Healthgrades™ Patient Safety Award

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Hospitals Compared to Hospitals Performing Worse than Expected for Patient Safety

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Is the CFP-BOD, and the CFP® mark, in Jeopardy? [VOTE]

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Early CFP® Board Leader Says Future of Certification in Jeopardy

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The CFP® Board’s strategy of punishing some certificate holders over compensation disclosure issues in what critics charge is an arbitrary manner threatens the future of the CFP® designation, according to one of the early leaders of the board who also chaired its disciplinary commission.

Please vote

And so, we ask this question.

Assessment 

Link: http://www.financial-planning.com/news/early-cfp-board-leader-says-future-of-certification-in-jeopardy-2686698-1.html?ET=financialplanning:e14975:86235a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=FP_Weekend__092713

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A Look at Predictive Health Care Modeling Priorities

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Definition 

According to Wikipedia,predictive modelingis the process by which a model is created or chosen to try to best predict the probability of an outcome. In many cases the model is chosen on the basis of detection theory to try to guess the probability of an outcome given a set amount of input data, for example given an email determining how likely that it is spam.

Models can use one or more classifiers in trying to determine the probability of a set of data belonging to another set, say spam or ‘ham’.

Assessment

Nearly any regression model can be used for prediction purposes. Broadly speaking, there are two classes of predictive models: parametric and non-parametric. A third class, semi-parametric models, includes features of both.

Parametric models make “specific assumptions with regard to one or more of the population parameters that characterize the underlying distribution(s)”, while non-parametric regressions make fewer assumptions than their parametric counterparts.

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How Much Money Do You Make – Doctor?

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Ruminations on the Last Taboo!

By Rick Kahler MS CFP® http://www.KahlerFinancial.com

Rick Kahler CFP“How much money do you make?”

We don’t ask people, let alone doctors and medical professionals, that question; but we’d love to know the answer.

In this country, we’re fixated on a person’s annual income. That’s the primary measure we use to determine social status and define success.

Income Qualifier?

Income also is the qualifier for government welfare programs. It defines people as poor, middle class, or rich. And, of course, it determines how much of your income the government will take. The more you bring in, the higher the percentage of your earnings you will pay in federal, state, and local taxes.

Income as a Poor Indicator of Net Worth

While we project a lot of things onto someone’s income, most of what we project is untrue. Income is not the best indicator of a person’s wealth or net worth.

Examples:

Last year Dr. Brent’s tax return showed an adjusted gross income of $20,000. Dr. Bill’s was $2 million. Who is richer? Most people would say Bill. The US and state governments also would say Bill. Actually, Brent is far and away the wealthier of the two.

Why and How?

Consider these two real-life examples:

  • Dr. Bill lives in New York, New York, which has both high property taxes and a city income tax. Paying city, state, and federal income taxes, plus property taxes on his luxurious home, takes around half of his salary. With take-home pay of about $1 million, Bill spends $1.2 million a year on his mortgage payments, college and private school tuition, and his lifestyle. He overspends his net income by $200,000 a year. He owes more on his condo than it’s worth, and he has significant credit card debt. When you total his assets and liabilities, he has a negative net worth of $1 million. He has managed to hold everything together so far, but technically, Bill is bankrupt.

Jaguar XJ

  • Dr. Brent lives in Rapid City, South Dakota. He is retired, owns a modest home which is paid for, and lives on about $40,000 a year. He didn’t pay any income taxes last year, partly because some of his income is from tax-free municipal bonds and mostly because he wrote off a large investment loss which left him with $20,000 of adjusted gross income. Brent has no debt. His net worth is $5,000,000.

Steering Jaguar

The truth is that what people make tells us very little about whether they are rich or not. In these examples, judging from income alone, it would be easy to reach the inaccurate conclusion that Bill must be far wealthier than Brent. His lifestyle is certainly more lavish—which of course is part of the reason he isn’t wealthy.

Many people who have high incomes but are heavily in debt might have lifestyles lower than others who make significantly less but have no debt. It’s not uncommon that people with high incomes choose to live a lifestyle that is far below what they could afford. In fact, this is one of the best ways to build real wealth.

The Income Non-Indicator

Income is a poor indicator of whether someone is rich. Even more important, it’s a poor indicator of how they handle money. I once worked with a family with an annual income of around $5 million who had a net worth of minus $3.5 million. They may have looked like “millionaires,” but they were not.

On the other hand, I work with many clients who have annual incomes around $100,000 a year, spend $60,000 a year, and are worth $2 to $5 million.

Assessment

The bottom line is that wealth is defined by net worth, not income. A high income doesn’t equal wealth; it equals a better opportunity to build wealth. Not everyone is wise enough to take advantage of that opportunity.

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“Retirement Investors Flock Back to Stocks”

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WSJ Front Page Headlines

[By Rick Kahler MS CFP® http://www.KahlerFinancial.com]

Rick Kahler CFP“Retirement Investors Flock Back to Stocks” was the front page headline of The Wall Street Journal on May 2, 2014.

I retweeted it to my Twitter feed, adding, “Just In Time to Ride Them to the Bottom Again.”

Introduction

Five years ago some of those same investors were abandoning stocks in sheer panic. In early March 2009, the Dow Jones Industrial Average hit a low of 6700. Many financial advisors spent hours listening to frightened clients wanting to sell out their entire portfolios and go to cash. It was an exhausting and traumatic period for doctors, financial advisors and clients.

Calm and Steady

Those who followed advisors’ recommendations to stay the course certainly came out on top. Their portfolios recovered nicely, with double-digit annualized returns for the past five years. Even over the past 10 years, most diversified portfolios earned very respectable returns far in excess of bank CD’s or bond yields.

Panic and Fear

Unfortunately, those who panicked and sold out paid an incredibly high price for the momentary relief of getting off the market roller coaster. Many of them kept their money on the sidelines until recently, waiting until “things were better” to reinvest.

Today-Bubbles?

Apparently that time has come. Here are some numbers from the WSJ article:

Retirement investors have recently increased their stock holdings by almost 40% from the market lows. Today, bond and money market funds make up only 25% of retirement plans, and 67% of new 401(k) contributions go toward purchasing stocks.

In 2007, bond and money market funds accounted for 21% of retirement plans. At the market top in October 2007, the average new 401(k) contribution going into stocks was 69%. Within 18 months stocks had declined almost 60% from their highs.

Correlations?

Do you see any potential correlations here? I have little doubt these individual investors, mistiming the market once more, are setting themselves up to get slaughtered all over again.

But, what about those who did get out of the markets five years ago and now realize they made a big mistake? Suppose you’ve learned the wisdom of staying in the market with a well-diversified portfolio. How do you get back in without waiting for the next crash?

Three Strategies:

Here are three strategies to rebuild your portfolio.

First, don’t go all in, but move into the market gradually with “dollar cost averaging.” Over the next two years, methodically (monthly or quarterly) buy into a diversified mixture of asset classes. If the market turns downward, which carries a high probability, you will buy into a falling market. You will also reduce the possibility of a huge market drop that might cause you to panic and sell out again.

Second, allocate your purchases to a mixture of US and international stocks, as well as options such as real estate investment trust (REIT) funds, commodity funds, managed futures funds, Treasury Inflation Protected (TIPs) bond funds, high yield bond funds, and high quality bond funds.

Finally, once your two-year dollar cost averaging is done and you are fully invested into your asset classes, rebalance at least once a year to maintain your original allocations as the values of the assets change.

For example, if you have allocated 30% of your portfolio to stocks, purchase more if stocks add up to less than 30% or sell some if they are over 30%.

Bull markets

Assessment

The research suggests there is a high probability that things will end badly for individual investors who try to time the markets. A few will succeed, but will confuse their “skill” with the fact they just got lucky. A methodical approach, however, provides a strategy to help you hold on, even in the face of market ups and downs.

Conclusion

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FOR SALE: Physician E-mail Lists with NPI Numbers

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Sensitive Data for Sale

[By Dr. David Edward Marcinko MBA]

Dr. DEMI received this email recently. Are you as incensed over it, as I? OR, am I being overly sensitive? Feel free to call or email John Edward, the sender, to tell him what you think: pro or con?

Hi ME-P,

I’m writing to check if you would be interested in reaching Physicians or Healthcare Executives?

We at AccurateB2Blist maintain a permission passed email list for physician practitioners with NPI numbers.

Our Lists

Below given are few additional lists we maintain within Medical Industry

  • Nurses
  • Dentists
  • Veterinarians
  • Healthcare Executives Email List
  • Physicians – Offices and Clinics of Doctors of Medicine
  • Physicians – Offices and Clinics of Doctors of Osteopathy
  • Doctors, Physicians and Surgeons Email List with NPI Number

Healthcare executives: 518,900 out of which 123,200 contacts are senior management level contacts.

Assessment

Please let me know if you would like to discuss further on your target audience? Looking forward to hearing from you. And, please do not print this email unless it is absolutely necessary. To opt out reply with ‘Leave out’ in the subject line!

By John Edward [Business Development Executive] AccurateB2Blist

+1951-373-6718

For Sale

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A Word on Automobile Cabin Air Filter Maintenance

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Not Just for Physician-Allergists

[By Dr. David Edward Marcinko MBA CMP™]

DEM 2013Cabin air filtration is easily the most forgotten automobile maintenance item in passenger or luxury cars.

Since their introduction in roughly the early 1990s, more and more cars are equipped with cabin air filters – from a sub-compact to a full-sized luxury car, nearly all cars available in North America now come equipped with them and thus there’s a pretty good chance your car is equipped with one, and a fair to middling chance that it needs replacement.

Now is the time to Inspect

So now, following pollen, grass and hay-fever, season, is a great time to learn more about your cabin air filter. Cabin air filters tend to be buried deep within the dashboard of your vehicle, where the heating, air conditioning and ventilation system are located. They are usually about the size of a standard sized sheet of computer paper, and can vary in terms of material, most common being a cellulose mesh.

The cabin air filter is responsible for removing particulate from the air, which can include a whole litany of things you don’t want to be breathing; diesel exhaust, rubber particles, pollen, dust and general air pollution among other things.

***

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***

Since the air entering the car through the heating and air conditioning system has to pass through the cabin air filter, the filter can get clogged quite quickly depending on environmental conditions, and a clogged cabin air filter drastically reduces the overall effectiveness of your HVAC system as it struggles to get air flow that a clean cabin air filter would provide.

Other excellent reasons to change your cabin air filter, besides better circulation, include fresher smelling air and fewer allergens entering the cabin. Many cabin air filters accumulate leaves and other debris that your car winds up ingesting which can lead to musty or stale odors. Ultimately, switching out your cabin air filter is a small expense that keeps you from inadvertently sneezing months later.

***

DEM's Jaguar

***

As your cabin air filter is “out of sight, out of mind”, it’s definitely a good idea to get in the habit of having it inspected and replaced regularly. What are the right intervals for you? It all depends where (and how much) you drive. It’s a small and affordable maintenance item that will ensure you have many miles of driving comfort ahead.

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Assessment

I replace the cabin filter in my classic 2000 Jaguar XJ-V8-L touring sedan each Spring. What about you?

***

filter

[Cabin Filter]

***

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Stock Market at New Highs!

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Is this a Bubble?

[A SPECIAL R&D REPORT FOR THE ME-P]

By David K. Luke MIM, MS-PFP, CMP™ [Certified Medical Planner™] http://www.networthadvice.com

David K. LukeThe market news has been replete with the phrase “new market high“ in the business news every couple of weeks as of late. The corresponding message is often that the stock market is likewise in a bubble. The S&P 500 index and the Dow Jones Industrial Average index are at all-time highs. The indexes have surpassed the 2007 peak.

The reality is however that the S&P 500 is up less than 6% from the beginning of the year, and the Dow is up about 2%. Most investors, of course, do not invest just in these two indexes, as these two indexes represent very large capitalized companies.

I am reminded of the customer in 1995 when I worked at a national brokerage firm that called me to liquidate his entire stock portfolio. “The stock market was too high,” he said. He was 5 years too early.

Risk Mitigation

Most investors will have a diversified portfolio that includes mid-cap stocks, small-cap stocks, and international stocks as well as large cap stocks such as found in the S&P 500.

Of course, these equity investments are also typically subdivided into the broader categories of “Growth” and “Value.” Which means most investors that believe in diversification will own four different “types” of stock, each divided into two different categories for eight different baskets of stock if you will. The typical daily news will focus only perhaps on the S&P 500, which is a portfolio of large capitalized growth stocks. This is only one of the eight different types of stock that an investor would typically own.

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In strong bull markets, typically all eight categories of stock go up together with some degree of correlation. This is also true in strong bear markets with all eight categories of stock going down in some degree of correlation. Portfolio managers typically try to offset high correlation of investments by owning investments in asset classes that typically do not all correlate together. This is a major technique used to reduce the volatility in an account.

However as you can see so far this year, most all of the eight stock indexes with the exception of small-cap growth are up slightly in line with the S&P index.

***

[As of June 13, 2014] 

Name Ticker % Total Return YTD % Total Return 12 Month
Large Cap iShares S&P 500 Growth IVW 5.59 22.55
iShares S&P 500 Value IVE 5.76 18.39
Mid Cap iShares S&P MidCap 400 Growth IJK 2.69 18.24
iShares S&P Mid-Cap 400 Value IJJ 7.66 23.19
Small Cap iShares S&P Small-Cap 600 Growth IJT -0.52 20.8
iShares S&P Small-Cap 600 Value IJS 2.3 21.37
Foreign Large Blend iShares Core MSCI EAFE IEFA 3.75 19.25
Barclays Aggregate Bond Index iShares Core US Aggregate Bond AGG 3.26 2.39

Source: Morningstar

***

Inflation

The buying power of the US Dollar has changed over the years. The Consumer Price Index (CPI), a common measure of inflation, has averaged around a 3% annual increase from 1913 – 2014 according to the U.S. Department of Labor Bureau of Labor Statistics.

In fact, an item purchased for $5.00 in 1913 would have a cost of $119.73 today, or a cumulative rate of inflation for the past 100 years of 2,294.7%. The cost of living rising each year is a safe bet. Inflation has increased every year in the past 50 years with one exception: 2009 when inflation fell -0.4%.

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Update: 06/17/2014 04:10 ET

[Market Update]
Symbol Last Change
DOW 16,808.49 +27.48
NASDAQ 4,337.23 +16.13
S&P 1,941.99 +4.21

Conclusions:

  1. The Market Indexes at new highs does not indicate a bubble. In fact, the market should, relatively speaking, regularly be hitting new highs because of the consistency of positive inflation. Prices of goods and services today are at all-time highs. Does that mean we are in an “inflation” bubble? No. This is normal.
  2. The S&P 500 is not an accurate measure of the US economy. While the S&P 500 is the common “market” indicator in the US, only about 55% of the earnings of the index come from the US. (Source: RBC Capital Markets Research, Capital IQ 2012). This is because mainly large multinational companies such as Google, IBM, and Apple that have a significant amount of overseas revenues weight the index.
  3. The S&P 500 or the Dow Jones Industrial Average (DJIA – 30 stocks) is most likely not an exact reflection of your personal stock portfolio, which would expectantly be more diversified. A typical well-diversified long-term investment portfolio would include not just large cap stocks (such as found in the S&P 500 or DJIA), but mid, small, and international stocks from the growth and value camp, as well as a diversified bond holding.
  4. Overpriced stocks, just like overpriced real estate, are more prudently ascertained by value measures, not simply by raw index numbers. A stock hitting new highs could still be quite undervalued. Meaningful variables such as earnings growth, price to earnings ratio, dividend yield, price-to-book, price-to-sales, and other metrics should be considered.

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On m-Health App Therapeutic Business Potential

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Top Ranked Therapy Areas

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How EMR Vendors Mis-Lead Doctors [Part 2 of 2]

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A SPECIAL ME-P REPORT

Practical “Tips and Pearls” from the Trenches

[Part Two]

By Shahid Shah MS http://www.healthcareguy.com

Shahid N. ShahAs your practice’s CIO it’s your job to challenge the vendors’ assertions about why you need an EMR, especially during the selection and production demonstration phase.

The most important reason for the digitization of medical records is to make patient information available when the physician needs that information to either care for the patient or supply information to another caregiver.

Electronic medical records are not about the technology but about whether or not information is more readily available at the point of need. In no particular order, the major reasons given for the business case of EMRs by vendors include:

  • Increase in staff productivity
  • Increase of practice revenue and profit
  • Reduce costs outright or control cost increases
  • Improve clinical decision making
  • Enhance documentation
  • Improve patient care
  • Reduce medical errors

Let’s tackle each potential benefit and see how they can be realized or left unfulfilled based on how a practice uses the technology solutions available to it. While thinking of the benefits, keep in mind that all automation solutions have voracious appetites for data entry and information. If you do not enter the data (either manually, through scanners, or integration with external systems) the value of the solutions cannot be realized. That’s why it’s crucial to consider how much time and effort you’d like to invest in data entry and if you’re not willing or able to take the time to enter the data into the system then the system is not going to work for you.

Increase in staff productivity

The first benefit often cited by vendors is improvement of your staff’s productivity. In a well-designed and properly implemented solution, an EMR can reduce the amount of time it takes for staff to locate records and find particular information about patients as well as generally conduct their tasks in a more efficient manner. However, actually achieving productivity improvement is much more difficult than vendors often make it sound. This is because the actual improvement in productivity is directly related to the amount of detailed data that is collected for patients across the entire practice workflow. Unless your practice has identified all or at least most major workflow steps and has created appropriate automation steps is unlikely that your productivity improvement will match what the vendor promises.

Ask your vendors specifically where the staff productivity improvements come from; in a demonstration have the sales person show you how specific functions of their software can improve staff effectiveness at particular tasks. Instead of citing just studies performed in large institutions, have the vendor show you how their benefits apply to your smaller setting. Ask specifically what happens if certain data is not entered in the way the vendor requires it; does it break the software, reduce the staff productivity benefits, or something else?

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Increase of practice revenue and profit

Most physician practices make money by seeing patients and charging fees for services; but when a vendor promises an improvement in revenue or an increase in profit, you must be very reluctant to believe the claims without specific evidence. An increase in revenue can only come when the number of patients seen per day per physician can be increased. An increase in profit can only be achieved if the costs associated with seeing patients can be reduced. Unless an EMR actually reduces the number of steps involved in seeing a patient and reducing the time associated with the non-clinical aspects of patient care there is no way that the introduction of the technology itself will increase revenue. Likewise, unless an EMR is designed to significantly remove staff burden and reduce the number of people in your office that you need to perform tasks associated with patient care, realizing an increase in profits will be tough.

During the software demonstration, ask the vendor about how the revenues increases come because of specific features. Dubious responses like studies performed in academic medical institutions or a reference to another client shouldn’t be enough – they should be able to demonstrate methodically how revenues will go up in your practice.

Reduce costs outright or control cost increases

In some fairly sophisticated implementations the reduction of costs has been proven to be possible; however outright cost reduction is still tough to gain. Controlling cost increases, however, is quite possible and is usually easier to attain because as your staff becomes familiar with their technology solutions they become more efficient over time and they are able to do more work with the same resources and staff therefore you may be able to increase the number of patients that you can see over time without increasing costs. Again, while immediate cost reductions are tough in a medical practice given that a large portion of your costs are associated with personnel, long-term cost reduction through either attrition or not having to hire new staff while still being able to increase their workload allows you to control costs better.

During the software demonstration, make sure you see how specific software features will reduce costs. You will get plenty of softballs being thrown your way about how other customers saw their costs go down or studies showing that large companies have seen the benefits. Your job as the CIO will be to force the vendor to tie cost savings specifically to use of their software, not computers in general.

Improve clinical decision making

Improving clinical decision-making is often a dubious endeavor and should not typically be the first reason you choose to implement an EMR; this is because clinical decision-making is and will remain a knowledge –based activity requiring significant training and teaching of computers before they can actually begin to improve clinical decisions. Physicians are some of the worlds’ best trained knowledge workers and they honed their clinical decision-making skills over a long period of time in very specialized training regimens that cannot easily at this time be duplicated by computers. When a vendor promises that an implementation of any EMR will improve decision-making from a clinical standpoint remain very skeptical.

Enhance documentation

Many vendors claim that their EMR’s will help improve and enhance clinical documentation. While this is very true for lead-based EMR is they are often creating much more documentation as far as quantity is concerned while likely reducing the actual quality of the information contained in the documentation. When implementing a template-based solution keep in mind that what a physician could normally easily write down in a couple of sentences will turn into many paragraphs in many pages of boilerplate text and boilerplate documentation that must then be stored red and understood by colleagues. So the promise of enhanced documentation is actually usually easy to achieve because you will get more pages of documents that are automatically generated but those pages that are generated may not necessarily be the most favorable from a clinical usefulness perspective.

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Improve patient care

Many vendors proclaim that the installation of an EMR sometimes by itself will improve patient care; if by improvement of patient care they mean actually moving patients through the different steps associated with patient care in your office in a faster and more customer friendly manner then there is some truth to that. However if by improvement of patient care the promise is to actually make people’s healthcare better or truly improve a patient’s health itself then those claims must also be seen with a skeptical eye. This is similar to the clinical decision making enhancement promises that are often made; just like clinical decisions, patient care is a very human activity and simply introducing a better record keeping system will not improve people’s health. We are an improvement in health can occur however is in the tracking of clinical goals and helping patients meet those goals by reminding patients for regular tasks.

Reduce medical errors

Reduction of medical errors is a laudable goal; and in fact many EMR’s and the use of computerized physician order entry systems can help reduce medical errors by ensuring that common clerical types of errors do not occur. When looking at medical and clinical errors those errors that can easily fit well established and known rules can be automated in a somewhat friendly and easy manner and by using such automated tools error reduction is possible.

Assessment

However, when rules become difficult to define or are not widely agreed-upon then errors associated with such rules would not be caught.

PART ONE: How to Demo and Buy an EMR Office System [Part 1 of 2]

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How to Demo and Buy an EMR Office System [Part 1 of 2]

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A SPECIAL ME-P REPORT

Practical “Tips and Pearls” from the Trenches

[Part One]

By Shahid Shah MS http://www.healthcareguy.com

Shahid N. Shah MSWhen getting demonstrations from vendors, the only way to understand the value for the money being spent or invested is to measure and communicate the productivity improvements that IT is supposed to deliver.

If you cannot measure how much time something takes before technology is implemented you will never know whether or not the purchase of any technology was a wise investment.

Some of the measurements you should consider are:

  • how long it takes to pull up a patient chart
  • how long it takes to update common data elements within a chart (meds, problems, etc.)
  • how long an appointment takes to schedule
  • how many patients are seen on a daily basis
  • how much data is being captured per patient visit
  • how long the check in and check out processes take
  • how much time spent on non-essential phone calls (better handled by automated email?)
  • how much time a physician spends on non-clinical activities

The actual items that you measure will depend on the tasks that you would like to automate; the simple listing of the tasks that you would like to automate often provides enough basic measurement metrics that you can perform a before and after comparison.

Vendor Demonstrations

When bringing vendors and for demonstrations or discussions you should lay out your workflow and your processes and share with them the kinds of tasks you would like to automate and the kind of staff productivity you are looking to improve and make your vendors focus on what’s important to you and not what features and functions they have in their solutions. Just remember the rule if you don’t measure you will never know whether you made an investment or simply spent money on something you didn’t need. If you don’t know how well you’re doing and where you want to improve vendors can give you any numbers and they will sound good to you.

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Here are some general tips for making sure you get good demo’s:

  • Demonstrations from vendors should not be about their software, but about how their solution benefits you. Make sure they spend most of their time talking about you, your practice, how their solution matches your practice, why each feature they are showing is important to your specialty and staff, and why they won’t fail in your office. Each time they talk about a general feature or function, bring them back to your practice.
  • When vendors talk about saving money and increasing productivity keep in mind that some money comes in the form of hard cash for the purchase of equipment and software but even more money will be spent in terms of early loss of productivity as new solutions are installed and staff becomes acclimated to it and potential loss in productivity forever if the wrong processes and steps are automated.
  • Force vendors in their demonstrations to talk about their failures in past installations – how many times were they removed/deinstalled, why did failures occur in the past, how did they recover from inevitable problems? The more a vendor can talk about why things go wrong and how they can help right the ship, the more likely they can help you out the jams you will get into.

To save you time, take 30 minutes and create a document that will tell vendors what you want them to show you in a demo and make the follow your script, not theirs.

Here are some tips for helping vendors demo to you:

  • See if you can do the first demo over the phone and web meeting software like WebEx or GotoMeeting. Remote demonstrations make more efficient use of time – the second or third demonstrations when you’re narrowing down selections are better in person.
  • Tell them there is no need for detailed company introductions and that you have no desire to hear that the vendor’s founders have found the secret sauce to healthcare technology that will save the healthcare industry. Vendors think you care about that stuff and will waste much of your time unless you make sure your wishes to not hear that are known in advance. They will not think you’re rude, they will thank you.
  • All medical records software do generally the same thing, they just do them in sometimes different ways and that’s what you care about – how they’re different. You’ll want to tell them to focus on how they different from other EMRs but not let them focus on competitors early on. Do this towards the end when you better understand their product and can ask more specific questions.
  • If the sales person wants to talk about the company, ask him to focus on the size of their service staff relative to their R&D staff, whether they provide in person phone support, do they have web-based support with screen sharing, and how much it will cost you to get support when you need it. While you’ll never talk to the CEO or founders of a vendor, you’ll definitely talk to their service staff so do ask about it.
  • Take the keyboard from the sales person. Never let a sales person drive the keyboard in a demo, you should do it yourself or have a computer-proficient staff member drive it.
  • Within the first 30 seconds of the demo, make sure you are shown how to lookup a patient by name and date of birth. If it takes more than 30 seconds to launch the app, log in, and type in a patient name or date of birth, and get to a chart then you should be disappointed.
  • Once you’re at the demo patient screen, try to make sense of it without letting the sales person talk and show you around. If there are too many fields and you’re getting confused, it’s probably not intuitive and you should be cautious. Again, don’t let the sales person show you what you don’t understand – try to figure it out yourself.
  • In the demo patient screen, can you find the face sheet, meds, problem lists, procedures, past documents, faxes, lab results, and other documents without help from the vendor?
  • Within the first three minutes of the demo, make sure you see how to add meds, problems, and procedures to an existing patient. These are common tasks and shouldn’t take long.
  • Within the first seven minutes of the demo, make sure you see how to add a note to the chart. This is how you’ll start to interact and input data into the system.
  • Within the first fifteen minutes of the demo, create a new patient record and try to reproduce a sample patient chart in the system. Use an anonymized patient chart and try to recreate it during the vendor’s demo.
  • Now is the time to ask about all the other features that you care about and want to see demonstrated. Try not to ask about features just to see if they have it; tie it to one of your metrics and tell them why you need it.
  • If you liked what you saw, now is the time to ask them what other customers they have and their recent customer wins, how they compare with competitors, how much they cost, and related questions. You’ll understand the vendor better once you’ve tried the software.

Key focus areas for your demonstrations

Sales people for vendors give demo’s hundreds of times and each demo is the same for almost everyone and it focuses on their product. Your job is to focus them into the following key areas that are of concern to you:

  • Chart access. You will want to know how patient charts indexed, searched, and stored. Ask how they handle lost charts and multi-user access to the same chart (meaning can multiple people simultaneously view and update a chart). Inquire about how charts can be accessed on a mobile phone, on a web browser at your house, on a workstation at a hospital you have privileges at, or on your laptop while you’re in CME training. An EMR that doesn’t give you fast access to your charts from everywhere on any kind of device is going to limit you. Ask them to allow you to point your iPhone to a sample chart and see how it will look.
  • Data entry and document creation. Ask over and over again how data gets into the system; will it be a model that allows you to dictate into a phone and have the results show up in the EMR or will it be through voice recognition where the computer is trained and tries to understand what you say and automatically and immediately converts your speech into text for the EMR? Be sure to ask to what extent your voice can create notes in their system. The most common input mechanism outside of voice dictation is “point and click” templating where you choose between many options by pointing and choosing patient symptoms, observations, and other details and the computer creates the notes for you. For all normal findings the software can create the standard notes but for all abnormal findings you either enter free text or dictate. The point and click model is very popular but is a time-consuming activity. Another technique is handwriting recognition on a tablet – if you can write fast enough on touch screen device or can point and click fast it can be something that you can use. All these techniques are important to cover in a demo so you can decide what’s best for you.
  • Data backups. If they are a cloud provider, ask them during the demo to show you how you can easily get access to the database behind the user interface to get your data out anytime you want to. Ask the cloud vendor their disaster recovery strategy – what happens if their primary site is inaccessible, how do you access the data? If your EMR is on-premises on a server, ask them about how they help you perform backups of the server either locally or over the Internet. If the EMR vendor says backups are your problem and doesn’t give you a strategy or guidance you’ll have more to worry about.
  • Patient portals and personal health records (PHRs). Patient engagement and ability for patients to directly connect with you and view their records through your EMR is an important capability. During the decision-making process be sure that for no extra cost patients should be able to see their personal health record (PHR) as another view of your EMR.

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Other considerations for your demonstrations

When you are looking to capture metrics and figure out which areas of your practice needs to be automated, take a look at the following general areas and make sure that when you are getting a demonstration you do so in a manner that fits the actual needs of your practice rather than what the software developers and consultants might think you need. If you don’t focus on your business problems than the vendors and consultants will focus you on what they think is important rather than what actually might be important to you. You’re better off reducing the number of areas you get demonstrated versus expanding.

PART TWO: How EMR Vendors Mis-Lead Doctors [Part 2 of 2]

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Why I Hate Non-Publicly Traded REITS

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On Product Frustration

Lon JefferiesBy Lon Jefferies MBA CFP®

As my experience in the financial planning and investment advisory industries has grown over the years, there is one investment that I’ve seen no logical reason to own — non-publicly traded real estate investment trusts.

Josh Brown, one of my favorite analysts and author of TheReformedBroker.com nailed each of my frustrations with these products. Here is a significant excerpt from his post:

 ***

I consider non-traded REITs or nREITS to be part of the group of investments that are just absolute murderholes for clients – they pay the brokers so much that they cannot possibly work out (and they rarely do without all kinds of aggravation and additional costs). Further, I have yet to hear a single credible explanation as to why a broker would recommend a non-traded REIT over a public REIT other than compensation. The only explanation that makes sense to me is that 7% is a lot more than the 1% commission you get doing an agency trade on a NYSE-traded REIT. A reader with experience in the industry sent this to me and I found it hilarious. Below, a fictional, transparent conversation between an indie broker and his “client” that would never occur…

If Brokers Were Transparent:

Rep:

Before we wrap up our quarterly portfolio review I would like to talk to you about a new investment I think you might be interested in.  You have been looking for more income and this is an investment vehicle that pays a 7% dividend.

Client:

Sounds great, give me the details.

Rep:

With your portfolio size and risk tolerance I would recommend a $100,000 investment.  Given that amount let’s first go over the fees. If you invest $100,000 I will be paid a commission of $7,000. My firm is going to get $1,500 – $2,000 in revenue share. My wholesaler, the salesman that works for the investment’s sponsor company, will get $1,000. He is a great guy, buys me dinner and takes me golfing. The sponsor company is going to get around $3,000 to pay for some of the costs they incurred in setting up the investment. So after Day 1 there will be around $87,000 left over to actually invest.  I bet you are getting excited.

Client:

Are you on drugs? Why would I pay 13% in fees on anything?

Rep:

Don’t worry, it won’t feel like you are paying $13,000 in fees. The rules allow my firm to report your investment at $100,000 on your statement. You never really know what its worth but you will think you never lost money. Pretty sweet huh?

Client:

You have to be kidding.

Rep:

No, this is a really good investment. Let me tell you about the income component before you jump to any conclusions. Like I said this investment pays a 7% dividend and the dividend won’t change.

Client:

That sounds high and how do you know it won’t change?

Rep:

You see, the sponsor just picks the 7% dividend number out of thin air. Here’s how it works. You see the vehicle you are going to invest in is new and it’s going to take the firm a while before your net $87,000 is actually invested. Later on, maybe 2-4 years from now they will have the money fully invested and it will generate actual cash flow. So they just pay a quarterly dividend of 7% by giving you your money back. This is great from a tax perspective because return of capital isn’t taxed as income.

Client:

Are we on hidden camera or something?

Rep:

Ha, you are funny. I bet this next benefit will change your mind.

Client:

I hope so or I should start looking for another financial advisor.

Rep:

This is the best feature. You can’t sell your investment until the sponsor has the opportunity to create liquidity. You might be locked up in this investment for 7-10 years.

Client:

This feels like the Twilight Zone. Your firm allows you to sell this crap?

Rep:

Oh yeah, our firm sells a ton of it. In fact independent broker dealer firms like mine sold over $20 billion of these investments in 2013. Think about that. Reps like me made over $140 million dollars and our firms pocketed $20-$30 million.

Client:

This is crazy, what is this investment?

Rep:

Non-traded REITs. $100,000 sound about right?

***

Currency

***

Josh touched on every part of these investments that I despise — excessive commission paid to the so-called “financial advisor” (salesman), a supposed “dividend” that is really just paying the investor his own money back (essentially providing an interest-free loan), and a complete lack of liquidity and transparency.

When I begin working with a new client who owns one of these products, it is impossible to obtain accurate, current information on the investment (not even a true value is apparent). Even worse, if the client wants to sell the investment he would need to do so at pennies on the dollar. For the most part, once an investor purchases one of these products he just needs to forget about it and hope that one day he can get his money back.

Assessment

The bottom line is that if your advisor ever recommends a non-publicly traded REIT, I’d strongly recommend you walk out the door and start searching for a true financial advisor with a fiduciary responsibility to act in your best interest.

Conclusion

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Are you Over Paying for Your 401(k) Plan – Doctor?

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Checking it Twice

By Guy P. Jones CFP® http://www.guypjones.com

Guy P. Jones CFPMany of the doctor and medical professionals I meet are surprised to find that their 401(k) plan has hidden fees. They often don’t have or take the time to learn all the aspects of setting up a new plan.

As a consequence, they often times buy what I call “The 401(k) in a Box” from the first provider that comes along or from a current vendor that is providing ancillary services for them.  Many plans have significant hidden fees and this is especially true of 401(k) plans offered to small businesses like a medical practice or clinic.

According to a recent study, the average 401(k) plan has hidden fees of 0.72% per year. That may not seem like much but it costs the average participant about $11,000 over the lifetime of their participation. That’s $350 per year – and the fees are extracted directly from the 401(k) your account!

But, what about doctors and small business owners whose 401(k) plans have fewer than 20 employees and less than $1 million in total assets?

Well, their situation is much worse. For these small 401(k) plans, hidden fees can jump from 0.79% to 1.89%, or up to $920 per plan participant per year. This can mean paying an estimated $28,000 in hidden fees over the lifetime of their participation. If you selected one of these 401(k) for your employees, you could be unknowingly costing them $350 – $920 per year in hidden fees.

What are 401(k) Plan Fees and Who Pays for Them?

401(k) plan fees and expenses generally fall into three categories:

  • Plan Administration Fees – The day-to-day operation of a 401(k) plan involves expenses for basic administrative services – plan recordkeeping, accounting, legal and trustee services – that are necessary for administering the plan as a whole. Generally the more services provided, the higher the fees.
  • Investment Fees – the largest component of 401(k) plan fees and expenses is associated with managing plan investments. Your net total return is your return after these fees have been deducted.
  • Individual Service Fees – Individual service fees are charged separately to the accounts of participants who choose to take advantage of a particular plan feature. For example, individual service fees may be charged to a participant for taking a loan from the plan or for executing participant investment directions.We all evaluate our vendors occasionally. I find most doctors and small business owners do not evaluate their retirement plans because they do not know what questions to ask:

Questions

  • When was the last time you reviewed your retirement plan for cost savings or plan improvements?
  • Is it time to find out how to get a plan started?

Retirement

Assessment

Getting education from a physician focused fiduciary financial advisor is an important step in the process to either grow the profitability of your current plan or realize the benefits of a 401(k) Plan.

Conclusion

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On Medicaid Payment Amounts

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In the USA 1999-2010

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Medicaid

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Introducing US Treasury Floating Rate Notes

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What they Are – How they Work?

[By Staff Reporters]

Back in January 2014, the US Treasury announced that it would hold an inaugural Floating Rate Notes (FRNs) auction this year, making FRNs the first new Treasury security since they introduced Treasury Inflation-Protected Securities (TIPS) more than 15 years ago.

Complimentary Products

FRNs will complement Treasury’s existing suite of securities, which include Treasury bills, notes, bonds, and TIPS.

The Treasury’s introduction of FRNs will provide a number of benefits to taxpayers including assisting Treasury in managing the maturity profile of the nation’s marketable debt outstanding, expanding Treasury’s investor base and, most importantly, helping to finance the government at the lowest cost over time.

Assessment

FRNs are a unique and attractive option for investors because the security features an interest payment that can adjust over time.

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US Capitol

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More:

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Developing the Millionaire’s Mindset [Part 2]

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Three More Components

By Rick Kahler MS CFP® http://www.KahlerFinancial.com

Rick Kahler CFPIn a previous ME-P, we looked at the first three components of a millionaire mindset: how to spend like a millionaire by living frugally, budget like a millionaire by putting essentials and savings first, and work like a millionaire by loving what you do and investing in your career.

All three of these are vital habits for anyone wanting to build financial independence and lead a satisfying life. But the millionaire mindset doesn’t stop there. Here are three more aspects of it.

4. Fail like a millionaire

The classic book, The Millionaire Next Door, by Thomas J. Stanley and William D. Danko, points out a statistic that initially seems backwards. The average millionaire makes 3.1 major financial, career, or business mishaps in a lifetime. The average non-millionaire makes 1.6 such mistakes.

Why do successful people fail so much more often? They don’t give up. They try again, and again, and again. As Steve Jobs, who had his own failures, said, “I’m convinced that about half of what separates successful entrepreneurs from the non-successful ones is pure perseverance.”

My own observation is that those who succeed also learn from their failures. A millionaire mindset means being willing to take risks, but also being smart enough not to keep making the same mistakes.

5. Network like a millionaire.

Those who succeed in starting businesses, building careers, and accumulating wealth aren’t afraid to ask for help. Millionaires know better than to rely solely on their own expertise. They are experts at building an expansive network of friends and acquaintances that they can turn to for help and advice. They understand that the more people you know, the more access you have to people you can learn from.

This, of course, is only one aspect of networking. Contrary to the projections of “greed” and “selfishness” often thrust upon them by public opinion and the media, successful people are also generous in giving back. The millionaire mindset includes an awareness that no one becomes successful in a vacuum. Millionaires are typically quick to acknowledge those who have helped them. They tend to pay it forward by mentoring, helping others to succeed, and sharing both their money and their wisdom.

6. Think like a millionaire

Having a millionaire mindset does not mean having a life goal of being rich. Millionaires think of money as a tool, not a goal. They don’t value wealth for its own sake. In fact, for many successful people, becoming rich is almost incidental. Their primary focus is succeeding at work they are passionate about.

A millionaire mindset is based on an attitude of gratitude, not one of entitlement. It includes the awareness that experiences and relationships are more valuable than things when it comes to creating sustainable happiness.

Successful millionaires understand that money itself will never give you meaning or make you happy. Yet they also understand that money is important. It is inseparable from our quest for meaning and happiness, because it touches everything we do. Financial planner Dick Wagner calls money “the most powerful and pervasive secular force on the planet.”

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Classic Jaguar

***

If you are struggling to pay the bills on a meager income, overwhelmed by debt, or living in chronic financial chaos, it’s highly unlikely that you’ll feel fulfilled and satisfied with your life. Money is an essential tool in today’s world, and learning to use that tool wisely is as important as learning the skills required for your career.

Assessment

No matter what direction your life or medical specialty takes you, developing a millionaire mindset will serve you well. It’s a crucial set of values to help you achieve your goals and realize your dreams.

PART ONE: Developing the Millionaire’s Mindset [Part 1]

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Employer Health Benefits Post PP-ACA

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Percentage of Employers who View Health Reform Impact on Aspects of Employer Benefits as Moderate / Tremendous

By http://www.MCOL.com

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 HealthcareWebSummit Events

Upcoming Webinars:

On Demand: IBM Webcast: Using Analytics to Improve Outcomes at the Point of Care
On Demand: A Fresh Approach to CDH: 5 Ways to Get In It to Win It
Predictive Modeling Web Summit June 4, 2014
Large Employers and Exchanges: Minimum Standards and Private HIX Considerations June 5, 2014
Cigna’s Collaborative Care Strategy: Engaging Healthcare Professionals June 18, 2014
Provider Contracts and Quality Measurement June 19, 2014
Understanding Medicare DSH Changes-Hospital/Medicare Advantage Plan Implications June 24, 2014
Accountable Care at a Tipping Point: Oliver Wyman ACO Research Findings June 27, 2014
2015 Medical Cost Trends & Implications: PwC Research Behind the Numbers July 15, 2014
Readmissions Web Summit August 14, 2014
Accountable Care Web Summit December 11, 2014

Flash Drives of Past Events

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Developing the Millionaire’s Mindset [Part 1]

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To Build a Solid Financial Foundation to Support your Goals

By Rick Kahler MS CFP® http://www.KahlerFinancial.com

Rick Kahler CFPIf you’re a new graduate, nursing or medical student, taking your first steps into the adult world, here is the most important financial advice I can offer: Develop a millionaire mindset.

This absolutely does not mean making wealth your life goal. But, thinking like a millionaire will help you build a solid financial foundation to support you in reaching your life goals.

Definitions

First of all, let me define “millionaire.” A millionaire is someone with a net worth of one million dollars. That amount would generate an income of around $30,000 a year. In today’s world, that’s not even close to lavish-lifestyle wealth.

You probably know several millionaires. If you don’t think of them as rich, it’s most likely because they practice the millionaire mindset.

Here’s how:

1. Spend like a millionaire

The number-one common denominator of wealth accumulators is frugality. Millionaires shop sales, clip coupons, read labels, compare prices, and bargain. People who build wealth usually don’t wear designer clothes, drive luxury cars, live in extravagant houses, or shop at Neiman Marcus. They typically wear jeans bought on sale, drive used Toyotas, live in middle class neighborhoods, and shop at Walmart.

There’s no place in a millionaire mindset for credit card debt. Pay cash for everything but your home. Use a credit card only for convenience and pay it off every month. If you ever find yourself unable to pay the full amount, cut up your card. Pay off the balance as quickly as you can, and then don’t use a credit card for at least one year.

2. Work like a millionaire

Most millionaires work long hours, and most of them love what they do. They often have some “skin in the game” by owning part or all of their own businesses. As much as possible, find a job and career you love. When you do, your work becomes play. Invest time and money to keep your career skills and knowledge current. The millionaire mindset knows that your career is your most valuable financial asset.

3. Budget like a millionaire

Most college students live on budgets that allow only a Ramen noodle lifestyle. When you start getting career paychecks, keep that lifestyle for a time. Don’t increase your budget when you get a new job, a raise, or a promotion. Always have your lifestyle at least one step below your income.

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Millionaire's Jaguar

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To budget like a millionaire, follow these steps on every gross dollar you earn:

  • First, pay your taxes. Estimate your total tax liability and be sure your employer withholds enough to cover it. If you are self-employed, deposit a percentage of every check into a savings account that you use solely to pay your quarterly estimated taxes. Never “raid” these funds.
  • Second, put away at least 20% or more of every gross dollar you earn until you have six months to one year of living expenses in an emergency account. Then continue to invest that 20% of your gross pay in qualified retirement plans like 401ks, 403bs, or IRAs.
  • Third, pay your fixed expenses like housing and utilities.
  • Fourth, set up short-term savings accounts for foreseeable future “unexpected” lump-sum expenses like car and home repairs, vacations, holiday giving, college tuition, and medical emergencies.
  • Fifth, go ahead and blow the rest any way you wish. For most people, this means living on 30 to 60 cents out of every gross dollar you earn.

Assessment

The ways you spend, budget, and work are only part of the millionaire mindset. In a future ME-P, we’ll look at other ways you can build a fulfilling life by thinking like a millionaire.

PART TWO: Developing the Millionaire’s Mindset [Part 2]

Conclusion

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Introducing Physician-Focused Consumerism [PFC]

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A New Process or Just a New Term?

[By Staff Reporters]

According to Javier Sanabria, Physician-Focused Consumerism is a set of initiatives designed to align physician decision making with high-quality healthcare outcomes provided in a cost-efficient manner.

 manage

Physician-focused consumerism can include the redesign of financial incentives, greater access to patient data, decision support tools, ongoing education about treatment alternatives, and an understanding of the financial impact of alternatives on patients. It can be the basis for collaborative efforts between employer health plan sponsors, provider systems, and physicians to help achieve high-quality care in a cost-effective manner.

Assessment

See more at: http://www.healthcaretownhall.com/?p=7450#sthash.AgjagVO7.dpuf

Conclusion

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Two Healthcare Sectors the Stock Market Got Wrong on Election Day 2012

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How various sectors in the Health Care Industry fared under the PP-ACA legislation?

[A SPECIAL R&D REPORT FOR THE ME-P]

By David K. Luke MIM, MS-PFP, CMP™ [Certified Medical Planner™]

Website: http://www.networthadvice.com

David K. LukeThere has been a lot of speculation since the words “Affordable Care Act” were first whispered years ago on how the various sectors in the Health Care Industry would fare under such legislation. I proposed that a good indicator would be to look at the performance of the individual health care sector stocks on the first trading day after the election.

(See With Obama Election Win, “Mr. Market” Weighs in on the ACA Equity Winners and Losers by David K. Luke on November 16, 2012).

Link: With Obama Election Win “Mr. Market” Weighs in on the ACA Equity Winners and Losers

The day after Pres. Obama’s reelection on Wednesday, November 7, 2012 the stock market was down over 2% as measured by the S&P 500 and the Dow Jones Industrial Average (DJIA). The common reason given was increased doubt that the impending “fiscal cliff” issue, which was splitting the House and the Senate, would be resolved. There was however, another big concern on investor’s mind: the future of the Affordable Care Act. While the election was close when measured by the popular vote with President Obama earning 51.06% versus Mitt Romney with 47.20%, the electoral vote showed a hands-down Obama victory with 332 versus 206 votes. Investors voted with their pocketbooks with that first trading session following the election showing certain healthcare sectors up in price, other healthcare sectors with moderate returns, and certain healthcare sectors down in price.

Disparate Health Care Sector Returns

It is interesting to look back now over a year and a half later and see how accurate those investor votes were on that first day of realization that health care reform was continuing forward at a much faster pace now that President Obama would be serving a second term. Keeping in mind that the day was a very negative day as a whole in the stock market, a number of healthcare sectors were up in price. This group includes Hospital Stocks and Medicaid HMOs. Note the phenomenal one-day returns (in a down 2% market!) on the sample stocks in these two groups:

Hospital Stocks

  • Health Management Associates (HMA) +7.3%
  • HCA Holdings Inc. (HCA) +9.4%
  • Community Health Systems Inc. (CYH) +6.0%
  • Tenet Healthcare Corp. (THC) +9.6%

Medicaid HMOs

  • Molina Healthcare Inc. (MOH) +4.6%
  • Centene Corp. (CNC) +10.1%
  • WellCare Health Plans Inc. (WCG) +4.4%

Such positive returns on a big down day in the market indicates investors assessing these healthcare sectors being good investments under an Obama presidency and a positive outlook for the implementation of the Affordable Care Act. The other up sector on that day was the Drug Wholesalers, up almost 1% on that negative day. (See “Selected Health Care Performance” Chart – below).

The market had a tepid response to the Pharmacy Benefit sector, as well as the Generic Pharmacy, Testing Labs, and Big Pharma. In my sample group, these sectors were down -.4%, -7%, -1.7%, and -1.4% respectively. It is important to note however that these sectors while slightly positive or barely negative still performed better than the general market that day.

Two Sectors

But, the two healthcare sectors that the stock market severely punished with the voting of substantially more sellers than buyers by investors on that first post-election day were the Medical Device Companies (down 2.5% in the sample group) and the Medicare Part D Companies (down 4.7% in the sample group). The thought at the time was that Medical Device Companies, facing an impending medical device excise tax of 2.3% on the sale of most medical devices in the United States, would be devastated, and that Medicare Part D Companies would face severe profit constraints with tighter-fisted government regulations imposed by the ACA.

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Stock_Market

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The Retro-Specto-Scope

In hindsight, investors were correct on two out of the three predictions based on stock market prices on the various healthcare sectors. Hospital Stocks, Medicaid HMOs, and Drug Wholesalers, the leading sectors indicated to be winners with the impending implementation of the ACA, are up 69.8%, 63.6% and 76.5% respectively in the sample groups since November 7, 2012. This remarkable and closely parallel return for these three sectors seemed to prove that the stock market on November 7, 2012 correctly picked the three winning health care sectors! The S&P 500 index for the same time is up 32.02%, a nice return for 1 ½ years but about half the return of these apparently huge benefactors of the ACA. The healthcare sectors that investors felt less positive about (but more positive than the general stock market) on that first postelection day were Pharmacy Benefit Companies, Generic Pharmacy Companies, Testing Labs, and Big Pharma. These four health care sectors are up 43.8%, 40.5%, 6.4%, and 20.5% respectively. Again, in terms of ranking the sectors, these four sectors performed in line based on the comparative returns of the other healthcare sectors.

Wisdom of Crowds

Amazingly, it appears that the emotional Mr. Market predicated quite accurately on Wednesday, November 7, 2012, in one day of trading, not just which health sectors would be good investments for the near future, but the actually ranking of the future performance of the sectors! It seems as though the stock market, as one large voting machine, precisely dissected the over 20,000 pages + of resulting legislation created from the original 906 pages (pdf here) of the PPACA law and distilled it down to profits and losses with the resulting winners and losers in the health care industry in one trading session.

Two [2] Big Misses

Investors however were way off on their concerns about Medical Device Companies and Medicare Part D Companies. The two sample groups were up 71.3% and 66.4% in the time of November 7, 2012 to May 19, 2014 respectively, more than double the S&P 500 for the same period, and in line with the best performing sectors! This is spite of the fact that stock sample of these two groups were the two worst performers on post-election day trading. What happened?

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Bear + A Falling Stock Chart

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The “Medical Device Excise Tax” Fable and the “Private Insurers Will Control Costs” Fairy Tale

Wall Street has sharpened their pencils in the last year and a half and realized they have gravely underestimated the profit potential of the Medical Device makers and the Managed Care Health Insurers, in spite of the ACA. Based on stock price performance of the sample group of major players in the past 18 months, fewer sectors look as profitable as the Medical Device Industry and the Medicare Part D Industry. What happened?

The Medical Device industry states that the tax will cost the US “tens of thousands of jobs” and that those jobs will be shipped overseas. A number of issues that are involved here however refute these claims (http://www.factcheck.org/2013/10/boehner-and-the-medical-device-tax/. It appears that any targeted reductions were not related to the implementation of the tax, which became effective January 1, 2013, in spite of heavy protest by the industry. Medical technology continues to have a bright future regardless of the tax.

The notion that the “Affordable” Care Act will help reign in the rampant cost increases of Medicare’s “Part D” program seem to be elusive. Private insurers have done a poor job of keeping drug prices down, especially when compared to the discounts the government gets for Medicaid. Medicare Part D companies wield significant influence on Capitol Hill, and impending steeper discounts look unlikely.

Everybody Wins, Except …

Before the ACA implementation, about 85% of Americans had health insurance. Currently with an additional 7 million Americans with health insurance thanks to Obamacare, an additional 2.2% of Americans now have coverage, or about 87% of all Americans. How can such a slight increase in new health care consumers be responsible for such large anticipated profits in the health care sector? It cannot. Wall Street is telling us that the new health law is not about new customers, but about increased profit margins for the health care industry. I can draw three conclusions:

  1. The Affordable Care Act may not be so affordable for health consumers
  2. Most companies in the Health Care Industry stand to gain financially with ACA. There is one sure loser with ACA: The physician, who can only look forward to increased workloads and mpending Medicare SGR pay cuts.

THE CHART [Research and Development]

Selected Health Care Sector Stock Performance Random Sampling of Publically Traded Companies From President Obama Re-election Date to Present

Chart

Conclusion

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Retail Perscription Drug Expenditures

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By Payer 2001-2011

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Retail Drugs

Conclusion

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