Technology, and most importantly, Financial Benchmarking. 

Volume 2 would be of greater interest to those in the policy sphere, both in Washington, DC, in state legislatures, consulting companies, medical colleges, and graduate schools of health administration, public health and related fields. Every day colleagues ask me to help explain the seemingly incomprehensible financial design of our healthcare system.  These two volumes would go a long way toward answering their queries. 

I also believe both volumes would be appropriate as text books and reference tools in graduate level courses taught in schools of business, public health, health administration, and medicine. 

In my travels about the nation, many faculty members would also benefit from the support of these two volumes as it is nearly impossible, even for experts in the field, to grasp all of the rapidly evolving details. 

On a personal level, I was particularly taken with the Competitive Strategy section and it brought back enjoyable memories of my work nearly twenty-five years ago at the Wharton School, on the campus of the University of Pennsylvania.  There, I was exposed to some of the best economic minds in the healthcare business and it was a watershed event for me forming some of my earliest opinions about the healthcare system. 

I also very much enjoyed the section on Health Policy, most especially, the section on the Sarbanes-Oxley Act for hospitals and healthcare organizations.  I believe we have not fully embraced the comprehensive nature of Sarbanes-Oxley on the hospital side, and envision a day when hospital boards will be held accountable for quality, in the same way that proprietary corporations are held accountable for the strength and comprehensiveness of their audit reports. Simply put, Sarbanes-Oxley for quality is around the corner and this volume goes a long way toward preparing our basic understanding of the Act and its potential future implications. Congratulations to all authors, but this one in particular deserves specific mention. As a board member for a major national integrated delivery system, I am happy that there appears to be a greater interest in the intricacies of Sarbanes-Oxley on the healthcare side of the ledger. 

In summary, Healthcare Organizations: [Financial Management Strategies] represents a unique marriage between the Institute of Medical Business Advisors, Inc., and its many contributors from across the nation.  As its mission statement suggests, I believe this massive interpretive text carries out its vision to connect healthcare financial advisors, hospital administrators, business consultants, and medical colleagues everywhere. It will help them learn more about organizational behavior, strategic planning, medical management trends and the fluctuating healthcare environment; and consistently engage everyone in a relationship of trust and a mutually beneficial symbiotic learning environment.  

Editor-in-Chief and healthcare economist Dr. David Edward Marcinko and his colleagues at the Institute of Medical Advisors, Inc should be complimented for conceiving and completing this vitally important project. There is no question that Healthcare Organizations: [Journal of Financial Management Strategies] will indeed enable us to leverage our cognitive assets and prepare a future generation of leaders capable of tackling the many challenges present in our healthcare economy.  

My suggestion therefore, is to “read it, refer to it, recommend it, and reap.”  

David B. Nash MD, MBA
The Dr. Raymond C and Doris N. Professor and
Chair of the Department of Health Policy
Jefferson Medical College
Thomas Jefferson University
Philadelphia, Pa, USA
 

Conclusion

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