BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Posted on August 15, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
BY DARRELL K. PRUITT DDS
Do you really need digital records, Doc?
Why?
“Ransomware criminals’ demands rise as aggressive tactics pay off – Average ransomware demands and payments are up as criminal enterprises pour money into the profitable operations.”
Crothers: “The ransomware crisis just keeps getting worse as criminal enterprises pour money into highly profitable ransomware operations, according to a report from Palo Alto Networks’ Unit 42 security consulting group. The average ransomware payment climbed 82% to a record $570,000 in the first half of 2021 from $312,000 in 2020.”
I am asking Dr. Roger P. Levin, DDS, founder and CEO of Levin Group, why he and his international consultant group still promote electronic dental records.
How about it, Dr. Levin? Can you describe how practice management software benefits dental patients? The software doesn’t make dentistry safer or less expensive than paper records – even if digital is more convenient for dentists and staff (most of the time).
Use National Financial Awareness Day to your Advantage
Aug. 14th is National Financial Awareness Day. Financial awareness is about more than just understanding the basics on how money works. It’s also about evaluating your own budget, savings and investments to make sure your finances are working for your needs.
So if it’s been a while since your last financial “check up,” National Financial Awareness Day can be the extra push you’ve needed to finally take a look under the hood.
Posted on August 11, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Review
This is a handy, word-packed reference book with health information technology terminology of the past, present, and future. The paperback book is small and compact in size but amazingly full of words, abbreviations, and even names of leaders in the health information technology industry. While any book like this will require updating on a periodic basis, many of the terms will remain relevant for a good period of time. I found the dictionary very useful and recommend it as a good addition to the reference shelf in the office or library.
—Doody’s Book Review
From the Back Cover
Over10,000 Detailed Entries!
“”There is a myth that all stakeholders in the healthcare space understand the meaning of basic information technology jargon. In truth, the vernacular of contemporary medical information systems is unique, and often misused or misunderstood? Moreover, an emerging national Heath Information Technology (HIT) architecture; in the guise of terms, definitions, acronyms, abbreviations and standards; often puts the non-expert medical, nursing, public policy administrator or paraprofessional in a position of maximum uncertainty and minimum productivity ?The Dictionary of Health Information Technology and Security will therefore help define, clarify and explain…You will refer to it daily.””
–– Richard J. Mata, MD, MS, MS-CIS, Certified Medical Planner? (Hon), Chief Medical Information Officer [CMIO], Ricktelmed Information Systems, Assistant Professor Texas State University, San Marcos
Posted on August 10, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
BY PROPUBLICA
Investigative Journalism in the Public Interest
***
***
A settlement is about to shield members of the Sackler family from civil litigation regarding their alleged roles in the opioid crisis. So it’s a good time to release the full video of Richard Sackler’s 2015 deposition.
On July 13, 2021, the Centers for Medicare & Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2022.
In addition to numerous payment updates in the MPFS, such as significant updates to the Merit-based Incentive Payment System (MIPS), new policies may preserve expanded telemedicine services through 2023 and clinicians may incur more difficulty earning bonuses under the Quality Payment Program (QPP) eligibility threshold. CMS also includes in the proposed rule a request for information to address COVID-19 vaccine reimbursement proposals. (Read more...)
Posted on August 6, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
There’s still time!
Submit your innovative solution in patient health management to the Pharmacy Benefit Management Institute (PBMI) Innovation Challenge by August 6, 2021 for the chance to be among one of the 5 finalists selected to pitch their ideas before a panel of judges at the PBMI 2021 Annual Meeting!
Be sure to submit your idea by August 6, 2021 for the chance to be featured in an upcoming issue of Managed Healthcare Executive with a full-year integrated marketing program valued at over $100K, in addition to formal acknowledgment at this year’s PBMI Conference.
Posted on August 4, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
***
TEXTBOOKREVIEW
Drawing on the expertise of decision-making professionals, leaders, and managers in health care organizations, Hospitals & Health Care Organizations: Management Strategies, Operational Techniques, Tools, Templates, and Case Studies addresses decreasing revenues, increasing costs, and growing consumer expectations in today’s increasingly competitive health care market.
Offering practical experience and applied operating vision, the authors integrate Lean managerial applications, and regulatory perspectives with real-world case studies, models, reports, charts, tables, diagrams, and sample contracts. The result is an integration of post PP-ACA market competition insight with Lean management and operational strategies vital to all health care administrators, comptrollers, and physician executives. The text is divided into three sections:
Managerial Fundamentals
Policy and Procedures
Strategies and Execution
Using an engaging style, the book is filled with authoritative guidance, practical health care–centered discussions, templates, checklists, and clinical examples to provide you with the tools to build a clinically efficient system. Its wide-ranging coverage includes hard-to-find topics such as hospital inventory management, capital formation, and revenue cycle enhancement. Health care leadership, governance, and compliance practices like OSHA, HIPAA, Sarbanes–Oxley, and emerging ACO model policies are included. Health 2.0 information technologies, EMRs, CPOEs, and social media collaboration are also covered, as are 5S, Six Sigma, and other logistical enhancing flow-through principles. The result is a must-have, “how-to” book for all industry participants.
Posted on August 4, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Health Insurance Business Harms Doctors, Patients and Hospitals –Inside Healthcare with Nate Kaufman–
Rich Helppie brings back healthcare expert and consultant, Nathan Kaufman, Managing Director of Kaufman Strategic Advisors.
Rich and Nate talk about the current policy issues surrounding healthcare, and why the United States’ approach to health insurance, care and finance are woefully inadequate in today’s landscape.
In 2020, at the request of the U.S. House Committee on Ways and Means (the Committee), the Medicare Payment Advisory Commission (MedPAC) began investigating the role that private equity (PE) plays in healthcare provided to Medicare beneficiaries.
In its June 2021 “Report to the Congress on Medicare and the Health Care Delivery System,” MedPAC included for the first time a chapter on PE’s effect on Medicare, wherein it discussed the findings and observations from its investigation and answered a number of questions posed by the Committee. This Health Capital Topics article will analyze MedPAC’s answers to those questions, review its investigation of PE’s role in healthcare, and summarize reactions from stakeholders.(Read more…)
On July 19, 2021, CMS released the proposed rule for the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Centers (ASCs) for calendar year (CY) 2022. The proposed rule builds on President Joe Biden’s July 9, 2021 executive order on “Promoting Competition in the American Economy,” as it relates to increasing access and price transparency in the healthcare industry.
In a press release regarding the proposed rule, CMS stated their commitment to addressing the persistent health inequities in the U.S. and finding opportunities to improve data collection that will lead to policy changes to help meet the health needs of patients. (Read more…)
Posted on July 30, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
15 Self-Funded Employers Analyzed Their Pharmacy Claims Data in Conjunction with the Commonwealth Fund and Discovered the Following Regarding their PBM FormularIES
Navigating a course where sound organizational management is intertwined with financial acumen requires a strategy designed by subject-matter experts. Fortunately, Financial Management Strategies for Hospital and Healthcare Organizations: Tools, Techniques, Checklists and Case Studiesprovides that blueprint. ―David B. Nash, MD, MBA,Jefferson Medical College, Thomas Jefferson University
It is fitting that Dr. David Edward Marcinko, MBA, CMP™ and his fellow experts have laid out a plan of action in Financial Management Strategies for Hospital and Healthcare Organizationsthat physicians, nurse-executives, administrators, institutional CEOs, CFOs, MBAs, lawyers, and healthcare accountants can follow to help move healthcare financial fitness forward in these uncharted waters. ―Neil H. Baum, MD, Tulane Medical School
The concept of a self-taught and student motivated, but automated outcomes driven classroom may seem like a nightmare scenario for those who are not comfortable with computers. Now everyone can breathe a sigh of relief, because the Institute of Medical Business Advisors just launched an “automated” final examination review protocol that requires no programming skill whatsoever.
In fact, everything is designed to be very simple and easy to use. Once a student’s examination “blue-book” is received, computerized “robotic reviewers” correct student assignments and quarterly test answers. This automated examination model lets the robots correct tests and exams, while the students concentrate on guided self-learning.
–Just Seeing the Cost of the Lab Test DECREASED the Number of Labs Ordered Per Patient by 9%.
–Doctors Also SUBSTITUTED a Lower Cost Lab Test for a Higher Cost Lab Test 10,000 Times.
The Doctors Were NOT Clinically Directed to Change Their Behavior.
The Doctors’ Pay Was NOT Affected by Their Lab Ordering Either Way.
This Study Illustrates How Giving Doctors Cost Information in a Setting of Clinical and Financial Independence AUTOMATICALLY Decreases Healthcare Waste.
Doctors Can Be Much Better Stewards of Healthcare Dollars … and the Technological Innovation Needed is Minimal.
Disclosure: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health.
Posted on July 24, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Residents disproportionately affected by COVID-19
***
BY JAMES BLUMENSTOCK MA
Residents of nursing homes have been disproportionately affected by COVID-19. The nature of this coronavirus—which is particularly harmful to older adults and people with multiple chronic conditions—has left residents vulnerable.
Additionally, the pandemic has exacerbated existing challenges in our fragmented long-term care system, which is financed, regulated, and administered by states, the federal government, and private care facilities.
During this webinar, panelists discussed policy options to support high quality care for nursing home residents during the COVID-19 pandemic.
NOTE: This webinar is a project of the Alliance for Health Policy and NIHCM Foundation, in collaboration with The Commonwealth Fund.
There is Copay for Each Office Visit and Visits are Unlimited.
Direct Primary Care Doctors Are Most Frequently Family Practice Physicians, but Internal Medicine and Pediatricians Can Also Have Direct Primary Care Practices.
The Average Direct Primary Care Practice Has a Panel of 345 Patients, with a Goal of About 600 Patients at Full Capacity.
For Comparison, the Typical Fee-for-Service Primary Care Doctor Has a Patient Panel of 2,500.
57% of Direct Primary Care Practices Contract with Employers That Pay the Monthly Membership on the Employee’s Behalf.
Direct Primary Care is a Strategy to Increase the Quality of Care and Decrease Healthcare Costs for an Employee Health Plan.
Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health.
Posted on July 22, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
BOOK REVIEW
“The Dictionary of Health Insurance and Managed Care lifts the fog of confusion surrounding the most contentious topic in the health care industrial complex today. My suggestion therefore is to ‘read it, refer to it, recommend it, and reap’.”
—Michael J. Stahl, PhD, Physician Executive MBA Program [William B. Stokely Distinguished Professor of Business]
The University of Tennessee, College of Business Administration
Posted on July 21, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
TEXTBOOK RELEASE AND REVIEW
Reviews
Navigating a course where sound organizational management is intertwined with financial acumen requires a strategy designed by subject-matter experts. Fortunately, Financial Management Strategies for Hospital and Healthcare Organizations: Tools, Techniques, Checklists and Case Studiesprovides that blueprint. ―David B. Nash, MD, MBA,Jefferson Medical College, Thomas Jefferson University
It is fitting that Dr. David Edward Marcinko, MBA, CMP™ and his fellow experts have laid out a plan of action in Financial Management Strategies for Hospital and Healthcare Organizationsthat physicians, nurse-executives, administrators, institutional CEOs, CFOs, MBAs, lawyers, and healthcare accountants can follow to help move healthcare financial fitness forward in these uncharted waters. ―Neil H. Baum, MD, Tulane Medical School
The U.S. individual tax return is based around the concepts of Adjusted Gross Income (AGI) and Taxable Income (TI). AGI is the amount that shows up at the bottom of page one of Form 1040, individual income tax return. It is the sum of all of the taxpayer’s income less certain allowed adjustments (like alimony, one-half of self-employment taxes, a percentage of self-employed health insurance, retirement plan contributions and IRAs, moving expenses, early withdrawal penalties and interest on student loans). This amount is important because it is used to calculate various limitations within the area of itemized deductions (e.g., medical deductions: 10 percent of AGI; miscellaneous itemized deductions: 2 percent of AGI).
When a healthcare professional taxpayer hears the phrase “an above the line deduction”, the line being referenced is the AGI line on the tax return. Generally, it is better for a deduction to be an above the line deduction, because that number helps a taxpayer in two ways. First, it reduces AGI, and second, since it reduces AGI, it is also reducing the amounts of limitations placed on other deductions as noted above.
Obviously, if there is an above the line there is also a “below the line” deduction. These below the line deductions are itemized deductions (or the standard deduction if itemizing is not used) plus any personal exemptions allowed. AGI less these deductions provides the taxable income on which income tax is actually calculated. All of that being said, it is better for a deduction to be an above the line deduction. Although this is a bit dry, it helps to understand the concepts in order to know where items provide the most benefit to the medical professional taxpayer.
PERSONAL TAXATION CALCULATIONS
Gross Income (all income, from whatever source derived, including illegal activities, cash, indirect for the benefit of, debt forgiveness, barter, dividends, interest, rents, royalties, annuities, trusts, and alimony payments-no more)
Less non-taxable exclusions (municipal bonds, scholarships, inheritance, insurance
proceeds, social security and unemployment income [full or
partial exclusion], etc.).
Total Income
Less Deductions for AGI (alimony, IRA contributions, capital gains, 1/2 SE tax,
moving, personal, business and investment expenses, and
penalties, etc.).
Adjusted Gross Income (bottom Form 1040)
Less Itemized Deductions from AGI, (medical, charitable giving, casualty,
involuntary conversions, theft, job and miscellaneous expenses, etc.), or
Less Standard Deduction (based on filing status)
Less Personal Exemptions (per dependents, subject to phase outs)
Taxable Income
Calculate Regular Tax
Plus Additional Taxes (AMT, etc.)
Minus Credits (child care, foreign tax credit, earned income housing, etc.)
Health Insurance Carriers Are Misaligned by Owning PBMs That Make More Money in Rebate Kick-Backs When the Employee Health Plan Spends More Money on Expensive Prescription Drugs.
Doctors Are Misaligned When They *Are Employed by Hospitals That Tie Test and Procedure Ordering Volume to Doctor Compensation.
Hospitals are Misaligned When They Buy Physician Practices and Raise the Prices for In-Office Testing and Procedures by 300%… Even Though NOTHING Has Changed Other Than the Sign on the Door.
Accordingly, True Employee Health Plan Innovation is ALIGNMENT Innovation That Provides Care Outside the of the Status Quo Fee-for-Service System.
Onsite Clinics, Near Site Clinics, Direct Primary Care and Capitated Virtual Care All Provide Real Alignment Innovation for Employee Health Plans.
It seemed too good to be true—on June 7, the FDA approved a breakthrough medication for Alzheimer’s disease. At the time, the drug “could mark a new era in treating the leading cause of dementia and the sixth leading cause of death in the US”, according to some experts.
–OR NOT–
The FDA’s approval of the drug was met with widespread criticism. And the ensuing scandal has undermined the integrity of the agency’s approval process for new treatments.
Backlash to Aduhelm continued to escalate last week. On Thursday, influential hospitals Cleveland Clinic, NYC’s Mount Sinai Health System, and Providence in Washington State said they wouldn’t administer Aduhelm, citing concerns over its effectiveness and safety.
Review
According to Morning Brew, the FDA approving Aduhelm was like you deciding to watch a movie knowing that it had a 47% rating on Rotten Tomatoes. In November 2020, an expert panel advised the FDA against approving the drug after a pair of studies showed conflicting results about its effectiveness.
Instead the agency fast-tracked it, arguing that the benefits of treating a devastating disease like Alzheimer’s outweigh the risks. An Alzheimer’s drug hadn’t been approved by the FDA in 18 years.
Some experts who helped the FDA evaluate Aduhelm protested the decision. Harvard Medical School Professor Dr. Aaron Kesselheim, the third member of the 11-person advisory panel to resign in the wake of the FDA’s approval, said it was “probably the worst drug approval decision in recent U.S. history.”
Effectiveness is one concern around Aduhelm. Side effects, which include brain swelling and brain bleeding, are another. The final issue is the price tag: $56,000. That’s a lot, but it could cost even more since patients might have to pay for periodic tests that look for side effects.
A study by the healthcare nonprofit Altarum concluded that by the mid-2020s, Aduhelm would account for more than 1% of all national health spending, and that’s on the low end of projections.
Looking Ahead … the blowback has been so bad that the acting FDA chief has ordered a federal investigation to explore the perhaps too-cozy relationship between the scientists who approved the drug and the drug-maker, Biogen.
Still, “once the product is approved, the cat’s out of the bag, the horse is out of the barn,” Johns Hopkins Drug Safety Expert Dr. G. Caleb Alexander told the NYT. More than 600 sites across the US are getting ready to administer Aduhelm, and they’re expecting high demand.
Recruitment has become a refined art in recent years as practices and physicians themselves grow increasingly savvy about the finer points of marketing positions and securing employment. It’s more competitive than ever, too. Many organizations are going after the same physicians. Add to that a shortage of doctors in key specialties and certain geographical areas and the pressure becomes that much more intense. Moreover, the aging of the physician workforce, their increased dissatisfaction with managed care, and changes in doctors’ work expectations (they want more free time) have affected the demand and supply.
Additionally, both practicing physicians and residents fresh out of training have become more discerning and skillful in managing the search process. Candidates have learned to be selective based on how they’re treated on the phone, how they’re treated in person during site visits, or how smoothly the negotiations go. One small bump in the road and they could choose to go elsewhere. In truth, they look to rule organizations out, not in.
Even the smallest of practices must have an effective recruitment plan because they compete directly with the big guys — larger practices and hospitals that have polished their efforts and perfected their processes.
Facts about Physician Recruiters and Executive Search Firms
1) If you are job hunting, you should send your resume to recruiters
Different recruiters know about different positions. They do not usually know about the same ones. This is particularly true with retained firms. By sending your resume out widely, you will be placed in many different confidential databases and be alerted of many different positions. If you send your resume to only a few, it may be that none you send to will be working with positions which are suited for you. Throw your net widely.
If you change jobs, it is also wise to send follow-up letters to the recruiters and alert them of your new career move. Many search firms follow people throughout their careers and enjoy being kept up-to-date. It is a good idea to have your resume formatted in plain text so you can copy and paste it into email messages when requested to do so. Then, follow up with a nicely formatted copy on paper by postal mail.
Some estimate that only 1% to 3% of all resumes sent will result in actual job interviews. So, if you only send 50 resumes, you may only have less than 2 interviews, if that many. Send your resume to as many recruiters as you can. It is worth the postage or email time. Generally, recruiters will not share your resume with any employer or give your name to anyone else without obtaining your specific permission to do so. The recruiter will call first, talk to you about a particular position and then ask your permission to share your resume with that employer.
2) Your resume will be kept strictly confidential by the executive search firm.
It is safe to submit your resume to a search firm and not worry that the search firm will let it leak out that you are job hunting. Recruiters will call you each and every time they wish to present you to an employer in order to gain your permission. Only after they have gained your permission will they submit your name or resume to the identified employer. The wonderful aspect of working with search firms is that you can manage your career and your job search in confidence and privacy.
3) Fees are always paid by the employer, not the job candidate.
Recruiters and search firms work for the employer or hiring entity. The employer pays them a fee for locating the right physician for the job opening. This is important to remember, in that when you interact with executive recruiters, you are essentially interacting with an agent or representative of the employer. Recruiters are more loyal to employers than they are to job candidates because they work for the employer. This should not present a problem, but, should cause you to develop your relationship with the recruiter with the same integrity and professionalism that you would with the employer.
Recruiters are paid fees in one of two ways – retainer fees or contingency fees. This is an important distinction and will affect your process with both the employer and the recruiter. Some employers prefer working with contingency firms and some with retained firms. Both are respected by employers and useful in your job search, but, the two types of firms will not be handling the same positions with the same employers simultaneously.
A “retained” recruiter has entered an exclusive contract with an employer to fill a particular position. The retained recruiter, then, is likely to advertise a position, sharing the specifics of the position, location and employer openly. The retained firm feels a great obligation to fulfill the contract by finding the best person for the job.
A “contingency recruiter” on the other hand, usually does not have an exclusive relationship with the employer, and is only paid a fee if the job search is successful. Often, if the employer uses contingency firms, there will be more than one contingency firm competing to fill a certain position. As a job hunter, if you are sent to an interview by a contingency firm, you may find that you are competing with a larger number of applicants for a position. Generally, retained firms only send in from 3 to 5 candidates for a position.
Recruiters will be paid fees equal to about 25% to 35% of the resulting salary of the successful candidate plus expenses. This does not come out of the job candidate’s salary. This is paid to the recruiter through a separate relationship between the employer and the search firm. This may seem like a large fee, but, keep in mind that recruiters incur a great many expenses when searching for successful job candidates. They spend enormous amounts of money on computer systems, long distance calls, mail-outs, travel and interviews. Recruiters work very hard for these fees. Employers recognize the value of using recruiters and are more than willing to pay recruiters the fees. All you have to do is contact the recruiter to get the process moving.
4) Not all medical recruiters work only with physicians.
Some search firms work exclusively with physicians or in healthcare, while others may work in several fields at once. Some of the larger generalist firms will have one or more search consultants that specialize in healthcare. It is important for you, as a job hunter, to assess the recruiters’ knowledge of your field. If you use industry or medical specialty buzz words in describing your skills, experience or career aspirations, you may or may not be talking a language the recruiter understands fully. It is wise to explore fully with the recruiter his understanding of your field and area of specialization.
5) Recruiters and search consultants move around.
Recruiters, like many professionals, move to new firms during their careers. Often you will find that recruiters will work at several firms during their careers. Since it is much more effective to address your letters to a person rather than “to whom it may concern”, it is smart for job hunters to have accurate and up-to-date information about who is who and where, since this can change frequently. Search firms also move their offices, sometimes to another suite, street or state. If you have a list of recruiters that is over one year old, you will certainly waste some postage in mailing your resumes and cover letters. Many of your mail-outs will be returned to you stamped “non-deliverable”, unless you obtain an up-to-date list. A resource, like the Directory of Healthcare Recruiters is updated very frequently, usually monthly [www.pohly.com/dir3.html].
6) Most search firms work with positions all over the country.
If you are from a particular state, and want to remain in that state, don’t make the mistake of only sending your resume to recruiters in your state. Often the recruiters in your state are working on positions in other states, and recruiters in other states are working on positions in your state. This is usually the case. Very few recruiters work only in their local area, most work all around the US and some internationally. Regardless of your geographic preference, you should still send your resume to all the healthcare recruiters. If you really only want to remain in your area, you can specify that preference in your cover letter.
7) Recruiters primarily work with hard to fill positions or executive positions.
Some recruiters specialize in clinical positions for physicians, managed care executive positions, healthcare financial positions or health administration positions. Others may specialize in finding doctors, nurses or physical therapists. Generally, an employer does not engage a recruiter’s assistance in filling a position unless it is hard to fill. Sometimes employers will engage search firms to save them the valuable time of advertising or combing through dozens of resumes.
Contingency recruiters tend to work with more mid-level management and professional positions, but, this is not always the case. Retained firms generally work with the higher level clinical or administrative positions.
One thing you will be assured of is that if a recruiter is working on a position that means that the employer is willing to pay a fee. That usually means that the position is a valued position and one worth closer inspection on your part. Even in healthcare, with certain exceptions, our economy is an “employer’s market”. This means that employers receive a deluge of resumes for their open positions. Increasingly, employers are using recruitment firms to handle their openings and schedule the interviews because employers simply do not have the manpower or time to handle the many resumes they receive. Therefore, if a job hunter is submitted by a recruiter, that job hunter has a great advantage over all other applicants.
Posted on July 18, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
THE SHERLOCK COMPANY
This podcast features a brief discussion by colleague Doug B. Sherlock CFA, Senior Health Care Analyst and President, Sherlock Company http://www.sherlockco.com featuring his insights into the quarterly financial reports of health plans, for the first quarter 2021.
The Charges Were Regarding Illegal Payments and Kickbacks to Doctors that Were Thinly-Veiled as ‘Speaker Fees’ and Fancy Dinners.
Why Where the Doctors Not Held Accountable and What Does This Say About a Doctor’s Mentality on Money?
Learn the Psychology of Doctors and Money.
Understand How It Leads to Counterproductive Relationships Between Physicians and Drug Companies, Which Can Compromise the #1 Rule in Medicine: The Patient Comes First, Always.
Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health
Posted on July 16, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
HSA Update 2021
By Michael Thompson
High-deductible health plans have been popular, but it’s becoming clear they are not right for all employees, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.
Specifically, Forrester Research Says That Customer Service is ‘Poor’ at Blue Cross of Texas and Illinois, Blue Shield of California, CareFirst Blue Cross, Anthem, United Healthcare, Cigna and Aetna.
Hospital Billing Customer Services Is Bad Too.
Hospital Billing Complexity is So Troublesome to Patients, that 40% Say They Avoid Preventive Care and Screening Tests Just to Avoid the Billing Headache.
Healthcare Customer Service is Terrible Because Health Insurance Companies and Hospitals Do Not Need Good Billing Customer Service to Be Successful, As Demonstrated by High and Rising Health Insurance Stock Prices and Large and Growing Hospital System Revenue.
For Health Insurance Companies and Hospitals, Not Fixing Their Poor Customer Service May Be a Calculated Business Decision.
Implications:To Help Make Their Employees’ Lives Better, Employers May Need to 1) Hire a Healthcare Navigation Company or 2) Deliver More Care to Their Plan Members Outside of the Traditional Health Insurance and Hospital Systems… and Avoid the Terrible Customer Service All Together.
Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health and is the Former Co-Founder of Compass Professional Health Services.
–The Private Equity Firm Offers an Up Front Lump Sum of Money and Administrative Services Such as Billing and Collections for the Practice.
–In Return, the Doctors in the Practice Agree to Have 30-40% of All Future Revenue Go to the Private Equity Firm.
The Up Front Lump Sum Can Be Equal to as Much as 10 – 20 Years of Income for a Physician.
The Older Doctors in the Practice Who Are Usually the Partners Frequently Take This Deal, Resulting in the Younger Partners Making Less Take-Home Pay.
Implication for Employers:
Private Equity Firms Create Larger Group Practices to Have Better Negotiating Leverage with Commercial Insurance Carriers and Obtain Higher Fee-for-Service Reimbursement.
Overall Healthcare Costs for Physician Services Go Up, While the Take-Home Pay for Doctors Goes Down… and the Private Equity Firm Keeps the Difference.
NOTE: The Older Doctors Who Are Paid the Lump Sum Are Still Required to Stay at the Practice for a Certain Number of Years After the Transaction.
Managed care is a prospective payment method where medical care is delivered regardless of the quantity or frequency of service, for a fixed payment, in the aggregate. It is not traditional fee-for-service medicine or the individual personal care of the past, but is essentially utilitarian in nature and collective in intent. Will new-age healthcare reform be even more draconian?
Unhappy Physicians
There are many reasons why doctors are professionally and financially unhappy, some might even say desperate, because of managed care; not to mention the specter of healthcare reform from the Obama administration. For example:
A staggering medical student loan debt burden of $100,000-250,000 is not unusual for new practitioners. The federal Health Education Assistance Loan (HEAL) program reported that for the Year 2000, it squeezed significant repayment settlements from its Top 5 list of deadbeat doctor debtors. This included a $303,000 settlement from a New York dentist, $186,000 from a Florida osteopath, $158,000 from a New Jersey podiatrist, $128,000 from a Virginia podiatrist, and $120,000 from a Virginia dentist. The agency also excluded 303 practitioners from Medicare, Medicaid, and other federal healthcare programs and had their cases referred for nonpayment of debt.
Because of the flagging economy, medical school applications nationwide have risen. “Previously, there were a lot of different opportunities out there for young bright people”; according to Rachel Pentin-Maki; RN, MHA”; not so today. In fact, Physicians Practice Digest recently stated, “Medicine is fast becoming a job in which you work like a slave, eke out a middle class existence, and have patients, malpractice insurers, and payers questioning your motives.” Remarkably, the Cornell University School of Continuing Education has designed a program to give prospective medical school students a real-world peek, both good and bad.
The Ripple Effects of Managed Care and Reform
“Many people who are currently making a great effort and investment to become doctors may be heading for a role and a way of life that are fundamentally different from what they expect and desire,” according to Stephen Scheidt, MD, director of the $1,000 Cornell fee program; why?
Fewer fee-for-service patients and more discounted patients.
More paperwork and scrutiny of decisions with lost independence and morale.
Reputation equivalency (i.e., all doctors in the plan must be good), or commoditization (i.e., a doctor is a doctor is a doctor).
The provider is at risk for (a) utilization and acuity, (b) actuarial accuracy, (c) cost of delivering medical care, and (d) adverse patient selection.
Practice costs are increasing beyond the core rate of inflation.
Medicare reimbursements are continually cut.
Early Opinions
Richard Corlin MD, opined back in 2002 that “these are circumstances that cannot continue because we are going to see medical groups disappearing.” Furthermore, he stated, “This is an emergency that lawmakers have to address.” Such cuts also stand to hurt physicians with private payers since commercial insurers often tie their reimbursement schedules to Medicare’s resources. “That’s the ripple effect here,” says Anders Gilberg, the Washington lobbyist for the Medical Group Management Associations (MGMA).
Assessment
And so, some desperate doctors are pursing these sources of relief, among many others:
A growing number of doctors are abandoning traditional medicine to start “boutique” practices that are restricted to patients who pay an annual retainer of $1,500 and up for preferred services and special attention. Franchises for the model are also available.
Regardless of location, the profession of medicine is no longer ego-enhancing or satisfying; some MDs retire early or leave the profession all together. Few recommend it, as a career anymore.
Assessment
To compound the situation, it is well known that doctors are notoriously poor investors and do not attend to their own personal financial well being, as they expertly minister to their patients’ physical illnesses.
Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think? Are you a desperate doctor? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.
Posted on July 12, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
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