PARSING “MEDICAL NECESSITY” IN HEALTH CARE

Posted on February 28, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

PARSING “MEDICAL NECESSITY” IN HEALTH CARE
Courtesy: https://lnkd.in/eBf-4vY
Terms and Definitions to Debate

DHIMC: https://lnkd.in/e9AmEhd
FOREWORD: https://lnkd.in/gywd_Ad

MEDICALLY NECESSARY CARE: The supplies and services used to diagnose and treat a medical condition within the standards of good medical care. The revenues from health insurance premiums spent to pay for the medical services covered by the plan. Usually referred as a ratio, such as 0.95, which means that 95% of premiums were spent on purchasing medical services. The goal is to keep this ratio below 1.00–preferably in the 0.75, range, since the insurance plan’s profit comes from premiums.

MEDICALLY NEEDY: Patients eligible for Medicaid whose medical bills and total income is below certain limits.

MEDICALLY UNNECESARY CARE: That part of a stay in a facility [case manager] determined as excessive to diagnose and treat a medical condition in accordance with the standards of good medical practice and the medical community. Excessive may be because stay was too long or available in a less costly or more efficient setting.

BUSINESS, FINANCE, INVESTING & INSURANCE TEXTS FOR DOCTORS:
1 – https://lnkd.in/ebWtzGg
2 – https://lnkd.in/ezkQMfR
3 – https://lnkd.in/ewJPTJs
THANK YOU
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Filed under: Managed Care, Practice Management, Quality Initiatives | Tagged: , , | Leave a comment »

FMV of the Medical Practice?

Posted on February 27, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

FINANCIAL OPINIONS OF MEDICAL PRACTICE FAIR MARKET VALUE [FMV]
Courtesy: https://lnkd.in/eBf-4vY
Plastic Surgery-Medical Practice Worth, Valuation, Sales & Succession Planning

For doctor-colleagues, buying or selling a practice may be the biggest financial transaction of their lives. Reasons for appraising practice worth include: sales, merger, succession, retirement and estate planning; partnership disputes and divorce; or as an important tool for organic growth and strategic planning.

DHEF: https://lnkd.in/dqdbWM9
FOREWORD: https://lnkd.in/ecwZWxu

However, the transaction is fraught with many pitfalls to avoid and no medical specialty seems immune; especially when it comes to contentious fair market value [FMV] appraisals.

ESSAY: https://lnkd.in/eujJySP
MAXIMIZATION: https://lnkd.in/dG8UYaa
BLUNDERS: https://lnkd.in/etgDpqr
Your comments are appreciate.

BUSINESS, FINANCE, INVESTING & INSURANCE TEXTS:
1 – https://lnkd.in/ebWtzGg
2 – https://lnkd.in/ezkQMfR
3 – https://lnkd.in/ewJPTJs
THANK YOU
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What is a Stock Market SPECIALIST?

Posted on February 25, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

WHAT IS A STOCK MARKET “SPECIALIST”?
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CMP® CURRICULUM: https://lnkd.in/dbAF_iY

DEFINITION: A member of a securities exchange with the essential function of maintaining a fair and orderly market, insofar as reasonably practicable, in the stocks in which he is registered as a specialist. To do this, s/he must buy and sell for his own account and risk, to a reasonable degree, when there is a temporary disparity between supply and demand. In order to equalize trends, he must buy or sell counter to the direction of the market.
DHEF: https://lnkd.in/dqdbWM9
FOREWORD: https://lnkd.in/ecwZWxu

At all times the specialist must put his customer’s interest before his own. All specialists are registered with the exchange, but are not employees of that exchange. Your thoughts are appreciated.

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:
1 – https://lnkd.in/ebWtzGg
2 – https://lnkd.in/ezkQMfR
3 – https://lnkd.in/ewJPTJs
THANK YOU
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“PERFORMANCE OF PUBLIC HOSPITALS IN KENYA”

Posted on February 24, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

“PERFORMANCE OF PUBLIC HOSPITALS IN KENYA”
Courtesy: https://lnkd.in/eBf-4vY
[THE ESSENTIAL ROLE OF MANAGEMENT]

Proud to be mentioned and cited in this new hospital management publication.
WHITE-PAPER: https://lnkd.in/eP_5JuR
Your thoughts are appreciated.

HOSPITAL MANAGEMENT & BUSINESS TEXTS:
1 – https://lnkd.in/eEf-xEH
2 – https://lnkd.in/e2ZmewQ
THANK YOU
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Doctors and Nurses FIRED During the US Pandemic

Posted on February 21, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

If They Speak Out About Lack of Gear

By Staff Reporters

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LINK:

https://www.bloomberg.com/news/articles/2020-03-31/hospitals-tell-doctors-they-ll-be-fired-if-they-talk-to-press

Your thoughts are appreciated

THANK YOU

Filed under: Health Economics, Health Insurance, Health Law & Policy, Practice Management | Tagged: , , , | Leave a comment »

On “SIGNIFY HEALTH”

Posted on February 19, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

The SEC Filing 

SIGNIFY HEALTH Goes Public

https://www.dallasnews.com/business/health-care/2021/02/11/signify-health-goes-public-with-7-billion-valuation-as-ceo-says-company-is-long-on-dallas/

By Signify Health

https://lnkd.in/ePKNEak

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Medicare Buy-In Policies for Older Adults on Health Insurance Coverage and Health Care Spending

Posted on February 18, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

RESEARCH REPORT

The Effects of Medicare Buy-In Policies for Older Adults on Health Insurance Coverage and Health Care Spending

  • Bowen Garrett
  • Jessica Banthin
  • Anuj Gangopadhyaya
  • Matthew Buettgens
  • Adele Shartzer
  • John Holahan
  • Diane Arnos

December2020 (corrected February 2021)

LINK:

https://www.urban.org/sites/default/files/publication/103348/the-effects-of-medicare-buy-in-policies-for-older-adults-on-health-insurance-coverage-and-health-care-spending.pdf#:~:text=The%20Effects%20of%20Medicare%20Buy-In%20Policies%20for%20Older,Medicare%20to%20purchase%20a%20Medicare-like%20health%20insurance%20plan.

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RED CROSS Day History

Posted on February 17, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

RED CROSS DAY

On this day in 1863, Henry Dunant founded the Red Cross, which would go onto receive the Nobel Peace Prize three times.

During the Battle of Solferino in the Franco-Austrian war, Swiss businessman Dunant was shocked to witness tens of thousands dead or wounded left on the field after just one day of fighting.

After this experience, on 17 February 1863, he decided to form the International Committee of the Red Cross in Geneva Switzerland with four other Swiss businessmen to take care of casualties and prisoners of war. In the following year, the first Geneva Convention was adopted, “for the Amelioration of the Condition of the Wounded and Sick in Armed Forces in the Field.”

The First World War was an enormous challenge for the organisation. At the outbreak of the war in 1914 medical staff from all over the world gathered to take care of the many wounded. One of them was the young Ernest Hemingway (awarded the Nobel Prize in Literature 1954), employed as an ambulance driver on the Austrian-Italian front. The experience later inspired him to write the novel ‘Farewell to Arms’.

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Henry Dunant was awarded the first ever Nobel Peace Prize in 1901 for his humanitarian work.

The organization he founded received the prize three times.

Learn more: https://bit.ly/2LgtfQY

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Primary Care Provider – Eliminating the Term

Posted on February 17, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

Eliminating the Term Primary Care “Provider”

Consequences of Language for the Future of Primary Care

By Allan H. Goroll, MD

LINK:

https://jamanetwork.com/journals/jama/article-abstract/2506307

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Stop Payer Bullying on Healthcare Providers

Posted on February 16, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

By Nate Kaufman

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The Real Cost of Health Care “Cost Sharing”

Posted on February 15, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

NBER WORKING PAPER SERIES

THE HEALTH COSTS OF COST-SHARING

  • Amitabh Chandra
  • Evan Flack
  • Ziad Obermeyer

Working Paper: 28439

http://www.nber.org/papers/w28439

DHEF

DHEF: https://lnkd.in/dqdbWM9

NATIONAL BUREAU OF ECONOMIC RESEARCH

1050 Massachusetts Avenue

Cambridge, MA 02138

February 2021

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BUSINESS & MANAGEMENT TEXTBOOKS OF INTEREST TO SAVVY PHYSICIANS

Posted on February 13, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

BUSINESS & MANAGEMENT TEXTBOOKS OF INTEREST TO SAVVY PHYSICIANS
Courtesy: https://lnkd.in/eBf-4vY

Health Economics, Finance, Accounting, Investing, HR and Insurance; etc.
BOOKS: https://lnkd.in/dys_xQz

 


INVITATION: https://lnkd.in/d2SefCY
SPEAKING TOPIC LIST: https://lnkd.in/e7WrDj9
MY “AVATAR”: https://lnkd.in/d6BU-TQ
Thank You
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Hedge Fund Titans

Posted on February 12, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

Top 15 Earning Managers for 2020

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Filed under: Health Economics, Health Insurance | Tagged: | 3 Comments »

International Day of Women and Girls in Science

Posted on February 11, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

International Day of Women and Girls in Science

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Filed under: Breaking News, Career Development, iMBA, Inc., LifeStyle | Tagged: | Leave a comment »

How the Vaccines Work?

Posted on February 10, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

PFIZER-BioNTech and MODERNA

By staff reporters

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Medical Practice Fair Market Value

Posted on February 9, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

FINANCIAL OPINIONS OF MEDICAL PRACTICE FAIR MARKET VALUE [FMV]
Courtesy: https://lnkd.in/eBf-4vY
Medical Practice Worth, Valuation, Sales and Succession Planning

ESSAY: https://lnkd.in/eujJySP
MAXIMIZATION: https://lnkd.in/dG8UYaa

NASDAQ

Download our Complimentary “Free” Resources
PART 1: https://lnkd.in/edwCnde
PART 2: https://lnkd.in/eBAvF_S
PART 3: https://lnkd.in/ekhVsWq
Thank You
***

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TIME-LINE TO LAUNCH A NEW MEDICAL PRACTICE

Posted on February 8, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

TIME-LINE TO LAUNCH A NEW MEDICAL PRACTICE
Courtesy: https://lnkd.in/eBf-4vY

 

ESSAY: https://lnkd.in/errcNEx
Thank You
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Women in Medicine

Posted on February 7, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

It’s a Celebration

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Filed under: "Doctors Only", iMBA, Inc. | Tagged: | 1 Comment »

Health Economics in the United Kingdom

Posted on February 6, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

Health Care Demand and Costs Rising!

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DHEF

DHEF: https://lnkd.in/dqdbWM9

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“Wear Red” Day for Women’s Heart Health

Posted on February 5, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

NATIONAL WEAR RED DAY 2021

National Wear Red Day for the year 2021 is celebrated / observed on Friday, February 5th.

Every year the first Friday of February has been dedicated to National Wear Red Day as an awareness day for American women to understand their number one health threat – heart disease.

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FEMALE HEART ATTACK SYMPTOMS

https://medicalexecutivepost.com/2021/01/08/heart-attack-symptoms/

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World Cancer Day

Posted on February 4, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

February 4th, 2021

When is World Cancer Day 2021? World Cancer Day is observed worldwide on February 4. The aim is to inform and encourage people on its prevention, early detection, and treatment. This initiative was taken by the Union for International Cancer Control to campaign and advocate for the targets of the World Cancer Declaration, penned in 2008.

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EMR Data Insecurity?

Posted on February 3, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

What Else is New?

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EHR Vendor Pays $18M to Settle Kickback Allegations | MedPage Today

UNDERSTANDING MEDICAL PRACTICE CYBER SECURITY RISKS | The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants (medicalexecutivepost.com)

https://www.womblebonddickinson.com/us/insights/blogs/states-gear-limit-use-biometrics-and-biological-data

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Filed under: Health Insurance, Health Law & Policy, Healthcare Finance, Information Technology | 2 Comments »

Malpractice Insurance “Policy Limits”

Posted on February 2, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

WHAT ARE “LIMITS” OF MALPRACTICE INSURANCE LIABILITY?

Courtesy: https://lnkd.in/eBf-4vY

HEALTH ECONOMICS DICTIONARY:

https://lnkd.in/dqdbWM9

DEFINITION: What the insurance company will pay on a doctor’s behalf in the event of a claim. If your limits of liability are “$1,000,000 / $3,000,000” it would mean that the insurance company would pay a maximum of $1 million per occurrence and $3 million per year for claims.

For further clarification, refer to the examples below and assume limits of liability of 1,000,000 / $3,000,000:

· In one year you have 4 lawsuits each for $800,000:
The insurance company pays $3,000,000 and you are responsible for $200,000.
· In one year you have 2 lawsuits each for $2,000,000:
The insurance company pays $2,000,000 ($1 million each) and you are responsible for $2,000,000 ($1 million each).
· In one year you have 9 lawsuits each for $20,000:
The insurance company would pay everything.

However, most states have minimum requirements for limits of liability should you have hospital privileges. And so your thoughts are appreciated.

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:
1 – https://lnkd.in/ebWtzGg
2 – https://lnkd.in/ezkQMfR
3 – https://lnkd.in/ewJPTJs
Thank You
***

Filed under: Health Economics, Health Insurance, Health Law & Policy | Tagged: , | 1 Comment »

The Vicious Cycle of Options Trading, Short Squeezes and Hedge Fund Positioning!

Posted on February 2, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

By JP Morgan

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Filed under: Investing | Tagged: , , | 2 Comments »

Hospitals and Price Transparency

Posted on February 1, 2021 by Dr. David Edward Marcinko MBA MEd CMP™

DISCLOSURE OF CASH PRICE

SECTION 1.

(a) In this section, “hospital” means a hospital: (1) licensed under Chapter 241; or (2) owned or operated by this state or an agency of this state. (b) A hospital shall disclose the hospital’s cash price for each health care service regularly provided by the hospital. The required disclosure must be made: (1) by posting the prices on the Internet website of the hospital; or (2) if the hospital does not have an Internet website, by providing the prices in writing on request to any person.

SECTION 2. This Act takes effect September 1, 2021.

Filed under: Health Economics, Health Insurance, Health Law & Policy, iMBA, Inc. | Tagged: | 3 Comments »