AMA: Prior Authorization and Patient Harm?

Posted on March 14, 2022 by Dr. Marcinko

By Staff Reporters

***

***

Prior Authorization and Patient Harm

 •  34% of physicians report that PA has led to a serious adverse event for a patient in their care.
 •  24% of physicians report that PA has led to a patient’s hospitalization.
 •  18% of physicians report that PA has led to a life-threatening event or required intervention to prevent  permanent impairment or damage.
 •  8% of physicians report that PA has led to a patient’s disability/permanent bodily damage, congenital anomaly/birth defect or death.

Source: AMA, “2021 AMA prior authorization (PA) physician survey,” February 2022

***

COMMENTS APPRECIATED

Thank You

Subscribe to the Medical Executive-Post.com

***

***

***

Filed under: CMP Program, Glossary Terms, Health Insurance | Tagged: , , , , , | Leave a comment »

Happy “Pi” Day 2022

Posted on March 14, 2022 by Dr. Marcinko

Happy “Pi” Day

Dr. David E. Marcinko MBA

MORE: https://en.wikipedia.org/wiki/Pi_Day

***

***

PI

***

CITE: https://www.r2library.com/Resource/Title/082610254

COMMENTS APPRECIATED

Thank You

***

***

Filed under: iMBA, Inc., LifeStyle | Tagged: , , , | 1 Comment »

Drugs, Money and the Middleman

Posted on March 14, 2022 by Dr. Marcinko

Join Our Mailing List

PIPELINE TO PROFITS

A little more about that … Kaiser Health News infographic!

untitled

By Dr. David E. Marcinko MBA via Georgia Pharmacy Association

***

Recently, KHN ran an infographic from Kaiser Health News that gave a rough explanation of how the money flows in the sale of a brand-name drug.

After thinking about it a bit, Greg Reybold, Vice President of Public Policy & Association Counsel for the Georgia Pharmacy Association, noticed some fundamental flaws.

“The infographic helps shed light on a process that lacks fundamental transparency,” he said, “but it doesn’t reflect all of the practices engaged in by some PBMs.”

Furthermore, he added,

“There are times, unbeknownst to patients, when some PBMs charge patients copays that are significantly higher than the cost of the drugs themselves, or they steer patients to brand name drugs for which the PBM receives a rebate when there is a less costly generic available.”

He also noted the infographic:

“reflects that the pharmacy make a profit — when in fact there are many times pharmacies lose money on prescriptions they fill through low reimbursements, the imposition of different types of fees, and aggressive audits.”

http://www.gpha.org/

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct Details

***

 

Filed under: Drugs and Pharma | Tagged: , , , , | 3 Comments »

CONCLUSION: The Six Commandments of Value Investing

Posted on March 14, 2022 by Dr. Marcinko

***

Investing and Chess

By Vitaliy Katsenelson, CFA

***

Conclusion: Investing and Chess 

I read somewhere that chess is a game of small advantages. When the game starts, the players are equal – both hold the same number of pieces in the same positions. But then every move either adds to your position (competitive advantage) or subtracts from it. These little decisions (resulting in a better pawn structure, a more secure king, a centrally positioned knight, and so on) that you make with every move accumulate into victory. 

Investing is not that much different, especially in today’s world where access to information has flattened. A mutual fund that manages $100 billion may spend $100 million on research, but that $100 million doesn’t buy any more than what a patient value investor can glean by reading financial statements. 

I am not talking about Warren Buffett either, who doesn’t even have a PC in his office. Ted Weschler and Todd Combs (Warren Buffett’s right-hand men) achieved phenomenal investment success without a fancy research department by simply reading carefully and following our Six Commandments. 

The key to succeeding in this irrational world is to actively ingrain each one of these principles into your investment operating system, improving your process just a little on a daily basis, and then success will follow. 

Finally, this would not be a worthy chapter if I did not contradict myself, just a little. Investing is also unlike chess. Investing affords us a luxury that few people appreciate: You can choose your own opponent. In chess tournaments, you don’t get to choose your opponent. Tournament organizers match you to someone with an equal rating; then as you win, you are progressively matched against better opponents. 

In investing, you are the “tournament organizer.” You get to walk into the room and, instead of choosing the geekiest opponent – the dude with thick glasses who hasn’t been on a date in years and has only thought and dreamt about chess – you can go for the muscular guy who spends five hours a day in the gym, and only joined the tournament because he lost a bet. 

Money doesn’t know how you made it. A hundred dollars made by solving easy problems (buying stocks where both your IQ and EQ were at their highest) buys as much as a hundred dollars that caused you to lose your hair. In investing, you don’t have to solve the problems that everyone else is solving. There are thousands of stocks out there, and your portfolio needs only a few dozen.

***

COMMENTS APPRECIATED

Thank You

Subscribe to the Medical Executive-Post

***

***

Filed under: Experts Invited, Financial Planning, Investing | Tagged: , , , , , | Leave a comment »

BALANCE BILLING: The Emerging “No Surprise” Act

Posted on March 14, 2022 by Dr. Marcinko

Balance Medical Billing

By Dr. David E. Marcinko MBA CMP®

CMP logo

The No Surprises Act is looking to make the practice of out of network balance billing a thing of the past.

CITE: https://www.r2library.com/Resource/Title/0826102549

***

No Surprises Act: New Law to Protect Against Surprise ...

***

Beginning in 2022, there will be few situations in which a patient can receive a bill for out-of-network care they believed would be covered by their insurance company. This new rule should especially benefit patients in emergency situations who don’t have the time or luxury to dig up the details on every provider they encounter.

CONGRESS: https://www.congress.gov/bill/116th-congress/house-bill/3630/

The No Surprises Act also requires insurance companies to provide patients with at least 90 days of coverage if an in-network provider moves out of network. That way, patients aren’t forced to switch providers immediately if such a move happens while they’re in the middle of a treatment plan.

DOCTORS: https://www.elixirehr.com/what-the-no-surprises-act-means-for-healthcare-providers/

Now, the No Surprises Act does have its limitations. Patients can still get a bill for out-of-network care if they visit an urgent care clinic for non-emergency purposes. Also, if consumers are informed that the care they’re about to receive is out of network and they give written consent to move forward, then they may get billed for that care even once the new rule takes effect.

CMS: https://www.cms.gov/nosurprises

YOUR COMMENTS ARE APPRECIATED.

***

***

Thank You

***

***

Filed under: "Doctors Only", Accounting, Breaking News, Career Development, CMP Program, Estate Planning, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Managed Care | Tagged: , , , , , , | 2 Comments »

%d bloggers like this: