CMS Final Rule Brings Transparency to Healthcare Industry

Posted on November 29, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

Healthcare Transparency

By Health Capital Consultants, LLC

On October 29, 2020, the Centers for Medicare & Medicaid Services (CMS) released the Transparency in Coverage final rule. This long-anticipated final rule stems from President Donald Trump’s June 2019 executive order on “Improving Price and Quality Transparency” and builds upon the hospital Outpatient Prospective Payment System (OPPS) price transparency requirements released in November 2019.

 

These requirements came under fire in a lawsuit filed by the American Hospital Association (AHA), Association of American Medical Colleges (AAMC), Children’s Hospital Association (CHA), and Federation of American Hospitals (FAH), against the Department of Health and Human Services (HHS); the requirements were upheld by the courts in June 2020 and the lawsuit is being appealed by the plaintiffs. (Read more…) 

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COMPREHENSIVE FINANCIAL PLANNING FOR PHYSICIANS & ADVISORS 2.0

Posted on November 27, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

COMPREHENSIVE FINANCIAL PLANNING FOR PHYSICIANS & ADVISORS 2.0
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BEST PRACTICES OF LEADING CERTIFIED MEDICAL PLANNERs®
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Thank You
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What is a Corporate Takeover?

Posted on November 25, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

WHAT IS A HOSTILE CORPORATE TAKEOVER?
Courtesy: https://lnkd.in/eBf-4vY

DEFINITION: Corporate shareholder transfer (takeover) against the wishes of management and directors, and usually financed by debt, such as junk bonds (low investment grade debt), and as in a Leveraged Buy-Out (LBO) situation.


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BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:
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THANK YOU
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2021 Prescription Drug Payment Model from HHS

Posted on November 24, 2020 by Dr. David Edward Marcinko MBA MEd CMP™
Administration Announces Prescription Drug Payment Model
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By staff reporters
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HHS Secretary Alex Azar has announced a drug payment model through the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services that will lower Medicare Part B payments for certain drugs to the lowest price for similar countries and save American taxpayers and beneficiaries more than $85 billion over seven years.
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Starting in January, the model, known as the Most Favored Nation (MFN) Model, will test an innovative way for Medicare to pay no more for high cost, physician-administered Medicare Part B drugs than the lowest price charged in other similar countries.
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Following the President’s recent Executive Orders to lower drug prices and improve access to life-saving medications, the MFN Model will protect current beneficiary access to Medicare Part B drugs, make them more affordable, and address the disparity of drug costs between the U.S. and other countries.
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Source: CMS [11/20/20]

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VBC via CMS

Posted on November 21, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

By Staff Reporters

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PATTERNS OF MEDICAL RISKS

Posted on November 21, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

PATTERNS OF PRACTICE RISKS

One of the next big areas of risk that will surface in the near future is the Pattern of Practice Risk.

Pattern of Practice refers to the way that a particular physician practices medicine. With computers, eHRs, standardized diagnosis and treatment codes, and the budgetary restraints inherent in medical practice, it is becoming easy to analyze a physician’s method of practice.

The treatment and diagnosis codes that a physician uses and submits to third party payers can be quantified and compared colleagues in the same or similar specialties. Statistical outliers can be identified. These outliers will then be further audited and required to justify their treatments. If no rational basis exists for the statistical differences, the outlier may find himself the subject of a fraud investigation.

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Tele-Medicine Valuation and Reimbursement

Posted on November 20, 2020 by Dr. David Edward Marcinko MBA MEd CMP™
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By Health Capital Consultants, LLC
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The second installment in this five-part Health Capital Topics series on the valuation of telemedicine will focus on the reimbursement environment for telemedicine.
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Telemedicine is reimbursed based on the services provided through this medium and includes many restrictions on where, how, and by whom services can be conducted. The first installment in this series introduced telemedicine and its increasing importance to, and popularity among, providers and patients. It also discussed the current and future challenges related to telemedicine, many of which hinge upon reimbursement restrictions and regulations. (Read more…)
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Covid-19 Economic Impact in the USA

Posted on November 18, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

Estimated Impacts

By http://www.MCOL.com

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A Real [FREE-MARKET] Hospital Bill

Posted on November 17, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

CIRCA 1969 = Morristown Memorial Hospital, NJ, USA

By Anonymous

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I rotated thru this facility back when I was at Temple University

Dr. David Edward Marcinko MBA

ME-P Editor-in-Chief

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The Nation’s Healthcare System

Posted on November 16, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

It is SICK!

By Nate Kaufman

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ABOUT THE Institute of Medical Business Advisors, Inc

Posted on November 13, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

About iMBA, Inc

By Staff Reporters

iMBA Inc., is a healthcare consulting and financial planning analytics firm specializing in medical practice management and physician alignment.

Our mission is to empower physician colleagues and healthcare organizations to drive clarity, improve performance, and create accountability.

Our team combines a cross-section of skill-sets including public and population health, financial operations, business intelligence, and data science.

And, our diverse background of experience includes advanced academic training, economic and financial research, global marketing, management consulting, and entrepreneurial spirit.

INSTITUTE WEB: www.MedicalBusinessAdvisors.com

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SCHEDULE A MEDICAL PRACTICE & FINANCIAL PLANNING CONSULTATION TODAY!
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For Doctors – By Doctors – Confidential – Video Conference
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DR. DAVID EDWARD MARCINKO MBA CMP®

[Chief Executive Officer]

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CONTACT: MarcinkoAdvisors@msn.com
Thank You
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Corona Virus [Pictorial] Update?

Posted on November 12, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

An Info-Graphic?

By Staff Reporters

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Filed under: Glossary Terms, Health Economics, Health Insurance, Quality Initiatives | Tagged: , , | 1 Comment »

A Veteran’s Suicide in Front of VA Clinic

Posted on November 11, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

Self Immolation

[By staff reporters]

A veteran committed suicide by setting himself on fire in front of a New Jersey VA clinic after staff at the clinic repeatedly failed to ensure he received adequate mental health care, an investigation of the death found.

Department of Veterans Affairs staff canceled an appointment Charles Ingram had in fall 2015 because a provider was unavailable, didn’t follow up to reschedule, and when he walked into the clinic to ask for an appointment, they didn’t schedule it until three months later, the VA inspector general found.

Ingram, a 51-year-old Gulf War veteran, had been approved to receive treatment at a non-VA facility, but no one at VA contacted him or scheduled the appointment.

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https://www.usatoday.com/story/news/politics/2017/11/15/vet-set-himself-fire-after-long-va-waits-appointment-cancellation-investigation-finds/866834001/#:~:text=WASHINGTON%20%E2%80%94%20A%20veteran%20committed%20suicide%20by%20setting,to%20ensure%20he%20received%20adequate%20mental%20health%20

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Continue reading →

Filed under: Ethics, Health Insurance, Health Law & Policy | Tagged: , | 7 Comments »

McCarran–Ferguson Act and Domestic Health Insurance

Posted on November 9, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

The McCarran–Ferguson Act

By Howard Green MD

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The McCarran–Ferguson Act, 15 U.S.C. §§ 1011-1015, is a United States federal law that exempts the business of insurance from most federal regulation, including federal antitrust laws to a limited extent.
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The McCarran–Ferguson Act was passed by the 79th Congress in 1945 after the Supreme Court ruled in United States v. South-Eastern Underwriters Association that the federal government could regulate insurance companies under the authority of the Commerce Clause in the U.S. Constitution and that the federal antitrust laws applied to the insurance industry.
-United States Federal Law
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Health Insurance industry redistributing unlimited cash from patient premiums into the Georgia US Senate run off election to prevent a Democrat Senate Majority from removing the health insurance exemption to Federal antitrust, monopoly, price fixing and collusion McCarran Ferguson laws.

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Product DetailsProduct DetailsProduct Details

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WHAT ARE THE NASDAQ MARKET LEVELS OF SERVICE?

Posted on November 5, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

WHAT ARE THE NASDAQ MARKET LEVELS OF SERVICE?
Courtesy: https://lnkd.in/eBf-4vY

· Level 1 = A single average price quote for those not trading OTC.
· Level 2 = Level 1 plus trade reports, executions, negotiations, networks, clearing; and bid-ask price quotes for all firms and customers.
· Level 3 = Level 1 and 2, plus the ability to enter quotes, execute orders and send information, for and by market-makers.
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3 – https://lnkd.in/ewJPTJs
THANK YOU
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Coronavirus: Where Has All the Health Economics Gone?

Posted on November 4, 2020 by Dr. David Edward Marcinko MBA MEd CMP™

Coronavirus: Where Has All the Health Economics Gone?

By: Cam Donaldson

By: Craig Mitton

LINK: Corona Economics

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Filed under: Health Economics | Tagged: , , | 1 Comment »

2019 MSSP Performance Results

Posted on November 2, 2020 by Dr. David Edward Marcinko MBA MEd CMP™
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By Health Capital Consultants, LLC
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On September 14, 2020 the Centers for Medicare & Medicaid Services (CMS) released the financial and quality performance results for the Medicare Shared Savings Program (MSSP) Performance Year (PY) 2019. The results revealed record net savings of $1.19 billion for Medicare, marking the third consecutive year of net savings.
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Most significantly, included in these results are the first six months of performance for accountable care organizations (ACOs) that enrolled in the MSSP under one of the Pathways to Success models that commenced in July 2019. These results provided the first look at ACO performance under the new, controversial model. (Read more…)
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