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

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    Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

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Seeking Chief Medical Director [CMD]

Magnolia Health Plan

By Missy Wohldmann

Dear Dr. Marcinko and ME-P Readers, 

Centene Corporation is seeking a Chief Medical Director (CMD) for Magnolia Health Plan (Magnolia), a wholly-owned subsidiary and HMO for the state of Mississippi. The regional headquarters for Magnolia is located in Jackson, Mississippi.

About Centene

A Fortune 500 company, Centene is a national leader in low-cost solutions for high quality healthcare services for uninsured and underinsured patients. Centene’s subsidiary health plans bring better health outcomes to their 1.5 million members. Centene’s core philosophy is that quality healthcare is best delivered locally. This local approach enables them to provide accessible, high quality and culturally sensitive healthcare services to their members in their own communities.

Visionary Needed

The Chief Medical Director will establish the strategic vision and attendant policies and procedures for Magnolia Health Plan. The CMD will provide leadership and direction to the medical management, quality improvement and credentialing functions for Magnolia Health Plan based on, and in support of, the company’s strategic plan. The CMD will review analyses of activities, costs, operations and forecast data to determine progress toward stated goals and objectives. Also within the purview of CMD will be oversight for compliance with National Committee on Quality Assurance (NCQA) and/or Joint Commission on Accreditation of Healthcare Organization (JACHO) standards as determined for accreditation of the health plan.

Candidates

Successful candidates will be physician leaders with thorough knowledge of quality improvement practices and familiarity with medical information systems, medical claims payment processing and coding. Knowledge of managed care, Medicaid, and case management programs are also essential. Board certification in a recognized medical specialty and an active medical license are required.

We welcome your interest, or nominations, for this highly visible role.

Assessment
Cejka Executive Search
4 CityPlace Dr., Ste. 300
St. Louis, MO 63141
314.236.4478 Office
mwohldmann@cejkasearch.com
http://www.cejkaexecutivesearch.com

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The “Whole Tooth” Blog Talk Radio to Interview Dr. Darrell Pruitt on eHRs

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Plugging my Interview and Otherwise Clogging Things

[By D. Kellus Pruitt DDS]

Where are the EDR cheerleaders when I need them? On Tuesday May 31st, I’ve got a show to put on!

http://www.blogtalkradio.com/thewholetooth

Where are the EDR Cheerleaders?

Every now and then I still come across EDR vendors on the internet who would mislead naïve dentists about their product to make a sale. Today, I held FirstEMR representative Robert Evans accountable for self-serving misinformation he posted on EMR and HIPAA forum. (My dad would be proud that I told him “Get that garbage out of here!”). Then, remembering my manners, I invited Mr. Evans to please call into The Whole Tooth Blogtalkradio program on May 31 to further discuss the future of EHRs in dentistry. Unfortunately, because of things like the reflexive “garbage” statement, I don’t think he’ll show.

I try my best to be “collegial,” but I simply cannot pretend unethical sales techniques are acceptable in my neighborhood, and I want to help my friends easily recognize them… so what if I have a little fun.

http://www.emrandhipaa.com/emr-and-hipaa/2010/11/18/emr-stimulus-q-and-a-emr-stimulus-money-and-dentists/comment-page-1/#comment-133132

Of Robert Evans

Thanks for your response, Robert Evans.

As I read your list of 6 rationalizations for electronic dental records here on the EMR and HIPAA forum , it occurred to me that you haven’t had a chance to read my detailed post on this thread from November 22 (Number 14) in which I de-bunked 28 similar myths – substantially including your 6. But since I never tire of doing this, let’s once again go through the details of a popular national blunder in dentistry you and other well-intentioned stakeholders in the HIT industry were sucked into.

“My personal background is medical administration and operations.” That would explain your misconceptions about EHRs in the unique field of dentistry.

For your first mistake, you say “Dentists can qualify as eligible providers for ARRA incentives” You really should have gone on to explain that for a dentist to qualify for the stimulus money, 30% of his or her practice has to be from Medicare/Medicaid. Since you surely should have known that, to fail to mention it could easily be interpreted as deceptive.

This is just a guess, but I’d say less than 10% of the dentists in the nation in private practice would make it on that qualification alone even if it made business sense to accept government money and the expensive demands that come with it. Since you are in the EHR business, you may have more accurate figures on that. What’s more, our grandchildren’s money will be gone long before the stimulus makes it to dentistry. You should already know that as well.

“All of our clients, including Dentists, Endodontists, Periodontists, Implant Surgeons and more are extremely pleased that they made the transition “ All of them, Robert? Really?

The ME-P Forum 

This ME-P forum right here is full of stories about disappointed providers – perhaps other than your clients – who are finding huge problems with the transition. De-installations are far too common. It seems like a while back it was close to 30%. Then again, since you are in the business, you probably have more accurate figures for that as well.

Even the stimulus money isn’t sufficient subsidy for physicians to realize a return on investment in EMRs. And virtually nobody is interoperable as planned. That means the office tools you sell raise the cost of healthcare rather than lower it. What’s more, physicians stand to benefit from interoperability much more than dentists regardless of stimulus money. And if a dentist can’t expect ROI from an office tool, it’s called a hobby.

By the way, have you looked at the Stage 2 Meaningful Use requirements that stand between dentists and disappearing ARRA money? Well-meaning outsiders with plans for the common good just don’t realize that someone has to enter every piece of irrelevant detail about dental patients that CMS requires in order to receive full payment.

It’s a trap, Robert. And it’s not very well hidden. Dentists don’t take candy from strangers.

The Benefits

“The benefits to your office are numerous and too many to mention here; but, please take into account the following”:

1. Never having to worry about compliance issues, as we are 100% compliant with all standards and formats that CMS is mandating.

– You are 100% scary. As long as a provider stores or transmits electronic PHI he or she clearly must be concerned about HIPAA compliance issues. What’s more, as a Business Entity for the dentists you serve, if your computer system is hacked or someone on your end otherwise fumbles or steals 500 or more of a dentists’ patients’ PHI, all of the dentist’s patients must be notified of the danger of identity theft. In addition, federal law stipulates that news of the data breach must be broadcast as a press release in the dentist’s local media. This can easily bankrupt a dentist… You just had to know about this before today.

Your compliancy claim is not only wrong, but it is irresponsible and unethical advertising. You are not 100% compliant. Since the Rule is intentionally vague, nobody is. Get that garbage out of here!

2. Greatly reduce or even eliminate human error. Some offices have brought back billing into their control and terminated the outsourcing.

– Are you kidding? Eliminate human error? Someone put you up to this didn’t they. And “outsourcing”? Once again, this is misleading and irresponsible information, Robert. What about keystroke errors? Only frustrated vendors wish computers would replace human intelligence.

3. Facilitate lab and prescription orders. Offices using e-scribe services are already on board into accepting the benefits of an EMR.

– So does this mean that when the lab delivery person comes to my office to pick up plaster models of a patient’s teeth, the prescription for the restoration must be sent separately by email instead of inserting a short hand-written note in the package… with the relevant patient’s models?

– I don’t sign enough prescriptions to make e-prescribing worth it. I really, really don’t. So how expensive would you make dental care?

4. Simple and efficient scheduling. The reception and schedulers are not tied to the telephone, fax and charting tasks as well as insurance verifications.

– That’s never before been a significant problem. Dental offices were run surprisingly efficient for decades before computers were around. Since dentistry is intricate handwork, the bottleneck in dental offices isn’t the front desk. It’s the dentist.

– What’s so wrong with telephone and fax, by the way? One doesn’t have to be a HIPAA-covered entity to use those tools.

– As for insurance verification, is the EDR intended to help the patient or the insurance company?

5. No fumbling for charts, paperwork, etc. (significant cost savings)

– Prove it.

6. Gain 15+ hours per week, back!

– Where did find this chunk of information? Please don’t insult us with wild, irresponsible statements to improve sales of your product. That would be unethical.

“Again, there are too many to list here, but contact me anytime for a quick on-site or online demonstration and let us prove to you that FirstEMR is the most appropriate solution to meet your required EMR needs.”

eDR Mandate? 

Did you intentionally say my “required” EMR needs? You wouldn’t be implying that EMRs are somehow “mandated” in dentistry are you, Robert? That would be called a rookie mistake and you would be about a year behind information published in the ADA News, which was wrong to mislead members on this point in 2008.

http://www.ada.org/5348.aspx

Rather than contacting you for a quick on-site or online demonstration, I’ll do you one better. I am to be interviewed on “The Whole Tooth” blogtalkradio on May 31 concerning the future of EHRs in dentistry. It promises to be an unprecedented discussion about the obscure topic, and is certain to be educational to thousands of dentists who have been misled for years about HIPAA and EDRs.

http://www.blogtalkradio.com/thewholetooth

Assessment

When the time comes, a telephone number will be provided for live questions. I invite you to call in, Robert, and we can discuss EHRs in dentistry before an audience of around 15,000.

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What Counts as a Good Doctor-Patient Relationship?

Nuances of Patient-Centricity

By Mario Moussa PhD MBA

By Jennifer Tomasik MS

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Researchers at the University of Pennsylvania are experimenting with an electronic nose that literally smells disease. In the not-too-distant future, it may be able to detect whether a patient has an infection in the lungs or somewhere else. There is no need to be radiated with an X-ray, or to wait anxiously for two days as bacteria sprouts from a biological sample. One simply lies in a hospital bed while the super-sensitive machine monitors the body’s exhalations.

Of Hippocrates

Hippocrates, the founding father of Western medicine, did it differently. He relied on smell, too. But, he used his actual nose. He sniffed and inspected his patients’ stool, as well as their earwax, pus, and phlegm. Then he went further, recording the details of his patients’ diets, the water they drank, the local weather, and even the positioning of their house. He spent a lot of time getting to know the highly personal facts of his patients’ lives. He was an early practitioner of individualized and holistic medicine.

Rise of the Historical Symptoms Review

But, doctors in the Hippocratic tradition have not always had this kind of intimate relationship with their patients. In 17th. and 18th. century Europe, the standards of human dignity imposed limits, especially on physical contact. Health providers were just as likely to scrutinize the story of an illness as its observable symptoms. Dr. John Symcotts, who had a successful practice that encompassed two English villages, captured his patients’ narratives in casebooks that contained vivid descriptions of intense subjective experiences. One patient, Miss Christian Tenum, complained of “a heavy burden or weight continually pressing down upon the top of her head,” a “pulsing of the arteries,” and “images passing before her eyes.” The diagnosis was unclear. Symcotts prescribed a fluid diet and a medicine that helped her expel stones with her urine. The outcome? Miss Tenum was cured.

Subjective Reporting

In Symcotts’ era, physicians treated subjective reporting as a valid source of information. Using an ancestral form of telemedicine, they even based diagnoses on letters. John Morgan, a founder of the University of Pennsylvania’s Medical School in the late 1700s, offered his expert opinion on patients who lived “ a distance from Philadelphia, whenever the history of the case is properly drawn up and transmitted to me for advice.” Why the emphasis on spoken and written first-hand accounts? In the words of one physician, there was a “repugnance” to physical examination that was “natural and proper.”

Link: www.BusinessofMedicalPractice.com

Assessment

Bottom line: intimacy can take strikingly different forms. This is especially important to remember in the world of Health 2.0, where you have so many choices for communicating.

In purely human terms, we think the relationship that Hippocrates had with his patients was neither better nor worse than the one Symcotts had with Miss Tenum or that Morgan had with his epistolary advice-seekers. Hippocrates paid meticulous attention to a patient’s circumstances: emotional outlook, diet, bodily secretions, family relationships and friends, climate, dwelling. Symcotts may not have known his patient in all of these ways, but he could hardly have been more committed to understanding Miss Tenum’s story in her own terms.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. In different, but equally valid ways, can Hippocrates, Symcotts, and Morgan be considered patient-centered? 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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Cost Conflicts-of-Interest in Medicine

Clinical Care versus Finance

By Render S. Davis MHA CHE

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Conflicts of interest are not a new phenomenon in medicine. In the fee-for-service system, physicians controlled access to medical facilities and technology, and they benefited financially from nearly every order or prescription they wrote. Consequently, there was an inherent temptation to over-treat patients. Even marginal diagnostic or therapeutic procedures were justified on the grounds of both clinical necessity and legal protection against threats of negligence. 

Costs Rarely Considered

While it could be construed that this represented a direct conflict of interest, it could also be argued that most patients were well served in this system because the emphasis was on thorough, comprehensive treatment – where cost was rarely a consideration.  It was a well known adage that physicians “could do well, by doing good.” 

Managed Care

In managed care, the potential conflicts between patients and physicians took on a completely different dimension.  By design, in health plans where medical care was financed through prepayment arrangements, the physician’s income was enhanced not by doing more for his or her patients, but by doing less.  Patients, confronted with the realization that their doctor would be rewarded for the use of fewer resources, could no longer rely with certainty on the motives underlying a physician’s treatment plans.  One inevitable outcome was the continuing decline in patients’ trust in their physicians.  This has been exacerbated to some degree by revelations of significant financial remuneration to physicians by pharmaceutical and medical products firms for their services as researchers or active participants on corporate-funded advisory panels, calling into question the physician’s objectivity in promoting the use of company products to their peers or patients.

Conflicts of Interest

Conflicts of interest may also create concerns at a much higher level, as evidenced by the issues raised in 2008 litigation against Ingenix, a company that for more than a decade, provided information to the insurance industry on payments to out-of-network physicians for their “usual and customary rates (UCR).” As noted in court documents, Ingenix was a wholly-owned subsidiary of United Healthcare and the UCR information sold by the company to insurers may have been fundamentally biased in favor of the insurers, causing patients to pay larger out-of-pocket fees.

Assessment

As a result, New York attorney general Andrew Cuomo filed suit against Ingenix.  This action was followed by suits brought against major insurers by the American Medical Association and several state medical groups for systematic underpayment to members, based on the biased data.  To date there have been monetary settlements, but the issue continues to raise growing concerns regarding conflicts of interest among the key payers for health care.

Conclusion

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Implementing the Global Strategic Health Plan

A Human Resources Issue for International Physician Entrepreneurs

By Henry H. Goldman PhD CPCM

 

Strategic planning is a fairly easy business managerial chore; not so for healthcare. Yet, physician executives and medical managers can usually determine the direction in which the company should move. They can generally determine, or make educated guesses about new services, products, expanded markets, changes in competition, innovations in technology, financing requirements, etc.

Gs and Os

Goals and objectives setting are staples of business management, worldwide. Most large organizations have accepted Russell Ackoff’s plea for them to create their own futures. It is not a difficult task to create a comprehensive set of alternative strategies at the corporate or divisional level. Making the strategies work for healthcare is the real issue.

Implementation

Implementing the strategic plan is an often-overlooked aspect of the planning process. Corporate and medical executives assume that the plan will be implemented. Generals always expect that their orders will be carried out, even if those orders are wrong. While strategy formulation is regarded as a staff function, strategic implementation is generally viewed as a key function of line management. If the strategic plan is to be put into place in a timely manner and the results of that plan, the anticipations and expectations that long-term goals and short-term objectives will be attained, then planners must examine the organizational issues involved in making the plan happen.

Full Link: goldman.strategic planning

Conclusion

The clear understanding of and the ability to deal with these issues during the strategy formulation process may make the difference between an international healthcare strategic plan that has become only an academic exercise – and a living, vital guideline to future profits and continued corporate success.

About the Author

Risk Management Associates International, LLP
5005 SW Raintree Circle
Lee’s Summit, MO 64082

Henry H. Goldman, Ph.D. is the Managing Director of the GOLDMAN-NELSON GROUP (USA), a global management consulting and executive training organization that he founded in 1981. Dr. Goldman’s areas of expertise include supervisory and management training, decision-making and problem solving, team building, international financial management, and strategic planning. He is frequently invited to facilitate programs and workshops on such diverse subjects as “Leading Organizational Change,” “Decision-Making for Managers,” “Budgeting in the Borderlands,” as well as issues dealing with global business and finance. Goldman recently served as Co-Editor of Taking Stock: A Survey on the Practice and Future of Change Management (Berlin, 2005). He has worked with executives and managers, worldwide, to develop an understanding of management and financial concerns in a global marketplace. He has conducted training programs along the Pacific Rim, Southern Africa, and the Middle East and among the Newly Independent States of the former Soviet Union. His clients include MGM Studios, Lucent Technologies–China, General Motors, Hughes Aircraft Company and Citizens’ Development Corps. He served as adjunct professor of management at the University of Macau, China, where he taught “Team Building” to MBA students. He is currently affiliated with the National Graduate School and Boston University’s Center for Executive Education. Dr. Goldman was recently appointed to the Mine Relief Global Business Council to assist in the remediation of land mines, world-wide, with a particular focus on the Turkey-Syria border.

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