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An iMBA Inc., Review


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[By Dr. David Edward Marcinko CMP® MBA]


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.




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.


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.


 train station


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. 


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


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




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

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



2 Responses

  1. How Should Errors In the Patient Medical Record Be Addressed?

    Coincidentally, I just found this essay By PETER ELIAS, MD.

    This summer an article in USA Today talked about Regina Holliday’s efforts to make the medical record more easily and promptly available to patients so it becomes as a tool patients use as they engage in co-managing their own care. Her cause is just and her story is compelling, so I was dismayed at the pushback saying: Not so fast. There are lots of errors and ambiguities in the record, so it is in everyone’s best interest to make the record hard for patients to obtain.

    MORE: http://thehealthcareblog.com/blog/2015/12/30/how-should-errors-in-the-patient-medical-record-be-addressed/

    What a concept!

    Hope Hetico RN MHA


  2. HHS Reinforces Limits on Fees for Patient Medical Records

    The Office of Civil Rights (OCR) in the Department of Health and Human Services (HHS) has released new guidance about patients’ rights to obtain their medical records and how much providers can charge them for copies. The new interpretations, presented in a “frequently asked questions (FAQ)” format, may force some practices to change their policies. OCR’s guidance interprets the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA). It is OCR’s responsibility to enforce the HIPAA Privacy Rule by sanctioning or fining practices.

    According to OCR, copying fees should be reasonable. They may include the cost of labor for creating and delivering electronic or paper copies; the cost of supplies, including paper and portable media such as CDs or USB drives; and the cost of postage when copies of records are mailed to patients at their request. But OCR specifically stated, “Labor for copying does not include costs associated with reviewing the request for access; or searching for and retrieving the PHI [personal health information], which includes locating and reviewing the PHI in the medical or other record, and segregating or otherwise preparing the PHI that is responsive to the request for copying.”

    Source: Ken Terry, Medscape News [3/1/16] via Dr. Allen Jacobs and PMNews March 07, 2016 #5,615


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