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    As a former Dean and appointed University Professor and Endowed Department Chair, Dr. David Edward Marcinko MBA was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.

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

    Professor David Marcinko was a board certified surgical fellow, hospital medical staff President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest drug, DME and pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published academic text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

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

    Later, Dr. Marcinko was a vital and recruited BOD  member of several innovative companies like Physicians Nexus, First Global Financial Advisors and the Physician Services Group Inc; as well as mentor and coach for Deloitte-Touche and other start-up firms in Silicon Valley, CA.

    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

    Dr. David E. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA, FPA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

    Marcinko is “ex-officio” and R&D Scholar-on-Sabbatical for iMBA, Inc. who was recently appointed to the MedBlob® [military encrypted medical data warehouse and health information exchange] Advisory Board.

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On Urgent Care Centers and Retail Medical Clinics

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And the Convenient Care Association

[By Dr. David Edward Marcinko MBA]

DEM blueThe Convenient Care Association [CCA] is comprised of companies, medical providers and healthcare systems that provide patients and consumers with accessible, [urgent], affordable and quality healthcare in retail-based locations.

The CCA works primarily to enhance and sustain the growth of the convenient care industry through sharing of best practices and common standards of operation.

urgent urgent

The CCA was founded in October 2006 and the first Convenient Care Clinics [CCCs] opened in 2000. The industry grew quickly since then.

Today there are approximately 1,060 clinics in operation, and CCA member clinics represent more than 95% of the industry.

To date, CCCs have served more than 3.5 million patients with its nurse practitioners [NPs] and physician assistants [PAs]. With this rapid expansion, and projected continued growth, it quickly became clear that the shared concerns and needs of both providers and patients could best be served through an association that allowed for:

  • Sharing best practices, common standards of operation, experiences and ideas.
  • Developing common standards of operation to ensure the highest quality of care.
  • A united voice to advance the needs of CCCs and their customers
  • A unified effort to promote the concept of CCCs, and to respond to questions about this evolving industry.
  • Reaching out to the existing medical community and creating new partnerships.
  • Building synergies with traditional medical service providers.

Assessment

The Public Health Management Corporation [PHMC], a nonprofit public health institute, provides executive management and administrative support for the Convenient Care Association.

urg 2

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The Evolution of Care Bundles for Sepsis

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Latest complimentary resource reviews the rationale for bundled interventions

WH

[By Winifred Hayes RN PhD]

Sepsis is a deadly condition with a high mortality rate.

In an effort to improve survival in patients with sepsis, clinicians have adopted care bundles—sets of clear evidence-based practices that, when reliably performed together, result in better patient outcomes than when they are implemented individually. The Evolution of Care Bundles for Sepsis, the latest white paper from Hayes, Inc., reviews how and why sepsis care bundles came to be and discusses how they may evolve in the future.

“Sepsis may lead to death in a large percentage of patients who come to the hospital for treatment,” says David Wade, MD, FACS, Chief Medical Officer at Hayes, Inc., and the author of the white paper. “Rapid treatment within the first few hours of diagnosis is the key to reducing mortality and morbidity.”

Studies

Many studies have reinforced the importance of early diagnosis and rapid treatment. Dr. Wade explains, “In thinking about this, I am struck by a phrase that comes from the world of fighter pilots and aerial combat. When you talk to fighter pilots about dog fighting, a phrase repeatedly rises to top as the most important thing. That phrase is Speed is Life. Sepsis is similar; the sooner you realize what is going on and start doing something about it, the better chance the patient will have of surviving.”

Care Bundles

Care bundles enable clinicians to act quickly and strategically. In the United States, the most widely known sepsis care bundles are those published by the Surviving Sepsis Campaign. Interesting developments in sepsis management also are coming out of the United Kingdom, where clinicians have embraced the Sepsis Six 1-hour bundle, a set of 6 interventions to be performed within 1 hour of diagnosis.

Download your complimentary copy of The Evolution of Care Bundles for Sepsis today to learn more about how these practices are improving survival for patients with sepsis.

About Hayes, Inc.

ImageProxy

Achieving best patient outcomes by using proven medical technologies is the basis on which Hayes was founded. Our team of analysts and clinicians is a trusted resource for unbiased and timely research, evidence analysis, and guidance that drive effective health care and contribute to cost management. For over 25 years, Hayes has been empowering clinicians, health plan policymakers, and government agencies in their mission to make sound evidence-based decisions that balance cost, quality and patient outcomes.

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The Disability Insurance Disconnect

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An Infographic

By DisabilityCanHappen.org

Think you’re invincible? You’re not alone. Most working Americans, and even some physicians, drastically underestimate the odds of experiencing an income-interrupting injury or illness that will last an extended period of time.

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acccidents

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Now consider that more than one in four of today’s 20-year-olds will have their income interrupted by a disability before they retire. That’s because some top causes of long-term disabilities aren’t catastrophic accidents, but common, everyday health issues like back pain, heart disease, arthritis, cancer, even pregnancy.

Yet; no matter how healthy, everybody has a risk that is too high to ignore.

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Ankle-Leg Trauma

[Copyright David Edward Marcinko and iMBA Inc., All rights reserved. USA]

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Assessment

You’ve probably protected your most prized possessions from damages and accidents, but what about the resource that makes all others possible — your paycheck? Learn more about the causes of disability and how you can defend your income from them at DisabilityCanHappen.org

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disability

[Click to Enlarge]

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Children with NO Healthcare Visits within 12 Months

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Regional Distribution 2012

By http://www.MCOL.com

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The Financial Crisis

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And – Cultural Capture

j kwak

I was asked to write something about an idea that I had slipped into 13 Bankersalmost in passing, about the cultural prestige of the financial industry and the political and regulatory benefits the industry derived from that prestige. My chapter turned into a discussion of the various mechanisms by which status and social networks can influence regulators, creating the equivalent of regulatory capture even without traditional materialist incentives (cash under the table, promises of future jobs, etc.).

Two weeks ago, an investigation by ProPublica and This American Life illustrated the culture of deference, risk aversion, and general sucking-upitude among New York Fed bank examiners that effectively resulted in the capture of regulators by the banks they were supposed to be regulating. As David Beim wrote in a confidential report about the New York Fed, the core problem was “what the culture expected of people and what the culture induced people to do.”

I wrote about the story for the Atlantic and referred to my book chapter, but at the time the chapter was not available for free on the Internet (at least not legally). The good people at the Tobin Project have since put it up on the book’s website, from which you can download it (legally!). Note that they are only allowed to put up one chapter at a time and they rotate them, so this is a limited-time offer.

Link: Cultural Capture and the Financial Crisis

free_278647

More: http://jameskwak.net/

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How Secure Is Your Password – Doctor?

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Tips on using strong passwords 

[Securing yourself from a world of hackers]

By Shahid N. Shah MS

Shahid N. Shah MS

What is at Risk?

Here are some specific tools, gadgets, cloud servers, EHRs and other reasons you should secure your PWs:

  • Fax Server – a fax server allows you to centrally manage all incoming and outgoing faxes. Since most medical practices live on fax, this is one of the fastest investments you can recoup.
  • Shared drives – start using shared drives either using your existing software or you can purchase inexpensive “network disks” for a few hundred dollars to share business forms, online directories, reports, scanned charts, and many other files.
  • Online backups and Internet PACS storage – there are online tools like JungleDisk.com that allow you to store gigabytes of encrypted data into the Internet “cloud” for just a few dollars a month.
  • E-mail (beware of HIPAA, though) – internal office messaging and email is a great place to start. If you haven’t started your office automation journey here you should. If you’re going to use it for patient communications you’ll need to make sure you have patient approvals and appropriate encryption. If you’re on Gmail today and you want to have customers immediately be able to communicate with you on Gmail, that’s generally HIPAA compliant because communications between two Gmail accounts stays within the Google data center and is not sent unencrypted over the Internet.
  • E-Prescribing – e-prescribing is a great place to start your automation journey because it’s a fast way to realize how much slower the digital process is in capturing clinical data. If e-prescribing alone makes you slower in your job, EMRs will likely affect you even more. If you’re productive with e-prescribing then EMRs in general will make you more productive too.
  • Office Online and Google Apps (scheduling, document sharing) – Google and Microsoft® have some very nice online tools for managing contacts (your patients are contacts), scheduling (appointments), dirt simple document management, and getting everyone in the office “on the same page”. Before you jump into full-fledged EMRs see if these basic free tools can do the job for you.
  • Modular clinical groupware – this is a new category of software that allows you to collaborate with colleagues on your most time-consuming or most-needy patients and leave the remainder of them as-is. By automating what’s taking the most of your time you don’t worry about the majority of patients who aren’t.
  • Patient registry and CCR bulletin boards – if you’re just looking for basic patient population management and not detailed office automation then patient registries and CCR databases are a great start. These don’t help with workflow but they do manage patient summaries.
  • Document imaging – scanning and storing your paper documents is something that affects everyone; all scanners come with some basic imaging software that you can use for free. Once you’re good at scanning and paper digitization you can move to “medical grade” document managements that can improve productivity even more.

eHRs

  • Clinical content repository (CMS) – open source systems like DrupalModules.com and Joomla.org do a great job of content management and they can be adapted to do clinical content management.
  • Electronic lab reporting – if labs are taking up most of your time, you can automate that pretty easily with web-based lab reporting systems.
  • Electronic transcription – if clinical note taking is taking most of your time, you can automate that by using electronic transcribing.
  • Speech recognition – another “point solution” to helping with capturing clinical notes; you can get a system up and running for under $250.
  • Instant Messaging (IM) – IM gives you the ability to connect directly with multiple rooms within your office using free software; if you want, you can also connect with patients and other physicians during work hours.

How to avoid the most common and dangerous passwords?

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password

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Understanding 1031 Exchanges

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The Ultimate Infographic Guide

By 1031 Gateway

In this infographic you will learn how to defer your capital gains taxes utilizing a 1031 exchange, what kinds of properties qualify for 1031, what the basic 1031 rules and time limits are, and how to benefit your heirs by stepping up your basis.

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1031Exchange

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Syphilis Is Surging!

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Public Health Officials Aren’t Sure Why?

[By Staff Reporters]

Nationwide, the CDC reports that primary and secondary syphilis rates increased by 10 percent between 2012 and 2013—an infection rate more than twice as high as figures from 2001.

Geography

The Atlanta, Baltimore, Detroit, Los Angles, Miami, Orlando, Portland, San Antonio, San Diego and San Francisco metro areas have some of the highest syphilis rates, according to the CDC.

In the San Francisco Bay area, reported cases rose from 438 in 2009 to 814 in 2013. In Washington, D.C., Dr. Raymond C. Martins, senior director of clinical education at Whitman-Walker Health,says that the clinic saw a 32 percent increase in syphilis cases among patients between 2011 and 2014.

And, in recent months, at least 15 cases of ocular syphilis, a serious complication of the disease that can cause blindness, have been reported in California and Washington state, according to an alert released earlier this month by the CDC.

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PCN

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Assessment

Most of these infections have occurred among HIV-positive men who have sex with men.

Link: http://www.msn.com/en-us/news/us/syphilis-is-surging-and-us-public-health-officials-arent-sure-why/ar-AAb3qBf?ocid=iehp

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Even More: Antibiotic Shortages on the Rise in US

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Fatigue and its Effect on Doctor’s & Prescriptions

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Fatigue Matters 

[By Staff Reporters]

First we had slow medicine, then fast medicine, and now it’s … fatigued medicine.

According to Aaron Carroll MD; fatigue matters even when it comes to doctors … especially when it comes to doctors.

Here is the data link in Healthcare Triage News.

Assessment

For those of you who want to read more, here is the paper we’re discussing!

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free

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Conclusion

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Developing New Medical Practice 2.0 “People” Skills

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The Times are Changing in …. 2015 and Beyond

[By Render S. Davis MHA CHE]

[By Dr. David Edward Marcinko MBA CMP™]

DEM white  shirtMedical practice today is vastly different from a generation ago, and physicians need new skills to be successful, and reduce liability risks while improving care delivery at lower costs.

In order to balance their obligations to both individual patients and to larger groups, physicians now must become more than competent clinicians.

Bedside Manner?

Traditionally, the physician was viewed as the “captain of the ship,” in charge of nearly all the medical decisions, but this changed with the dynamics of managed care and the health reform of the PP-ACA.

Today, the physician’s role may be more akin to the ship’s navigator, utilizing his or her clinical skills and knowledge of the health care environment to chart the patient’s course through a confusing morass of insurance requirements, care choices, and regulations to achieve the best attainable outcome.

Some of these new 2.0 “People” skills include:

  1. Negotiation – working to optimize the patient’s access to appropriate services and facilities;
  2. Being a team player – working in concert with other care givers, from generalist and specialist physicians, to nurses and therapists, to coordinate care delivery within a clinically appropriate and cost-effective framework;
  3. Working within the limits of professional competence – avoiding the pitfalls of payer arrangements that may restrict access to specialty physicians and facilities, by clearly acknowledging when the symptoms or manifestations of a patient’s illness require this higher degree of service; then working on behalf of the patient to seek access to them;
  4. Respecting different cultures and values – inherent in the support of the Principle of Autonomy is acceptance of values that may differ from one’s own. As the United States becomes a more culturally heterogeneous nation, health care providers are called upon to work within and respect the socio-cultural and/or spiritual framework of patients and their families;
  5. Seeking clarity on what constitutes marginal care – within a system of finite resources, physicians will be called upon to carefully and openly communicate with patients regarding access to marginal and/or futile treatments. Addressing the many needs of patients and families at the end of life will be an increasingly important challenge in both communications and delivery of appropriate, yet compassionate care;
  6. Supporting evidence-based practice – physicians should utilize outcomes data to reduce variation in treatments and achieve higher efficiencies and effectiveness of care delivery;
  7. Fostering transparency and openness in communications – physicians should be willing and prepared to discuss all aspects of care and treatment, especially when disclosing problems or issues that may arise;
  8. Exercising decision-making flexibility – treatment algorithms and clinical pathways are extremely useful tools when used within their scope, but physicians must follow the case managed patient closely and have the authority to adjust the plan if clinical circumstances warrant;
  9. Fostering “patient and family centered care – whenever possible, medical treatments should be undertaken in a way that respects the patient’s values and preferences, and recognizes the important role to be played by family in supporting the patient’s care and well-being. For details on engaging families in this process, visit the website for the Institute for Family-Centered Care at www.familycenteredcare.org.;
  10. Becoming skilled in the art of listening and interpreting — In her ground-breaking book, Narrative Ethics: Honoring the Stories of Illness, Rita Charon, MD Ph.D., a professor of Clinical Medicine at Columbia University’s College of Physicians and Surgeons, writes of the extraordinary value of utilizing the patient’s narrative, or personal story, in the care and treatment process. She notes that, “medicine practiced with narrative competence will more ably recognize patients and diseases, convey knowledge and regard, join humbly with colleagues, and accompany patients and their families through ordeals of illness.” In many ways, attention to narrative returns medicine full circle to the compassionate and caring foundations of the patient-physician relationship.

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Masks

[The Masks of Change]

Courtesy SplitShire

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Assessment

These represent only a handful of examples to illustrate the myriad of new skills that today’s savvy physicians must master in order to meet their timeless professional obligation of compassionate patient care; coupled with risk avoidance, assumption, transference and reduction mechanisms.

*NOTE: Health 2.0 is information exchange plus technology. It employs user-generated content, social networks and decision support tools to address the problems of inaccessible, fragmentary or unusable health care information. Healthcare 2.0 connects users to new kinds of information, fundamentally changing the consumer experience (e.g., buying insurance or deciding on/managing treatment), clinical decision-making (e.g., risk identification or use of best practices) and business processes (e.g., supply-chain management or business analytics.

About the Author

Render Davis was a Certified Healthcare Executive, now retired from Crawford Long Hospital at Emory University, in Atlanta, GA He served as Assistant Administrator for General Services, Policy Development, and Regulatory Affairs from 1977-95.  He is a founding board member of the Health Care Ethics Consortium of Georgia and served on the consortium’s Executive Committee, Advisory Board, Futility Task Force, Strategic Planning Committee, and chaired the Annual Conference Planning Committee, for many years.

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Conclusion

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On Medical Provider Network Referral Leakage

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Understanding the Referral Relationship

[By Dr. David Edward Marcinko MBA]

[By http://www.MCOL.com]

DEM blueDeveloping and cultivating a steady stream of referrals involves good planning, an investment of time and energy in the referral relationship, and a keen understanding of referring physicians’ needs and priorities.

Enhancing the referral relationship is a step-by-step process, not unlike the clinical process, that begins by identifying target physicians and their needs, prioritizing the list of referral contacts and then determining the best way to reach them.

A physician may routinely refer patients to a particular specialist because he or she has an out­standing reputation for medical expertise and competence, is more accessible than comparable practitioners or has a convenient location for the referring physician’s patients. The physician may have a relationship with the specialist because of marketing by a local hospital or the specialist’s own practice. And, in some cases the two physicians have a social relationship. Once again, there are many ways to create and maintain the relationship. Physicians should choose the approach that works best for them, put together a plan and stay consistent. Look for ways to make the relationship a win-win for both practices or for the referring hospital or outpatient facility.

If you are not comfortable with developing referral relationships for your practice, seek out partners, office staff or hospital partners who can appropriately assist, train or support you in this effort. Many hospitals have staff focused on physician sales and service.

The Society for Healthcare Strategy and Market Development (SHSMD) recently reported that 41% of hospitals had dedicated sales staff support, with more than half of those using their sales staff to support cardiology and radiology.[i] Often, hospitals are seeking physician speakers for community seminars, wellness programs and other outreach efforts. Ask about participating in these venues. Offer to write articles for newsletters, the Web site or local media outlets. All of these expose the physician and the practice to referral sources as well as the public.

Six Root Causes of Leakage

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ImageProxy

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Communication is Key

It really comes down to the age-old golden rule of doing unto others as you would want them to do unto you. Not surprisingly, referral relationships are built on mutual respect, trust and courtesy. Focusing on the needs of the referring physician is the best way for both relationships to thrive.

Communication is especially important in not only nurturing the referral relationship, but also improving the quality of care.

A recent study that examines the attitudes primary care physicians have regarding communication with hospitalists found that 3% of primary care physicians reported being involved in discussions about discharge and 17% to 20% reported always being notified about discharges.[ii]

The study suggests that delayed or inaccurate communication at discharge may negatively effect continuity of care and contribute to adverse events. Communication tools such as computer-generated summaries and standardized formats may result in a more timely transfer of information, making discharge summaries more consistently available during follow-up care.

Many physicians indicate a preference for quick voice mail updates on patients they’ve referred supported by the electronic or faxed record. This type of proactive communication is the basis of a strong and lasting referral relationship. In fact, the relationship can be further strengthened by tailoring communication to individual primary care doctors, according to their preferences.

Indeed, the most responsive specialists ask the referring physician how best to stay in touch because one size does not fit all. Some physicians prefer face-to-face contact, others phone or facsimile and still others e-mail.  The use of electronic medical records and other electronic communication devices can help the physician enhance the consistency, speed and real time level of their physician-to-physician communication.

Primary care doctors want to work with specialists who recognize their role in treating the patient on an ongoing basis. Many want frequent communication about the plan of care and status. At the very least, tertiary specialists should always pay the courtesy of discharge communication—a phone call, e-mail, timely letter or fax when they return the patient to the community physician. The specialist should include the diagnosis, any issues that he or she may have identified; any changes in treatment and medication, follow-up recommendations and a phone or pager number if the referring physician has questions or concerns.

Both sides should keep each other informed of changes within their respective practice including new partnerships, expanded services, staff changes and insurance plan participation. Paying close attention to these relationship and communication basics builds trust and respect among colleagues and improves care to patients.

***

Healthcare Center

***

Systems Can Help With Communication

A cardiac surgeon in the Northeast with a very busy practice dictates immediately following each case, and then at the end of the day calls to update the referring physician even if he just leaves a voice mail with his pager number. The referring physician has 24/7 access to the cardiac surgeon, who, two weeks later, has his practice administrator send a thank-you note for the referral. At a conference of specialists who were questioning their own ability to commit to this level of time, he simply stated “how can you not afford to pay attention to this part of your practice?”

Another example involves a large specialty practice that was challenged with communication back to the referring physician. They hired a clinician to support them as patient/practice case manager, with a primary job focus on communicating about the patient, ensuring discharge information was forwarded and conducting a personal office call with the referring physician. This ensured it was received, understood and if not, helping the referring physician to gain quick access to the specialist.

Citations:

[i] “By the Numbers, 2008.”  Society for Healthcare Strategy and Market Development of the American Hospital Association.

[ii] Sunil Kripalani, M.D., et al., “Deficits in Communication and Information Transfer Between Hospital-Based and Primary Care Physicians,” The Journal of the American Medical Association, Feb. 28 2007, 297; 831-841.

More:

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On Domestic Healthcare Access Disparities

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Most Populous US States

By http://www.MCOL.com

***

Disparity

***

More:

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On Getting Health Insurance [A Personal Journey]

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A Former Teacher Engages Reality

[By Jeffrey M. Hartman]                   

jhIn late 2014, I did something many teachers never have to consider doing. I sought my own health insurance. After leaving my teaching career, I opted to work for myself. My plan was to live off my savings while getting started. This meant I was going to have to buy insurance rather than rely on a school to provide it. The misadventure that unfolded provided unsurprising but unsettling insights.

Bubble-Boy

I lived in a bubble during my teaching career. The comforts my job afforded me affected my perspective. How did people in other fields work so late each day? Why did anyone agree to work during the summer? I had a salary that kept me more than comfortable and health insurance that most people would have envied. Although I frequently reminded myself how fortunate I was, I still took too much of my situation for granted. When I decided to up and leave, reality poured into my bubble.

Great Coverage

Health insurance had never concerned me. Working in schools my entire adult life, I didn’t fret over having coverage. It was a given; an amount taken out of each check. If anything, I felt guilty for having such great coverage. I rarely used it. I happened to be a healthy person and I infrequently visited my doctor. Being so cavalier about my coverage while other people suffered without it made me feel like some kind of heel. My wife used it occasionally, so it wasn’t completely wasted.

A Career Abandoned

By abandoning my career, I forced myself to face a sudden and real need for coverage. I’ll admit resenting the need to have something I wasn’t likely to use, but I accepted the situation and proceeded. I had left other teaching jobs. After each departure, I replaced the job quickly, moving to a better job each time. This was another example of my chosen field distorting reality. Not many people enjoy that kind of mobility. Benefits had come along with each new job. With no intention of taking a new job last fall and no immediate income from working for myself, I was on deck to try HealthCare.gov.

****

Healthcare Gov Search

****

Enter HealthCare.gov

Prior to any of this, most of my experience in dealing with health insurance involved my mother. I helped her get Supplemental Security Income and Medical Assistance. The process was arduous, but after an appeal, she got what she needed. More recently, I assisted my grandmother in connecting with a home health care aide through her insurance. This was tricky as well, but perseverance paid off. Having to deal with these systems gave me a notion of what to expect when navigating a massive health insurance bureaucracy.

Experienced as I was, working through HealthCare.gov tested my patience. The site achieved infamy in early 2014 following its beleaguered launch. I expected the site administrators to have fixed most of the bugs for the second year. Perhaps they had. What I found was convoluted, nonetheless. I managed, but not without incident.

Registration

The first hiccup came during registration. I followed the directions on the screen and provided the requested information, but the site couldn’t verify my identification. I’d never had a problem like this registering for anything else. It prompted me to upload registration documents, but I found no way to do this. I called customer service and a helpful but disaffected person verified my identification simply by asking for my address and Social Security number.

I completed the application and was eager to see my results. Before I registered, I had investigated what coverage might be available. I expected to be eligible for one of several seemingly suitable plans. Upon seeing my results, I was shocked to find my wife and I only qualified for Medicaid. Nothing else was available. I knew Medicaid had a resource limit in my state. I also knew my savings were approximately thirty times that limit. The site never asked about resources. It only asked for income, which was zero at the time. My wife’s income didn’t put us over the Medicaid income limit, but this was irrelevant.

I realized my situation was an anomaly. Most people don’t go from my former income to nothing by choice while not having any solid replacement. At the time, I was paying a high premium for continuing coverage from my former employer. I was determined to get something less costly through the Marketplace for the start of 2015. My state was going to deny me Medicaid. I had to appeal.

Non-Appeals

I couldn’t find a way to appeal online, at least not in my state. I had to mail the completed appeal form. After several weeks, I got no response. The deadline approached for having coverage by the first of the year. I called customer service. The representative told me I’d have to apply for Medicaid and get rejected before appealing. This was going to take too long. I called my state Department of Health and Welfare. A representative confirmed I’d be denied. He urged me to call HealthCare.gov again and simply state I’d been denied instead of going through the process. I did. I handled the appeal over the phone. An hour later, I had new insurance. I had even paid my first premium, which definitely stung.

Over the next month, HealthCare.gov sent me three letters and called me twice to remind me my identification had yet to be verified and my appeal had been denied. I politely informed them I had handled each issue. No one I spoke with could tell that I had, nor could they tell I’d selected and paid for coverage, even though I had.

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doctors

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New Coverage

Dealing with the new coverage was almost comical. I’d selected the same provider I had while teaching, but a different plan. My wife and I selected the same physicians we had seen for years. Despite our history with each, making appointments or filling prescriptions required us to provide detailed proof of our existence and needs through phone calls, faxes, and emails. This was necessary for the first several interactions. Inquiries and referrals were much more tedious than what we had known. Over four months, the provider sent us a total of ten new insurance cards. All the inefficiency with both systems prompted some reflection.

One could expect such confusion within large systems. However, I’ve thought of what difficulty others users might face. I’d like to think I’m relatively literate, tech-savvy, and patient. I have family members who would have been stumped after the first few screens of the on-line HealthCare.gov site. The parents of some of the students I taught would have had similar difficulty. People in such situations might have the greatest need for coverage. The complicated and buggy nature of Healthcare.gov requires a small army of customer service operators to help befuddled applicants through problems. I shiver thinking about the resources spent maintaining this backup system in lieu of having a more functional interface, but I guess this creates jobs. Similarly, my actual provider requires a maddening degree of redundancy that might strain the coping skills of needy clients. I wonder how many people just give up when pursing complicated but necessary claims.

Assessment

Perhaps by 2016 HealthCare.gov will be streamlined and smart enough to not confound its users. My provider might be as streamlined and smart as it’s going to get. I’ve rarely seen such bloated systems. Maybe I’ve been ignorant to what other people endure. Having outstanding coverage handed to me while teaching and being healthy my whole life kept me out of touch. My new experiences were mild inconveniences, but I fear how similar complications could stifle those really needing help. I suppose I’ve emerged from my bubble.

More:

ABOUT

Jeffrey M. Hartman is a former teacher who blogs at http://jeffreymhartman.com/

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Death in the Digital Age

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On Digital Assets

By co-operativefuneralcare.co.uk

An infographic to show the key statistics from our recent report which highlights how the growing use of digital channels in our daily lives can cause additional stress for bereaved loved ones.

***

Death-in-the-digital-age-infographic-the-co-operative-funeralcare-1024

Earth Day 2015

Nixon tapped FBI to spy on Earth Day

ED2013

How President Nixon spied on the first Earth Day

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Enter the ROBO Financial & Medical Advisors

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Machines will Rule … Soonest?

[By Dr. David Edward Marcinko MBA CMP™]

DEM white  shirtMachines beat humans at chess. Machines can pilot airplanes to land at O’Hare; or on Mars. There is now a machine that beats the best of us at Jeopardy.

And, many predict that an Artificial Intelligent medical clinician is ten years away.

Just think tele-medicine and tele-health.

And, no one will use a biological doctor in twenty five years. Then, of course, enter the singularity*.

Innovation

I’m not sure who said it first, but this quote has been floating around Twitter lately:

“In 2015 Uber, the world’s largest taxi company owns no vehicles, Facebook the world’s most popular media owner creates no content, Alibaba, the most valuable retailer has no inventory, and Airbnb, the world’s largest accommodation provider owns no real estate.”

Assessment

Fundamental assumptions about what is needed to be a successful doctor, financial advisor, or other business has changed in just the last few years.

So – I ask MD and FA colleagues – will you keep up professionally, or fall behind? What are the ethical implications of these technology innovations; if any?

***

robot

[Vanguard’s “Robo Advisor” – Good for Clients but Bad for Advisors?] 

***

More:

Even More:

Note: From Wikipedia, the free encyclopedia.

The Singularity

The technological singularity is the hypothesis that accelerating progress in technologies will cause a runaway effect wherein artificial intelligence will exceed human intellectual capacity and control, thus radically changing civilization in an event called “the singularity”.[1] Because the capabilities of such an intelligence may be impossible for a human to comprehend, the technological singularity is an occurrence beyond which events may become unpredictable, unfavorable, or even unfathomable.[2]

The first use of the term “singularity” in this context was by mathematician John von Neumann. In 1958, regarding a summary of a conversation with von Neumann, Stanislaw Ulam described “ever accelerating progress of technology and changes in the mode of human life, which gives the appearance of approaching some essential singularity in the history of the race beyond which human affairs, as we know them, could not continue”.[3] The term was popularized by science fiction writer Vernor Vinge, who argues that artificial intelligence, human biological enhancement, or brain–computer interfaces could be possible causes of the singularity.[4] Futurist Ray Kurzweil cited von Neumann’s use of the term in a foreword to von Neumann’s classic The Computer and the Brain.

Proponents of the singularity typically postulate an “intelligence explosion”,[5][6] where superintelligences design successive generations of increasingly powerful minds, that might occur very quickly and might not stop until the agent’s cognitive abilities greatly surpass that of any human.

Kurzweil predicts the singularity to occur around 2045[7] whereas Vinge predicts some time before 2030.[8] At the 2012 Singularity Summit, Stuart Armstrong did a study of artificial general intelligence (AGI) predictions by experts and found a wide range of predicted dates, with a median value of 2040. Discussing the level of uncertainty in AGI estimates, Armstrong said in 2012, “It’s not fully formalized, but my current 80% estimate is something like five to 100 years.”[9]

***

eye

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Taxing the Rich … and Doctors?

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The Effect of Taxing America’s Wealthy

By blog.turbotax.intuit.com.

The wealth difference between states demonstrates that certain states had much stronger increases in affluent taxpayers.

For example, Warren Buffett recently called to raise tax rates on taxpayers making more than $1 million and proposed an additional increase on taxpayers whose income exceeds $10 million.

So, where do the “super-rich live and what would it look like if they were given additional taxes?”

 ***

rich

[Click to Enlarge]

Assessment

But, what about the “rich” doctors? Are they even rich, merely affluent or new members of the holloi polloi working class? Do tell.

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Understanding Financial Broker and Advisor Licenses

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Series #65 VS Series #7

By Michael Zhuang

When I am approached by a prospective client, the question they always ask without fail is “Are you properly licensed?” This is actually the wrong question to ask. The right question should be, “Which license do you have?”

The Types of Licenses

Generally, there are two types of licenses for people who call themselves a “financial advisor.” People who passed the series #65 test and people who passed the series #7 test. The nature of these two licenses is as far apart as heaven and earth.

The Securities License

Series #7 is a securities license. People who have passed this test can legally be a stock-broker. They are actually prohibited by law to give financial advice, except incidental to the financial products they are selling.

A financial advisor with a series #7 license can receive third party payments like kickbacks, commissions etc in conjunction with the products they sell you. They are not required to put your interest first as they are not your fiduciary. Legally they abide by a much lenient “suitability standard.” That is, if they think the product is suitable for you, irrespective of the cost, they are legally off the hook.

All of Morgan Stanley, Merrill Lynch and other Wall Street firms’ financial advisors are required to pass the series 7# license.

The Advisor License

Series #65 is an advisor license. People who have passed this test are legally called registered investment advisors or RIA representative. An RIA representative’s compensation is in the form of fees paid directly by the client. He or She is prohibited to receive any third party payment unless disclosed to and approved by the client first.

###

Wall Street

###

Assessment

When searching for a financial advisor, it’s crucial to find out what licensure he or she has. Do not use a stock-broker as your financial advisor – unless you’re in the habit of letting you friendly neighborhood used car salesman hand pick your vehicle purchases.

More:

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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The Best National Public Health Weeks Ever!

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Georges C. Benjamin MD
[APHA Executive Director]

Dear David,

Thank you! This was one of the best National Public Health Weeks ever! Millions of people around the country were involved and learned about Healthiest Nation 2030. More people celebrated the benefits of public health, read about public health, attended events, sent letters to Congress or interacted on social media than we’ve seen in years.

To cap it off, the U.S. Senate passed a resolution supporting our vision of creating the healthiest nation in one generation!

ImageProxy

Let’s build on the momentum!

We need everyone to understand the challenges we face in creating the healthiest nation and the role we all play in getting there. Please, let’s all take one more step to keep the conversation going.

View and share the webcast “Raising the Grade”
View a recording of APHA President Shiriki Kumanyika, Dr. Gail Christopher and our panel of experts as they discuss opportunities that exist and challenges we need to overcome to create the healthiest nation.

Share the healthiest nation infographic
Do your friends and family know that the U.S. is far from the best in most measures of health when compared to other high-income countries? We’ve created a simple infographic that shows our challenges and what we all need to do to improve it. Share it today!

Now’s the time to submit your NPHW news to The Nation’s Health!
We know that held great events during National Public Health Week 2015. So how about letting the rest of the nation know?

The Nation’s Health will feature coverage of events held around the nation in its July issue, and your news and photos could be part of it. See The Nation’s Health website for full submission details. The deadline has been extended to April 20. Don’t delay!

Inspire people to take action
Are you doing something to help create the healthiest nation? Enter our “We Can Do Better” contest. Show us what you are doing to create the healthiest nation with a photo, video, meme or just describing an activity. You can win $100, and we’ll share your entries on APHA’s website to inspire others.

Lead by example
Thousands of people have taken the first step on the path to the healthiest nation by pledging to “create a healthier me” and “create a healthier we.” Have you signed the healthiest nation pledge yet? Have you shared it family, friends and colleagues?

To be successful, we need to focus on the social determinants of health, form broader partnerships and build a movement for change. Together, we can become the healthiest nation!

Sincerely,
Georges C. Benjamin MD

Conclusion

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Cost of average U.S. hospital stay $33,079

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A Healthcare Financial Infographic

By FaceThe factsUSA.org.

The cost of the average American hospital stay nearly doubled from 2000 to 2010 while average stay length declined. The decade was a period of low inflation, but some sectors of the economy didn’t get the memo. Charges for a hospitalization soared from an average $17,390 in 2000 to $33,079 in 2010.

In the U.S. we spend almost three times as much on a hospital stay as other industrialized countries, even though their average stay tends to be longer.

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hospital-stay-us

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More:

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

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Are You A Top Performing Financial Advisor?

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An Infographic

[By Gabriel Lalonde]

To gain a better understanding of how today’s investment advisor’s are running their practices, Maximizer Software commissioned an original study based on surveys with 903 financial advisers from Canada and the United States.

The goal of the survey was to identify specific issues and trends that make investment advisers more successful.

***

WME-Infographic_highres-1024x664

[Click to Enlarge]

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Unique

The infographic above illustrates what sets top investment advisers apart from the rest of their peers.

Assessment

To find out how your practice can become a top performer take a look at our report! 

More:

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

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Tax Day and “Tax Freedom Day” is April 15-18, 2015

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More Time … More Pain!

[By Staff Reporters]

You get three extra days to file your taxes this year. They’ll be due this Monday, April 18th.

But, it’s not because of a previously announced processing delay that will prevent people who itemize their taxes from filing before mid- to late February, the IRS said Tuesday.

Instead, the bonus days come thanks to Emancipation Day, a little-known Washington, D.C., holiday that celebrates the freeing of slaves in the district.

***

money-pie

[Tax Money Pie]

***

What it Is?

In the United States; according to Wikipedia, Tax Day is a colloquial term for the day on which individual income tax returns are due to the federal government.[1] The term may also refer to the same day for states, even where the tax return due date is a different day.

Since 1955, for those living in the United States, Tax Day has typically fallen on April 15.[1] For those filing a U.S. tax return but living outside the United States and Puerto Rico, Tax Day has typically fallen on June 15, due to the two-month automatic extension granted to filers by IRS Publication 54.[2]

Due to Emancipation Day in Washington, D.C. (which is observed on the weekday closest to April 16), when April 15 falls on a Friday, tax returns are due the following Monday; when April 15 falls on a Saturday or Sunday, tax returns are due the following Tuesday.

  • In 2014, Tax Day was Tuesday, April 15
  • In 2015, Tax Day was Wednesday, April 15
  • In 2016, Tax Day will be Monday, April 18
  • In 2017, Tax Day will be Tuesday, April 18

Assessment

Similarly, April 15th is the deadline for filing Income Tax Returns (ITR) in the Philippines.

“Tax Freedom” Day with Personal Calculator

Conclusion

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

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On The State Licensing Process of Physicians

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By State Medical Boards

robert-cimasitodd-zigrang

By ROBERT JAMES CIMASI; MHA, ASA, FRICS, MCBA, AVA, CM&AA, CMP

By TODD A. ZIGRANG; MBA, MHA, ASA, FACHE

(C) Health Capital Consultants, LLC All rights reserved. St. Louis, MO USA

A SPECIAL ME-P REPORT

USA

http://www.HealthCapital.com

Every state and the District of Columbia require the licensure of all allopathic (M.D.) and osteopathic (D.O.) physicians [1] Although the specific criteria for licensure vary by state, each state requires candidates to submit proof of completion of the requisite number of years of graduate medical education and passage of examinations verifying that “the physician is ready and able to practice competently and safely in an independent setting [2].

Moral Character

Additionally, a physician applying for licensure is typically required to have “good moral character,” absent his or her involvement in illegal activities [3] Most physicians satisfy the exam requirement by submitting proof of their successful completion of the United States Medical Licensing Examination (USMLE) or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) to the licensure board [4] However, as some practicing physicians may have been licensed under a previously administered exam, certain state licensing boards may consider a combination of other examinations sufficient to meet licensure requirements, so long as those exams were completed prior to 2000 [5]

Of State Medical Boards

The licensure of physicians is governed by a state medical board, the “primary responsibility” of which board, according to the Federation of State Medical Boards, is to “protect consumers of health care by ensuring that all physicians…are properly licensed and comply with various laws and regulations pertaining to the practice of medicine[6] To accomplish this goal, state legislatures have delegated certain powers to the state’s medical board, including the power to grant, suspend, and revoke licenses; conduct investigations into complaints against physicians; and, release guidelines related to best medical practices [7] State medical boards have traditionally consisted solely of physicians; however, there has recently been an increase in the number of non-physician board members on state medical boards [8].

History

Over the last 50 years, state medical boards have faced intense scrutiny regarding their commitment to disciplining physicians based on quality concerns [9] In 1960, the American Medical Association (AMA) heard “sobering” facts from the Federation of State Medical Boards that “much confusion over the definitions and objectives exists” related to state medical board enforcement of medical standards [10] From 1963 to 1967, 0.06% of all physicians were subject to discipline, while in 1981, 0.14% of all physicians were subject to discipline, due in large part to the problems identified by the AMA [11] Although the rate of physician discipline rose eightfold by the mid-1990s, to date, there are continuing concerns regarding state medical board enforcement of quality standards.

A March 2011 report by advocacy group Public Citizen found that over 55% of physicians who faced clinical privilege disciplines by hospitals from 1990 to 2009 did not have a corresponding action from a state medical board [12] Additionally, in 2011, state medical boards imposed 3.06 “serious disciplinary actions” (e.g., revocations, surrenders, suspensions, and probations of medical licenses) per 1,000 physicians, an increase from the 2010 rate of 2.97 per 1,000, but a decrease from the 2004 rate of 3.72 per 1,000 [13] Numerous reasons have been offered to explain the disparity in quality enforcement by state medical boards, the most prominent being that physicians are loath to report fellow physicians for major disciplinary actions such as licensure revocation[14]

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Assessment

Other reasons include a focus by state medical boards on “character-related misconduct” over clinical quality standards [15] as well as a lack of resources to investigate and enforce quality standards, which forces state medical boards to rely on physicians and hospitals to “police” themselves [16].

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 REFERENCES

[1]       “State Medical Boards: Future Challenges for Regulation and Quality Enhancement of Medical Care,” By James N. Thompson, Journal of Legal Medicine, Vol. 33, No. 9 (January-March 2012).

[2]       “State Medical Boards: Future Challenges for Regulation and Quality Enhancement of Medical Care,” By James N. Thompson, Journal of Legal Medicine, Vol. 33, No. 9 (January-March 2012); “Healthcare Valuation: The Four Pillars of Healthcare Value,” By Robert James Cimasi, MHA, ASA, FRICS, MCBA, AVA, CM&AA, Hoboken, NJ: John Wiley & Sons, Inc., 2014, p. 449-450.

[3]       “Medical Practice: Education and Licensure,” in “Legal Medicine,” By S. Sandy Sanbar et al., 6th Ed., Mosby, 2004, p. 81.

[4]       “Medical Licensure,” American Medical Association, 2014, http://www.ama-assn.org/ama/pub/education-careers/becoming-physician/medical-licensure.page, (Accessed 12/19/14); “COMLEX-USA,” National Board of Osteopathic Medical Examiners, 2014, http://www.nbome.org/exams-faq.asp (Accessed 12/19/14).

[5]       “Medical Licensure,” American Medical Association, 2014, http://www.ama-assn.org/ama/pub/education-careers/becoming-physician/medical-licensure.page, (Accessed on 12/19/14); “Healthcare Valuation: The Four Pillars of Healthcare Value,” By Robert James Cimasi, MHA, ASA, FRICS, MCBA, AVA, CM&AA, Hoboken, NJ: John Wiley & Sons, Inc., 2014, p. 450.

[6]       “What is a State Medical Board?” Federation of State Medical Boards, 2014, http://www.fsmb.org/policy/what-is-a-smb-faq (Accessed 12/19/14).

[7]       “What is a State Medical Board?” Federation of State Medical Boards, 2014, http://www.fsmb.org/policy/what-is-a-smb-faq (Accessed 12/19/14).

[8]       “What is a State Medical Board?” Federation of State Medical Boards, 2014, http://www.fsmb.org/policy/what-is-a-smb-faq (Accessed 12/19/14); “Character, Competence, and the Principles of Medical Discipline,” By Nadia N. Sawicki, Journal of Health Care Law & Policy, Vol. 13, No. 1, 2010, p. 291.

[9]       “Character, Competence, and the Principles of Medical Discipline,” By Nadia N. Sawicki, Journal of Health Care Law & Policy, Vol. 13, No. 1, 2010, p. 287, n. 7; “To Err is Human: Building a Safer Health System – Summary,” Institute of Medicine, 2000, http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf (Accessed 12/19/14).

[10]     “Medical Licensure Statistics for 1960,” Journal of the American Medical Association, Vol. 176, No. 8 (May 27, 1961), p. 694.

[11]     “Medical Licensing Board Characteristics and Physician Discipline: An Empirical Analysis,” By Mark T. Law & Zeynep K. Hansen, Journal of Health Politics, Policy and Law, Vol. 35, No. 1 (February 2010), p. 66.

[12]     “State Medical Boards Fail to Discipline Doctors with Hospital Actions Against Them,” By Alan Levine et al., Public Citizen, March 2011, http://www.citizen.org/documents/1937.pdf (Accessed 12/19/14).

[13]     “Public Citizen’s Health Research Group Ranking of the Rate of State Medical Boards’ Serious Disciplinary Actions, 2009-2011,” By Sidney M. Wolfe, M.D., et al., Public Citizen, May 17, 2012, http://www.citizen.org/documents/2034.pdf (Accessed 12/19/14).

[14]     “Medical Boards are Too Lax, Critics Claim,” By Wayne J. Guglielmo, MA, MedScape, October 17, 2014, http://www.medscape.com/viewarticle/833141 (Accessed 12/3/14);

[15]     “Character, Competence, and the Principles of Medical Discipline,” By Nadia N. Sawicki, Journal of Health Care Law & Policy, Vol. 13, No. 1, 2010, p. 287.

[16]     “Medical Licensing Board Characteristics and Physician Discipline: An Empirical Analysis,” By Mark T. Law & Zeynep K. Hansen, Journal of Health Politics, Policy and Law, Vol. 35, No. 1 (February 2010), p. 90; “Medical Licensure Statistics for 1960,” Journal of the American Medical Association, Vol. 176, No. 8, May 27, 1961, p. 694.

NC Update: H543v2 – 04152015

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Annuities and their Associated Costs

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Another Look at Expenses

By Rick Kahler MS CFP

Rick Kahler MS CFPAnnuities are popular investments; almost every new physician or other client I see has one. Part of any investment adviser’s due diligence is to understand the history and intentions of the investments in a portfolio.

When I ask why someone purchased an annuity, the most common responses are: “We didn’t have to pay any fees or commissions.” “There are no ongoing expenses.” “All my money is working for me.” “The principal is guaranteed.”

Warning … Warning!

Any time you read or hear “no fees,” “no commissions,” “no expenses,” “free,” or “guaranteed” used in conjunction with an investment, it’s a red flag. All investments, including annuities, have costs associated with them. You need to ask some probing questions about those costs before proceeding.

Fixed Annuity Example

Let’s look at the costs for one popular type of annuity, the fixed annuity. This simply gives you a stated rate of return that often can change annually, similar to a bank certificate of deposit.

Suppose Investor A is sold a fixed annuity with a guaranteed return of 3.5%. Investor B invests her money in a plain vanilla portfolio of mutual funds holding 60% stocks and 40% bonds, which has a long-term projected return of 6%.

The insurance company selling the annuity must earn enough of a return on Investor A’s money to cover their expenses, pay commissions, and return something to Investor A. There is no magic formula on how that’s done. The insurance company invests the money in the same asset classes available to anyone. For the sake of this example, it’s reasonable to assume the insurance company would hold the same 60/40 portfolio as Investor B.

The annuity incurs internal costs for administration, managing the money, insuring the return of principal, and commissions paid to salespeople. While these vary somewhat from company to company, a cost of 2.5% isn’t unreasonable.

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If the company earns 6% and deducts 1% to recoup the upfront commission paid to the salesperson, 1.0% for management costs, and 0.5% for administrative fees, they pay out the remainder as a “fixed” return of 3.5%. Investor A only sees that 3.5% fixed return. If Investor A wants out of the policy before the cost of the up-front commission is fully recovered (usually 4 to 15 years), he will also incur a “surrender penalty” that is approximately equal to the remaining amount of commission paid to the broker selling the policy.

Investor B’s 60/40 portfolio will have the same 6% gross return as the insurance company’s portfolio. If Investor B purchases index funds from a company like Vanguard, her costs could be as low as 0.10%, leaving her a return of 5.9%.

Suppose Investors A and B each accumulates $1 million in retirement funds. The difference between Investor A’s guaranteed 3.5% return and Investor B’s average and unguaranteed 5.9% return is potentially an extra $2,000 a month in retirement income. Guarantees come with a cost.

Why Bother?

Given these numbers, you may wonder why anyone would purchase a fixed annuity? Why bother?

One reason is that many buyers don’t have the confidence that they can invest the money wisely or the stomach to watch the portfolio’s inevitable peaks and valleys.

Another reason is that most buyers don’t fully understand the costs.

Assessment

Unlike stocks, bonds, and mutual funds, most annuities are sold, not bought. I have never had a new client who independently purchased a no-load annuity. The annuities I typically see were sold by someone who received a commission. Commissions are not inherently bad, but in most cases they do inherently create a conflict of interest.

There are always fees associated with any investment. In my experience, the less transparent those fees are, the higher they are.

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The “Doc-Fix” Taxpayer Calculator

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Determining you Financial Share on “TAX DAY”

[By Staff Reporters]

One of the most-onerous votes in recent years on Capitol Hill is the so-called “doc fix.” That’s the patch Congress re-ups periodically to make sure that seniors on Medicare continue to receive medical care.

If Congress doesn’t cough up a chunk of change for the doc fix, doctors who treat Medicare recipients could experience an abrupt 21 percent reduction in their federal reimbursement – and would likely stop taking those patients.

In late March, the House approved a permanent replacement for the doc fix.

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Click here to see your share of the Medicare doc fix

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A solution has eluded lawmakers for years 

In fact lawmakers tinkered with this particular Medicare payment method some 17 times since 1997. That’s when the amount of money the federal government had available to pay doctors started to dip into the red. So in order to make sure physicians were paid and seniors didn’t lose benefits, Congress engineered a short-term –but expensive– Band-Aid to cover the difference.

Assessment

Hence the name, the “doc fix.”

Conclusion

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3 Technologies That Are Revolutionizing the Driving Experience

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Update for Doctors and Medical Professionals

[By Dr. David Edward Marcinko MBA]

[By Nalley Lexus Roswell, GA]

Dr. David E. Marcinko MBA

Auto manufacturers have always been at the forefront when it comes to new technology. In a very competitive market, being able to develop new gadgets and capabilities is critical when it comes to selling new cars.

While new car models feature the latest developments, engineers are already working on the ‘next big thing.’ So what will be the next big developments in technology to revolutionize the driving experience?

The Ideas

Here are three ideas for doctors and medical colleagues. All from a guy who used to change his own oil.

  1. Cars that can communicate with each other

One of the biggest challenges in road safety comes from the independence that one vehicle has over another. Car drivers are almost entirely insulated from each other and the outside world until disaster strikes. One technology that is trying to address this problem is called Vehicle-to-Vehicle communication – or V2V. V2V technology is now being used by manufacturers as potential technology for future cars.

V2V sends wireless signals about a car’s location, speed, and direction. These signals are, in turn, received by other cars, which interpret this information and make appropriate conclusions. That may be simply to warn the driver, or it could mean applying the brakes. A logical progression from V2V is V2I – Vehicle-to-Infrastructure. This would allow cars to talk to traffic signals and other technology to help further control traffic and speeds.

  1. Airbags that prevent collisions

The airbag is almost certainly one of the greatest car safety gadgets and has saved countless lives since the technology was first developed. Airbags are a great example of a passive safety feature, which means that they reduce the risk of death or injury in the event of an accident. The technology could be used, however, as an active safety feature, which could actually help prevent accidents.

Manufacturers are now experimenting with air bags, which would deploy beneath a vehicle in the event that a potential collision was about to occur. A special coating would help slow the car down, helping the driver to stop much more quickly. By lifting the car up, these bags would also reduce the risk of injury from passengers slipping under seat belts and would lessen any potential damage or injury from bumper-to-bumper impact.

  1. Cars that can drive themselves

The ultimate new technology must surely be one that removes the need for a car to have a driver. Any kind of independent driving technology would, of course, ensure that rules were always adhered to and would remove the margin for human error that almost certainly costs many lives every year. The technology giant Google has invested heavily in the self-driving car to date, although the big manufacturers are also likely to adopt this technology. Who knows whether it will be possible to purchase a self-driving production car within ten years?

DEM's 2000 Jag XJ-V8-LJaguar front seat

Jag interior

JaguarBoot

[My 2000 Jaguar XJ-V8 Luxury Touring Sedan] 

Assessment

I covered the ER for more than a decade. If any one of these innovations can save a life; then I am all for it.

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Conclusion

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Do You Have These Horrible Investments in Your Portfolio?

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Beware Structured Products and Annuities

By Michael Zhuang

Principal of MZ Capital Management

[Contributor to Morningstar and Physicians Practice]

Recently, I had a new client. As part of the on-boarding process, I examined her old portfolio and found some things I didn’t recognize.

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Cusip Symbol Description Return
25190A104 N/A Deutsche Bk AG London BRH Ret Opt Secs Lkd Ishare MSCI Mexico Capped -21.15%
25190A203 N/A Deutsche Bk AG London BRH Ret Opt Secs Lkd Ishare Euro STOXX 50 Idx -26.60%
90273L815 N/A USB AG London BRH Notes Five 15 -22.30%

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Structured Products

What these products have in common is they don’t have a ticker symbol, meaning they are not publicly traded securities. They also have weird descriptions and they all lost a lot of money.

I called Fidelity (my custodian firm) to find out what they were and how I could get rid of them. I was told that they are structured products created by the bank(s) to shove into their clients’ accounts (The managing “advisor” works for UBS).

That rang a bell! My very first job was a financial engineer for a French bank – Societe Generale. My job was to create structured products that had appealing features and made the bank a lot of profits. Now, that I finally see them in action from, the client side of the equation; I am not proud.

Annuities

But, these structured products are not nearly as bad as an Allianz annuity that a client bought from an insurance agent “friend” a while back. He bought the annuity eleven years ago for $150-k, and over the years, saw it steadily increases in value to $189-k.

Then, there came a time when he needed the money. So, he called to cash out and was shocked to discover there was a $62-k surrender charge. In other words, he was able to get $127-k back. I subsequently called Allianz on his behalf to find out when the surrender charge would end and was told there was no end! In other words, there would always be a huge surrender charge.

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What the Heck!

So, what in the heck does that value of $189-k really mean, when every time you want to take out the “value”, you have to pay a hefty ⅓ surrender charge?

Alas, Allianz explained the client can annuitize and take the amount out over ten years (or twenty years,) during which no interest will be accrued.  So, they will take your principal -or- they will take your interest, either way they screw you.

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Assessment 

Do you have structured products or annuities in your portfolio? Don’t know – Find out, now!

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

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Emotional Intelligence [EQ] in Medicine

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The Five Basic Non-Cognitive Competencies

[By Render S. Davis MHA CHE]

[By Dr. David Edward Marcinko MBA]

DEM white shirt

Many of us have encountered a person who may intellectually be at upper levels, but whose ability to interact with others appears to that of one who is highly immature.

This is the individual who is prone to becoming angry easily, verbally attacks co-workers, is perceived as lacking in compassion and empathy, and cannot understand why it is difficult to get others to cooperate with them and their agendas

[THINK: Sheldon Cooper PhD D.Sc MA BA of the The Big Bank Theory TV show].

Enter Daniel Goleman

The concept of Emotional Intelligence [EQ] was brought into the public domain when Daniel Goleman authored a book entitled, Emotional Intelligence.”

According to Goleman, emotional intelligence consists of four basic non-cognitive competencies: self awareness, social awareness, self management and social skills. These are skills which influence the manner in which people handle themselves and their relationships with others.  Goleman’s position was that these competencies play a bigger role than cognitive intelligence in determining success in life and in the workplace.

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Five Domains

He and others contend that emotional intelligence involves abilities that may be categorized into five domains:

  • Self awareness: Observing and recognizing a feeling as it happens.
  • Managing emotions: Handling feelings so that they are appropriate; realizing what is behind a feeling; finding ways to handle fears and anxieties, anger and sadness.
  • Motivating oneself; Channeling emotions in the service of a goal; emotional self control; delaying gratification and stifling impulses.
  • Empathy: Sensitivity to others’ feelings and concerns and taking their perspective appreciating the differences in how people feel about things.
  • Handling relationships: Managing emotions in others; social competence and social skills.

Source: Emotional Intelligence: what is and why it matters” – Cary Cherniss, PhD, presented at the annual conference of the Society of Industrial and Organizational Psychology, April 2000.

The Importance of Emotional Intelligence in the Workplace

Mike Poskey, in “The Importance of Emotional Intelligence in the Workplace.” continued his definition by stating that emotional intelligence is considered to involve emotional empathy; attention to, and discrimination of one’s emotions; accurate recognition of one’s own and others’ moods; mood management or control over emotions; response with appropriate emotions and behaviors in various life situations (especially to stress and difficult situations); and balancing of honest expression of emotions against courtesy, consideration, and respect.

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A Set of Competencies

In 1995, Goleman then expanded on the works of Howard Gardner, Peter Salovey and John Mayer. He further defined Emotional Intelligence as a set of competencies demonstrating the ability one has to recognize his or her behaviors, moods and impulses and to manage them best, according to the situation.

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Assessment

So, how does all this relate to medical practice today? Please … do tell us!

Conclusion

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About the Co-Author

Render Davis was a Certified Healthcare Executive, now retired from Crawford Long Hospital at Emory University, in Atlanta, GA He served as Assistant Administrator for General Services, Policy Development, and Regulatory Affairs from 1977-95.  He is a founding board member of the Health Care Ethics Consortium of Georgia and served on the consortium’s Executive Committee, Advisory Board, Futility Task Force, Strategic Planning Committee, and chaired the Annual Conference Planning Committee, for many years.  

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Do You Consider Yourself a Fiduciary – Are You?

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2015 IBD Report Card

By Diana Britton of WealthManagement

Why and How to Become a Certified Medical Planner™

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IBDRC-fiduciary

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Link: http://wealthmanagement.com/ibd-report-card

How This Survey Was Conducted: Between Jan. 14 and Feb. 25, 2015, REP. magazine emailed invitations to participate in an online survey to print subscribers and advisors in the Meridian-IQ database at over 80 independent broker/dealers. By Feb. 25, a total of 2,069 completed responses were received. Brokers rated their current employers on several items related to their satisfaction. Ratings are based on a 1-to-10 scale, with 10 representing the highest satisfaction level.

Note: Large IBDs, over 2,000 advisors: Cambridge, Cetera Advisor Networks, Commonwealth, LPL, Raymond James Financial Services, Securities America and Voya. Small IBDs, fewer than 2,000 advisors: CUNA Brokerage Services, Independent Financial Group, Investacorp, Investors Capital, NFP, Securities Service Network, Sigma, Signator, Summit, The Investment Center, United Planners and VSR.

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Conclusion

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

Ethical Implications of “Mystery Patient Shoppers” and Secretly Recording Conversations With Physicians

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[By Staff Reporters]

CONVERSATIONS RECORDED WITH PHYSICIANS

With recent advances in technology, smart phones can become recording devices with the touch of a button. This technological capability gives patients and their families the ability to easily and surreptitiously record conversations with physicians. The frequency of such recordings or whether they even occur is unknown. The ubiquity of smart phones, however, suggests the potential for secret recordings to occur.

Link: http://jama.jamanetwork.com/article.aspx?articleID=2204226#jvp150030r8

As of January 2014, 58% of Americans owned a smart phone, including 83% of young adults. Although recording conversations with physicians may provide some benefit for patients and their families, secret recordings can undermine patient-physician relationships and ultimately affect the provision of health care.

Source: Michelle Rodriguez, JD; Jason Morrow, MD, PhD; Ali Seifi, MD. JAMA March 12, 2015. doi:10.1001/jama.2015.2424

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“MYSTERY PATIENT SHOPPER” RISKS

In 2014, the Department of Health and Human Services proposed a “mystery shopper” program to gauge primary-care physicians’ timeliness in accepting new patients, according to a notice in the Federal Register. The plan calls for contacting 4,185 primary-care physicians—465 in each of nine as-yet-unnamed states—twice, once by someone pretending to be a new patient who has private insurance and once by someone pretending to be a publicly insured patient.

Link: https://www.fiercehealthcare.com/practices/more-patients-are-recording-doctor-visits

Scenarios will involve patients with both urgent medical concerns and those requesting a routine medical exam. The purpose of this program is to assess the timeliness with which primary-care services could be provided, gain insight into reasons why availability is lacking, and provide current information on primary-care availability and accessibility.

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Assessment

Ethical or NOT?

Now, what about doctors recording patients?

Link: https://www.kevinmd.com/blog/2016/06/doctors-patients-secretly-record.html

VA Update: https://www.research.va.gov/currents/0318-Mystery-shopper-model-being-used-to-boost-VA-care.cfm

Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Sign the pledge to create the healthiest nation in one generation

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The Healthiest Nation Pledge

  • By Susan L. Polan PhD
  • [Associate Executive Director]
  • Public Affairs and Advocacy

Dear Dr. David E. Marcinko,

Study after study consistently confirms an unpleasant fact: Americans live shorter lives and suffer more health issues than people in other high-income countries.

  • We live up to four years less than our peers.
  • We suffer more chronic disease, such as diabetes, cancer and heart disease.
  • We have higher infant mortality rates.
  • Within the U.S., there is as much as a 15-year difference in life expectancy depending on where you live, your race, your income and how educated you are.

In truth, the U.S. trails other high-income countries in these and most other measures of health.

Hope and Change

How do we change this? We need to make healthy lifestyle choices both as individuals and as a society. Our health is affected by a complex web of social and environmental factors that are often outside of our individual control. The homes we live in, our access to healthy food, the quality of our schools, clean air and water – these and other factors directly affect our health. And for many people, they limit their ability to make healthy choices.

Together We Can

Together we can change this. If we join together, we can demand that our leaders consider health in all their decisions. We can create communities that have a positive influence on our health – communities where it is easy for us all to make healthy choices.

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ImageProxyPH

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Assessment

Take the first step. Sign the pledge to create the healthiest nation in one generation. Ask your colleagues, friends and family to sign also. The more people who sign, the more influence we can wield. And the more momentum we can build for change.

Sincerely,

Susan Polan

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The Resurgence of Prescription Drug Price Increases‏

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Form ADV Part II [The Essential Document]

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Lifting the “Veil of Secrecy” on Selecting Financial Advisors

[By Dr. David Edward Marcinko MBA CMP™]

DEM white  shirtBy law, financial advisors must provide you with a form ADV Part II or a brochure that covers the same information. Even if a brochure is provided, ask for the ADV. Today, it may even be online.

While it is acceptable, even desirable, for the brochure to be easier to read than the ADV, the ADV is what is filed with the appropriate state or SEC. If the brochure reads more like a slick sales brochure or the information in the brochure glosses over the items on the ADV to a high degree, one should consider eliminating the advisor from consideration.

Types of Advisors

Registering with a state or SEC gives an advisor a fiduciary duty to the client. This is a high standard under the law. There are several types of advisors who are exempt from registering and filing an ADV.

First, there are registered representatives (brokers).  Brokers have a fiduciary responsibility to their firms regardless of whether they are statutory employees or independent contractors.

Second are attorneys and accountants whose advice is “incidental” to their legal or accounting practices. But, why would one hire someone whose advice is “incidental” to his primary profession?

A top-notch advisor is a full-time professional and should be registered.  One should insist that their advisor be registered.

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Lifting veil of secrecy

[The Author in Chicago Seeking Fiduciary Transparency]

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The ADV will describe the advisor’s background and employment history, including any prior disciplinary issues. It will describe the ownership of the firm and outline how the firm and advisor are compensated. Any referral arrangements will be described. If an advisor has an interest in any of the investments to be recommended, it must be listed as well as the fee schedule. There is also a description of the types of investments recommended and the types of research information that is used.

Assessment

A review of the ADV should result in an alignment of what the advisor said during the interview and what is filed with the regulators. If there is a clear discrepancy, choose another advisor. If it is unclear, discuss the issue with the advisor.

  • SEC Headquarters
  • 100 F Street, NE Washington, DC 20549
  • (202) 942-8088

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Rapid Learning Health Systems and PCMC

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Emerging Competitive Trends in Modern Healthcare Today

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imba inc

By Dr. David Edward Marcinko MBA CMP

By Hope Rachel Hetico RN MHA CMP

SOAR

dave-and-hope10Several trends are affecting the healthcare industry today. These trends are, in turn, having an impact on the financial performance of the entire healthcare ecosystem [patients, payers and providers], alike.

The ability of physicians, allied healthcare providers and the entire industry to respond to these trends is determined by the willingness to adapt, ability to re-train, and overall business flexibility. Central, of course, is the level of leadership in making the changes.

Perhaps the foremost trend, due to the PP-ACA, HSAs and Value Based Health Care, etc., is Patient Centered Medical Care [PCMC].

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[Rapid Learning Health System in a PCHC Model]

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Patient-Focused Healthcare

Patient-Centered, or Patient-Focused or Holistic Health Care has several names. It focuses on patient needs, attempting to humanize patient care. Patient-Centered healthcare therefore incorporates the following:

  • patient education;
  • active participation of the patient;
  • involvement of the family;
  • nutrition;
  • art; and
  • music.

These are thought to improve patient outcomes [1]. Furthermore, some think that patients will benefit from learning how to cope with healthcare processes before they enter into those processes and that this knowledge will result in better outcomes [2].

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two

[The Current Healthcare Ecosystem]

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An example of this would be classes to prepare couples for childbirth. These classes teach prospective parents the different stages of labor and strategies for dealing with the challenges associated with each stage. They cover options for pain management such as breathing and relaxation techniques and/or analgesics. The classes also provide education about clinical options such as induced labor and caesarian sections, and they cover practical issues such as what to wear and what kind of car seat to buy to transport the newborn home.

In fact, we know from personal experience that this type of education is enormously beneficial in reducing stress and improving the decision-making ability of patients who are involved in healthcare processes.

As a result of this movement, some healthcare organizations have tried to re-engineer the processes by which care is delivered in order to make it more patient focused. This is accomplished, in large part, by bringing the therapy to the patient rather than bringing the patient to the therapy.

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3

[A Life-Long Continuous Learning System]

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For example, storing more supplies and equipment in the patient’s hospital room means that more services can be performed in the room. Obviously, this trend has significant implications for the operations management function in healthcare organizations in the areas of layout and human resources management. Supplies and equipment may be arranged differently to facilitate patient-focused care.

Considerable staffing changes and cross training may be in order, to provide this type of service. Changes in facility layout to implement patient-focused care and reduce nonproductive movement of patients and personnel should be considered, especially when a facility is contemplating expansion or renovation of facilities.

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Citations and References

[1]  See Mang, A.L. “Implementation Strategies of Patient-Focused Care.” Hospital and Health Services Administration. 40:3 (1995): 426-525; and Kremitske, D.L. and West, D.L. “Patient-Focused Primary Care: A Model.” Hospital Topics. 75:4 (1997): 22-28.

[2]  Douglass, K. “No Pain; Big Gain.” Hospitals and Health Networks. 72:20 (1998): 38-39.

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Understanding the Failure to Recognize Mutual Fund Fees

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Going Granular and Deep with Obligatory “Fund Facts”

[By Dr. David Edward Marcinko MBA CMP™]

DEM blueAn attractive investment and a polished sales pitch can often hide the underlying costs of the investment, leading some medical professionals to give up a significant portion of the long-term growth of their assets to fees. Fees absolutely matter.

In a good market investors have a propensity to ignore them and in challenging markets they are scrutinized, but in the end no matter what type of market we are in fees do make a substantial difference in your long-term investment returns.

Assessing the Worth of the Investment

The first step in assessing the worth of the investment under consideration is figuring out what the fees actually are.  If a medical professional is investing in a mutual fund, these costs are found in mutual fund company’s now obligatory “Fund Facts”.

This manuscript clearly outlines all the fees paid – including upfront fees (or commissions/loads), deferred sales charges, and any switching fees.  Fund management expense ratios are also part of the overall cost of ownership. Trading costs within the mutual fund can also impact performance.

The List of Fees Keep Coming … and Coming!

Here is a list of the traditional fees from investing in a mutual fund:

  • Front end load: It is the commission charged to purchase the fund through a broker or financial advisor. The commission reduces the amount you have available to invest. Thus if you start with $100,000 to invest and the advisor charges a 5 percent front end load, you end up actually investing $95,000.
  • Deferred Sales Charge (DSC) or back end load: Charge imposed if you sell your position in the mutual fund within a pre-specified period of time (normally five years). It is initiated at a higher start percentage (i.e. as high as 10 percent) and declines over a specific period of time.
  • Operating Fees: These are costs charged by the mutual fund including the management fee rewarded to the manager for investment services. It also includes legal, custodial, auditing and marketing.
  • Annual Administration Fee: Many mutual fund companies also charge an additional fee just for administering the account – usually under $150 per year. A 1 percent disparity in fees for a medical professional may not seem like a lot. But fees do make a considerable impact over a longer time period. [For example, a $100,000 portfolio that earns 8 percent before fees, grows to $320,714 after 20 years if the client pays a 2 percent operating fee. In comparison, if the investor opted for a fund that charges a more reasonable 1 percent fee, after 20 years, the portfolio grows to be $386,968 – a divergence of over $66,000! For many investors, this is the value of passive or index investing. In the case of an index fund, fees are generally under 0.5 percent, thus offering even more fee savings over an elongated period of time].

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  fd9dd41a78cfc9c81d890534ddf26cce

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[The Carousel of Fees]

Assessment

Fees and expenses can have significant impact on the performance of your investments. Always monitor the costs of an investment program to ensure that fees and expenses are reasonable for the services provided and are not consuming a disproportionate amount of the investment returns.

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Curing By Numbers

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Taking Cloud Computing to a New Level

[By GE Healthcare IT]

American healthcare has by far the most expensive system in the world, but few would argue that it’s also the most efficient. A study published in the Journal of American Medical Association found that almost 40 percent of patients are misdiagnosed in primary care1. Another report by the American College of Physicians discovered that unnecessary testing and medical procedures, and extra days in the hospital caused by wrong diagnosis could add up to $800 billion per year2.

That’s close to a third of all U.S. healthcare costs. “There is a lot of waste in the system,” says Jeanine Banks, general manager of marketing at GE Healthcare IT. “We want to help rein in the costs and make the system far more efficient.”

That’s not just talk. Engineers at GE Healthcare IT are developing a new “cloud imaging” solution that will allow doctors to create a professional profile, store patient images and data together in one place, view 3D images from anywhere, and access intuitive analytics. “It’s like LinkedIn professional networking meets diagnostic imaging,” Banks says. “It’s all about virtually limitless computing, storage and collaboration on tough cases to help healthcare teams make more informed decisions.”

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3D-ASL

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Banks says that the information physicians need to make diagnoses is often fragmented and sits in siloes. The new platform, GE’s Cloud Imaging solution, allows doctors to exchange images and use social digital tools to share cases with each other over a network instead of distributing CDs, as common practice now. “They can open their browser, click on a link and share quickly,” she says.

Banks says that GE intends to give hospitals the flexibility to host the system on their own servers, as a private cloud, or through GE’s public cloud environment. “We are committed to using industry standards to make it easy to connect medical devices, link with existing PACS (picture archiving and communication systems) and EMR (electronic medical records environments), and enable consistent access to a flourishing ecosystem of apps,” she says. “Providers don’t need more silos of data.” GE’s first Cloud Imaging pilot site is the Kadlec Health System in Washington State. Kadlec is helping evaluate the platform ahead of plans to demonstrate the new solution during the annual meeting of the Radiological Society of North America in December. “It’s an opportunity for them to use it inside their health system and give us feedback,” Banks says.

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tumblr_inline_nhryxgljMi1qzgziy

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For Banks, this is the beginning of a new healthcare revolution. “What if together with industry we could help physicians reduce waste?” she asks. “We could process that information, learn from past diagnostic decisions and store the data all in the cloud to inform future decisions. One day, we could tap into knowledge based on cases from around the world.”

Assessment

That’s just brilliant.

Citations:

1 Journal of American Medical Association 2012

2 Reuter’s, citing study by American College of Physicians  

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Emerging New-Wave Cloud Technology for HIPAA

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Securing Electronic Communication in the Cloud

[By Carol S. Miller BSN MBA PMP]

Carol S. MillerTo help hospitals and health systems comply with burdens of the Health Insurance Portability and Accountability Act [HIPAA] regulations, best practices are emerging for securing all electronic communication – cloud, wireless, and texting –  of protected health information.

These new technologies will continually be evolving with hospitals, providers and patients move to new means of communication.

And so, below is a very brief description of one: cloud solutions.

Cloud Solutions

Cloud solutions are becoming a needed commodity in treating patients today but also present a risk to privacy and security violation.  Despite the advantages of cloud computing, organizations are often hesitant to use it because of concerns about security and compliance.

Specifically, they fear potential unauthorized access to patient data and the accompanying liability and reputation damage resulting from the need to report HIPAA breaches. While these concerns are understandable, a review of data on HIPAA breaches published by the HHS shows that these concerns are misplaced.

In fact, by using a cloud-based service with an appropriate security and compliance infrastructure, a facility can significantly reduce its compliance risk.

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USB drive

[A.I. and the “SINGULARITY”]*

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Because HIPAA compliance involves stringent privacy and security protections for electronic protected health information (PHI), many cloud providers are balking at signing new Business-Associate agreements.

Most cloud-technology providers, such as Box and Dropbox, do not include the built-in privacy protections that guarantee HIPAA compliance. Because many cloud storage companies store plaintext data on their servers, PHI is especially vulnerable to breaches and compliance violations.

Note:

The SINGULARITY is that hypothetical moment in time when Artificial Intelligence [AI] will have progressed to the point of a greater-than-human intelligence.

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ABOUT THE AUTHOR

  • Carol S. Miller; BSN, MBA, PMP
  • ACT IAC Executive Committee Vice Chair at-Large
  • HIMSS NCA Board Member
  • President – Miller Consulting Group
  • 7344 Hooking Road
  • McLean, VA 22101
  • Phone: 703-407-4704
  • Fax: 703-790-3257
  • email: millerconsultgroup@gmail.com

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The Economics of Electronic Healthcare Transactions

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For FY 2013

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website

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The Medical Painting Gallery of HCC, LLC

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A Digital Medical Painting Gallery GOOD FRIDAY Review

Courtesy Robert James Cimasi; MHA ASA FRICs MCBA AVA CM&AA CMP™

[Health Capital Consultants, LLC]

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OK; I was never much of a liberal arts guy in my younger days; despite my Jesuit education at Loyola University. Always more of a modified STEM scientist.

Still, I remember the first time I learned of this famous painting in college, then medical school [a requirement of all anatomy students, worldwide]. So, imagine how blessed I felt when I viewed the original when I visited Amsterdam … chilling!

And, this painting and entire gallery seems an appropriate ME-P for Good Friday 2015.

David Edward Marcinko

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The Anatomy Lesson of Dr. Nicolaes Tulp

Rembrandt (1606–1669)

[1632: commissioned by Chirurgijnsgilde, Amsterdam]

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CLICK FOR MORE:

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Assessment

Paintings are part of the collection of the U.S. National Library of Medicine. 

Conclusion

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Human error causes alarming rise in data breaches

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For the Insurance, Healthcare, Education, and Financial Services Sectors

[By Egress Software Technologies]

http://www.egress.com

Human error causes alarming rise in the number of data breaches and resulting monetary penalties, according to ICO FOI request carried out by Egress Software Technologies.

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humanerror_infog_noheader_page

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PC bug

[Blame Human Error – Not Hardware Bugs]

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