CMS Final Rule Brings Transparency to Healthcare Industry

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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WHAT IS COMMON STOCK “PAR” VALUE?

WHAT IS COMMON STOCK “PAR” VALUE?

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DEFINITION:

For common stock, the value on the books of the corporation. It has little to do with market value or even the original price of shares at first issuance. The difference between par and the price at first issuance is carried on the books of a corporation as “paid-in capital” or “capital surplus.”

Par value for preferred stocks is also liquidating value and the value on which dividends (expressed as a percentage) are paid, generally $100 per share.

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COMPREHENSIVE FINANCIAL PLANNING FOR PHYSICIANS & ADVISORS 2.0

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

WHAT IS A HOSTILE CORPORATE TAKEOVER?
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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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2021 Prescription Drug Payment Model from HHS

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]

VBC via CMS

By Staff Reporters

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PATTERNS OF MEDICAL RISKS

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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New C-Suite Title Innovations

Who’s Reaching the C-suite in 2020?

A new analysis by LinkedIn’s Economic Graph team shows the fastest-growing “chief” titles of this year.

Chief diversity officer tops the list: Hiring for the title has grown about 84% as a proportion of total C-suite hires this year, relative to 2019’s share. While that’s the fastest expansion of any C-suite job this year, the title itself is still relatively uncommon in corporate America, accounting for less than half of 1% of all C-suite hires.

Chief growth officers — which often combine oversight of marketing, strategy and other functions — have also been in high demand. The title has been popular for a long time among consumer products companies, but it’s now popping up more often at tech companies.

Others on the list include chief underwriting officer (+43%) and chief revenue officer (+29%), as well as roles focused on people and talent. Regardless of the specialty, there’s widespread agreement that when a specific domain becomes important enough to win a spot in the C-suite, that’s a powerful signal about a company’s overall priorities.

Tele-Medicine Valuation and Reimbursement

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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

Estimated Impacts

By http://www.MCOL.com

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A Real [FREE-MARKET] Hospital Bill

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

It is SICK!

By Nate Kaufman

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Diwali – 2020

Diwali, Deepavali or Dipavali

By Dr. David E. Marcinko MBA

Diwali, Deepavali or Dipavali is the Hindu festival of lights, which is celebrated every autumn in the northern hemisphere.

One of the most popular festivals of Hinduism, Diwali symbolises the spiritual “victory of light over darkness, good over evil and knowledge over ignorance”.

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During the celebration, temples, homes, shops and office buildings are brightly illuminated. The preparations, and rituals, for the festival typically last five days, with the climax occurring on the third day coinciding with the darkest night of the Hindu Lunisolar month Kartika.

In the Gregorian calendar, the festival generally falls between mid-October and mid-November.

Invite Dr. Marcinko

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ABOUT THE Institute of Medical Business Advisors, Inc

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?

An Info-Graphic?

By Staff Reporters

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A Veteran’s Suicide in Front of VA Clinic

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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McCarran–Ferguson Act and Domestic Health Insurance

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

What is ADVERSE SELECTION in Health Insurance?

ADVERSE SELECTION:

By staff reporters

The tendency of people who are less than standard health insurance risks to seek or continue insurance to a greater extent than other individuals.  This so called “selection against the insurer”, or “anti-selection”, is a form of stacking the deck and is also found in the tendency of policy owners to take advantage of favorable options in health insurance or managed care contracts.

Or, a particular health plan, whether indemnity or managed care, is selected against by the enrollee, and thus an inequitable proportion of enrollees requiring more medical services are found in that plan.

Example:   Low enrollee out-of-pocket costs might lure those individuals requiring more health services into an HMO rather than an indemnity-plan because the former does not have a deductible.

Therefore, the HMO would have a greater proportion of less-healthy enrollees, thereby driving up costs and increasing financial risks. Also occurs with one of the following:

  1. When a premium doesn’t cover costs. Some populations, perhaps due to age or health status, have a great potential for high utilization.
  2. Some population parameter such as age (e.g., a much greater number of 65-year-olds or older to young population) that increases the potential for higher utilization and often increases costs above those covered by a payer’s capitation rate.

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Product DetailsProduct Details

WHAT ARE THE NASDAQ MARKET LEVELS OF SERVICE?

WHAT ARE THE NASDAQ MARKET LEVELS OF SERVICE?
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· 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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Coronavirus: Where Has All the Health Economics Gone?

Coronavirus: Where Has All the Health Economics Gone?

By: Cam Donaldson

By: Craig Mitton

LINK: Corona Economics

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Election Day – A Medical Perspective

VOTE SAFELY

By Staff Reporters

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2019 MSSP Performance Results

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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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