HISTORIC PURPOSE OF MEDICAL RECORDS and S.E.S.

Posted on December 31, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

An iMBA Inc., Review

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DEM white shirt

[By Dr. David Edward Marcinko CMP® MBA]

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As little as a hundred years ago, detailed medical records were likely to have been compiled by medical researchers such as Charcot and Hughlings-Jackson. The medical record was an aide memoire for detecting changes in patients’ conditions over time, solely for the benefit of the physician in treating the patient.

As health care became more institutionalized, medical records became a communications device among health care providers. Doctors made progress notes and gave orders. Nurses carried them out and kept a record of patient responses. A centralized record, theoretically, allowed all to know what each was doing. The ideal was that if the doctor were unable to care for the patient, another physician could stand in his or her shoes and assume the patient’s care.

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Enter Third Parties

Then pressures from third party payers occurred. As insurance and then government programs became larger players in the compensation game, they wanted to know if the care they were paying for was being delivered efficiently.

Why were these tests ordered?
Why weren’t these studies done?
Why had the patient remained hospitalized after his temperature had returned to normal for so many hours and no pain medications had been required?
Why couldn’t this pre-operative work be done on an outpatient basis?

Though the real push behind these questions was the desire to save money, utilization review also directly contributed to better patient care. A patient who was being given inefficient care was getting substandard care as well. Utilization review was mainly retrospective; denial of compensation was rarely imposed, and suasion by peers was the main effector of change. Though “economic credentialing” was shouted about, it rarely showed itself in public.

PP-ACA

Even health reform which openly admitted economic incentives as one of its motivators preferred to find some other reason for deciding not to reimburse, or admit Dr. Jones to its narrow panel of ACA, or other “skinny” network providers, or not renewing Dr. Smith’s contract an HMO. The medical record remained essentially a record of patient care which was good or not, efficient or not. If the record wasn’t complete, the doctor could always supplement it with an affidavit, use information from somewhere else, or provide explanations.

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Socio Economic Status

Today, the concept known as Socio Economic Status [S.E.S.] is conceptualized as the social standing, or class of an individual or group. It is often measured as a combination of education, income and occupation. Examinations of socioeconomic status often reveal inequities in access to medical resources, plus issues related to privilege, power and control. SES is increasingly being considered as another payment component [CPT® codes] to medical providers, as reflected in the paper medical record, EMR and elsewhere.

Assessment

Have you encountered any Socio Economic Status initiative in your clinic, hospital or other medical institution?

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]

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Filed under: iMBA, Inc., Practice Worth, Risk Management | Tagged: EMRs, Marcinko, medical records, Socio Economic Status | 2 Comments »

Emerging PATIENT Collaborative Medical Marketing Trends

Posted on December 30, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Seeking End-to-End Solutions?

[By Dr. David Edward Marcinko CMP® MBA]

http://www.BusinessofMedicalPractice.com

Given today’s economic and political environment, with its’ increasing competitive pressures, medical practices are focused more-than-ever on patient acquisition and patient retention. Modern medical practices are teaming together to offer comprehensive end-to-end solutions.

If you are partnering with other healthcare organizations to pool in your expertise, offer joint solutions and take up joint medical marketing and patient communications programs, be careful how you execute and about what you agree with your partners on sharing patient databases.

Policy

It is advisable to formulate a simple and clear privacy policy and adhere to that in the partnership agreements. Comply with the policy at all patient touch points. Communicate this very clearly with your partners and patients prominently in all your channels of communication. Inventory your data collection processes and gateways. Select appropriate projects to add security to your data across extended networks and partners.

Note there is no silver bullet to protect the privacy. Privacy compliance is as much a business issue as it is a technical issue, sometimes more so.

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Implications for Patient Strategies

While you are formulating and implementing privacy policies; you need to address the following questions:

Do your patients respond to your practice’s privacy strategy? It is not enough to have a privacy policy that is so confidential no one is aware of that. It is imperative for practices, once they implement their privacy strategies, to understand how patients are responding and loop the feedback to fine-tune policies accordingly.
How do you consider the impact on the patient from every privacy decision you make? Every privacy decision made will impact the patient and your practice; but to what extent? How do you determine this impact? Some of them will be patient-facing and some will be in the back–end. This step is essential so that you can make appropriate decisions and make optimum usage of resources.
Will your medical practice operations support the privacy initiative? Privacy enablement requires resources and training with perhaps no immediate, apparent short-term value-add to the top-line or bottom-line. Medical practices that take a proactive view of privacy enablement as cost of doing business in the 21st century will benefit. Practices still need to adopt critical processes and technology that agree with their resources and gradually privacy enable in an incremental way.

Role of Technology

There is no technology silver bullet. Privacy enabling a practice is composed of elements of company loyalty towards patients, commitment to build long lasting and profitable patient management by building trust, and engaging cross-functional teams that can pick and deploy suitable data security across the network.

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Steps

Here are some salient steps for secure data management that affect technology choices of any medical practice:

Privacy-compliant database development – healthcare organizations have to “listen” and record what patients are saying, and if and how they prefer to be contacted, or not at all. All these details will have to be stored in a secure database, which is regularly refreshed with the outcome of practice communications with patient. This will be the central repository that the office draws upon to design and execute consistent and privacy enabled patient communications.
Protect the data across the practice, from group to group, area to area, or from network to network. It is not enough for a medical practice to protect data from external intruders, but also from internal data abusers. It is not enough that patient data is secure during transmission at the patient touch point. It also needs to be safe where it is stored. It is not unusual to have patient data stored or lying around where it is accessible by internal intruders. Therefore it is imperative for medical practices to go beyond traditional firewalls to have multi-layered security at the data level.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

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http://www.CertifiedMedicalPlanner.org

Filed under: Information Technology, Practice Management, Touring with Marcinko | Tagged: Dr. Marcinko, Emerging PATIENT Collaborative Marketing Trends, HIT, medical marketing, medical practice management | Leave a comment »

HUMANITARIAN WISDOM IN PATIENT CARE AS A MORAL IMPERATIVE AND …

Posted on December 29, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

…. A MEDICAL RISK MANAGEMENT TOOL in 2018!

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DEM white shirt

[Dr. David Edward Marcinko CMP™ MBA MBBS]

http://www.CertifiedMedicalPlanner.org

EDITOR-IN-CHIEF

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In SECTION ONE, of our newest textbook, on medical practitioner personal risk management issues, let us all recall the Canadian physician Sir William Osler MD, one of the founders of Johns Hopkins Hospital in my hometown of Baltimore Maryland, and where I played stickball in the parking lot as a kid. He left a sizeable body of wisdom that has guided many physicians in the practice of medicine. So, allow me to share with you some of that accumulated wisdom and the quotes that have served me well over the years.

From Dr. Osler, I learned the art of putting myself in the patient’s shoes. “The motto of each of you as you undertake the examination and treatment of a case should be ‘put yourself in his place.’ Realize, so far as you can, the mental state of the patient, enter into his feelings.” Osler further stresses that we should “scan gently (the patient’s) faults” and offer the “kindly word, the cheerful greeting, the sympathetic look.”¹

“In some of us, the ceaseless panorama of suffering tends to dull that fine edge of sympathy with which we started,” writes Osler in his famous essay “Aequanimitas.”² “Against this benumbing influence, we physicians and nurses, the immediate agents of the Trust, have but one enduring corrective — the practice towards patients of the Golden Rule of Humanity as announced by Confucius: ‘What you do not like when done to yourself, do not do to others.’”

Medicine can be both art and science as many physicians have discovered. As Osler tells us, “Errors in judgment must occur in the practice of an art which consists largely of balancing probabilities.”² Osler notes that “Medicine is a science of uncertainty and an art of probability” and also weighs in with the idea that “The practice of medicine is an art, based on science.”^3,4

Osler emphasized that excellence in medicine is not an inheritance and is more fully realized with the seasoning of experience. “The art of the practice of medicine is to be learned only by experience,” says Osler. “Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone can you become expert.”⁵

Finally, some timeless wisdom on patient care came from Osler in an address to St. Mary’s Hospital Medical School in London in 1907: “Gain the confidence of a patient and inspire him with hope, and the battle is half won.”⁶

Osler has also imparted plenty of advice on the business of medicine. In “Aequanimitas,” Osler says there are only two types of doctors: “those who practice with their brains, and those who practice with their tongues.”⁷

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In a valedictory address to medical school graduates at McGill University, Osler suggested treating money as a side consideration in a medical career.⁸ “You have of course entered the profession of medicine with a view of obtaining a livelihood; but in dealing with your patients let this always be a secondary consideration.”

“You are in this profession as a calling, not as a business: as a calling which exacts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow man,” explains Osler in the address to St. Mary’s Hospital Medical School.⁶ “Once you get down to a purely business level, your influence is gone and the true light of your life is dimmed. You must work in the missionary spirit, with a breadth of charity that raises you far above the petty jealousies of life.”

It is not easy for doctors to combine a passion for patient care, a knowledge of science and the maintenance of business, according to Osler in the British Medical Journal.⁹ “In the three great professions, the lawyer has to consider only his head and pocket, the parson the head and heart, while with us the head, heart, and pocket are all engaged.”

While some aspects of practice may fall short or be devoid of appropriate financial remuneration, the giving of one’s time, expertise and experience in improving patient outcomes and the quality of their lives may be the greatest gift. “The ‘good debts’ of practice, as I prefer to call them … amount to a generous sum by the end of each year,” says Osler.⁹

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http://www.BusinessofMedicalPractice.com

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MEDICAL Ethics for Challenging Times

[Finding Your Moorings in an Era of Dramatic Change]

Marcinko Ethics

By Render S. Davis MHA

By David Edward Marcinko

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And so, as you read and reflect on the chapter of SECTION ONE, always remember the words and wisdom of Dr. William Osler, and keep patient welfare as your first priority.

Dr. David Edward Marcinko; CMP™ MBA MBBS [Hon]

[Chief Executive Officer]

iMBA Inc., Norcross, GA

References

Penfield W. Neurology in Canada and the Osler centennial. Can Med Assoc J. 1949; 61(1): 69-73
Osler W. Aequanimitas. Chapter 9, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 159
Bean WB. William Osler: Aphorisms, CC Thomas, Springfield, IL, p. 129.
Osler W. Aequanimitas. Chapter 3, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 34
Thayer WS. Osler the teacher. In: Osler and Other Papers. Johns Hopkins Press, Baltimore, 1931, p. 1.
Osler W. The reserves of life. St. Mary’s Hosp Gaz. 1907;13 (1):95-8.
Osler W. Aequanimitas. Chapter 7, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 124
Osler W. Valedictory address to the graduates in medicine and surgery, McGill University. Can Med Surg J. 1874; 3:433-42.
Osler W. Remarks on organization in the profession. Brit Med J. 1911; 1(2614):237-9.
Jacobs. AM: PMNews, April, 2015.

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[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]

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Filed under: "Doctors Only", CMP Program, Ethics, Financial Planning, iMBA, Inc., Risk Management | Tagged: CMP, CMP Program, David E. Marcinko, Financial planning MDs, medical risk management, Render Davis | Leave a comment »

State Health Rankings

Posted on December 28, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

For 2015

By http://www.MCOL.com

*** ImageProxy

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

[HOSPITAL OPERATIONS, ORGANIZATIONAL BEHAVIOR AND FINANCIAL MANAGEMENT COMPANION TEXTBOOK SET]

[Foreword Dr. Phillips MD JD MBA LLM] *** [Foreword Dr. Nash MD MBA FACP]

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Downhill Racing Meets Value Investing

Posted on December 26, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

More on Value Investing

By Vitaliy Katsenelson CFA

I wrote this article in May. Every time it was destined to be published in the pages of Institutional Investor, it got bumped by another, more timely one I had written. Finally, when a space opened in September, the market had taken a major dive, and what was supposed to be an “evergreen” article was suddenly out of touch with reality.

Here is the irony: This piece addresses complacency, but its author was complacent too. The X-mass market has recouped its summer losses, and this article is relevant again.

The Skier

I am a skier. When someone says this, you assume he or she is good. Well, I thought I was good. I was not Lindsey Vonn, but I had the technique down. I’d be the fastest person going down the mountain, always waiting for my friends at the bottom. Then, at the beginning of last season, I went skiing with my kids at Vail. It had snowed nonstop for a few days. Vail is a very large resort, and the mountain crew could not keep up with the snow, so I found myself skiing on unusually ungroomed slopes in powder more than knee-deep. Suddenly, something changed. I could not ski. I could barely make turns. I was falling multiple times per run. My kids, including my nine-year-old daughter, Hannah, were now waiting for me as I dug myself out of pile after pile of snow. My technique — along with my confidence — was gone. The discomfort froms constant falling turned into fear. I was ready to go back to the hotel after only two hours on the slopes. I was devastated. It was as if I had never skied.

The Ski Instructor

So I talked to a ski instructor about this incident. He told me that I’m a “good skier” on groomed slopes because they allow me to go fast without trying hard. Speed covers up a lot of mistakes and lack of skill. Skiing in powder requires different skis — not the skis I had — but more importantly, it slows you down and makes you rely on skills that I thought I had but didn’t.

The FED

During the past six years, the Federal Reserve neatly groomed, manicured and then finely polished investment slopes for all asset classes by lowering interest rates to unprecedented levels — providing a substantial accelerant that indiscriminately drove valuations of all assets higher. But ubiquitously rising valuations cover up a lot of mistakes and often a lack of skill. Whether you had a rigorous investment process or were throwing darts, over the past six years it hardly mattered — you made money. Bull markets don’t last forever, and this one is not an exception. Stock valuations (price-to-earnings) are just like a pendulum, swinging from one extreme to another.

Modernity

Today the stocks in the S&P 500 index trade at about 50 percent above their average valuation (if you adjust earnings down for very high corporate margins). Historically, above-average valuations have always been followed by below-average ones — taking away the riches that the previous years provided.

In other words, at some point it is going to snow and snow hard. Just as I, the great skier, found myself overconfident and unable to deal with the new terrain, investors will find themselves doing face-plants when the stock market turns from bull to bear. But here is great news:

Now the stock slopes are still finely groomed with stocks near all-time highs, and we all are given a unique opportunity to make adjustments to our portfolios and investment process. You should start by carefully analyzing each stock position in your portfolio. No drooling over how each of them did for you in the past. Drawing straight lines from the past into the future is very dangerous.

The Future

Instead, focus on the future — a future in which average stock valuations will likely be lower. Returns for a stock are driven by three variables: earnings growth, change in P/E and dividend yield. You should impartially examine each variable to determine if a stock deserves to be in your portfolio.

Then make one of three decisions: buy (more), hold or sell. Just remember, hold is a decision. If you choose not to sell an overvalued stock, one that has low or negative expected returns in the long run, that is a decision. We must all reexamine and future-proof our investment process. Six years of rewards and no risk will loosen the process of even the most disciplined investor.

Finally, if you are feeling very confident about your investment prowess today, take a moment to relive that gut-wrenching feeling you had the last time the stock market took a 20 percent dive. This will reset your confidence to the appropriate level and help you to avoid the mistakes that come from focusing too much on reward and too little on risk.

***

P.S. I took the kids skiing at Beaver Creek a week ago, for the first time this season. My daughter Hannah, who will be ten in a few weeks, has magically improved over the summer. However, Jonah, who is an amazing skier, has completely lost his form. He grew five or six inches since last spring — he’s 14 and pushing 6 feet now. His center of gravity has shifted, and he is still adjusting his technique to his new, oversized body.

Assessment

As a father, I smile when I see Hannah beating Jonah down the slope. Jonah, like any teenager, needs to be humbled. My skiing? The slopes were perfectly groomed. I was awesome! I just hope it doesn’t snow.

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ABOUT

Vitaliy N. Katsenelson, CFA, is Chief Investment Officer at Investment Management Associates in Denver, Colo. He is the author of Active Value Investing (Wiley 2007) and The Little Book of Sideways Markets (Wiley, 2010).

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]

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Filed under: Investing, Portfolio Management | Tagged: Investment Management Associates, value investing, Vitaliy Katsenelson CFA | 1 Comment »

R.I.P. Lon Jefferies MBA CFP®

Posted on December 24, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

***

Dear ME-P Readers and Subscribers

It is with a heavy heart that we inform you that Lon Jefferies passed away unexpectedly this weekend due to complications inherent with a seizure disorder. We are extremely saddened by Lon’s all-too-soon departure. He was a vital contributor to this Medical Executive-Post and Financial Planning industry writ large; and he will be greatly missed.

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Lon Jefferies

http://www.NewWorthAdvice.com

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As you know, Lon was an excellent financial planner and prolific blogger. To his credit – one of the variables he planned for – was the possibility of a life altering event such as this. With this foresight, Lon chose to align his financial planning services with his team at Net Worth Advisory Group. Lon’s plan ensures that each client can continue to receive the same high level of financial planning and assistance going forward, while allowing his beneficiaries to receive some residual income.

Our most sincere sympathies go out to Lon’s new bride Jen, his parents, and their families.

With best regards and sincere sympathy.

Dr. David Edward Marcinko MBA CMP® MBBS

[Publisher and Editor-in-Chief]

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Filed under: Ethics, iMBA, Inc. | Tagged: Lon Jefferies MBA CFP® | 2 Comments »

Top Twelve USA Pediatric Hospitals

Posted on December 23, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Domestic Hospitals for 2015

By http://www.MCOL.com

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ImageProxy

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

Filed under: Health Insurance | Tagged: Pediatric Hospitals | 1 Comment »

FORECASTS – IT’S THAT TIME OF THE YEAR FOR [Physician] INVESTORS

Posted on December 22, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

No, not the holidays!

Art

By Arthur Chalekian GEPC

[Financial Consultant]

***

It’s the time when physician investors begin to consider pundits’ forecasts for the coming year.

Here are a few of those forecasts:

1. “Flat is the new up,” was the catch phrase for Goldman Sachs’ analysts last August, and their outlook doesn’t appear to have changed for the United States. In Outlook 2016, they predicted U.S. stocks will have limited upside next year and expressed concern that positive economic news may bring additional Fed tightening. Goldman expects global growth to stabilize during 2016 as emerging markets rebound, and Europe and Japan may experience improvement.

2. Jeremy Grantham of GMO, who is known for gloomy outlooks, is not concerned about the Federal Reserve raising rates, according to Financial Times (FT). FT quoted Grantham as saying,

“We might have a wobbly few weeks … but I’m sure the Fed will stroke us like you wouldn’t believe and the markets will settle down, and most probably go to a new high.”

Grantham expects the high to be followed by a low. He has been predicting global markets will experience a major decline in 2016 for a couple years, and he anticipates the downturn could be accompanied by global bankruptcies.

3. PWC’s Trendsetter Barometer offered a business outlook after surveying corporate executives. After the third quarter of 2015, it found:

“U.S. economic fundamentals remain strong, but markets and executives like predictability, and that’s not what we’ve been getting lately … Trendsetter growth forecasts are down, so are plans for [capital expenditure] spending, hiring, and more. It doesn’t help that we’ve entered a contentious 2016 election season …”

4. The Economist had this advice for investors who are reviewing economic forecasts:

“Economic forecasting is an art, not a science. Of course, we have to make some guess. The average citizen would be well advised, however, to treat all forecasts with a bucket (not just a pinch) of salt.”

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[End 2015 – Begin 2016]

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Assessment

Doctor – What are your stock market predictions for 2016?

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

Filed under: Investing, Portfolio Management | Tagged: Arthur Chalekian, Goldman Sachs, Jeremy Grantham, PWC's Trendsetter Barometer, The Economist | 3 Comments »

Congress Passes Permanent Tax Provisions

Posted on December 21, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

By Cindy Freking CPA

[Tax Manager ]

cfreking@whirleyproactive.com

Late on December 15th, a bipartisan agreement was reached on tax extenders—i.e., the 50 or so temporary tax provisions that are routinely extended by Congress on a one- or two-year basis—and numerous other tax provisions in the “Protecting Americans from Tax Hikes (PATH) Act of 2015” (the Act). This agreement makes permanent many of the individual and business extenders and contains provisions on Real Estate Investment Trusts (REITs), IRS administration and the Tax Courts and miscellaneous other provisions.

Below are some provisions that have been made permanent:

DEPRECIATION & EXPENSING PROVISIONS

The Act makes permanent the $500,000 expensing limitation and $2 million phase out amounts under Code Section 179
For property placed in service after Dec 31, 2015, the Act provides that air conditioning and heating units are now eligible for expensing
Assets for which the De Minimis election applies are not counted in determining the Code Section 179 expensing election or the ceiling
15 Year Write off for Qualified Leasehold , Retail Improvements & Restaurant Property

INDIVIDUALS

American Opportunity Credit
Enhanced Earned Income Tax Credit
Above the line Educator Expenses
Exclusion for Employer Provided Mass Transit & Parking
State and Local Sales deduction
Liberalized rules for Qualified Conservation Contributions
Nontaxable IRA transfers to eligible charities

BUSINESSES

Research & Development credit & offset now available against taxes in addition to income taxes
Reduction in S-Corporation recognition period for Built in Gains Tax
Exclusion of 100% Gain on certain small business stock
Enhanced deduction for Food Inventory
Differential Wage Payment Credit (active duty employees)

Assessment

The above provides a brief overview of the Act. There are various provisions that have been extended through 2016 and 2019 and other miscellaneous provisions. If you need additional information or have questions, please contact your CPA.

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

Filed under: Accounting, Taxation | Tagged: Accounting, Cindy Freking CPA, Code Section 179, real estate investment trusts, tax | 2 Comments »

On Medical Provider Directory Accuracy?

Posted on December 20, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

By http://www.MCOL.com

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ImageProxy1CUR6RZ6

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

[PRIVATE MEDICAL PRACTICE BUSINESS MANAGEMENT TEXTBOOK – 3rd. Edition]

[Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]

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Filed under: Health Insurance, Practice Management, Quality Initiatives | Tagged: Medical Provider Directory Accuracy? | Leave a comment »

Irish Health Minister For Health (Leo Varadkar) Slams Greedy Drug Companies.. Plus.. Pharma CEO, Martin Schkreli Is Arrested For Fraud..

Posted on December 19, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Pharma CEO Martin Schkreli is Arrested For Fraud

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pills+many+colors+mrc

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Drugs and Pharma, Ethics | Tagged: Leo Varadkar, Martin Schkreli | 3 Comments »

On Criminal Penalties for Acts Involving Federal Healthcare Programs

Posted on December 19, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

“Knowingly and Willfully”

[By Carol S. Miller RN MBA]

Individuals and entities are prohibited from “knowingly and willfully” making false statements or presentations in applying for benefits or payments under all federal and state healthcare programs. Individuals also are prohibited from fraudulently concealing or failing to disclose knowledge of an event relating to an initial or continued right to payments.

There is also prohibition against knowingly and willingly soliciting or receiving any remuneration (including any kickbacks, bribes, or rebates) directly or indirectly, in cash or in kind, in exchange for referrals. Violations may result in felony convictions with penalties including imprisonment and fines.

Individuals or entities can be excluded from Medicare and Medicaid and more than 200 other federal healthcare programs for a minimum of five years if there is one prior fraud or abuse conviction. Thee exclusions last for ten years and if there are two prior convictions, the exclusion can become permanent. The minimum period of discretionary exclusion is three years, unless DHHS determines that a different period is appropriate.

It is just as important to communicate to the employees when laws or regulations do not impact your organization, such as the Family Medical Leave Act (FMLA), the employment provisions of the Americans with Disabilities Act (ADA) or continuation of health benefits under the Consolidated Omnibus Budget Reconciliation Act (COBRA). These benefits apply only to organization with a specific number of employees, so smaller organizations are not necessarily required to offer these benefits.

***

However, the Patient Protection and Affordable Care Act (PPACA) provides a slightly different situation for the provider’s practice. PP-ACA mandated coverage, penalizing employers who failed to provide it, and creating mechanisms for people to pool risk and buy insurance collectively.

Further the Act stated: 1) all individuals not covered by an employer sponsored health plan, Medicare or Medicaid or other public insurance programs such as Tricare to secure an approved private-insurance policy or pay a penalty, unless the individual has a financial hardship or is a member of a recognized religious sect exempted by the Internal Revenue Service and 2) businesses, including larger medical practices which employ 50 or more people but do not offer health insurance to their full-time employees will pay a tax penalty if the government has subsidized a full-time employee’s healthcare through tax deductions or other means.

This is known as the employer mandate. What this means for the provider’s practice is that if the provider is offering healthcare benefits to their staff, the coverage needs to be comparable with the requirements stated in the PP-ACA and if the practice is not offering healthcare benefits, then the practice must direct the individual to one of the Health Insurance Exchanges that are offering individual coverage plans.

More:

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

***

Filed under: Health Insurance, Risk Management | Tagged: ACA, carol s. miller, employer mandate, Federal Healthcare Programs, Health Insurance Exchanges | 3 Comments »

Doctor-Patient RELATIONSHIPS in the MODERN Health 2.0 ERA

Posted on December 18, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

[Can We Talk? – A Collaborative Shift in Bedside Manner]

By Mario Moussa PhD MS

By David E. Marcinko MBBS MBA CMP

By Jennifer Tomasik PhD MS

Jennifer Tomasik

“The single biggest problem in communication is the illusion that it has taken place.”

— George Bernard Shaw

Star Trek fans have seen the future of medicine.

Leonard McCoy, also known as “Bones,” describes himself as a “simple country doctor,” although he plies his trade using 23rd. century medical technology. A deeply caring humanist, Bones often spars with the hyper-logical Spock—half human, half Vulcan. But as the Star Trek saga unfolds through The Next Generation, Deep Space Nine, and finally Voyager, Star Fleet physicians become increasingly rational and less recognizably human. The Voyager’s “Doctor” is no person at all. “He” is an infallible computer program designed to mimic compassion, self-assurance, and other soulful qualities.[i]

Health/Web 2.0

Today, when patients communicate through instant messaging, Twitter, Facebook, and other Health/Web 2.0 electronic mediums, they might feel that health providers are already more like the virtual “Doctor” than the all-too-human “Bones.” Before long, according to one technology expert, 20% – 50% of all doctor-patient communication will be virtual.[ii] But we suggest you pause before rocketing ahead into this brave new future that advocates call Health 2.0—the application of social media tools to the health care environment.

Electronic technology

Electronic technology in all of its forms has obviously had a profound impact on medicine. We focus here on just one of its most notable effects: the changing doctor-patient relationship. We believe Health 2.0 has the potential to deepen this relationship—or not. It depends on how you use it.

There are an almost overwhelming number of social media tools for managing the doctor-patient relationship. How do you choose the right ones? We offer some guidance in this essay by focusing on three issues:

The issues

What matters most in the doctor-patient relationship?
What counts as a good relationship?
How should you use social media tools to build a relationship?

We have found that there is no one best way to use Health 2.0 technology. But there is just one rule. As the novelist E.M. Forster said, “Only connect.”

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masks

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Conclusion

Petrany, Stephen M. “Star Trek and the Future of Family Medicine.” Family Medicine 40.2 (2008): 132 – 133.
Silverman, Jennifer. “Impact of Virtual Visits on Doctor-Patient Relationship Unclear: an end to ‘true medicine’?” Ob.Gyn. News 38.21 (2003): 29.

***

[PRIVATE MEDICAL PRACTICE BUSINESS MANAGEMENT TEXTBOOK – 3rd. Edition]

[Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]

***

Filed under: Ethics, Practice Management, Pruitt's Platform | Tagged: bedside manner, Jennifer Tomasik PhD, Mario Moussa PhD, Patient RELATIONSHIPS in the MODERN Health 2.0 ERA | 5 Comments »

Does organic food cause autism? Could Nicolas Cage movies make you more likely to drown? Six ways to misuse statistics

Posted on December 17, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

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Biostatistics Model

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Filed under: iMBA, Inc. | 1 Comment »

The “Perfect” Holiday Gift for your Favorite Doctor – YES REALLY!

Posted on December 17, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

http://www.CertifiedMedicalPlanner.org

Now, is the perfect time of year to consider one, or all, of these texts as the perfect holiday gift for your favorite doctor, or allied health care professional.

Also, may be used as a client-prospecting tool for Financial Advisors, Wealth and Practice Managers, and CPAs, etc.

Smile, learn and prosper with iMBA in 2016.

*** holiday_gift ***

Last Generation Holiday Gift for MDs

***

RECENT BOOKS FROM iMBA, Inc.

Next Generation Holiday Gifts for MDs

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Filed under: Book Reviews, Financial Planning, iMBA, Inc., Insurance Matters, Practice Management, Recommended Books, Retirement and Benefits | Tagged: Financial Planning, Holiday gifts, Investing, medical practice management, wealth management | Leave a comment »

Newer Thoughts on Long Term Care Insurance

Posted on December 16, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Most LTCI policies are SOLD… not Bought!

By Dr. David Edward Marcinko MBA CMP™

To be sure, physicians and Financial Advisors are aware that there is a sometime need to recommend a LTCI policy to clients. Of course, in such cases, it is a good idea to work with a low load provider (or the physician or client’s agent).

The Need?

Yet, most LTCI policies are sold by insurance agents for big commissions; not bought, and that most statistics used to sell LTCI policies are fear-based and half-truths. I know, as I was a licensed insurance agent for more than a decade.

Even the Department of Health and Human Services [DHHS] gets into the fear mongering on their website quoting that “about 70 percent of people over age 65 require some type of long-term care services during their lifetime”

Source: http://www.longtermcare.gov/LTC/Main_Site/Planning/Index.aspx

Department of Health and Human Services

This may be a deceptive statistic as it omits the length of long-term care needed in these 70% of cases. And, it is not 3+ years in all these cases [our estimate is closer to 2.5]. With the stamp of approval by the Supreme Court of the United States SCOTUS on the PP-ACA, we may be looking at social LTCI in the US like other social medicine countries and give up on private LTCI insurance altogether.

Other Countries

Germany introduced mandatory long-term care insurance in 1995. Japan and France also have a LTCI tax funded insurance plan. And, the poor utilization and growing risks associated with long-term care insurance, are leading a growing number of insurance agents, financial advisors and Certified Medical Planners™ to recommend alternatives to their clients.

***

Assessment

To be a thought-leader ahead of the curve, the newest aging trend is away from LTCI and toward sheltering at home – living at home and dying at home. Perhaps, this is the way it should be.

Dying should not be a for-profit industry.

http://www.CertifiedMedicalPlanner.org

More:

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]

***

Filed under: CMP Program, Ethics, Health Insurance, iMBA, Inc., Research & Development, Retirement and Benefits, Touring with Marcinko | Tagged: David E. Marcinko, long term care insurance, LTCI | 2 Comments »

Peri-Operative MEs and ADEs

Posted on December 14, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

One in Twenty [1/20]

By http://www.MCOL.com

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ImageProxy

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

[HEALTH INSURANCE, MANAGED CARE, ECONOMICS, FINANCE AND HEALTH INFORMATION TECHNOLOGY COMPANION DICTIONARY SET]

[Mike Stahl PhD MBA] *** [Foreword Dr.Mata MD CIS] *** [Dr. Getzen PhD]

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Filed under: Drugs and Pharma, Quality Initiatives | Tagged: ADEs, Drugs, MEs, pharma, www.MCOL.com | 1 Comment »

Deception in the Financial Service Industry

Posted on December 13, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

ME-P Special Report

Continue reading →

Filed under: Ethics, Experts Invited, Financial Planning | Tagged: Deception in the Financial Service Industry, fiduciary advisor, fiduciary oath, Financial Planning, Lon Jefferies MBA CFP® | Leave a comment »

Healthcare Costs for 7 Primary Care Consumer Markets

Posted on December 12, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Total Annual Spending / Per Capita

By http://www.MCOL.com

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ImageProxy

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More:

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

[PRIVATE MEDICAL PRACTICE BUSINESS MANAGEMENT TEXTBOOK – 3rd. Edition]

[Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]

***

Filed under: Health Economics, Practice Management | Tagged: healthcare costs, mcol.com, Primary Care Consumer Markets | 4 Comments »

Three common misunderstandings and reality checks about the ACA’s Cadillac tax

Posted on December 11, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Beginning in 2018

[By Grant Thornton]

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3-misconceptions-about-the-affordable-care-acts-cadillac-tax-1-638

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

[PRIVATE MEDICAL PRACTICE BUSINESS MANAGEMENT TEXTBOOK – 3rd. Edition]

[Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]

***

Filed under: Health Insurance, Taxation | Tagged: ACA, ACA's Cadillac tax | 8 Comments »

Core Universal Concepts about Wealth Preservation and Asset Protection for Doctors

Posted on December 10, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

By Ike Devji JD PC

Understanding these Four Core Concepts

Think of asset protection they way you teach patients about wellness.

It’s a system and lifestyle that requires some discipline and good habits in four core areas:

A culture of good habits, procedures, accountability and compliance

Avoiding or eliminating higher risk behavior often starts with having good, professionally drafted, legally compliant policies and procedures on a variety of risk management issues and consistently implementing and enforcing them uniformly. There is no more dangerous and ineffective manager than one who is conflict averse or who wants to be everyone’s friend. Leadership requires that you help everyone be and do their best by managing them actively and creating expectations and boundaries.

Proactively managing all your predictable risks, not just those related to medical malpractice

We won’t dwell on this issue beyond noting that medical malpractice lawsuits are still a real threat and no matter what various experts tell you about statistics, how many actually go trial, or future reductions due to the PP-ACA, etc.; we all have seen the devastating first hand effects of these claims. And, no matter how remote a risk may be;: what if it is you? Are you emotionally, legally and financially prepared[i] for a adverse claim or judgment that could potentially stop your income, cost you your hospital privileges or practice, trigger a payer audit and/or take seven figures off your life’s work and net worth? Most physicians are not.

That said, malpractice liability is not the only, or even the most predictable and recurring exposure you face. You are a physician, but you are also potentially an executive, a parent, a business owner, a compliance officer, a breadwinner, the driver of vehicle, the owner of a home; and wear a variety of other hats you may not even think about. Having experienced help in properly identifying as many of these other, non profession liability risks as possible, and addressing them proactively both personally and professionally is a key part of any defensive strategy.

Insurance, all the right kinds and in the right amounts

Insurance needs to be thought of as an “insurance program”, not a line item, and works as a system of overlapping coverage. Most physicians have an overly simplified vision of what they should have in place, mainly some form of professional liability insurance typically a “1-3” policy meaning $1-MM per occurrence policy with a $3-MM aggregate. Many attorneys advise physicians to buy, “Every dollar you can afford, then have a back-up plan.” This goes far beyond your professional liability or malpractice insurance and includes half a dozen or more varieties of specialty insurance that can be well covered with the help of a top-notch property and casualty (P&C) insurance agent. A word of caution, having an asset protection plan consisting of putting defensive legal tools in place without the complimentary insurance, commonly known as “going bare”, is never the best idea and if nothing else, subjects you to the exposure of massive legal fees for defense costs which are easily six figures.

Defensive legal structures

There will inevitably be gaps in the number of things that can be covered or the dollar limit to which you can insure yourself. Do not ever rely on your “umbrella” policy alone as effective universal coverage. This is where all the trusts, LLCs, partnerships, corporate structures and estate-planning techniques attorneys are fond of and come into play. You must have good policies and procedures with insurance against instances in case those fail, and have a backup plan if the first two layers fail.

Remember that asset protection is fact specific and use your facts. Every doctor seeking asset protection must have a thorough review of his/her own assets, have his/her personal and professional risks identified and have tools and solutions implemented by a qualified and experienced professional.

In other words, the familiar pattern of examination, diagnosis and then personalized treatment. There may be a reasonable and proven course of treatment for any particular problem, but your advisors should always know what the problems are before they start proposing specific solutions.

[i] The Physician’s (and Business Owner’s) Asset Protection Self Exam: http://www.proassetprotection.com/2012/05/the-physicians-simple-asset-protection-self-exam/

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]

***

Filed under: Health Law & Policy, Professional Liability, Risk Management | Tagged: asset protection MDs, Ike Devji JD, medical malpractice, Professional Liability MDs, Risk management MDs | 1 Comment »

More on Texting in Medicine and HIPAA

Posted on December 9, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

Clarifying the Confusion about HIPAA

A Special ME-P Report

[By Carol S. Miller RN MBA PMP]

millerconsultgroup@gmail.com

Texting is Ubiquitous

Text Messing (or SMS) Messaging has become nearly ubiquitous on mobile devices. According to one survey, approximately 72 percent of mobile phone users send text messages. Clinical care is not immune from the trend, and in fact physicians appear to be embracing texting on par with the general population. Another survey found that 73 percent of physicians text other physicians about work.

(Source: Journal of AHIMA, “HIPAA Compliance for Clinician Texting”, by Adam Green, April 2012)

Texting can offer providers numerous advantages for clinical care. It may be the fastest and most efficient means of sending information in a given situation, especially with factors such as background noise, spotty wireless network coverage, lack of access to a desktop or laptop, and a flood of e-mails clogging inboxes. Further, texting is device neutral—it will work on personal or provider-supplied devices of all shapes and sizes. Because of these advantages, physicians may utilize texting to communicate clinical information, whether authorized to do so or not.

Risk Levels

All forms of communication involve some level of risk. Text messaging merely represents a different set of risks that, like other communication technologies, needs to be managed appropriately to ensure both privacy and security of the information exchanged.

Text messages may reside on a mobile device indefinitely, where the information can be exposed to unauthorized third parties due to theft, loss, or recycling of the device. Text messages often can be accessed without any level of authentication, meaning that anyone who has access to the mobile phone may have access to all text messages on the device without the need to enter a password.

Texts also are generally not subject to central monitoring by the IT department. Although text messages communicated wirelessly are usually encrypted by the carrier, interception and decryption of such messages can be done with inexpensive equipment and freely available software (although a substantial level of sophistication is needed. If text messages are used to make decisions about patient care, then they may be subject to the rights of access and amendment. There is a risk of noncompliance with the privacy rule if the covered entity cannot provide patients with access to or amend such text messages.

According to 2012 data from CTIA–The Wireless Association, U.S. citizens alone exchange nearly 200 billion text messages every month. So it’s not surprising that an increasing number of clinicians are using text messaging to exchange clinical information, along with a wide range of other modes — smartphones, pagers, computerized physician order entry, emails, etc. Electronic communication is certainly faster, can be more efficient, enhances clinical collaboration and enables clinicians to focus on patient care. But with these benefits comes an increased risk of security breaches.

(Source: Clarifying the Confusion about HIPAA – Compliant Texting, by Megan Hardiman and Terry Edwards, May 2013)

***

Hype over the Health Insurance Portability and Accountability Act

Unfortunately, vendor hype about the Health Insurance Portability and Accountability Act is causing many hospitals and health systems to implement stop-gap measures that address part — but not all — of a problem. To identify all vulnerabilities, health care leaders need to consider not only text messaging, but all mechanisms by which protected health information in electronic form is transmitted — as well as the security of those mechanisms.

Mobile device-to-mobile device SMS text messages are generally not secure because they lack encryption. The sender does not know with certainty that his or her message is indeed received by the intended recipient. In addition, telecommunications vendor/wireless carrier may store the text messages. Recent HHS guidance indicates text messaging, as a means of communicating PHI, can be permissible under HIPAA depending in large part on the adequacy of the controls used. A hospital or provider may be approved for texting after performing a risk analysis or implementing a third-party messaging solution that incorporates measures to establish a secure communication platform that will allow texting on approved mobile devices.

A study reported in Computer World in May 2013 by the Ponemon Institute with 577 healthcare and It professional in facilities that ranged from fewer than 100 beds to over 500 beds stated that fifty-one percent of the respondents felt HIPAA compliance requirements can be a barrier to providing effective patient care. Specifically HIPAA reduces time available for patient care (85% of the respondents), makes access to electronic patient information difficult (79% of the respondents) and restricts the use of electronic mobile communications (56% of the respondents).

The study stated “respondents agreed that the deficient communications tools currently in use decrease productivity and limit the time doctors have to spend with patients. “ They also stated “they recognized the value of implementing smartphones, text messaging and other modern forms of communications, but cited overly restrictive security policies as a primary reason why these technologies were not used.” Clinicians in the survey stated that only 45% of each workday is spent with patients; the remaining 55% is spent communicating and collaborating with other clinicians and using the electronic medical record and other clinical IT systems.

Several other statements:

Because of the need for security, hospitals and other healthcare organizations continue to use older, outdate technology such as pagers, email and facsimile machines. The use of older technology can also delay patient discharges – now taking an average of 102 minutes.
The Ponemon Institute estimated that the lengthy discharge process costs the U.S. hospital industry more than $3.189 billion a year in lost revenue, with another $5 billion lost through decrease doctor productivity and use of outdated technology. Secure text messaging could cut discharge time by 50 minutes.

(Source: Computer World, “HIPAA rules, outdate tech cost U.S. hospitals $3.38 B a year”, by Lucas Mearian, May, 2013)

***

Suggestions

Several suggestions offered for these preferred mobile devises are: 1) ensure encryption and access to individuals who need to have access; 2) use secure texting applications; and 3) even consider alerting employees with warnings before they send an email or share files that lets them know they are liable for the information sent.

More:

About

Ms. Carol S. Miller has an extensive healthcare background in operations, business development and capture in both the public and private sector. Over the last 10 years she has provided management support to projects in the Department of Health and Human Services, Veterans Affairs, and Department of Defense medical programs. In most recent years, Carol has served as Vice President and Senior Account Executive for NCI Information Systems, Inc., Assistant Vice President at SAIC, and Program Manager at MITRE. She has led the successful capture of large IDIQ/GWAC programs, managed the operations of multiple government contracts, interacted with many government key executives, and increased the new account portfolios for each firm she supported. She earned her MBA from Marymount University; BS in Business from Saint Joseph’s College, and BS in Nursing from the University of Pittsburgh. She is a Certified PMI Project Management Professional (PMP) (PMI PMP) and a Certified HIPAA Professional (CHP), with Top Secret Security clearance issued by the DoD in 2006. Ms. Miller is also a HIMSS Fellow.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

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Filed under: Information Technology, Risk Management | Tagged: Carol S. Miller RN, Computer World, HIPAA, Ponemon Institute, texting and HIPAA, texting in medicine, The Wireless Association | 1 Comment »

Update on the FOMC and Interest Rates

Posted on December 7, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

What if the Fed DOESN’T Raise Rates?

By Michael A. Gayed CFA

***

With odds high for the Federal Reserve’s first rate hike in nearly a decade, and seemingly everyone predicting that rising rates are coming in the next few weeks, why in the world is the yield curve not steepening aggressively?

Something curious is happening

There is a mistaken notion out there that if the Fed raises rates, the cost of capital on everything is going to rise. This is far too simplistic a way of viewing the bond market. If the Fed raises rates and the market perceives it as being too early, then longer duration bond yields likely would actually fall and credit spreads likely would widen. In other words, some rates could fall because the Fed is raising short rates.

***

In a healthy environment, Fed hiking would coincide with a steepening yield curve, as growth and inflation expectations become more aggressively priced in. As of late, it seems as though the bond market vastly disagree with the Fed’s December timing.

Of course all this could change, as probabilities continuously change

So, if the Fed decides not to raise rates, and the yield curve continues to flatten, then something very serious may be underway in terms of 2016 economic expectations. It does seem plausible that from a cycle perspective, the era for passive buy and hold investing in large-cap stocks is nearing its end, allowing for more active alpha opportunities to present themselves.

This would likely translate into more volatility in equities, which we believe our alternative Morningstar 4 Star overall rated ATAC Inflation Rotation Fund (Ticker: ATACX, rating as of 9/30/15 among 234 Tactical Allocation Funds derived from a weighted average of the fund’s 3-year risk-adjusted return measures) is distinctly qualified to handle given our focus on being defensive in Treasuries at the right time.

Having said that, despite my own personal believe the Fed will raise rates, it is concerning to see how longer duration bonds are behaving.

The key needs to be a comeback in commodities and emerging market stocks

For the yield curve in the United States to steepen, and for the Federal Reserve to “get it right,” likely a surprise recovery is needed in cyclical growth sentiment. Commodities and emerging markets are among the most sensitive areas of the investable landscape to that, so it stands to reason that their movement would show the whites of the eyes of that happening. The issue however is that every time is looks like budding momentum is about to become more entrenched, that momentum quickly reverses and creates a false positive on rising growth expectations.

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gears

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Recent manufacturing data confirms that not much has changed on the growth side of the equation. So far, broader equities seem to not care given historically favorable December seasonality. That doesn’t mean one should not be considering this in an overall asset allocation policy.

Complicating-The European Central Bank

In many ways, crushing the Euro through more stimulus has the same effect as Federal Reserve tightening precisely because a rising Dollar is a contractionary force to exports. European stimulus is Fed tightening IF it results in a Dollar super-spike. Should that occur, the Fed would be more likely that not to not raise rates and actually do another round of stimulus.

Assessment

Insane sounding? Maybe. But; so is an environment where no amount of money printing seems to be accelerating the economy.

ABOUT

The ATAC Rotation Mutual Funds are managed by Pension Partners, LLC, an independent registered investment advisor. The strategies were developed by Co-Portfolio Managers Edward M. Dempsey, CFP® and Michael A. Gayed, CFA. The Funds rotate offensively or defensively based on historically proven leading indicators of volatility, with the goal of taking less risk at the right time.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

****

Filed under: Health Economics, iMBA, Inc., Investing, Practice Management, Recommended Books | Tagged: FOMC, interest rates, IRS, Michael A. Gayed CFA | 5 Comments »

Proposing a Possible [San Bernardino CA] Medical Work Place Violence Prevention Initiative?

Posted on December 5, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

The Haddon Matrix for Health Place Injury Prevention and Workplace Violence

By

[Eugene Schmukler; PhD MBA MEd – Certified Trauma Specialist]

***

An invaluable tool for healthcare violence prevention program establishment is the Haddon Matrix. In 1968, William Haddon, Jr., a public health physician with the New York State Health Department, developed a matrix of categories to assist researchers trying to address injury prevention systematically. The idea was to look at injuries in terms of causal factors and contributing factors, rather than just using a descriptive approach. It is only recently that this model has been put to use in the area of workplace violence.

The Matrix Framework

The matrix is a framework designed to apply the traditional public health domains of host, agent, and disease to primary, secondary, and tertiary injury factors. When applied to workplace violence, the “host” is the victim of workplace violence, such as a nurse. The “agent” is a combination of the perpetrator and his or her weapon(s) and the force with which an assault occurs. The “environment” is divided into two sub domains: the physical and the social environments. The location of an assault such as the ER, the street, an examining room, or hospital ward is as important as the social setting in patient interaction, presence of co-workers, and supervisor support.

Modifications

Subsequent versions of the matrix divide the environment into Physical environment and Social, Socio-economic, or Sociocultural environment. Each factor is then considered a pre-event phase, an event phase, and a post-event phase.

***

sad

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Medical / Healthcare Setting

The Haddon Matrix lends itself to a medical setting in that it uses a classical epidemiological framework to categorize “pre-event,” “event,” and “post-event” activities according to the infectious disease vernacular, host (victim), vector (assailant or weapon), and environment. The strength of the Haddon Matrix is that it includes the ability to assess “pre-events” or precursors in order to develop primary preventive measures.

Phases	Host	Agent	Physical Environment	Social Environment
Pre-event (prior to assault)	Knowledge Self-efficacy Training	History of prior violence communicated	Assess objects that could become weapons, actual weapons, egress (means of escape)	Visit in pairs or with escort
Event (assault)	De-escalation Escape techniques Alarms/2-way phones	Reduce lethality of patient via increasing your distance	Egress, alarm, cell phone	Code and security procedures
Post-event (post-assault)	Medical care/counseling Post-event debriefing	Referral Law enforcement	Evaluate role of physical environment	All staff debrief and learn Modify plan if appropriate

Policy?

From the perspective of administration, the Haddon Matrix does not implicate policy. This means that the matrix does not necessarily guide policy. When implemented, the Haddon Matrix can be a “politically” neutral, trans-or multi-disciplinary, objective tool that identifies opportunities for intervention. Furthermore, it outlines sensible “targets of change” for the physical and social environment.

Phase	Affected individual and population	Agent used	Environment
Pre-event	Psychological first aid	Communicate efforts to limit action	Have plans in place detailing agency roles in prevention and detection
Event	Population uses skills	Mobilize trauma workers	Communicate that response systems are in place
Post-event	Assessment, triage, and psychological treatment	Communicate, establish outreach centers	Adjust risk communication
End results	Limit distress responses, negative behavior changes and psychological illness	Minimize loss of life and impact of attack	Minimize disruption in daily routines

More: Was the San Bernardino CA Massacre Work Place Violence?

***

Assessment

And so, was San Bernardino workplace violence – or not; please opine?

Conclusion

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***

Filed under: Ethics, Practice Management, Professional Liability, Risk Management | Tagged: assault, ER, Eugene Schmuckler PhD, gene schmuckler, Haddon Matrix, healthplace injury, medical assault, medical battery, medical workplace violence, William Haddon MD, workplace violence | 5 Comments »

Was the San Bernardino CA Massacre Work Place Violence?

Posted on December 4, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

ASSESSMENT OF WORKPLACE VIOLENCE … A HEALTHCARE P.O.V.

By Eugene Schmuckler PhD MBA MEd CTS
By Dr. David Edward Marcinko MBA MBBS

What Really Is Workplace Violence?

Workplace violence is more than physical assault — it is any act in which a person is abused, threatened, intimidated, harassed, or assaulted in his or her employment. Swearing, verbal abuse, playing “pranks,” spreading rumors, arguments, property damage, vandalism, sabotage, pushing, theft, physical assaults, psychological trauma, anger-related incidents, rape, arson, and murder are all examples of workplace violence.

Registered Nurses Association of Nova Scotia

The Registered Nurses Association of Nova Scotia defines violence as “any behavior that results in injury whether real or perceived by an individual, including, but not limited to, verbal abuse, threats of physical harm, and sexual harassment.” As such, workplace violence includes:

threatening behavior — such as shaking fists, destroying property, or throwing objects;
verbal or written threats — any expression of intent to inflict harm;
harassment — any behavior that demeans, embarrasses, humiliates, annoys, alarms, or verbally abuses a person and that is known or would be expected to be unwelcome. This includes words, gestures, intimidation, bullying, or other inappropriate activities;
verbal abuse — swearing, insults, or condescending language;
muggings — aggravated assaults, usually conducted by surprise and with intent to rob; or
physical attacks — hitting, shoving, pushing, or kicking.

Non-work Related Situations

Workplace violence can be brought about by a number of different actions in the workplace. It may also be the result of non-work related situations such as domestic violence or “road rage.” Workplace violence can be inflicted by an abusive employee, a manager, supervisor, co-worker, customer, family member, or even a stranger.

University of Iowa Injury Prevention Research Center

The University of Iowa Injury Prevention Research Center classifies most workplace violence into one of four categories.[1]

Type I Criminal Intent — Results while a criminal activity (e.g., robbery) is being committed and the perpetrator had no legitimate relationship to the workplace.
Type II Customer/Client — The perpetrator is a customer or client at the workplace (e.g., healthcare patient) and becomes violent while being assisted by the worker.
Type III Worker on Worker — Employees or past employees of the workplace are the perpetrators.
Type IV Personal Relationship — The perpetrator usually has a personal relationship with an employee (e.g., domestic violence in the workplace).

***

Assessment

And so, was San Bernardino workplace violence – or not; please opine?

More:

ABOUT

Dr. Eugene Schmuckler was Coordinator of Behavioral Sciences at a Public Training Center before accepting his current position as Academic Dean for iMBA, Inc. He is an international expert on personal re-engineering and coaching whose publications have been translated into Dutch and Russian. He now focuses on career development, change management, coaching and stress reduction for physicians and financial professionals. Behavioral finance, life planning and economic risk tolerance assessments are additional areas of focus. Formerly, Dr. Schmuckler was a senior adjunct faculty member at the Keller Graduate School of Management, Atlanta. He taught courses in Organizational Behavior and Leadership, Strategic Staffing, Training and Development, and the capstone course in human resources management. He is a member of a number of professional organizations including the American Psychological Association, the Academy of Management, and the Society for Human Resource Management. A native of Brooklyn New York, he received his BS degree in Psychology from Brooklyn College. He earned his MBA and PhD degrees in Industrial and Organizational Psychology from Louisiana State University. Currently, he serves on the executive BOD for: www.MedicalBusinessAdvisors.com and is the Dean of Admissions for www.CertifiedMedicalPlanner.org

Conclusion

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[1] Cal/OSHA, 1995; UIIPRC, 2001. 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

***

Filed under: Breaking News, Research & Development, Risk Management | Tagged: David Edward Marcinko, Eugene Schmuckler, San Bernardino CA Massacre, Work Place Violence | 2 Comments »

About the lack of ePHI encryption in transmission and at rest?

Posted on December 3, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

e-Patient Health Information is Vulnerable!

[By Shahid N. Shah MS]

ePHI is vulnerable to be compromised in all the states it is in. Whether it is at rest (in databases and files), or in motion (being transmitted through networks), or in use (being updated, or read), or is disposed (discarded paper files or electronic storage media).

An extra layer of security

Using encryption puts an extra layer of security to ePHI because even if someone gains access or reads ePHI, if it is encrypted then the chances of ePHI getting compromised diminishes. It makes the data unreadable and unusable by unauthorized persons. When ePHI is transmitted through networks, it is possible that it will be accessed by unauthorized persons, thus compromising ePHI. These type of unauthorized access hacking may not be immediately known, but can cause many damages.

Major Mitigation

ePHI should be encrypted and there must also be reasonable and appropriate mechanisms in place to prevent access to ePHI so that it is not accessed by persons or software programs that have not been granted access rights.

There are many different encryption methods and technologies to encrypt data in motion (SSL, VPN) or at rest.

So, choose the methods and technologies that best meet the physician’s office requirements.

***

Success criteria

A risk analysis/assessment reports will provide a clear indication of whether these type of risks exists or has been mitigated with appropriate controls.

Assessment

Auditing logs that track access to ePHI can be verified periodically to check if there has been unauthorized access by persons or software programs that have not been granted access rights.

More:

About: Meet Shahid N. Shah MS [Our Newest IT Thought-Leader]

Conclusion

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[Mike Stahl PhD MBA] *** [Foreword Dr.Mata MD CIS] *** [Dr. Getzen PhD]

***

Filed under: Information Technology | Tagged: EHR encryption, ePHI, HIT, Shahid N. Shah MS, SSL, VPN | 3 Comments »

APHA – Giving Tuesday

Posted on December 1, 2015 by Dr. David Edward Marcinko MBA MEd CMP™

ImageProxy

Dear Dr. David Marcinko,

#GivingTuesday is the global movement dedicated to giving back. It kicks off the holiday giving season and I hope you will join me by making a contribution to APHA.

Please consider making a donation in two areas where we need your help the most:

APHA general fund – allows APHA to continue producing timely reports and webinars on the health impacts of climate change, racism, transportation and so much more.
Leadership Challenge $15,000 matching grant campaign – supports student scholarships to attend the APHA Annual Meeting.

Your donation makes you part of Generation Public Health, APHA’s movement to create the healthiest nation in one generation. With your generous contribution we can continue to support the groundbreaking work of public health professionals and help turn today’s students into tomorrow’s leaders.

After you make your donation, please share on Facebook, Twitter, Instagram and other social media that you donated on #GivingTuesday and joined #GenerationPublicHealth.

Thank you for all that you do to support APHA!

Sincerely,
Dr. B Signature
Georges C. Benjamin, MD
[Executive Director]

Filed under: Career Development, Ethics | Tagged: APHA - Giving Tuesday, Generation Public Health, Georges C. Benjamin, MD | Leave a comment »

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