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RAC Demand Letters Replaced

CMS Transfers Responsibility

By Staff Reporters

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January 2012 marks a significant change for Recovery Auditors as the Centers for Medicare & Medicaid Services (CMS) is transferring the responsibility for demand letters from the auditors to claims processing contracts. The reason for the change is “to avoid any delays in demand letter issuance,” according to MLN Matters article 7436.

The Result

As a result, when a Recovery Auditor finds improper payments, they will submit claim adjustments to your Medicare (claims processing) contractor. The contractors will carry the responsibility of fielding concerns throughout the time frame of the payment recovery and the appeals process.

Assessment

Read the full article here.

Conclusion

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The Cost of Early [HIT] Adopters

An eHR Lesson for Physicians?

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With the rapid change in technology, such as eHRs, knowing when to purchase a truly innovative product is becoming increasingly more difficult. With promises of changing our lives or saving time and money, more often than not, the initial release doesn’t live up to these expectations – at least not right away.

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Assessment

However, many of us – doctors included – wait in long lines to be the first adopters, understanding that we most likely will pay more and have to deal with problems. Even with these known hurdles, being an early adopter does have its benefits.

Conclusion

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Video on Being a ‘Real Doctor’

DVM vs MD, etc.

By Dr. David Edward Marcinko MBA

[Publisher-in-Chief]

While discussing the future of medicine at Drexel University in Philadelphia recently [privately and off-the-record], a medical colleague shared the below video with me that strangely struck a chord.

Turf Battles

MD vs DO vs DPM vs DDS vs NP vs ANP vs PA vs DNP vs OD vs PT vs DC etc.

Can you think of any others; formal degrees and designations, or mere turf battles?

Assessment

Trust me … it’s worth 3.55 minutes out of your life to view and ponder.

Link: http://www.xtranormal.com/watch/6868901/veterinarian-vs-md

Conclusion

Have we created a system that is more careless health than health care?

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Doctor’s Lawsuit Targets Parents of Patient Who Overdosed

By Marshall Allen
ProPublica, Aug. 26, 2011, 10:57 am

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The dramatic rise in prescription narcotics use [1]—and the subsequent increase in overdose deaths—has led to a spate of lawsuits around the country targeting doctors for malpractice or running pill mills [2]. But legal experts say the case of one family physician in Henderson,Nev., stands out.

The case of Kevin Buckwalter

Dr. Kevin Buckwalter has turned the tables, filing a lawsuit against the parents of a young woman who died from an overdose of narcotics that he prescribed.

Buckwalter’s suit accuses John and Maggie DeBaun of abusing the legal process, intentionally inflicting emotional distress and interfering with his ability to do business by filing a medical malpractice case against him for the death of their daughter.

“I’ve never heard of such a lawsuit,” said Stacey Tovino, a professor at the William S. Boyd School of Law at theUniversity of Nevada, Las Vegas. Tovino and otherNevada legal experts said it appears to them that Buckwalter abused the legal process in an attempt to intimidate the DeBauns.

Buckwalter did not respond to a call for comment. His brother Bryce, who serves as his attorney, declined to comment about the lawsuit. In an email, he accused this reporter of harassment for attempting to contact his brother, said he would seek a restraining order and threatened to sue ProPublica.

A Controversial Subject?

Buckwalter has been a subject of controversy for several years. A 2008 Las Vegas Sun investigation [3], also by this reporter, highlighted the opinions of four pain-management specialists who reviewed Buckwalter’s care of patients and said it appeared to be negligent.

Staci Voyda, a teenager addicted to prescription narcotics, wrote in her journal that she went to Buckwalter to get off drugs. But his treatment included ramping up her dosages of narcotics. She killed herself in August 2007, and family members say the drugs pushed her over the edge.

Another Buckwalter patient, 69-year-old Barbara Baile, was prescribed large doses of narcotics, which caused constipation so severe it ruptured her bowels. A subsequent infection killed her.

These are prescriptions for Xanax and morphine written by Dr. Kevin Buckwalter for Andrea and Clint Duncan. (Sam Morris/Las VegasSun) | See Las Vegas Sun’s full investigation on Painful Painkillers [4].

The DeBauns’ daughter, Andrea Duncan, died in 2005 from intoxication with opiates and benzodiazepines [5], a class of drugs that includes Valium and Xanax. Four days earlier, her husband Clint, also a Buckwalter patient, had overdosed on prescription narcotics and died.

In a 2007 videotaped deposition [6] for an unrelated lawsuit, Buckwalter described the treatment he provided Duncan. Under oath, Buckwalter said he did not examine Duncan on her first visit because he “did not have time,” yet prescribed her 300 tablets of Xanax, an anti-anxiety medication, and the painkiller hydrocodone, a synthetic opiate.

The following year, the U.S. Drug Enforcement Administration and Nevada State Board of Medical Examiners stripped Buckwalter of his license to prescribe controlled substances. The DEA attributed at least eight overdose deaths [7] to Buckwalter. The medical board blamed him for four cases of malpractice [8], including one in which the patient died. Buckwalter closed his practice.

Dallaslawyer Kay Van Wey, who specializes in pill mill cases, filed six lawsuits against Buckwalter on behalf of patients who died or were harmed. The DeBaun case was filed in April 2009, past the statute of limitations in Nevada. But Van Wey argued in the complaint that the deadline should be extended because Buckwalter allegedly concealed his negligence and altered medical records.

A judge didn’t buy the argument and dismissed the case. Buckwalter claims in his lawsuit that the DeBauns sued to harass and annoy him.

Buckwalter has denied all of the allegations that he provided substandard care. His lawsuit against the medical board to get his prescribing privileges reinstated was unsuccessful.

Jeffrey Stempel, a professor at the UNLV law school, said that for the DeBauns’ lawsuit to be considered an “abuse” of the legal process, there would have to be some ulterior motive other than seeking damages for their daughter’s death.

Assessment

Ann McGinley, another professor at the UNLV law school, said it takes more than simply filing a lawsuit to support a claim of intentional infliction of emotional distress. And given that Buckwalter lost his ability to prescribe controlled substances in 2008, it’s difficult to see how the DeBauns interfered with Buckwalter’s ability to conduct his business, she said.

McGinley said that if lawsuits like Buckwalter’s became more common, they could have a chilling effect, discouraging patients from pursuing legitimate malpractice claims. “My concern is that other doctors will take this on as something that they will do regularly,” she said.

Link: http://www.propublica.org/article/doctors-lawsuit-targets-parents-of-patient-who-overdosed

Conclusion

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Dr. Somnath Basu on Retirement Happiness [Video Clip]

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By Staff Reporters

A PodCast Clip

This brief podcast clip features Dr. Somnath Basu, director of the California Institute for Finance [CIF].

Dr. Basu, a popular ME-P thought-leader, shares his insights on what makes people happy in retirement.

Assessment: http://www.youtube.com/watch?v=iTrtmW831Xk

Conclusion

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How Lifetime Benefits and Contributions Point the Way Toward Reforming Our Senior Entitlement Programs

By Staff Reporters

From Expert Voices

By C. Eugene Steuerle PhD [Institute Fellow and Richard B. Fisher Chair, The Urban Institute]
By Stephanie Rennane [University of Maryland]

For August 2011

Reforms to Medicare and Social Security will likely be debated over the next few months as the new “super committee” formed by the debt ceiling agreement works to develop its long-term deficit reduction plan.

The Essay

In this essay, Dr. Eugene Steuerle and Stephanie Rennane help to inform this debate by presenting findings from their newly updated analysis showing that seniors retiring today can expect to receive dramatically more in entitlement program benefits during retirement than they contributed to the programs while working.

For example, the average Medicare beneficiary can expect $3 in benefits for every $1 paid in payroll taxes.

Link: http://nihcm.org/images/stories/EV-Steuerle-Rennane-FINAL.pdf

Assessment

The authors posit that the magnitude of the resources involved when viewing these programs in tandem over a lifetime gives policymakers new impetus and flexibility to develop coordinated entitlement reforms that promote a coherent, equitable and sustainable support system for current and future generations of seniors.

Conclusion

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Dr. Somnath Basu on Financial Planning Client Expectations [PodCast]

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By Staff Reporters

On Client Attitudes in the New Economy

In this encore podcast, Somnath Basu PhD examines how the recent economic turmoil has changed financial planning clients’ attitudes and expectations.

Dr. Basu is a popular ME-P contributor and thought-leader.

Assessment: http://www.youtube.com/watch?v=jzAkB8h5v3Q

Conclusion

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A Nutrition Label for Health Insurance Plans?

Appreciating “Search Frictions”

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

Because products vary so much across many characteristics, health insurance is not easy to shop for. Comparing plans is an apples-to-oranges problem.

Of Search Frictions and Economic Externalities

As a former insurance agent for more than a decade, this is a situation by design – to obfuscate the patient and consumer.  

The challenges of comparison – health insurance plan – shopping then, creates what economist and colleague Austin Frakt PhD calls “search frictions” or inefficiencies in the ability to wisely choose. This may be likened to economic “externalities” and perhaps even motivated the recent development of (draft) standards for health plan labeling.

Beginning March 2012

So, how much will the new health plan labels, required starting next March, help consumers in their search for plans? How much grease will they add to the otherwise highly frictional process? I sure don’t know.

A good place to start however, is an examination of those frictions. What are they and how much do they matter?

Link: http://www.healthcare.gov/news/factsheets/labels08172011b.pdf

Assessment

Did food nutrition labeling, and the old food pyramid help – or confuse – consumers? What about the old and new cigarette warning label warnings? Or – the prohibition of alcohol for pregnant women – helpful or not! Any labeling for that matter?

Conclusion

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The Debt Agreement Explained in Three Steps

The Bi-Partisan Compromise

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The recent budget compromise created a joint committee of Congress, which you might have seen referred to as the “super committee.”

This committee is responsible for developing a bipartisan plan for reducing our deficit by $1.5 trillion over the next 10 years. (That’s on top of about $1 trillion from the down payment that was included in the first phase of the deal.)

Brought to you by The White House.

 

Conclusion

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Practice Management: http://www.springerpub.com/product/9780826105752

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

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

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Why PACs Won’t Jeopardize a Hospital’s Tax Exempt Status?

According to IRS Private Letter Ruling

By http://www.garfunkelwild.com/

Recently, the Internal Revenue Service (“IRS”) issued a private letter ruling (the “Ruling”) that will allow the requesting tax-exempt hospital to establish and operate a social welfare organization as a means of engaging in political activities and establishing a larger presence in the political arena. The Ruling concluded that these actions will not jeopardize the hospital’s tax-exempt status under the Internal Revenue Code of 1986, as amended, (“IRC”) § 501(c)(3). Pursuant to IRC § 501(c)(3), a corporation organized and operated exclusively for religious, charitable, scientific, literary or educational purposes is exempt from federal income taxes, provided that its net earnings do not inure to the benefit of a private individual and a substantial part of its activities do not involve lobbying or related political conduct.

The Requesting Hospital

The requesting hospital is a comprehensive regional, integrated health care system that has qualified as a tax-exempt, charitable organization (the “Hospital”).  Currently, the Hospital conducts an insubstantial amount of lobbying through its government affairs department (the “Department”), in an effort to improve the cost efficiency of health care services. The Ruling serves to permit the Hospital to take a more active role in the political arena, through the formation of a separate, non-profit social welfare organization (the “Organization”) that will, in turn, establish two independent political action committees (collectively “PACs”).

Social welfare organizations are tax-exempt entities that are designed to promote the general welfare of the community. See IRC § 501(c)(4).  Social welfare organizations may conduct political campaign activities and establish political organizations, as long as political campaigning is not the primary activity. Reg. § 1.501(c)(4)-1(a)(2)(ii).  Accordingly, in order for the Hospital to create the Organization, the IRS requires that the Organization (a) remain independent from the Hospital and (b) apply for tax-exempt status as a social welfare organization.  Notwithstanding the preceding sentence, the Hospital proposed that it would remain the sole voting member of the Organization, and that the majority of the Organization’s Board of Directors would be officers, directors or employees of the Hospital.  The IRS permitted the Hospital to act accordingly, provided the Hospital complied with the IRS requirements set forth in this Legal Alert, and expanded upon in the Ruling.

More on the Private Ruling

The Ruling permitted the Organization to establish two PACs for the purpose of accepting contributions from, or making expenditures to, a political candidate or party.  See IRC § 527(e). As part of its analysis, the IRS concluded that the PACs, Organization and Hospital must operate independently, in order to ensure that the political activities of the Organization and the PACs would not be attributed to the Hospital and would not impact the Hospital’s tax-exempt status.  To comply with the Ruling, the PACs must maintain separate bank accounts and records, as well as separate addresses and phone numbers.  In addition, any leasing or sharing of employees, goods or services among the Hospital, Organization and PACs must be conducted at arms-length.

Assessment

Furthermore, the Ruling concluded that the Hospital may establish and operate a voluntary payroll deduction plan permitting Hospital employees to make political contributions through the PACs.  The Ruling provided that political contributions by employees of the Hospital will not impact the tax-exempt status of the Hospital, as long as the Hospital does not influence the employees’ choices regarding contribution.

Editor’s Note

Please note that this Private Letter Ruling is limited to the facts at issue, and should not be relied upon by anyone other than the Hospital.

Conclusion

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On the Deadliest Disease Outbreaks in History

Black Death to Measles

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From the From the Black Death to the measles, rapidly spreading diseases have taken a toll on humanity for centuries. Here’s a look at the biggest and deadliest pandemics ever.  

A collaboration between GOOD and Column Five Media.

Conclusion

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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How to Burglar-Proof Your Cash Stash?

Avoid Burglar-Friendly Spots

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If the wobbly financial markets have you hoarding cash at home, beware. Yes, as a doctor, you may be safe from bear markets, but you’re still vulnerable to losses, especially if you leave your money and valuables in burglar-friendly spots.

View the image below to expand the infographic and see where you’re best off hiding your cash, according to tips gathered from a real burglar, and places where you shouldn’t put any money.  

Conclusion

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Physician Advisors: www.CertifiedMedicalPlanner.com

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Recruiting Medical Director

Corvallis Clinic‏

By Judy Kliethermes

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Corvallis Clinic, a large, physician-owned, multi-specialty clinic located in the heart of Willamette Wine Valley, is seeking a Medical Director. Corvallis Clinic is comprised of 82 providers located at five sites. Founded in 1947, Corvallis Clinic boasts more than 25 specialties and employs 600 medical professionals. Corvallis Clinic serves more than a quarter million people in surrounding communities and has been recognized for superior performance by the American Medical Group Association, the National Committee of Quality Assurance, and the Medical Group Management Association.

The Medical Director will be responsible for EHR implementation and enhancement, risk management, peer review and quality improvement. Additionally, the Medical Director must have experience working with LEAN and Six Sigma concepts as they relate to process improvement. The Medical Director will be charged with encouraging physician involvement and will act as a change agent for the organization.

Furthermore, the Medical Director will be the face of Corvallis Clinic and will be expected to represent the clinic in civic and community events and activities. We are seeking collaborative, patient-focused physician leaders who have strong experience leading physician-owned clinics.

Medical Director candidates must be board-certified and possess a minimum of ten years clinical experience. An MBA or MHA is preferred, but not required. The role is 80% administrative; 20% clinical.

I would welcome your interest.

Sincerely,

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4 CityPlace Dr., Ste. 300
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OCR Imposes Penalties for Employee’s Unauthorized Viewing of PHI

By Garfunkel Wild, PC

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Early in July, the Department of Health and Human Services Office of Civil Rights (“OCR”) entered into a settlement for $865,500 with UCLA Health System (“UCLAHS”) as a result of complaints alleging that UCLAHS employees repeatedly and without permissible reason looked at the electronic protected health information (“ePHI”) of celebrity patients.

Initial Complaints

Although the complaint was initially made by only two patients, in its investigation OCR determined that from 2005-2008 unauthorized employees of UCLAHS repeatedly looked at the ePHI of numerous other patients as well. In addition to paying the settlement, UCLAHS committed to a correction action plan that includes (1) implementation of policies and procedures; (2) robust training for employees; (3) a commitment to sanction offending employees; and (4) designation of an independent monitor to assess compliance over 3 years.

Assessment

This settlement is the fourth settlement in a year and highlights OCR’s increasing enforcement of violations to HIPAA Privacy and Security Rules. Failure to have an effective HIPAA compliance program can result in significant monetary penalties, and therefore, providers and business associates alike should be evaluating their HIPAA compliance programs to ensure that appropriate safeguards are in place.

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Docs and FAs Stressed Out Over Fee Disclosures?

Financial Services and Healthcare Industry Affected

By Dr. David Edward Marcinko MBA CMP™

[Publisher-in-Chief]

Starting April 1, 2012, financial advisors [FAs] are going to have to disclose fees for their services to retirement plan sponsors, according to changes to the ERISA rules.

But, as you may not know, advisor fees to retirement plan fiduciaries have gone unnoticed for decades because their compensation comes out of the service providers’ compensation.

Link: http://blog.registeredrep.com/yield_of_dreams/2011/08/12/stressed-over-fee-disclosure-look-to-service-providers-for-templates/

Are Medicine and the Financial Services Sector Similar?

Recently, while visiting the Wharton School at the University of Pennsylvania, and discussing same with several colleagues, I realized that this is not unlike medical provider fees which are typically paid for by a private or public third party insurance-like carrier. Historically, relatively covert to patients, but not so much today!

For example, in 2007, federal and state legislatures called for hospitals across the country to make their prices “transparent.” The term was defined as the full, accurate, and timely disclosure of hospital charges to consumers of healthcare, as well as the process employed to arrive at those fees.

Moreover, transparency does not merely involve publishing a list of prices and fees.  Essentially, hospital CXOs must be able to present their prices in a manner that is understandable to the general public and they must be prepared to explain the rationale behind their charges.

And, for the solo or small group medical practitioner, dentist, retail or direct care practice, is this a trend that is growing or declining?  

Assessment

So, where are fees for FAs, under the above scenario, headed. We know the answer for doctors, of course, buy why are the FAs so fretful? Is it because they fear a healthcare-like meltdown disaster?

And, why would any vendor [doc or FA] fear letting the customer / patient  know the price of his products or services? Aren’t there many companies who are a huge success, following just this business model; retail / wholesale anyone? Why fear telling folks what you charge?

Conclusion

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Establishing Your Medical Practice’s Fair Market Value

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Part One of Medical Practice Valuation

By Dr. David Edward Marcinko, MBA, CMP

By Professor Hope Rachel Hetico, RN, MHA, CMP

www.CertifiedMedicalPlanner.org

In recent years, the physician practice market has experienced a noticeable increase in practice merging and acquisitions. Medical practices are being acquired by health systems in anticipation of Accountable Care Organization (ACO) delivery models.

For physicians, the decision to buy, sell, or merge a medical practice is more complicated than ever, and determining a medical practice’s worth is crucial to this process. Over the next two months, we’ll review the why, when, and how of the contemporary medical practice valuation.

Value Isn’t an Absolute Number

A medical practice’s tangible and intangible assets can be grouped into two broad categories:

  • Physical assets: Examples are real estate, medical records, leaseholds, medical equipment and furnishings, and accounts receivable (A/R).
  • Non-physical assets: These include goodwill, restrictive covenants, buy/sell agreements, managed care contracts, and an assembled workforce.

Estimates of value differ markedly, depending on the purpose of the appraisal, the acumen of the appraiser, etc. To help determine the value, some important questions to consider are:

  • What is the value of the practice for purchase or sale?
  • What is the value of a practice for merger?
  • What is the value of practice assets for joint venture with a corporate partner?
  • What is the value to establish buy-in or buy-out arrangements for partners?
  • What is the value of practice assets for purchase or sale, apart from ongoing operations?

To answer these questions, physicians (buyers and sellers) must understand how practices are valuated—beginning with the following informal, and then more formal, definitions:

Informal Terms of Valuation

  • The “asking price” is often arbitrary and difficult to substantiate, and typically is reduced 25-50 percent after negotiations.
  • The “creative price” is derived by way of creative financing. For example, the practice may provide the down payment.
  • The “emotional price” may involve either a motivated buyer or seller, who pays an under- or overinflated price for the practice.
  • The “friendly price” is reserved for associates, partners, or other colleagues.
  • The “realistic price” is one that both buyer and seller believe is fair.

Formal Terms of Valuation

  • Most appraisers use “fair market value” (FMV) as the standard to derive a reasonable value for a practice. FMV means an arm’s length transaction between an unpressured, informed buyer and an unpressured, informed seller.
  • The “business enterprise value” of a practice equals a combination of all assets (tangible and intangible), and the working capital, of a continuing business.
  • The value of “owner’s equity” equals the combined values of all practice assets (tangible and intangible), less all practice liabilities (booked and contingent).
  • The “working capital value” equals the excess of current assets (cash, A/R, supplies, inventory, prepaid expenses, etc.) over current liabilities (accounts payable, accrued liabilities, etc.).

Realizing that there is no absolute sales price is the essence of FMV. When determining valuation, look for a price range with a reasonable floor and ceiling.

Understand The Lingo

If you are a practice buyer or seller, make sure you understand terms and appraisal definitions.

That’s a lesson George Farmer, a primary care physician inFlorida, learned the hard way. He asked his accountant to appraise his business. When he was ready to sell, his attorney (who also happens to be his brother-in-law) drew up the sales contract. Farmer was pleased that the practice sold quickly for its full asking price.

What he didn’t know (but would discover) is that accounting or “book” value—the figure his accountant gave him—is far different than the FMV that he could have received.

Was the CPA wrong? Not really. Was the doctor incorrect? No. But each was operating under a different set of terms and definitions, without knowledge of each other’s perspectives.

How to Begin Valuation

The following steps should occur before the practice appraisal process begins:

  • Retain an appraiser (for each side) who understands the changing health care industry.
  • Aggregate historic practice business information and consolidated financial statements, operating statistics, payer mix, CPT® utilization, acuity rates, etc.
  • Eliminate one-time, non-recurring expenses, adjusted or normalized for excessive or below normal expenses.
  • Understand key assumptions used in financial projections.

To determine value, appraisers should follow the American Society of Appraisers’ Principles of Appraisal Practice and Code of Ethics. The IRS issued guidelines in 1995 further suggesting that appraisers use the general methods of the Uniform Standards of Professional Appraisal Practices (USPAP), which recognize three approaches to medical practice valuation.

1. Income Methods

There are two methods to value a practice by income:

(a) Capitalization Method: The excess earnings or capitalization method estimates value by dividing normalized historical or current income by an appropriate rate of return for the buyer. This method does not require assumptions.

(b) Discounted Method: Discounted Cash Flow (DCF): Analysis requires assumptions to estimate practice value by discounting future net cash flows to their present worth based on market rates of return required by an investor. Understanding the key assumptions produces a meaningful estimate of practice value. These assumptions may include:

  • projections of future practice revenue, productivity, reimbursement trends, and shifts in payer mix
  • projections of practice cost structures and projected physician compensation
  • after-tax practice cash flows
  • reinvestments to replace equipment or other assets
  • residual practice value at the end of the forecast period
  • discount rate based on the practice specific weighted average cost of capital
  • practice efficiencies, operations, and competitive market conditions

The DCF analysis consistently produces higher values than other methods of estimating practice value because there may be supportable reasons to forecast improvements in future practice performance.

2. Marketplace Multiples

Market transaction multiples are ratios developed by correlating actual practice sale prices to key practice performance measurements. Common multiples include comparisons of sale price to revenue, sale price to earnings before interest and taxes (EBIT), sale price to earnings before interest, taxes, and depreciation allowance (EBITDA), gross revenue, net revenue, and the sale price to number of physicians.

Market transaction multiples are typically limited to serving as a benchmark for testing the reasonableness of the other approaches. They are becoming less common and less useful.

3. Cost Approach

The cost approach calls for identification and separate valuation of all the practice assets, including goodwill, depreciated over 15 years.

The cost approach is more labor intensive than using the enterprise analysis to estimate practice value; especially for a new practice, which typically includes the expenses to acquire space, office furnishings, equipment, marketing, advertising, staff development, and losses incurred during the startup period. This estimate of “replacement cost or cost avoidance” value represents an upper limit (or ceiling) of value, and generally is not considered useful in estimating the value of an established medical practice.

Net Income Statement Adjustments

When analyzing a set of financial statements to determine practice value, adjustments (normalizations) generally are needed to produce a clearer picture of likely future income and distributable cash flow. It also allows more of an “apples to apples” line item comparison. This normalization process usually consists of making three main adjustments to a medical practice’s net income (profit and loss) statement.

1. Non-Recurring Items: Estimates of future distributable cash flow should exclude non-recurring items. Proceeds from the settlement of litigation, one-time gains/losses from the selling of assets or equipment, and large write-offs that are not expected to reoccur, each represent potential nonrecurring items. The impact of nonrecurring events should be removed from the practice’s financial statements to produce a clearer picture of likely future income and cash flow.

2. Perquisites: The buyer of a medical practice may plan to spend more or less than the current doctor-owner for physician executive compensation, travel and entertainment expenses, and other perquisites of current management. When determining future distributable cash flow, income adjustments to the current level of expenditures should be made for these items.

3. Non-cash Expenses: Depreciation expense, amortization expense, and bad debt expense are all non-cash items which impact reported profitability. When determining distributable cash flow, you must analyze the link between non-cash expenses and expected cash expenditures.

The annual depreciation expense is a proxy for likely capital expenditures over time. When capital expenditures and depreciation are not similar over time, an adjustment to expected cash flow is necessary.

Some practices reduce income through the use of bad debt expense rather than direct write-offs. Bad debt expense is a non-cash expense that represents an estimate of the dollar volume of write-offs that are likely to occur during a year. If bad debt expense is understated, practice profitability will be overstated.

Balance Sheet Adjustments

Adjustments also can be made to a practice’s balance sheet to remove non-operating assets and liabilities, and to restate asset and liability value at market rates (rather than cost rates).

Assets and liabilities that are unrelated to the core practice being valued should be added to or subtracted from the value, depending on whether they are acquired by the buyer. Examples include the asset value less outstanding debt of a vacant parcel of land, and marketable securities that are not needed to operate the practice. Other non-operating assets, such as the cash surrender value of officer life insurance, generally are liquidated by the seller and are not part of the business transaction.

Assessment

With a basic understanding of practice valuation and the steps involved, buyers and sellers will be better prepared for next steps. So, next time in Part 2, we will discuss the art of the deal, and how to structure the practice sale.

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:

AdditionalReading:

Cimasi, Robert James: Valuation of Hospital in a Changing Reimbursement and Regulatory Environment. In,Marcinko,DE(Editor): Healthcare Organizations (Financial Management Strategies). Institute of Medical Business Advisors Inc.,Atlanta,Ga., 2011

Marcinko,DE: “Getting it Right,” How Much is a Plastic Surgery Practice Really worth? Plastic Surgery Products, August 2006.

Marcinko,DEand Hetico, HR: The Business of Medical Practice (third edition). Springer Publishing,New York,N.Y., 2011.

Marcinko,DEand Hetico; HR: Risk Management and Insurance Planning for Physicians and Advisors, Jones andBartlettPublishers,Sudbury,Mass., 2007.

Marcinko,DEand Hetico; HR: Financial Planning for Physicians and Advisors, Jones andBartlettPublishers,Sudbury,Mass., 2007.

Marcinko,DEand Hetico, HR: Dictionary of Health Insurance and Managed Care, Springer Publishing,New York,N.Y., 2007.

Marcinko,DEand Hetico, HR: Dictionary of Health Economics and Finance, Springer Publishing,New York,N.Y., 2007.

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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America’s One-Stop Shop for Healthcare [HIEs]

Health Insurance Exchanges [HIEs]

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Brought to you by ACS a Xerox Company

For some Americans, selecting a health insurance plan will soon feel a bit like shopping. As part of healthcare reform, each state is required to have a Health Insurance Exchange (HIE or HIX) in operation by Jan. 1, 2014.

Given the complexity of the topic, we’ve created the attached infographic that visually represents the process Americans will experience when participating. If you’re planning to write about HIXs in the near future – we hope you’ll consider using this graphic to help explain the process to your readers.

Here is additional information on HIXs to support the infographic:

  • Q:  How will states develop a HIX? A: States can either build their own HIX structure or buy a platform from the federal government.
  • Q:  Who can participate in a HIX? A: Only individuals without other coverage, individuals from whom coverage is unaffordable or inadequate, or small employers can participate in the exchange in 2014. Large employers can join the exchange in 2017.
  • Q:  How many people are expected to participate? A: The Exchanges are expected to cover as many as 29 million people by 2019, including five million with employment-based coverage.

Conclusion

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CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Medicare and the Budget Control Act’s Joint Select Committee

Creating Spending Reductions for the Next Decade?

By Children’s Home Society of Florida Foundation

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Under the compromise between President Obama and leaders of the House and Senate, the Budget Control Act of 2011 created spending reductions of over $900 billion during the next decade. The bill also requires leaders of the House and Senate to appoint members to a Joint Select Committee. The committee has three Republican, three Democratic Senators, three Republican and three Democratic Representatives.

House and Senate leaders have now appointed the committee members. The 12 committee members are tasked with creating a $1.5 trillion budget solution by Thanksgiving. Their bill will be voted on without amendments by December 23, 2011.

If the committee is not able to develop and pass a bill by Dec. 23, there will be $1.2 trillion in budget cuts. Half of the cuts will come from the Department of Defense and one-half will be reductions in payments to Medicare providers.

Majority Leader Harry Reid (D-NV) appointed three Senators. The Co-Chair of the Joint Select Committee will be Sen. Patty Murray (D-WA). His other two appointees are Sen. John Kerry (D-MA) and Sen. Max Baucus (D-MT). Sen. Kerry is Chair of the Senate Foreign Relations Committee and Sen. Baucus is Chair of the Senate Finance Committee.

Republican Leader Mitch McConnell (R-KY) appointed Sen. John Kyl (R-AZ), Sen. Pat Toomey (R-PA) and Sen. Rob Portman (R-OH). Sen. Kyl is the Republican Whip and a senior member of the Finance Committee. Sen. Toomey is a member of the Budget Committee. Sen. Portman was previously Director of the Office of Management and Budget.

Speaker John Boehner (R-OH) appointed Rep. Jeb Hensarling (R-TX) as Co-Chair of the committee. His other appointments are Rep. Dave Camp (R-MI) and Rep. Fred Upton (R-MI). Rep. Camp is Chairman of the Ways and Means Committee and Rep. Upton chairs the Energy and Commerce Committee.

Democratic Leader Nancy Pelosi (D-CA) appointed Rep. James Clyburn (D-SC), House Ways and Means Member Xavier Becerra (D-CA) and Budget Committee Member Chris Van Hollen (D-MD).

The Joint Select Committee is expected to initiate meetings in September after Congress returns from the August recess.

Editor’s Note: There will undoubtedly be a spirited debate. All of the twelve committee members will want to avoid drastic budget cuts for the Department of Defense or Medicare providers. The group will need to discuss potential cuts in discretionary expenditures, defense and entitlements. With the appointments of key taxwriters Baucus and Camp, it is clear that taxes will also be a part of the discussion. Whether or not there are tax increases as part of the budget solution remains to be seen.

Conclusion

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Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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How to Take Care of Your Eyes

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In celebration of National Eye Health Week we at Ultralase have immersed ourselves in the world of vision in order to produce this handy graphic containing facts and tips to help encourage you, and the rest of the world to Love Your Eyes. Brought to you by www.ultralase.com

 

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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The Sick Cost of Medical Paperwork – Maybe?

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[By Staff Reporters]

If there’s one thing Americans can agree upon 100%, it’s that the cost of helath care is completely insane. Costs are far higher in theUSthan in any other industialized nation, and even health care reform hasn’t been able to reel them in yet.

But, where is all the money going, exactly? Hundreds of billions are going straight into the paper shredder. Brought to you by Medicaltranscription.net

 

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What Does the S&P Downgrade Mean?

If France Is Rated Higher Than the US!

By Marian Wang
ProPublica, Aug. 8, 2011, 5:38 p.m.

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The decision by credit rating agency Standard & Poor’s to downgrade the United States [1] after markets closed on Friday may have kicked up political [2] consternation [3] and triggered a market plunge [4], but it also raises important questions about the reliability of credit ratings and, for that matter, the firms that bestow them.

Just over a dozen countries currently have an AAA [5]—or lowest-risk—rating from each of the three main rating agencies: Moody’s, Fitch, and Standard & Poor’s. Until this weekend, the United States was among them. (It’s now roughly on par with Australia, which also has two AAAs and one AA+.)

So, which countries are among the lucky few that still have perfect ratings from all three firms? The United Kingdom and France, just to name a couple. S&P apparently thinks that both the U.K. and France are safer investments than the United States.

The United States still has a higher per-capita GDP [6] than most countries, including both the U.K. and France. Last year, the U.S. GDP grew 2.9 percent [6]—almost double the U.K.’s 1.4 percent and France’s 1.5 percent. Between April and June of this year, the U.S. GDP grew 1.3 percent [7] while the U.K. economy grew 0.2 percent [8]. A June forecast from the Bank of France estimated that the country’s economy would grow 0.4 percent [9] in the second quarter. (U.S. growth, granted, is still slower than it used to be [10].)

As a percentage of GDP, both the U.K. and France have a higher percentage of external debt [11], or debt owed to outside bondholders. In 2010—the latest year for which the Organization for Economic Cooperation and Development has numbers—U.S. external debt was 61 percent of GDP, compared to France’s 67 percent and the U.K.’s 86 percent. Austria also maintains a lowest-risk rating from all three firms, and its external debt was 66 percent of GDP last year. 

Let’s not forget unemployment. Our July 2011 unemployment rate figure was 9.1 percent [10]. That’s higher than the U.K.’s, which has hovered around 7.7 percent [6], but it’s lower than France, which had 9.7 percent unemployment in June.

S&P, in explaining the historic downgrade—the first in U.S. history—cited both the U.S. debt burden and the political brinksmanship over the debt ceiling as reasons it lowered the credit rating of the United States to AA+, with a negative outlook.

So, what do the ratings mean, really? It seems to be a question that economists and investors are asking, too.

“France is not, in my view, a AAA country,” a UBS economist told Bloomberg [12]. And yet there are no indications [13] that France will face a downgrade, the Wall Street Journal reports. In fact, all three of the rating agencies recently affirmed France’s triple-As [12].

Credit rating agencies have taken a collective hit to their reputations for issuing flimsy triple-A credit ratings on securities that collapsed and helped trigger the financial meltdown. A Senate investigation earlier this year identified the firms as “a key cause [14]” of the financial crisis. Documents released by congressional investigators also pointed to serious conflicts of interest [15] that caused some ratings firms to bend to the wishes of the banks that paid for their ratings. 

Assessment

As we’ve written, some of the same problems with company culture [16] and inaccurate ratings [17] have persisted. Meanwhile, the Office of Credit Ratings—an office created by Dodd-Frank, the financial reform bill, to oversee these firms—hasn’t even been set up because Congress didn’t allocate funds for it. Other efforts written into the measure to lessen U.S. reliance on ratings and open up the firms to more liability have been slowed or stalled altogether.

Wiping out the references to credit ratings in U.S. law is a “harder task than the legislation assumes,” said Barbara Roper, director of investor protection for the Consumer Federation of America. The downgrade, she thinks, may provide just enough impetus to keep those efforts moving. 

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Hospitals Slowly Affiliating with RBACs

The Rise of Role-Based Access Controls

By Dr. David Edward Marcinko MBA CMP

Last month I visited the University of Pennsylvania in Philadelphia. Of course, I graduated from Temple University myself and worked as an admissions clerk in the ER, back in the day.

There I learned that some local hospitals are affiliating in role-based access control (RBAC) electronic networks by controlling which patients, medical providers or health plans have access based on the needs of patients, payors, physicians, or insurers. User, doctor, and patient rights and services are then grouped by name, and access to medical resources is restricted to only those authorized.

The technology was first pioneered and used in London hospitals several years ago.

Example:

For example, when an RBAC network system is used by a hospital, each individual that is allowed access to the hospital’s network would have a pre-defined role (doctor, nurse, lab technician, administrator, patient, etc.).

If someone is defined as having the role of doctor, for example, then that user can access only resources of the healthcare network that the role of doctor has been allowed access to (electronic medical records, for example).

If another user has access as a diabetic patient, then that user cannot access unapproved health services, like OB-GYN. Each user is assigned one or more roles, and each role is assigned one or more privileges for users in that role.

Assessment

Link: http://www.computerweekly.com/Articles/2007/10/19/227566/How-to-implement-role-based-access-control.htm

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Things You Didn’t Know About Death

Not a Unique Experience

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Death is an experience that we’re all going to have at one point or another. Why not take a few minutes to learn some interesting and some truly bizarre facts about death, dying, and the dead? Brought to you by medicalinsurance.org

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USN&WR – Meet the ADA President

Dr. Raymond Gist

By Kellus Pruitt DDS

I just found a US News Health article by Angela Haupt titled, “The Era of Electronic Medical Records.”

http://health.usnews.com/health-news/most-connected-hospitals/articles/2011/07/18/most-connected-hospitals?PageNr=1 

Even though dentistry wasn’t mentioned even once, I took liberties with the comment I posted. Besides, dentistry is never mentioned anywhere in the healthcare press, and that’s just not healthy. That is the point I hope I got across to Angela Haupt when I suggested she become Dr. Gist’s 7th Facebook friend.

 

Dear US News and World Report:

Last year, President Barack Obama promised that digitizing America’s health records will go beyond just improving care. He said transforming from paper to digital is a “panacea for the economy.” Somehow, illness became a renewable national resource.

I’m pretty sure neither the President nor US News have a clue about the business of dentistry.

Defying your common, misinformed bias for EHRs over paper records, here is a bite of reality from a dentist who actually treats patients: Other than me, the nation’s other 170,000 dentists are stone-silent about adoption of electronic dental records. Don’t you find that odd? What’s more, stakeholders inside and outside the American Dental Association, including even software vendors, avoid public discussions of EDRs. Dr. Oz’s Sharecare.com won’t even touch the topic. Why?…  a reporter might ask.

Do you trust that the widely-respected ADA always represents first and foremost the safety of dental care for both dentists and their patients? Let me fix that for you: ADA President Dr. Raymond Gist recently opened a Facebook, and two days ago, I was fortunate enough to be his second fan and the first to post a comment.

https://www.facebook.com/pages/Raymond-F-Gist/165275266868843

I took advantage of an unprecedented opportunity to speak directly to a vetted ADA official and asked the President, “Are electronic dental records more or less dangerous for dentists and patients than paper records?” I’m disappointed that Dr. Gist still has not responded. Why did he even bother opening a Facebook, one might ask.

Here’s what I think:

Because of the cost and safety issues with digital records that I warned each ADA President about since 2006, EDRs, and especially HIPAA, have become so difficult to defend in a free-market that nobody even tries any more. I think a handful of ADA leaders expected pigs to fly much sooner than this.

Assessment 

Want to do some real reporting, US News? Become Dr. Raymond F. Gist’s 7th Facebook fan and ask him on behalf of your publisher if EDRs are safer than paper dental records. Sure. It’s unconventional, and as far as journalism goes, it’s kind of kinky to post a question on someone’s Facebook. Nevertheless, it could be fun to watch a USN&WR reporter be treated with the same level of respect ADA officials offer dues-paying members.

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Events Planner: August 2011

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Events-Planner: AUGUST 2011

By 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 175,000 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.

So, enjoy the Medical Executive-Post and this monthly Events-Planner with our compliments. 

A Look Ahead this Month – And now, the important dates:

  • August 15-18: National Quality Colloquium at Harvard, Cambridge,  MA

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

MarcinkoAdvisors@msn.com

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On Single Unit Surgical Centers

Proposed Registration and Licensure Requirements

By Garfunkel Wild, PC

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Legislation enacted on March 23, 2009 required single suite surgical facilities that are conducted by surgical practices (the “Surgical Practices”) to register with the New Jersey Department of Health and Senior Services (“NJDHSS”) by September 17, 2009, and prohibited registration of new Surgical Practices. However, registration requirements were not implemented or enforced.  Previously, Surgical Practices were regulated by the Board of Medical Examiners.  The proposed regulations intend to set forth both registration and regulatory requirements for existing Surgical Practices, but preserve the statutory moratorium on new Surgical Practices.

New Jersey Department of Health and Senior Services

Surgical Practices that are in operation on the effective date of the proposed regulation must register with the NJDHSS or cease operations no later than ninety (90) days from the effective date.  A Surgical Practice that has not commenced operation by the effective date but has filed specifications and/or other required building or zoning documents with the municipality in which the Surgical Practice will be located must register with the NJDHSS prior to commencing operations.  All Surgical Practices to be registered in the future must register within two (2) years of receiving approval from the municipality in which it will be located. Registration will be valid for one year and will be subject to annual renewal.  Along with the renewal application, the registrant would be required to submit a copy of its certification from the Centers for Medicare and Medicaid Services (“CMS”) or other documentation of accreditation. In the event that a Surgical Practice fails to maintain such certification or accreditation, the registration would lapse.

The proposed regulations would also provide for standardized requirements for the transfer of ownership and relocation of all Surgical Practices. Importantly, a Surgical Practice would be permitted to apply for approval of a transfer of ownership by submitting a completed registration application at least ninety (90) days prior to the planned transfer of ownership.  Additionally, a registered Surgical Practice would be permitted to relocate within twenty (20) miles after submitting certain documentation set forth in the regulations. A relocated Surgical Practice would not be permitted to expand the scope of services at a new location.

New Legislation

In addition, legislation has been introduced which would go further than the proposed regulations and require all Surgical Practices in operation as of the date of enactment to become licensed by the NJDHSS as ambulatory care facilities licensed to provide surgical services within one year of the effective date.  Such Surgical Practices would be exempt from the ambulatory care facility assessment.  In addition, the moratorium on new ambulatory care facilities would remain in effect. 

Assessment

If this legislation is enacted, the NJDHSS would not issue new registrations for Surgical Practices after the effective date.  However, a registered Surgical Practice may transfer ownership or relocate after the effective date if it becomes licensed as an ambulatory care facility prior to applying for a new license. Surgical Practices would be required to obtain ambulatory care accreditation from an accrediting body recognized by CMS as a condition of licensure.

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Continued Barriers and Issues with eHRs

More on the electronic documentation of medical information

By Carol S. Miller BSN, MBA, PMP

Many providers of health care are moving forward with electronic medical records [eMRs] and documentation of related information.

However,  there are still significant perceived and real barriers impacting some doctors and practitioners of care in moving forward with this process.

Here’s why in four brief points:

  • High Start-up Cost is probably the foremost barrier or concern of providers.  The EHR product, hardware, initial and annual software license, training both initially during implementation and ongoing, and other peripherals,  and the follow on module updates, maintenance, and/or replacements are all associated with a cost that can be quite an expensive proposition especially to a small provider practice.
  • Loss of productivity does occur as the staff and providers learn the new system and associated process changes in day-to-day operation.
  • There are many EHR products in the marketplace.  Providers are faced with decision points on which vendor system to purchase and the degree of modules needed to successfully support the clinical work within that practice.  In general, technical integration such as uncertain quality of system purchased, functionality issues, lack of integration with other applications and other like issues can impact a smooth transition to EHRs and actually create more problems and cost than the existing process in place.  In addition, incompatibility between systems (user interface, system architecture and functionality) can vary between suppliers’ products.
  • Certification, security, ethical matters, privacy and confidentiality issues are still a high concern.  The increased portability and accessibility of electronic medical records may increase the ease with which they can be accessed and stolen by unauthorized persons or unscrupulous users.  Even today large-scale breaches in confidential records occur and others can easily happen whena more integrated connectivity exists between systems, providers, hospitals, and wireless devices.  Continued concerns about security contribute to the widespread adoption of EHRs still are pervasive in the provider community.  Still lingering is the privacy concern and the adequate protection of individual records being managed electronically.  As an example, with an electronic record in a hospital setting, there can easily be over 100 individuals from doctors, nurses, technicians, admissions, quality control, billing staffing and many more who have access to at least part of a patient’s record during an average hospital stay.  In addition, there are multiple individuals at payers, clearinghouses, research firms, and others that have access to patient information at any given time.

Order Book Now [more from this author]

Healthcare Organizations” [Management Strategies, Tools, Techniques and Case Studies].

In-Process from: (c) Productivity Press 2012

http://www.crcpress.com/product/isbn/9781439879900

About the Author

Carol S. Miller has an extensive healthcare background in operations, business development and capture in both the public and private sector. Over the last 10 years she has provided management support to projects in the Department of Health and Human Services, Veterans Affairs, and Department of Defense medical programs. In most recent years, Carol has served as Vice President and Senior Account Executive for NCI Information Systems, Inc., Assistant Vice President at SAIC, and Program Manager at MITRE. She has led the successful capture of large IDIQ/GWAC programs, managed the operations of multiple government contracts, interacted with many government key executives, and increased the new account portfolios for each firm she supported.

She earned her MBA from Marymount University; BS in Business from Saint Joseph’s College, and BS in Nursing from the University of Pittsburgh. She is a Certified PMI Project Management Professional (PMP) (PMI PMP) and a Certified HIPAA Professional (CHP), with Top Secret Security clearance issued by the DoD in 2006. Ms. Miller is also a HIMSS Fellow, Past President and current Board member and an ACT/IAC Fellow.

Conclusion

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Healthcare Associated Infections [HAIs]

The Unknown Killer

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Each year, Healthcare Associated Infections (HAIs) affect millions of patients and add billions of dollars to healthcare costs in the U.S. GE’s Healthcare division is aggressively working to find ways to address this issue and prevent the widespread occurrence of HAIs in the future.

GE and JESS3 partnered to create an infographic which visualizes several statistics related to the spread of HAIs such as the number of people who die of HAIS in the US annually, the staggering number of people who are affected by HAIs annually and the incredible cost it creates per patient and to the healthcare system. By laying out the complex numbers in this sharp and colorful graphic, GE hopes to raise awareness about the widespread problem which scientific evidence suggests could often be preventable.

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A New Take on Accounts Receivable [AR] Factoring for Doctors

 Understanding How Medical Practice Business Factoring Works

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AR factoring is a financial transaction whereby a business, like a medical practice, sells its accounts receivable (i.e., invoices) to a third party (called a factor) at a discount in exchange for immediate money with which to finance continued business.

Factoring differs from a bank loan in three main ways.

First, the emphasis is on the value of the receivables (essentially a financial asset), [1][2] not the firm’s credit worthiness.

Second, factoring is not a loan – it is the purchase of a financial asset (the receivable).

Finally, a bank loan involves two parties whereas factoring involves three.

Conclusion

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Benchmarks of Health Plan Administrative Costs

2011 Edition‏

[By John Park]

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Recently, we began the release of our fourteenth annual edition of administrative performance benchmarks for health plans. It is the culmination of 515 health plan years of experience with all major sectors of the health plan industry. The attached brochure briefly describes our 2011 benchmarks.

First Universe Release

The first universe to be released was comprised of data of Blue Cross Blue Shield plans. Nearly 70% of all Blue Cross Blue Shield licensees participated this year.  A summary of the results for this universe is here:

http://www.sherlockco.com/docs/navigator/Navigator%20July%2011.pdf.

Results

In short, per member administrative expenses increased by only 1.0% in 2010 and only 1.8% when you adjust to back out changes in product mix.

This growth rate is very low by any standard.

Sherlock Company’s Benchmarks

Between the MLR provisions of the Accountable Care Act, which are intended to “create incentives for” health plans” to become more efficient,” and a weak overall economy, health plans face greater pressure to optimize their administrative costs. Sherlock Company’s benchmarks of administrative expenses enable your plan to quickly determine whether it is operating at best practice and to identify which functional areas provide the highest return on management’s efforts to improve performance.

Accordingly health plans serving more than one-half of all insured Americans are users of our benchmarks.

Assessment

Additional information can be found at http://www.sherlockco.com/seer.shtml

Sherlock Company

Douglas B. Sherlock, CFA

Senior Health Care Analyst

sherlock@sherlockco.com

Ph:  215-628-2289

Fax: 215-542-0690

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PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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