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Human Nature, Medical Ethics and Modern Principles

  • By David Edward Marcinko FACFAS CMP® MBA MBBS
  • By Render S. Davis MHA CAE
  • By Hope Rachel Hetico RN MHA CPHQ CMP®
  • By Gary A. Cook EJD CFP® CLU RHU MSFS CMP®

In any textbook of gravitas on medical risk management, asset protection and insurance planning, a chapter on human nature is usually placed at the end of the book, or as an appendix, or an afterthought if included at all.

However, we elected to prominently place this material as the premier chapter of our textbook.


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



In the end, the success of any risk management endeavor ultimately comes down to changing human behavior – helping a doctor/nurse/technician alter whatever s/he was doing toward something that will better allow them to avoid errors and pursue quality care and practice management goals.

Yet, there is still remarkably little education or training for medical professionals focused directly on motivation or change theory, in any related area except psychiatry/psychology or perhaps professional liability.

Instead, doctors are increasingly turning to professional consultants to learn best practices on how to help them actually make the behavioral changes necessary to achieve their quality improvement and risk reduction goals; as we attempt to answer these questions.

The Queries:

  • Are you and your medical practice, or clinical, ready for change?
  • How to transition from [traditional] solo practitioner B-models to modern forms?
  • What are leadership, management and governance?
  • In group practices, how is leadership shared?
  • What issues need be considered when hiring a practice administrator or clinic CEO?
  • What is medical ethics and munificence? Why is it needed? How does it work?
  • What are the types of risk?
  • How are risks managed in the medical practice space?




Leadership Shortcomings

In addition, medical practitioners need to strive to avoid what Zenger and Folkman describe as the 10 most common leadership shortcomings based on a survey of 11,000 leaders. They include:

  • Lacks energy and enthusiasm
  • Accepts mediocre self performance
  • Lacks clear vision and direction
  • Poor judgment
  • Not collaboration
  • Not following standards
  • Resistant to new ideas
  • Doesn’t learn from mistakes
  • Lacks interpersonal skills
  • Fails to develop others.

Source: Zenger and Folkman: The Daily Stat: The 10 Most Common Failures of Business Leaders, Harvard Business Publishing, June 4, 2009. 



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


2 Responses

  1. Have you done your risk assessment, Doc?

    “Lack of Risk Assessment Key in UWM $750-K HIPAA Settlement”
    [By Elizabeth Snell on December 15, 2015]


    “The University of Washington Medicine (UWM) recently agreed to a $750,000 fine as part of a HIPAA settlement, which was the result of a 2013 incident. UWM filed a breach report to OCR November 27, 2013, where an email containing malicious malware reportedly compromised 90,000 individuals’ ePHI.”

    Perhaps it would be wise to list ransomware in the risk assessment, and how one intends to mitigate the loss… Such as paying the ransom (one or more times). Any better idea?

    The fines for not having prepared a risk assessment will always be more expensive than quietly surrendering to extortion. That is how extortion works. Unlike HHS, successful parasites don’t kill their hosts.

    D. Kellus Pruitt DDS



    The overarching issue will be that of shifting from fee for service to value based payments.

    While some providers are still awaiting a turnaround in Obamacare or are trying to eke out the last remaining fee for service payments in their area they may be doing a great disservice to themselves and their organization because the market will shift (and is shifting) right under their feet with the competitor who is taking the lead in market share and margin opportunity.

    The cognitive shift for most hospitals in preparing for this transformation is that it takes a lot of planning and resource allocation of human as well as technology capital. The ACA was described as “the biggest homework assignment hospitals have ever had” and for those who did the homework, they are thinking in terms of:

    1) Network environment for a broad continuum of services (not just acute care) this includes prescription drugs, home health, rehab and mental health.

    2) Data Network thinking is a start because you are now able to manage the continuum in order to get to the data. The data is still dirty and noisy because it’s still mostly billing and charge data not clinical measures and outcomes. People will point to shiny objects and solve one or two big cases before they get out of hand as being their medical management strategies but we are finding in the ACO world is doing a lot of little things correctly and consistently.

    3) Risk Score By managing the continuum and the consistency of outcome you can change the patient risk score which then measures some opportunity for savings through improvement. It’s not cost cutting, it’s managing the patients better that will create the best savings opportunity in a value based environment.

    For small to medium sized hospitals and medical groups the ability to take full risk is very hard to manage. There may not even be a large enough headcount to define a meaningful outcome and clinical guideline. Collaboration at the contracting level with payers and Medicare will force each community to then see regional results and make best use of their resources and capacity.

    The true post reform environment will be most manageable for those who started doing the groundwork in 2012, thinking in terms of network, good data, and risk adjusters that are the foundation for the new model of care. But getting started now gives you a chance to build on your current resources. Having a plan for full integration must be laid out and then all deadlines cut in half. Speed of decision-making and a strong, accountable leadership is the order of the day. It is not point A to point B; it’s full throttle point A to Z with multiple stops and variations in between.

    Unlike the past, those coming late to the game will not be gobbled up by the winners; they may be forced to close because they waited too long or while they were speeding down the road with blinders on they missed the turn on the highway and are forever lost looking for the short cut that does not exist in moving to the new model of care and financing.

    William J DeMarco MA CMC
    Pendulum HealthCare Development Corporation


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