Enter “Population Health” Management

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Understanding the Costs and Risks


[By Dr. David Edward Marcinko MBA]

Gratefully, our book, Financial Management Strategies of Hospitals and Healthcare Organizations [Tools, Techniques, Case Studies and Checklists] has become an academic best seller.

It contains a chapter on Wellness and Population Health 2.0; included here for your review [By Jennifer Tomasik, Carey Huntington, and Fabian Poliak].                 .

Population Health

I am especially proud of this work.  This managerial book mimics the popular style of colleague Atul Gawande MD in his acclaimed work The Checklist Manifesto.

Why? All hospitals are still subject to the imperative: No Margin – No Mission.


Pop Health



In an example of population health management and policy leadership, another colleague, David B. Nash MD MBA of the Wharton School, and Endowed Dean of Jefferson University Medical School [father of population health], even wrote the “Foreword”.

Click on this link to read it entirely.

Link: Foreword.Nash



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


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Understanding Professional Medical Employer Organizations

Join Our Mailing List PROFESSIONAL Human Resources Options

By Eric Galtress

“In-house service and support activities are monopolies.  They have little incentive to improve productivity. In fact, they have considerable disincentive to improve their productivity. Clerical, maintenance and support work, do not make a direct and measurable contribution to the bottom line.”

       “Sell the Mailroom” by Peter F. Drucker


Labor Law

Labor Law compliance begins with the hire of your very first employee, thus a well managed human resources (HR) function should be an area of strategic focus by the medical executive, regardless of practice size or the number of employees. Consideration of this vital role can help contribute to an efficient, highly effective and productive professional staff committed to the goals of the practice encompassing a positive and nurturing culture evident to your patients, while maintaining your competitive edge.


Human Resources are the major expense driver of today’s medical practice and addresses staffing requirements, wages and other compensation, payroll and tax compliance, labor law compliance, employee benefits, training, employee turnover, safety, risk management and workers’ compensation. These responsibilities must be performed in accordance with State and Federal guidelines, beginning with the hire of your very first employee.

At specific employee level thresholds, employers are required to comply with a growing number of employee-related requirements including State and Federal Laws.  These laws govern the proper method of how employees must be treated and paid, as well as ensuring that their rights in the workplace are protected. State and Federal Regulators each create vast amounts of workplace legislation every year, many of which become law.

In most cases, the specific requirement (either State or Federal) that affords the employee the most workplace rights and/or protection and benefits takes precedence over the other.  Non-compliance can subject the practitioner/business owner to hefty fines, penalties, business interruption, litigation, and in some cases, even practice failure.

Moreover, these HR efforts are backed by labor attorneys, service providers, brokers and other consultants. Given the typical size of a medical practice, this presents a compelling argument that practices should consider taking advantage of an innovative alternative:  being able to delegate (outsource) part or most of the HR burden as well as the employee / employer related liabilities.


Simply put, instead of the practitioner/staff performing the HR requirements, part or most of this responsibility can be outsourced to an off-site HR services provider that specializes in labor law compliance, employee management and cost control. The practitioner retains functional control of the employees and the service provider handles the HR issues.

Added value is achieved by the practice in receiving these services more cost effectively since their needs are combined with those of the many other practices and businesses the provider already serves. Outsourcing is a matter of simple economics, enabling the practitioner to gain relief from cumbersome employee administration, while enhancing productivity and benefits for the staff members.

The HR outsourcing relationship is not to be confused with a Physician Practice Management Company (PPMC).  The HR services provider has no financial interest or ownership whatsoever in the practice.





To have an outside firm take responsibility and much of the liability to perform activities traditionally handled by internal staff and resources because:

  1. They can do it cheaper and/or faster.
  2. They can do it better because of their expertise and experience.
  3. They have all of the required professional staff and/or facilities.
  4. They take all or part of the risk and the liability to do it right.
  5. They can expand their service offering commensurate with your growth needs
  6. They save you the time of doing it yourself or having one or more of your key staff members distracted from the priorities of the practice.
  7. They help safeguard against chaos should the key person handling HR suddenly leave
  8. They help maintain the high standards of the practice with regard to the employees and the workplace.
  9. Outsourcing can benefit all parties.

Human resource management

In general, HR management consists of the activities, responsibilities and issues of any practice/business, corporation, partnership or other business entity that comes as a result of having employees (IRS1099 independent contractors are not considered employees).

Some of these requirements are mandatory such as paying minimum wage and providing workers’ compensation insurance protection; other aspects and their related administrative functions can be at the discretion of the owner(s) of the practice or business such as sponsoring health benefits, retirement plans for their employees or paid vacation and sick time.

Employer POV

What follows is an overview of the HR requirements of being the employer. This includes a condensed view of employment and labor laws, government compliance issues, employee related costs and the alarming upsurge in employee litigation. The last poses a growing level of liability, vulnerability and distraction to today’s medical executive and practitioner/owner, second only to that of medical malpractice.


As a result, many physicians without available HR expertise are finding it increasingly difficult to focus on growing their practices.



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




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New Medical Informed Consent Dilemma

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Emerging Problems

By Dr. David Edward Marcinko; MBA, CMP™


According to the Dictionary of Health Insurance and Managed Care, informed consent is the oral and written communication process between a patient and physician that results in the agreement to undergo a particular procedure, surgical intervention or medical treatment.

Unfortunately, a lack of standardization surrounding this process represents a major risk for patients and surgeons, and may lead to inaccurate patient expectations, lost or incomplete consent forms, missing encounter documentation and delays in critical surgeries and procedures.

History: Render S. Davis of Emory University [2008 recipient of the Health Care Ethics Consortium’s Heroes in Healthcare Ethics Award] writes for us in the Business of Medical Practice www.MedicalBusinessAdvisors.com that the concept of informed consent is rooted in medical ethics and codified as a legal principle. It is based on the assertion that a competent person has the right to determine what is done to him or her [self-regulated autonomy].

Rationale: The American Medical Association recommends that its members disclose and discuss the following with their patients:  

  • The patient’s diagnosis, if known,
  • The nature and purpose of a proposed treatment or procedure,
  • The risks and benefits of a proposed treatment or procedure,
  • Alternatives (regardless of cost or health insurance coverage),
  • The risks and benefits of the alternative treatments and,
  • The risks and benefits of not the procedure.

The requirements for informed consent are spelled out in statutes and case law in all 50 states. It is a necessary protocol for all hospitals, medical clinics, podiatry practices and ASCs.

Inadequacy of Traditional Consent Forms-to-Date

The typical informed consent process, particularly one that relies solely on traditional generic consent forms, is often inadequate, incomplete or offers the potential for not fully explaining and documenting a particular procedure to a given patient. 

Traditional consent forms are subject to errors and omissions, such as missing signatures (patient, provider or witness), missing procedure(s), and missing dates that place the validity of consent at risk. Lost or misplaced forms may result in delayed or postponed procedures often at the expensive of costly operating room time. Moreover, far too many forms are generic in nature and wholly unsuited for a specific patient or increasingly sophisticated medical procedure.

Patient Safety Background

According to the Institute of Medicine’s [IOM] repot, To Err is Human, more than 1 million injuries and nearly 100,000 deaths occur annually in the United States due to mistakes in medical care. Wrong patient, wrong-side, wrong-procedure and wrong-toe surgery are particularly egregious. In fact, these are among several other “never-events” that Medicare, and an increasing number of private insurance companies are refusing to reimburse.

Based on the need to make healthcare safer, the Agency for Healthcare Research and Quality (AHRQ) undertook a study to identify patient safety issues and develop recommendations for “best practices”.

AHRQ Evidence Report

The AHRQ report identified the challenge of addressing shortcomings such as missed, incomplete or not fully comprehended informed consent, as a significant patient safety opportunity for improvement.

The authors of the AHRQ report hypothesized that better informed patients “are less likely to experience errors by acting as another layer of protection.” And, the AHRQ study ranked a more interactive informed consent process among the top 11 practices supporting more widespread implementation.

General Accounting Office report found that malpractice insurance premiums were relatively flat for most of the 1990’s, but projections began to increase dramatically to 2010.

Results of Improper Informed Consent

Failure to obtain adequate informed consent, depending on state law, may place surgeons, resident, fellows, ambulatory and office surgery centers, medical clinics and hospitals at risk for litigation ranging from medical negligence to assault and battery.

Proceedings Involving Informed Consent

Informed consent is often a factor in medical malpractice litigation. Some attorneys note that physicians are liable, and that plaintiffs may be able to recover damages, in cases involving improper informed consent, even if the procedure is successful. Inadequate informed consent is often cited as a secondary cause in malpractice complaints and anecdotal evidence suggests this strategy may be especially pursued in podiatric malpractices cases.

Avoiding Litigation

The AMA advises its membership of the following regarding informed consent:  

“To protect yourself in litigation, in addition to carrying adequate liability insurance, it is important that the communications process itself be documented. Good documentation can serve as evidence in a court of the law that the process indeed took place. A timely and thorough documentation in the patient’s chart by the physician providing the treatment and/or performing the procedure can be a strong piece of evidence that the physician engaged the patient in an appropriate discussion.”

Impact of Comprehensive Informed Consent Forms

Another study found that providing informed consent information to patients in written form increased comprehension of the procedure. It was also hypothesized that: 

  • Better informed patients are more compliant with medical advice and recover faster.
  • Informed consent discussions strengthen physician-patient relationships and increase patients’ confidence in their doctor.
  • Well informed patients are more engaged in their own care, and are thus less likely to experience surgical errors than more passive, or less informed patients. 

Medical Ethics

The ethical foundation of informed consent is based on the creation of an environment that supports respect for patients and protects their right to autonomous, informed participation in all collaborative Healthcare 2.0 decisions. 


Thus, the essence of the informed consent problems of modern medicine today!

More: http://www.ePodiatryConsentForms.com 

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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


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PODCAST: Employer Healthcare Priorities

By Eric Bricker MD

A Mercer Employer Survey




Thank You

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MORE: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko


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