Re-Imagining Global Health Care Business Models?

The State of MEDICAL TOURSIM in the USA

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By Dr. David Edward Marcinko MBA CMP®

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SPONSORED: www.CertifiedMedicalPlanner.org

American businesses are extending their cost-cutting initiatives to include offshore employee medical benefits, and facilities like the Bumrungrad Hospital in Bangkok, Thailand (cosmetic surgery), the Apollo Hospital in New Delhi, India (cardiac and orthopedic surgery) are premier examples for surgical care. Both are internationally recognized institutions that resemble five-star hotels equipped with the latest medical technology.

What Is Medical Tourism? - YouTube

Foreign countries where I studied medicine and surgery, and practiced briefly, such as Finland, England, Canada and Germany are also catering to the English-speaking crowd, while dentistry is especially popular in Mexico and Costa Rica. Although this is still considered “medical tourism,” Mercer Health and Benefits was retained a decade ago by three Fortune 500 companies interested in contracting with offshore hospitals and The Joint Commission [TJC] has accredited 88 foreign hospitals through a joint international commission.

To be sure, when India can discount costs up to 80%, the effects on domestic hospital reimbursement and physician compensation may be assumed to increase downward compensation pressures.

So far, so good; right? Thumbs Up!

But, then came the Corona Virus Pandemic!

Hand With Thumb Down Free Stock Photo - Public Domain Pictures

Johns Hopkins University Covid 19 Tracker: https://coronavirus.jhu.edu/map.html

India Today: https://www.indiatoday.in/coronavirus

INDIA RATIONING: https://www.msn.com/en-us/health/medical/who-to-be-saved-who-not-to-be-inside-a-hospital-during-indias-covid-19-crisis/ar-BB1golnK?li=BBnb7Kz

ASSESSMENT: Your thoughts are now appreciated.

ORDER Textbook: https://www.amazon.com/Comprehensive-Financial-Planning-Strategies-Advisors/dp/1482240289/ref=sr_1_1?ie=UTF8&qid=1418580820&sr=8-1&keywords=david+marcinko

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***

What is the Current Rate of Return [CRR] for Your [Pandemic] Investments?

THE INVESTING “CURRENT RATE OF RETURN

By Dr. David Edward Marcinko MBA CMP®

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SPONSORED: http://www.CertifiedMedicalPlanner.org

Stock Market Pandemic History

Technology stocks have largely been in favor since the COVID-19 pandemic began, but re-openings in the U.S. and elsewhere as vaccines take hold have pushed investors toward value stocks, which are geared more toward the economy. But lately, stronger growth expectations are also sparking worries of higher inflation, and a potential tapping of the brakes by central banks.

Therefore, an important concept for physicians and all investors to understand is the Current Rate of Return (CCR).

So, What Exactly is CRR?

According to this principle, the current rate of a taxable return must be evaluated in reference to a similar non-taxable rate of return. This allows you to focus on your portfolio’s real (after-tax return), rather than its’ nominal, or stated return. Since most medical professionals own a combination of both vehicles, it is important to calculate the average rate of return (ARR), as demonstrated in the following matrix. Usually, this will result in the assumption of more risk, for the possibility of great return.

To compare after tax yields, with taxable yields, use the following formulas:

Tax equivalent yield = yield / (1 – MTB), while taxable yield X (1-tax rate) = tax exempt yield.

Example: if the yield on a tax exempt municipal bond was 6%, and you are in a 28% tax bracket; the equivalent taxable yield (ETY), is 8.3%, calculated in the following manner: 06 / 1.00 – .28 =.083, or, 8.3% ETY.

This means that you would need a taxable instrument paying almost 9 % to equal the 6 percent tax exempt bond.   

ASSESSMENT: Your thoughts are appreciated.    

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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***

On Nursing Capitation Reimbursement?

Partial-Risk Medicare Nursing Capitation Economics is Still Not Working!

By Dr. David E. Marcinko MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Capitated reimbursement is predominantly, but not exclusively, within the realm of physician providers. But, a decade ago Community Nursing Organization project examined an innovative approach to community nursing and ambulatory care services for Medicare beneficiaries. The hypothesis was that provision of such services would promote the timely and appropriate use of health care and to reduce the use of costly acute care services.

Organizations participating in the CNO demonstration were paid a fixed per-member-per-month capitated rate for covered services. But, the participating CNOs were only at risk under capitation for a subset of Medicare benefits [partial-capitation or carve-out]. The financial incentive was to minimize utilization covered under the capitated payment, but not necessarily to minimize utilization of services not covered because traditional Medicare, not the CNO, would be at risk.

Assessment

Final results indicated that the CNO model under partial capitation led to increased Medicare costs based on findings consistent across several analytic approaches. The cost differences between treatment and control or reference groups persisted after the application of increasingly complex risk-adjustment methods.

Moreover, the differences increased over time and were robust to changes in the way CNO participation was defined.

Lastly, there was no statistically significant evidence of increase in physical or social functioning of the treatment group, as compared with the control group. CNOs cost more without providing any health benefits along dimensions measured

[Source: Voluntary Partial Capitation: The CNO Medicare Demonstration Project, Austin Frakt, Steve Pizer, Robert Schmitz, and Soeren Mattke – Health Care Financing Review 2005).

Your thoughts are appreciated.

CAPITATION ECONOMICS WHITE-PAPER: https://healthcarefinancials.files.wordpress.com/2008/11/capitation-actuarial-medical-econometrics.pdf

SECOND OPINIONS: https://medicalexecutivepost.com/schedule-a-consultation/

INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

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THANK YOU

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