Dr. David Edward Marcinko MBA MEd CMP™

In-House Cultural Change and the Medical Quality Paradigm Shift

Posted on July 13, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Leadership Concepts for Physicians and Healthcare CXOs

By Dr. David Edward Marcinko MBA

[Editor-in-Chief]

The toughest part of implementing any medical quality improvement program is changing the healthcare organization’s culture. The physician-executive or chief executive officer must be committed to change, not just give lip service to it. The core to TQM or, for that matter, any of the several new popular quality programs, like six-sigma, is the buy-in of senior management to change the culture of the practice organization to support the individual’s pursuit of quality.

Re-Frame the Situation

The cultural change requires a complete reorientation of job descriptions and duties. It requires a collaborative rather than an adversarial work force. The phrase, “it’s not my job,” cannot work in a quality healthcare environment. Medical quality programs cannot work where employees refuse to be “their brothers’ keepers.” This collaborative working system is difficult to implement, but not impossible to achieve. It involves certain basic changes to the traditional American work ethic of “rugged individualism.” It suggests that the individual employee must become a partner in the healthcare enterprise and be just as concerned about quality as the CEO. Quality really does become everybody’s business.

Assessment

Quality requires new thinking about the relationships that have traditionally existed between labor [nurses, therapists, assistants, and aides, etc] and management [physician-owner, CEO, clinic administrator, managers, etc]. It requires a new direction; a new partnership must be forged between management and the clinical floor, between management and administrative staff, and between line and staff management.

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.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: "Doctors Only", Career Development, Ethics, Practice Management, Quality Initiatives | Tagged: corporate culture, leadership, medical culture, medical quality improvement, organizational behavior | 8 Comments »

Update on Senior Donut Hole Rebate Checks

Posted on July 13, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

More Seniors to Receive One-Time Donut Hole Rebate Checks

By Staff Reports

Medicare Beneficiaries Whose High Prescription Drug Costs Have Put Them in the Medicare Part D Donut Hole to Receive $250 Rebate Checks as a Result of the Affordable Care Act

WASHINGTON – The next round of more than 300,000 eligible seniors who have entered the Medicare Part D “donut hole” this year have been mailed their tax-free, one time rebate check for $250, U.S. Department of Health and Human Services Secretary Kathleen Sebelius announced recently. These one-time rebate checks are the first step in closing the prescription drug coverage gap under the Affordable Care Act. The first round of checks were distributed in the middle of June. As qualifying Medicare recipients “fall into the donut hole,” they will be sent a rebate check by Medicare.

“Seniors and other Medicare recipients in the Medicare donut hole are struggling to afford the medications they need and their basic living expenses. Seventy percent of our first round of these $250 rebate checks were cashed within a week of eligible Medicare recipients receiving them; so, we know that folks really need some help,” said Secretary Sebelius. “The Affordable Care Act starts to close the donut hole this year, giving much-needed relief to millions of seniors. In 2011, the Affordable Care Act takes an additional step for Medicare beneficiaries in the donut hole by providing them with a 50 percent discount on their brand name medications. Every year from 2012 until 2020, the Affordable Care Act will take progressive steps to close the donut hole.”

“Seniors also need to know that they will just receive their check at their usual address – they don’t have to take any extra steps,” said Centers for Medicare & Medicaid Services Deputy Administrator and Director for the Center for Medicare, Jonathan Blum. “And they should never give out their personal information. If someone asks for your personal Medicare information over the phone who isn’t a trusted resource like Medicare, please don’t provide it. Seniors or family members should contact us at 1-800-MEDICARE to report any of these types of calls or go to www.stopmedicarefraud.gov to learn more about efforts to fight fraud and scams against seniors.”

On Thursday, July 8th, at 2:00 p.m., HHS Secretary Kathleen Sebelius joined local officials in Manchester, N.H., for a forum with senior citizens to discuss the rebate checks and other benefits of the Affordable Care Act as well as efforts to fight Medicare fraud.

The $250 checks are being mailed to those Medicare beneficiaries who entered the Medicare Part D donut hole, also known as the coverage gap, in the second quarter of 2010 and are not eligible for Medicare Extra Help (also known as the low-income subsidy or LIS) or enrolled in a qualified retiree prescription drug plan. The donut hole is the period in the prescription drug benefit in which the beneficiary pays 100 percent of the cost of their drugs until they reach the catastrophic coverage phase.

About Medicare Extra Help

Medicare Extra Help provides assistance to seniors so they don’t face higher costs or a coverage gap in their prescription drug coverage. Qualifying Medicare beneficiaries who entered the donut hole in the first quarter of 2010 who were not eligible for Medicare Extra Help received a check in the first round of rebates mailed June 10^th. Going forward, a check for qualifying beneficiaries newly reaching the donut hole in 2010 will be mailed monthly.

Assessment

More information about the “donut hole” rebate checks, please contact www.HealthCare.gov or 1-800-MEDICARE. For further questions about Extra Help (or the LIS) benefit under Part D, please contact the Social Security Administration at www.ssa.gov.

Conclusion

Doctors and FAs – how will this rebate assist your patients and clients? Feel free to comment and 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.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Health Economics, Health Law & Policy, Healthcare Finance | Tagged: Affordable Care Act., CMS, Donut Hole, Donut Hole rebate checks, Jonathan Blum, Kathleen Sebelius, low-income subsidy, medicare, Medicare Extra Help, Medicare Part D | 4 Comments »

Determining the Required Rate of Investment Return

Posted on July 12, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Financial Fundamentals of Medical Practice Sales

Dr. David Edward Marcinko; MBA, CMP™

SPONSOR: www.CertifiedMedicalPlanner.org

A physician investor’s required rate of return [RoR], for the sale of a medical practice, takes into account that monies received sooner have a greater value than those received later. And, the greater the risk in receiving future cash flows the lower their current value. Moreover, one must always keep in mind returns that can be earned on alternative investments. A required rate of return takes all these factors into account.

The Process

The process of selecting an appropriate required rate of return begins with an assumption that all investors will require, at a minimum, the risk-less rate of return offered by government securities. Government securities with a maturity similar to that of the duration of the investment in a private [practice] company are selected, and normally; and a duration of ten to twenty years is used. Because of the minimal default risk associated with government securities, the rate is referred to as the risk free rate. THINK: Freddie Mac and Fannie Mae.

Physician Investors

Investors typically require returns greater than the risk free rate. The additional return (in excess of the risk free rate) is called the risk premium. Risk premiums are generally calculated through an analysis of historically realized rates of return segmented by varying levels of risk, and medical practice specialty, etc. This analysis illustrates that higher historical rates of return occur in situations of higher risk. For example, securities issued by the U.S. government have lower rates of return than securities issued by large corporations. Returns on the equity of large corporations are greater than those of debt securities issued by the same firms. Thus, historical rates of return are generally used as a proxy for future required rates of return; despite the market implosion of 2008-10 and can be adjusted for 2024.

Healthcare Business Valuation

When valuing a medical practice, clinic or healthcare business entity, one must compare the risk of the expected cash flows of the entity being valued to the risk of the cash flows of like [private] publicly traded securities and to determine an appropriate required rate of return based on that assessment.

Cash Flows

It is generally assumed that the expected cash flows from an investment in a closely held healthcare business are at least as risky as those of large publicly traded firms. The combination of the large firm equity risk premium and the risk-less rate of return provide an indication of the required rate of return for the buyer or seller. Beyond that, additional risk premiums related to entity size, proportion of debt and health industry conditions exist; and many other possible company specific risk factors may be appropriate.

Assessment

When valuing a small business like a medical practice, we appraisers generally employ required rates of return 10 percent to 30 percent beyond the current long-term risk free rate for the risky and fragmented healthcare industrial complex.

In summary, the required rate of return used to value a closely held medical business represents the return a physician investor demands to invest funds now with the expectation of the uncertain cash flows associated with ownership of a private company.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Practice Management, Practice Worth | Tagged: Healthcare Business Valuation, medical practice sale, rate of return, risk premium. | 1 Comment »

What is the Cost of eHRs?

Posted on July 12, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

A Retrospective Look-Back

By Richard J. Mata; MD CIS CMP™

Studies by the Organization for Economic Cooperation and Development (OECD) show that healthcare spending in the U.S. accounts for 16-17% of GDP, which is more than six-seven percentage points higher than the average of 8.9% in other OECD countries. This translates into per capita health spending of $5,635 in the U.S. compared with median costs of $2,280 in other OECD countries.[1] Suggestions as to the economic drivers of U.S. health spending include excessive service use, administrative complexity, population aging, threats of malpractice litigation, defensive medicine practices, and the lack of patient waiting lists. In further comparisons with the OECD countries, it appears the U.S. overpays for physician visits, hospital stays, and pharmaceuticals.

In the Year 2004

A 2004 OECD paper suggested that one way of improving performance would be to move towards EHR:

Health systems should invest in automated health-data systems, including electronic medical records and systems to automate medication orders in hospitals. Better systems for recording and tracking data on patients, health and health care are needed to make major improvements in the quality of care.[2]

In the U.S., possible savings from the adoption of EHR have been projected to reach $142 billion in physician office visits, and $371 billion in hospital costs over a 15-year period. These projections have not been validated by the experience in other OECD countries where the adoption movement is ahead of U.S. efforts by anything from four to thirteen years.

Nevertheless, the U.S. began its quest to move towards EHR in 2004 as medical software companies began actively marketing their systems, although funding for this endeavor did not come through until 2006. In spite of this effort, the U.S. has the lowest percentage of physician providers using any EHR compared to Germany, Canada, United Kingdom, and Australia. The U. S. physicians’ low adoption rate involves fear of the loss of productivity, lack of financial incentives, and high startup costs of as high as $40,000 per physician EHR adoption.

When spending on IT implementation in the healthcare system is compared on an international level, the U.S. lags dramatically behind the major OECD countries. The U.S. spends $0.43 per capita compared to a high of $193 in the U.K. This difference is even more dramatic when compared with the German experience, where IT adoption in the healthcare system is almost universal. In thirteen years, Germany has spent $1.88 billion. Their annual per capita cost has been $1.63. The U.S. has reached only 25% of that expenditure so far.

Barriers to Adoption

The greatest barrier to adoption of EHR in most OECD countries has been the need to simplify the health insurance contracts payment structures with standard nomenclatures that can be adapted to EHR. The major OECD countries also report that there must be a national adoption of IT standards in the healthcare system as well as a national effort to focus on privacy and confidentiality standards. This assures better coordination of implementation and provides better strategies for adoptions through public incentives and grants.

Domestic 5 Year Costs

In the U.S., the five-year costs for a national IT healthcare network have been estimated to be as high as $103 billion in capital and $53 billion in interoperability. Hospital costs for functionality were estimated to be $51 billion, skilled nursing facilities would bear $31 billion of costs, and physician offices would bear $18 billion of the costs. (Anderson, 2006) EHR systems that have been implemented have been used mainly for administrative rather than clinical purposes.

In the Year 2005

A 2005 study by Richard Hillestad and colleagues at RAND[3] estimates that implementation of a nationwide EHR network would take about 15 years and cost hospitals about $98 billion and physicians about $17 billion. Over the 15-year period, the average annual cost to hospitals would be $6.5 billion and the average annual cost to physicians would be $1.1 billion (CQ HealthBeat [1], 9/14). However, if 90% of providers adopted such a network, annual savings would total $81 billion, including $77 billion from improved efficiency and $4 billion from reduced medical errors, the RAND study found. The study estimates that an EHR network would reduce adverse drug events in inpatient hospital settings by 200,000 annually and reduce such events in ambulatory settings by two million annually, saving $1 billion annually in hospitals and $3.5 billion in ambulatory settings. For hospitals, about 60% of these savings would be from reduced adverse drug events in patients ages 65 and older, while 40% of savings to ambulatory practices from reduced medication errors would be in patients 65 and older (CQ HealthBeat [1], 9/14).

Assessment

In addition, the study estimates that a national EHR network would save Medicare about $23 billion annually and save private insurers about $31 billion annually. The study projects that the estimated total annual savings of $81 billion would double if providers followed all checkup reminders and other prompts from the system (AP/Las Vegas Sun, 9/14). Currently, about 20% to 25% of hospitals and 15% to 20% of physician offices have EHR systems, according to the study (CQ HealthBeat [1], 9/14).

But, what is the estimated cost in 2010?

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

References:

[1] For details of the report, see http://www.oecd.org/dataoecd/29/52/36960035.pdf.

[2] OECD, Towards High-Performing Health Systems, see http://www.oecd.org/document/26/0,2340,en_2649_37407_31734042_1_1_1_37407,00.htm.

[3] See http://www.rand.org/health/feature/2006/060414_shekelle.html. The report is also discussed in some detail in Neergaard, AP/Las Vegas Sun, 9/14/05. See http://www.ihealthbeat.org/index.cfm?Action=dspItem&itemID=114707.

Filed under: Health Economics, Information Technology, Practice Management | Tagged: EHRs, EMRs, GDP, HIT, HIT costs, HIT expenditures, OECD, Richard J. Mata, Richard Mata, www.healthcarefinancials.com | 7 Comments »

Health Plan Management Navigator

Posted on July 11, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ADVERTISEMENT

July 2010 Edition

By Erin Sawchuk

erinsawchuk@sherlockco.com

Dear ME-P Readers

Please find attached the early July 2010 Edition of our health Plan Management Navigator. In this month’s edition, we suggest an approach to quantifying best practice of administrative activities of health plans. Determining best practice for health plans is a knotty problem because of the complexity of the product and because some of what makes for best practice cannot be captured in the current year’s administrative expense line. We offer a solution that we hope to implement but we would be grateful for any insights you wish to share on this matter.

Financial and Operating Results

Navigator also summarizes some of the May financial and operating results of health plans reporting in our Dashboard. Operating earnings are weak on soft revenues and compressing margins. Enrollment trends in Medicare, Medicaid and ASO products are relative bright spots. Plans are adapting by reducing staffing ratios.

Link: Early July 2010 Navigator[1]

Web Casts

Please save 2:00 on July 16, and 2:00 on August 5 for two important web conferences. The first will summarize the results of this year’s SEER benchmarks for Independent / Provider-Sponsored plans. The second will summarize this year’s SEER benchmarks for Blue Cross Blue Shield Plans.

The Plan Management Navigators containing the respective peer group data will be sent to you a day or so before the web conference. There is no charge to participate, but we would be grateful if you would let us know in advance. Please reply back to me.

Assessment

Erin Sawchuk [Sherlock Company]

P.O. Box 413

Gwynedd, PA 19436

www.sherlockco.com

215-628-2289 – Phone

Conclusion

Feel free to comment and 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

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Career Development, Health Economics, Health Insurance, Healthcare Finance, Monthly Reports, Research & Development | Tagged: ASO, Blue Cross Blue Shield Plans, Erin Sawchuk, Medicaid, medicare, Plan Management Navigator, SEER, Sherlock Company | Leave a comment »

Identifying Suspicious Short Selling

Posted on July 11, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

But Not Who’s Behind the Trades

By Karen Weise
ProPublica, July 8, 2010

Last weekend, The Wall Street Journal highlighted new academic research [1] showing that investors may be trading on insider information after companies approach hedge funds for loans.

Researchers found that on average, in the five days before companies announce a loan from a hedge fund, the volume of short sales increases by 75 percent as compared with the 60 days before a deal is announced. There was no comparable uptick in betting against companies that borrowed money from commercial banks instead.

Short Selling

With short selling, hedge funds and other investors make money by wagering that a stock’s price will fall. Borrowing from hedge funds rather than commercial banks can be seen as a sign of distress, as hedge funds tend to charge higher interest rates.

One of the researchers, Debarshi Nandy of the Schulich School of Business at York University in Toronto, told ProPublica that the findings pose an important question of whether hedge funds are using insider information inappropriately.

Working Draft

Here’s a PDF of a working draft of the paper [2]; the final version is not yet published. When companies ask hedge funds to consider giving them a loan, they typically require that the funds sign nondisclosure agreements. That’s because the borrowers divulge confidential financial information in the process of trying to get a loan — information that can provide insight into a company’s future performance. That, in turn, can be valuable to investors.

Examining Changes

In looking at instances when companies made changes to existing loans, researchers found that the short sales on companies amending loans from hedge funds were profitable, whereas similar short sales on companies amending loans from banks resulted in losses. But, the researchers stop short of saying that hedge funds definitely make insider trades. It’s all a little bit hazy because there is little disclosure required for hedge funds and short selling. While the paper identifies “abnormal” shorting activity, the identity of the investors making the trades is a mystery. “If it is truly insider trading by the fund or a ‘tip-ee’ of the fund, it would really be good to get some further data on who is actually doing the trading,” said Anita Krug, an expert in the laws governing hedge funds.

Assessment

Investors are required to notify the Securities and Exchange Commission when taking large long positions, but there is no equivalent requirement for short bets. During the week that Lehman Brothers collapsed in the fall of 2008, the SEC issued a temporary order [3] requiring investors to report large short positions, but it did not renew that requirement last summer when the order lapsed [4]. The pending financial reform bill also would not require disclosure.

Conclusion

Short sellers say more regulations would discourage their trading, which they argue helps moderate market bubbles and contributes to market efficiency, says Mark Perlow, an attorney at K&L Gates who represents hedge funds.

Link: http://www.propublica.org/article/identifying-suspicious-short-selling-but-not-whos-behind-the-trades

And so, feel free to comment and 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.

https://www.crcpress.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

Filed under: Alternative Investments, Breaking News, Financial Planning, Investing, Research & Development | Tagged: Debarshi Nandy, hedge funds, Karen Weise, Mark Perlow, ProPublica, SEC, Securities and Exchange Commission, Short Selling | 1 Comment »

Health Information Privacy Breaches

Posted on July 10, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Breaches Affecting 500 or More Individuals

By Staff Reporters

As required by section 13402(e)(4) of the HITECH Act, the DHHS Secretary must post a list of breaches of unsecured protected health information affecting 500 or more individuals. The following breaches have been reported to the Secretary.

www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/postedbreaches.html

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Filed under: Health Law & Policy, Information Technology, Risk Management | Tagged: ARRA, EMRs, Health Information Privacy Breaches, HHS, HIPAA, HITECH, medical privacy | 6 Comments »

The IPS Dentist

Posted on July 10, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ADVERTISEMENT
Dental Consultants

We’re a highly skilled team of dental consultants with over 45 years of combined dental, medical and management experience.

Multi-Venued

Through a combination of personal on-site visits and modern video conferencing we consult with any practice across the nation to help them increase their profits and create a more successful working environment. We evaluate our clients’ exceptional professional services and add to them to improve patient loyalty and harmony among the staff. We will provide your practice with the tools to have complete control over exponentially increasing accomplishments and professionalism.

Our Commitment

We stand tall on our commitment to making skilled professionals more successful in their day to day transactions with incredible results on our clients’ bottom lines.
IPS works to implement key systems:

* Positive patient experience
* Treatment presentation and acceptance
* Re-Care and profitable hygiene programs
* Product scheduling
* Effective marketing
* Increased referrals
* Control of collections and accounts receivable control
* Professional risk reduction
* Employee motivation
* Team building and training
* Retirement and transitions strategies

Innovative Practice Solutions

And, we give you the tools to evolve your practice into a more profitable operation. By taking the best of what you’re already doing and adding proven systems and methods we help you take your practice to the next level.

Assessment

ipsdentist.com
ipsdentist@yahoo.com

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Filed under: "Doctors Only", Career Development, Practice Management | Tagged: DDS, dental economics, dental practice management, DMD, IPS Dentist | 1 Comment »

The PPACA and Physician’s Ability to Bill

Posted on July 9, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ADVERTISEMENT

Failure of Physician Referral Sources to Enroll in Medicare’s Provider Enrollment, Chain and Ownership System [PECOS] May Affect their Ability to Bill

By Garfunkel Wild, PC

In response to, among other things, the Patient Protection and Affordable Care Act that was signed into law earlier this year, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule on May 5, 2010 that requires all:

Physicians [1] and non-physician practitioners [2] who order or refer Medicare beneficiaries for, or furnish Medicare beneficiaries with, Part B covered items and services; and
Physicians who certify home health services be enrolled in PECOS as of July 6, 2010 in order for the billing provider to receive payment for the ordered, referred, or furnished items or services under Medicare Part B (and, in the case of home health services, Part A). Some of the types of claims that will be affected by this new rule include:
Claims from laboratories for ordered tests;
Claims from imaging centers for ordered imaging procedures;
Claims from suppliers of DMEPOS for ordered DMEPOS;
Certification for Part A and Part B covered home health services; and
Claims from specialists or specialty groups for referred services (including, but not limited to, physical therapy services).

In addition to prohibiting payment for these services, the interim final rule also requires that the teaching physician — NOT the intern or resident — be identified on the claim for Part B services as the referring or ordering physician whenever an intern or resident orders or refers. This is also effective as of July 6, 2010.

Assessment Therefore, all providers who bill for ordered, referred, or furnished items or services that are payable under Medicare Part B (and home health care providers who bill for Part A and/or Part B covered services) should check the “Ordering and Referring Report” maintained by CMS to confirm whether the ordering or referring provider has an enrollment record in PECOS before submitting a claim as of July 6, 2010.

This Report can be viewed at: www.cms.gov/MedicareProviderSupEnroll/06_MedicareOrderingandReferring.asp.

If the ordering or referring provider is not listed on the Report, there is confusion as to whether billing providers are entitled to submit claims for items and services ordered or referred by such providers. While CMS has acknowledged that some providers have encountered problems getting their information into PECOS and announced that, for the time being, it will not implement changes that would automatically reject claims based on orders, certifications, and referrals made by providers that have not yet had their applications approved by July 6, 2010, CMS has expressly declined to delay implementation of the interim final rule as of the date of this Alert.

References [1] This includes a doctor of medicine or osteopathy, doctor of dental medicine, doctor of dental surgery, doctor of podiatric medicine, doctor of optometry, and doctor of chiropractic medicine.

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: "Doctors Only", Breaking News, Health Economics, Practice Management | Tagged: Centers for Medicare and Medicaid Services, CMS, DMEPOS, medicare, Patient Protection and Affordable Care Act, PECOS, PPACA | Leave a comment »

Video Introduction to HealthCare.Gov

Posted on July 9, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

“Take Health Care into Your Own Hands”

[By Staff Reporters]

This new federal government Website is managed by the US Department of Health & Human Services; located at 200 Independence Avenue, S.W. – Washington, D.C. 20201

Assessment: http://www.healthcare.gov/news/videos/tour.html

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Breaking News, Health Insurance, Health Law & Policy, Videos | Tagged: Department of Health & Human Services;, HealthCare.Gov, HHS | 3 Comments »

Understanding the Premise of Appraisal Value and Investment Time Horizon

Posted on July 8, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Key Issues in Healthcare Entity Valuation and Appraisal

By Robert James Cimasi; MHA, ASA, AVA, CBA, CMP™

www.HealthCapital.com

The Premise of Value under which any healthcare entity fair market valuation is conducted is an assumption further defining the Standard of Value to be used.

The Premise of Value defines the hypothetical terms of the sale and answers the question, “Value under what further defining circumstances?” Two general concepts relate to the consideration and selection of the Premise of Value, i.e., “value in use” and “value in exchange.”

Value in Use

Value in use is that premise of value that assumes that the assets will continue to be used as part of an ongoing business enterprise, producing profits as a benefit of ownership.

For example, in valuing the assets of a surgical hospital, the valuator must determine whether it is appropriate to value simply the tangible assets, or if it is appropriate to consider the enterprise as a going concern and incorporate the potential value of intangible assets. Orderly liquidation value involves assuming that the equipment is sold, perhaps separately, over a reasonable period of time. Forced liquidation assumes that the equipment is sold as quickly as possible to the first bidder.

Value in Exchange

Value in exchange is often referred to as “liquidation value.” Liquidation value describes a sale of the assets of a business enterprise under conditions other than its continued operation as a going concern.

The liquidation can be on the basis of an orderly disposition of the assets where more extensive marketing efforts are made and sufficient time is permitted to achieve the best price for all assets, or on the basis of forced liquidation where assets are sold immediately and without concern for obtaining the best price.

Liquidation

Of course, costs of liquidation should be considered in the value estimate when using this premise of value. Shortening the investment time horizon may have a deleterious effect on the valuation of the subject entity as it presents a restriction on the available pool of buyers and investors and the level of physician ownership, as required under the standard of Fair Market Value.

Assessment

Do the dual issues of value premise and time horizon still seem logical in modernity; why or why not? How comfortable are you that a reasonable FMV can be determined for any healthcare entity after passage of The Patient Protection and Affordable Care Act in March of 2010? Please comment and opine.

Channel Surfing the ME-P

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: CMP Program, Health Economics, Practice Worth | Tagged: fair market value, FMV, healthcare appraisal, medical practice valuation, Robert Cimasi, Value in Exchange, Value in Use, www.certifiedmedicalplanner.com, www.healthcarefinancials.com | 4 Comments »

The Pros and Cons of eMRs

Posted on July 7, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Delving Deeper into the Historic Origins of Debate

[By Richard J. Mata MD, CIS, CMP™]

According to Wager, Ornstein, and Jenkins, in 2005, the perceived advantages of an EHR system include the following:

Quality of the patient records (legible, complete, organized) — 86%
Better access to patient records (available, convenient, fast) — 86%
Improved documentation for patient care purposes — 93%
Improved documentation of preventive services — 82%
Improved documentation for quality improvement activities — 82%

Items viewed as an advantage by fewer respondents include the following:

Administrative cost savings — 38%
Improved efficiency — 61%
Security of patient records — 64%

Nothing directly was said about cost savings or increased medical care quality. These topics have become more contentious issues during the past few years.

The Gurley Opinion

According to HIT expert Lori Gurley, in 2006, of the American Academy of Medical Administrators:

“The EHR provides the essential infrastructure required to enable the adoption and effective use of new healthcare modalities and information management tools such as integrated care, evidenced-based medicine, computer-based decision support, care planning and pathways, and outcomes analysis” (Schloefell et al). Although the benefits that support implementation of an EHR are clear, there are still barriers too, therefore the concept is still not accepted. “However, this could also be said of almost every other area of positive change and improvement within healthcare systems […]” (Schloefell et al). There must be more involvement by the government and the private sector “to make changes where possible to instigate, motivate, and provide incentives to accelerate the development of solutions to overcome the barriers” (Young).

THINK: ARRA and HITECH, today. Of course, there are obviously advantages and disadvantages to both the paper medical record and the EHR.

Multi-Factorial Issues

Many factors must be considered before any healthcare organization or medical practice should implement an EHR. The organization must first obtain as much information as possible about this new concept, and then the information must be carefully reviewed and the pros and cons discussed. Only then should the organization make their decision about this very important issue.

“The [EHR] as a part of a Clinical Information System (CIS) is a powerful tool which ties together documentation of the patient visit (clinical information), coding (diagnosis, and treatment procedures), which then translates into more accurate billing processes, reduces reprocessing of medical claims, and that translates into increased customer satisfaction with a provider” (Koeller). Although the technology is available, progress towards an EHR has been slower than expected. “Widespread use of [EHRs] would serve both private-and public-sector objectives to transform healthcare delivery in the United States” […] EHRs would also “enhance the health of citizens and reduce the costs of care” (Dick, Steen, and Detmer).

The MRI Study

According to a 2005-07 survey by the Medical Records Institute, the following factors are driving the push towards EHR systems within medical organizations:

Motivating Factors	2005	Ambulatory
The need to improve clinical processes or workflow efficiency.	89.3%	91.2%
The need to improve quality of care.	85.0%	85.3%
The need to share patient record information among healthcare practitioners and professionals.	81.1%	66.9%
The need to reduce medical errors (improve patient safety).	76.1%	69.1%
The need to provide access to patient records at remote locations.	67.9%	65.4%
The need to improve clinical documentation to support appropriate billing service levels.	67.1%	76.5%
The need to improve clinical data capture.	64.6%	61.0%
The need to facilitate clinical decision support.	60.7%	50.7%
The requirement to contain or reduce healthcare delivery costs.	54.6%	61.8%
The need to establish a more efficient and effective information infrastructure as a competitive advantage.	53.6%	53.7%
The need to meet the requirements of legal, regulatory, or accreditation standards.	50.0%	44.1%
Other	5.7%	5.1%
Totals	280	136
Margin of Error	+/- 5.8%	+/- 8.4%

Now, compare this with the results of the 2007 survey that focused on the factors driving hospitals to expand their use of EHR.

Driving Factors in a Hospital	2007
Efficiency and convenience, e.g., better networking to the medical community and patients and remote access	57.8%
Satisfaction of physicians and clinician employees	42.2%
The need to survive and thrive in a much more competitive, interconnected world.	41.0%
Regulatory requirements of JCAHO or NCQA.	35.6%
Savings in the Medical Record Department and elsewhere, including transcription.	24.0%
Value-based purchasing/pay for performance	17.7%
Pressure from payer groups, such as Leapfrog Group	15.2%
Possibility of subsidized purchase of HER, e-prescribing systems, etc. by purchasers/payers/large health systems.	8.8%
Totals	329
Margin of Error	+/- 5.4%

Assessment

How have these motivating and driving factors changed today; have they really changed in 2010?

Does this deeper dive reveal any other truths; political, social, business or economic? Is this historical review helpful in understanding the reluctance or eagerness for EMR acceptance, or not?

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Filed under: Glossary Terms, Information Technology, Practice Management | Tagged: American Academy Medical Administrators, ARRA, Clinical Information Systems, EHRs, EMRs, health information technology, HITECH, Lori Gurley, Medical Records Institute, Richard Mata, www.healthcarefinancials.com | 32 Comments »

Understanding Clinical and Financial Features of Medical Practice eMRs & Hospital IT Systems

Posted on July 7, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ADVERTISEMENT

[A Three Part CD Primer for the Practicing Physician, CXO or Nurse-Executive]

Are You in Medical Practice or Healthcare Administration? – Buy this CD-ROM!

PART I: Understanding Hospital Information Systems

For the last 30 years, hospital information systems (HISs) have steadily grown in popularity. At present, nearly every acute care hospital in the United States has at least some form of HIS – at a minimum – performing administrative tasks such as patient billing, payor accounting, and employee payroll tracking. Depending on the size of the hospital, an information system may initially cost from several hundred thousand dollars to tens of millions of dollars. In 2005, about $25.8 billion was spent on hospital information technology (IT) in the United States.

By 2010-11 and beyond, it has become critical that such a system produce a positive return on investment (ROI) through patient care quality improvements, increases in organizational efficiency, or enhanced negotiating power with third-party payors and other stakeholders. Some HIS projects, especially more complex undertakings, have been clear failures to the extent that the organization had to abandon the new HIS in favor of the previous manual system. The goal of Part I is to illustrate how hospitals can maximize the chances for successful implementations of HIS while at the same time providing a positive ROI.

PART II: eMRs for the Independent Medical Practice

Many large organizations have a Chief Information Officer (CIO), a Chief Technology Officer (CTO), perhaps a Chief Medical Information Officer (CMIO), or Chief Medical Officer (CMO) that is tasked to do things like figure out the information technology (IT) and computer systems that support clinical and business goals within a healthcare organization. Smaller groups and practices don’t have enough resources to have dedicated staff for such a purpose so the selection, launch and implementation of eMRs will fall onto the physician staff or other senior leadership at a practice … Are you ready?

PART III: Health Information Technology Risks

Your clinical and business data and how it is used is vital to your medical organization. Information technology (IT) and its infrastructure must therefore be protected through careful security policies. These policies are guided in part by the risk inherent in your health organization’s IT infrastructure, its competitive strategy, and its asset and risk management policies. It is important, however, not to over focus on security implementation so that you overlook the clinical operation management and patient-centered care in your healthcare facility.

There are two parts to the security equation: the first involves meticulous inventory of hardware, accessories, and software and the other involves establishing secure IT policies and procedures. Management systems like those developed by the International Standards Organization (ISO) and the National Institute of Standards and Technology (NIST) serve as very functional models that can be applied in the clinical setting.

Part III of this CD-ROM reviews the model codes that offer templates on how to put protections in place and the regulations that have been designed to ensure information security. It also discusses the business continuity and risk management systems you need to keep your organization functioning in case of security and/or privacy breaches. It also offers interpretation and recommendations in making choices as they relate to the IT systems and discusses good healthcare security and privacy practices. For example, the use of role-based access in an electronic health record (EHR) is not mandatory, but that does not mean that it cannot be implemented. In fact, it is usually desirable. Many organizations will used a modified role-based system to limit the amount of protected health information (PHI) that one needs to access.

Special Added Bonus

We also include the following valuable resources for your office staff:

1. Glossary of managed care terms

2. Glossary of health information technology

3. Glossary of medical management abbreviations and practice business acronyms.

Table of Contents: CD-TOC

Now, be among the first-adopters to use this CD for the vital HIT, eMR and IT administration aspects of your medical office, hospital or clinic. You will be glad you did.

Testimonial:

“I am finally beginning to understand HIT and eMRs” [Dr. Sarah Jane Fergson]

And, the handsome, sturdy package makes the checklist CD an ideal gift for the recent graduate, mid-career doctor or mature medical practitioner.

Product Specifications:

Compatible with any PC or Mac computer; Adobe Acrobat Reader® required.

Price: Only $99 USD, includes SPH and tax.

TO ORDER: Please send your check or money order [for CD-ROM] to: iMBA Inc, Suite #5901 Wilbanks Drive, Norcross, GA 30092-1141 [770.448.0769] or MarcinkoAdvisors@msn.com

OR – you may order electronically right here: <a href=”https://www.e-junkie.com/ecom/gb.php?c=cart&i=762864&cl=109140&ejc=2

Filed under: Glossary Terms, Information Technology, Practice Management, Sponsors | 2 Comments »

About Regional Health Information Organizations

Posted on July 6, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

The RHIO Concept – Defined

[By Richard J. Mata MD, CIS, CMP™]

Regional Health Information Organizations (RHIOs), or data exchanges, are multi-stakeholder organizations. They might include groups of hospitals, medical societies, payers, major employers, and other healthcare organizations.

Generally, these stakeholders are developing RHIOs with the goal of affecting the safety, quality, and efficiency of healthcare as well as improving access to healthcare by expanding the use of health information technology. It is expected that RHIOs will be responsible for motivating and causing integration and information exchange in the nation’s revamped healthcare system

Assessment

Regions in the U.S. continue to use various definitions of “multi-stakeholder organizations.” For instance, in Wichita, Kansas, the Clinics Patient Index is a software architecture as well as support environment that facilitates integration among outpatient clinics and hospital emergency departments.

And, what will be the affect of [HR 3590], or the Patient Protection and Affordable Care Act, on RHIOs?

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Glossary Terms, Information Technology | Tagged: ARRA, Clinics Patient Index, EMRs, HITECH, Regional Health Information Organizations, RHIOs, Richard Mata | 3 Comments »

Gulf Cleanup Training Ignores Advice from Health Agency

Posted on July 6, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Concerned Workplace Safety Experts

By Sasha Chavkin, ProPublica – June 17, 2010 2:05 pm EDT

As we’ve reported, workplace safety experts have expressed concern that Gulf oil spill responders aren’t getting enough safety training [1]. On Wednesday, we spoke with a federal official who said the four-hour safety course that BP is providing to Gulf cleanup workers lacks basic information on health risks and is too short to cover the necessary material.

Joseph Hughes, director of the worker training program at the National Institute for Environmental Health Sciences, said the course fails to incorporate important information. Among the subjects not included are chemical inhalation, the health effects of dispersants, and the risks of direct contact with weathered crude oil.

Hughes’ agency, part of the Department of Health and Human Services, helped develop the training. “We tried to recommend what we thought the right training topics were, but all of those were not included,” he said.

ProPublica Reports

As we reported on Wednesday, cleanup workers are continuing to suffer health problems [2] [2] that they believe to be related to chemical exposure, including vomiting, dizziness, and nose and throat irritation.

Hughes also said the course’s four-hour duration — a fraction of the 24-hour training usually required for cleanup workers [3] [3] who may be exposed to hazardous materials — is insufficient and rests upon a faulty interpretation of safety regulations. In 1990, the Occupational Safety and Health Administration issued a directive following the Exxon-Valdez disaster that allowed the minimum training to be cut to four hours [4] [4] for workers performing low-risk tasks such as beach cleanup.

“The idea of the Exxon-Valdez exemption is that they would not have direct contact with crude oil or weathered oil,” Hughes said. However, he said that some spill responders receiving the four-hour training, such as booming and skimming workers on vessels, are “definitely having direct oil contact.”

The BP Spokesman

BP spokesman Toby Odone stated that the safety trainings are appropriate for the work people are doing. “Training for Vessels of Opportunity and shoreline workers is 4+ hours and includes properties of oil, insect bites, heat, marine operations such as laying and collecting boom,” Odone wrote in an e-mail. The Vessels of Opportunity program employs local boat operators and crews in cleanup activities.

Odone also wrote that workers going into oiled areas are accompanied by a technician with 40 hours of training, and that the training was approved by the government. “It was developed with OSHA and approved by OSHA and the US Coast Guard,” he wrote.

OSHA is in charge of monitoring workplace safety for the cleanup. We at ProPublica have been trying to get in touch with officials there since Monday to discuss the safety trainings, but haven’t yet gotten a response.

Hughes said that his office is pressing Unified Command — the interagency spill response team that consists of BP, Transocean, the Coast Guard and numerous federal agencies — to implement an eight-hour training course for those at greater risk of contact with hazardous materials. The course would include the chemical exposure curriculum that is not provided in the current trainings.

“The group that I’m still concerned about is the booming and skimming workers,” Hughes said. “There’s an effort under way to increase the training of those workers that’s being discussed at the highest level.”

On Wednesday, Aubrey Miller, senior medical adviser in Hughes’ agency, testified to a House subcommittee that OSHA is “working with BP to develop a new eight-hour curriculum [5] [5] for worker safety and health training,” according to a transcript of his remarks provided by the agency.

Hughes said he had not heard any dates for when this eight-hour training program would start.

Assessment

As it stands, Hughes said the training goes against the precautionary principle — the concept that the possibility of harm is enough to warrant action to reduce the risks to public health.

“We thought it was backwards,” he said of the current curriculum,“that it had a reduced amount of protection for workers.”

Link: http://www.propublica.org/feature/gulf-cleanup-training-ignores-advice-from-health-agency-official-says

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Health Law & Policy, Op-Editorials, Quality Initiatives | Tagged: BP, DHHS, Exxon-Valdez, Gulf Cleanup Training, Gulf oil spill, Joseph Hughes, National Institute for Environmental Health Sciences, Occupational Safety and Health Administration, OSHA, Sasha Chavkin, Toby Odone, Transocean, Unified Command, Vessels of Opportunity | Leave a comment »

Defining Electronic Medical Record Systems

Posted on July 5, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Does Linguistic Obfuscation Exacerbate our Use Ambivalence?

[By Dr. Richard J. Mata; CIS, CMP™]

[By Dr. David E. Marcinko; MBA, CMP™]

The 2003 Institute of Medicine (IOM) Patient Safety Report [1] described an EHR [2] as encompassing:

a longitudinal collection of electronic health information for and about persons;
[immediate] electronic access to person- and population-level information by authorized users;
provision of knowledge and decision-support systems [that enhance the quality, safety, and;
efficiency of patient care] with support for efficient processes for health care delivery.

The IOM Report

A 1997 IOM report, The Computer-Based Patient Record: An Essential Technology for Health Care, provides a more extensive definition:

A patient record system is a type of clinical information system, which is dedicated to collecting, storing, manipulating, and making available clinical information important to the delivery of patient care. The central focus of such systems is clinical data and not financial or billing information. Such systems may be limited in their scope to a single area of clinical information (e.g., dedicated to laboratory data), or they may be comprehensive and cover virtually every facet of clinical information pertinent to patient care (e.g., computer-based patient record systems).

The HIMSS Model

The EHR definitional model document developed by the Health Information and Management Systems Society (HIMSS, 2003) includes:

“a working definition of an EHR, attributes, key requirements to meet attributes, and measures or ‘evidence’ to assess the degree to which essential requirements have been met once EHR is implemented.”

The IOM Model

Another IOM report, Key Capabilities of an Electronic Health Record System [Tang, 2003], identifies a set of eight core care delivery functions that EHR systems should be capable of performing in order to promote greater safety, quality and efficiency in health care delivery:

8 Core Principles

Today, we realize that the eight core capabilities that Electronic Health [Medical] Records should possess are:

— Health information and data. Having immediate access to key information – such as patients’ diagnoses, allergies, lab test results, and medications – would improve caregivers’ ability to make sound clinical decisions in a timely manner.
— Result management. The ability for all providers participating in the care of a patient in multiple settings to quickly access new and past test results would increase patient safety and the effectiveness of care.
— Order management. The ability to enter and store orders for prescriptions, tests, and other services in a computer-based system should enhance legibility, reduce duplication, and improve the speed with which orders are executed.
— Decision support. Using reminders, prompts, and alerts, computerized decision-support systems would help improve compliance with best clinical practices, ensure regular screenings and other preventive practices, identify possible drug interactions, and facilitate diagnoses and treatments.
— Electronic communication and connectivity. Efficient, secure, and readily accessible communication among providers and patients would improve the continuity of care, increase the timeliness of diagnoses and treatments, and reduce the frequency of adverse events.
— Patient support. Tools that give patients access to their health records, provide interactive patient education, and help them carry out home monitoring and self-testing can improve control of chronic conditions, such as diabetes.
— Administrative processes. Computerized administrative tools, such as scheduling systems, would greatly improve hospitals’ and clinics’ efficiency and provide more timely service to patients.
— Reporting. Electronic data storage that employs uniform data standards will enable health care organizations to respond more quickly to federal, state, and private reporting requirements, including those that support patient safety and disease surveillance.” [3]

Assessment

With all the confusion surrounding terms like quality improvement and “meaningful use” which can mean major Federal dollars to the coffers of a medical practice, clinic or hospital; are we still confused about basic definitional terms?

And, does eMR linguistic obfuscation exacerbate our use ambivalence and encourage physician/dentist eMR avoidance?

Conclusion

Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.

References:

[1] See http://www.himss.org/content/files/PatientSafetyFinalReport8252003.pdf.

[2] EHR (electronic health record) is often used interchangeably with EMR (electronic medical record). In this discussion, EHR will be used consistently.

[3] See http://www.iom.edu/.

Filed under: Glossary Terms, Information Technology, Practice Management | Tagged: david marcinko, EHRs, electronic health records, electronic medical records, EMRs, health information technology, HIMSS, HIT, IOM, Richard Mata, www.healthcarefinancials.com | Leave a comment »

Beware Medical and Money Management ‘Groupthink’

Posted on July 5, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Helping Doctors Understand Peer Comparisons

By J. Wayne Firebaugh CPA, CFP® CMP™

By Dr. David E. Marcinko MBA, CMP™

Source: http://www.CertifiedMedicalPlanner.org

More than a few mutual, hedge and endowment fund managers have noted that they commonly compare their endowment and portfolio allocations to those of peer institutions and that as a result, allocations are often similar to the “average” as reported by one or more surveys/consulting firms.

One interviewed endowment fund manager expanded this thought by presciently noting that expecting materially different performance with substantially the same allocation is unreasonable. It is anecdotally interesting to wonder whether any “seminal” study “proving” the importance of asset allocation could have even had a substantially different conclusion. It seems likely that the pensions and funds surveyed in these types of studies have very similar allocations given the human tendency to measure one-self against peers and to use peers for guidance.

This is a truism in medicine as well as the financial services sector.

Understanding Peer Comparisons

Although peer comparisons can be useful in evaluating your portfolio, or your hospital or medical practice’s own processes, groupthink can be highly contagious and dangerous.

For historical example, in the first quarter of 2000, net flows into equity mutual funds were $140.4 billion as compared to net inflows of $187.7 billion for all of 1999. February’s equity fund inflows were a staggering $55.6 billion, the record for single month investments. For all of 1999, total net mutual fund investments were $169.8 billion[1] meaning that investors “rebalanced” out of asset classes such as bonds just in time for the market’s March 24, 2000 peak (as measured by the S&P 500).

Of course, physicians and investors are not immune to poor decision making in upward trending markets. In 2001, investors withdrew a then-record amount of $30 billion[2] in September, presumably in response to the September 11th terrorist attacks. These investors managed to skillfully “rebalance” their ways out of markets that declined approximately 11.5% during the first several trading sessions after the market reopened, only to reach September 10th levels again after only 19 trading days. In 2002, investors revealed their relentless pursuit of self-destruction when they withdrew a net $27.7 billion from equity funds[3] just before the S&P 500’s 29.9% 2003 growth.

Amateurs versus Professionals [is there such a thing?]

Although it is easy to dismiss the travails of mutual fund investors as representing only the performance of amateurs, it is important to remember that institutions are not automatically immune by virtue of being managed by investment professionals.

For example, in the 1960s and early 1970s, common wisdom stipulated that portfolios include the Nifty Fifty stocks that were viewed to be complete companies. These stocks were considered “one-decision” stocks for which the only decision was how much to buy. Even institutions got caught up in purchasing such current corporate stalwarts as Joe Schlitz Brewing, Simplicity Patterns, and Louisiana Home & Exploration. Collective market groupthink pushed these stocks to such prices that Price Earnings ratios routinely exceeded 50 [nothing in the internet age]. Subsequent disappointing performance of this strategy only revealed that common wisdom is often neither common nor wisdom.

The Bear Sterns Example

Recall that The New York Times reported on June 21, 2007, that Bear Stearns had managed to forestall the demise of the Bear Stearns High Grade Structured Credit Strategies and the related Enhanced Leveraged Fund. The two funds held mortgage-backed debt securities of almost $2 billion many of which were in the sub-prime market. To compound the problem, the funds borrowed much of the money used to purchase these securities. The firms who had provided the loans to make these purchases represented some of the smartest names on Wall Street, including JP Morgan, Goldman Sachs, Bank of America, Merrill Lynch, and Deutsche Bank.[4] Despite its efforts Bear Stearns had to inform investors less than a week later on June 27 that these two funds had collapsed. The subsequent fate of these firms, and the history of the past two years, need not be repeated to appreciate that the king surely had no clothes.

Assessment

What broader message lies in this post relative to such medical initiatives as P4P, various clinical quality improvement endeavors and benchmarks, hospital peer-review, PROs, Medicare compliance, etc?

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

References

[1] 2001 Fact Book, Investment Company Institute.

[2] Id.

[3] 2003 Fact Book, Investment Company Institute.

[4] Bajaj, Vikas and Creswell, Julie. “Bear Stearns Staves off Collapse of 2 Hedge Funds.” New York Times, June 21, 2007.

Filed under: Investing, Portfolio Management | Tagged: Arbitrage Pricing Model, Bank of America, Bear Sterns, behavioral finance, Deutsche Bank, endowment fund, Goldman Sachs, group thnk, hedge fund, JP Morgan, medical peer review, Medicare compliance, Merrill Lynch, modernm portfolio theroy, P4P | 2 Comments »

Speaking and Opining at Health Conference Away Games

Posted on July 3, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

On the Road Again … with Me

By Dr. David Edward Marcinko; MBA

[Publisher-in-Chief]

I just returned from a quick unplanned trip to Baltimore, Maryland visiting several individual and corporate consulting clients. There was also an antecedent side-trip to serve as a pharmaceutical company speaker and workshop conference mentor, as well.

Topics for the manager’s meeting in Atlanta Georgia included healthcare policy and reform, eMRs, economics, compensation and leadership. Not only was it held close to home and where I did my internship, residency and fellowship training, among other things; it was located near where I attended business school almost two decades earlier. So; how could a conference in such a storied location fail to be tons of fun? It can’t – and it didn’t.

[picapp align=”none” wrap=”false” link=”term=baltimore+maryland&iid=301134″ src=”http://view.picapp.com/pictures.photo/image/301134/buildings-the-waterfront/buildings-the-waterfront.jpg?size=500&imageId=301134″ width=”380″ height=”253″ /]

Impressive Venue

I was impressed with the Marriott Marquis hotel organization (lots of conference staff with directions to buildings and meeting rooms), the resources (catering, efficiently delivered and free WiFi everywhere), attendees, presenters, and beautiful downtown urban location.

Impressive Meeting

But, most of all I was impressed with the speakers, topics and content – and floored by the informal post-mortem discussions. I received good-excellent feedback on the slide-show I authored and presented, and even watched a few speakers take their licks, always kindly delivered (all in the name of progress) from an informed and engaged audience. If I’m ever able to perform half as well as the average discussant in the future, I’ll be very pleased, indeed.

Self-Learning Didactics

Of course, I gave and learned a much vis-a-vie the bilateral educational principles of andragogy and heutagogy, although nothing I’m ready to put into writing right now. Rest assured however, future ME-Ps will be of higher quality relative to the counterfactual that I didn’t attend the conference meeting.

Assessment

Finally, I met several colleagues who read, comment and post to the ME-P. All had kind words to say about this electronic forum. From what I heard, it’s beginning to feel like we are becoming a valuable resource to the community we serve. I’m delighted.

Please continue to send in ideas, alert us of important developments in healthcare administration and financial planning; and/or ping us when you see a good paper or topic idea that needs to be fleshed-out, or a book, product or service that deserves to be promoted; etc.

Conclusion

Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Health Economics, iMBA, Inc., Media Mentions and PR, Practice Management, Touring with Marcinko | Tagged: iMBA, Inc., medical management, Practice Management, speaking engagements, www.medicalbusinessadvisors.com, www.MedicalExecutivePost.com | Leave a comment »

About the National Health Information Network

Posted on July 3, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

The NHIN Defined

By Richard J. Mata MD, CIS, CMP™

On November 15, 2004, DHHS called for public comments on its plans for a National Health Information Network (NHIN) within ten years (see Federal Register, vol. 69, no. 219).

This would include establishing “interoperable” (easily exchanged) EHRs for all citizens.

DHHS Template

DHHS outlined four main purposes for the national network:

inform clinical practice (with data from EHRs);
interconnect clinicians so that they can exchange health information using advanced and secure electronic communication;
personalize care with consumer-based health records and better information for consumers; and
improve public health through advanced bio-surveillance methods and streamlined data collection for quality measurement and research.

Assessment

What is the impact of the Patient Protection and Affordable Care Act on the NHIN? How close are the NHIN’s goals and original template to reality?

Your thoughts and commented are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Glossary Terms, Information Technology | Tagged: National Health Information Network | Leave a comment »

Understanding Absolute Investment Returns

Posted on July 2, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Exploiting Market Inefficiencies

By J. Wayne Firebaugh CPA, CFP® CMP™

By Dr. David E. Marcinko MBA, CMP™

Source: www.HealthcareFinancials.com

This class of investments seeks to exploit market inefficiencies and generate positive returns regardless of broader market performance. Often, investments in this class are made through the use of hedge funds. Hedge funds will often employ leverage, short-selling, and arbitrage to take advantage of pricing distortions in their targeted strategy area.

Relation to Healthcare Endowments

When investing an endowment’s assets in this category, the physician director or money manager should be aware of fee structures that commonly include performance-related incentive fees, hurdle rates, and claw-back clauses. The endowment managers should also remember that these types of investments generally have much less transparency than other asset classes with which they may be more familiar.

Assessment

Finally, since many of these investments are offered only to accredited investors, the physician or investment manager is often free to pursue much more aggressive strategies than would otherwise be pursued for retail or lay customers.

Conclusion

But, can we [anyone] exploit market inefficiencies? Is the market efficient or inefficient? What about Modern Portfolio Theory [MPT] or the Arbitrage Pricing Model? Did we really learn anything from the market crash of 2008?

Your 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, be sure to subscribe. It is fast, free and secure.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Investing, Portfolio Management | Tagged: Alternative Investments, Arbitrage Pricing Model, david marcinko, efficient market hypothesis, EMH, hedge funds, Modern Portfolio Theory, Wayne Firebaugh | Leave a comment »

How the ME-P Views Client Engagements and Consultations

Posted on July 2, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ADVERTISEMENT

An Expert Led – Future Focused Firm – Enhancing Doctor and Advisory Practices

By Ann Miller RN, MHA

[Executive Director]

ME-P consultants use advanced analytics, medical practice intelligence, education, deep experiential insight and publications to deliver measurable value across the full continuum of the independent health care administration and integrated economics and financial services space. Our team includes DOs, CPAs, MDs, DPMs, MBAs, PhDs, CFAs, MSFSs, CFPs®, RNs, CMPs™ and health care leaders, business leaders and CXOs. All have extensive strategic, operational, academic, technological, business and financial experience, certifications and licenses.

[picapp align=”none” wrap=”false” link=”term=financial+advisor&iid=5289604″ src=”5/0/3/9/Group_of_people_333f.jpg?adImageId=12975963&imageId=5289604″ width=”337″ height=”506″ /]

Typical Clients

Our clients include medical practices, hospitals and health systems; financial advisory firms RIAs and BDs; pharmaceutical companies, academic medical centers and physician organizations; private equity and investment firms, health insurance providers and medical device manufacturers are included. We help build a foundation for improving care delivery, related financial services sector performance and overall matrix or organizational advancement through the systems we implement. And, we enable our clients to:

Evaluate current performance, identify improvement areas and drive progress over time
Uncover opportunities to capture market share and grow volumes
Anticipate future demand using our proprietary forecasting model
Adopt innovative care delivery processes and structures to meet clinical, financial and service goals
Develop informed, effective leadership teams to drive organizational change and growth
Launch seminars, lectureships, collaborative workshops and speaking engagements.

The ME-P Difference

Along with the ME-P website, here is how we are different: www.CertifiedMedicalPlanner.com

ME-P is future-focused

We have a track record of predicting trends that keep you ahead of the competition. We continuously scan the horizon to anticipate changes that will transform practices, clinics, hospitals, the financial services industry, RIAs and medical practices.

ME-P is expert-led

Our experts collaborate with you to form powerful relationships, support critical decision making, address challenges and uncover opportunities. We bring a unique understanding of your challenges—many of our experts are former financial services colleagues, physicians, CXOs, insurance agents, executives and nurses, etc.

ME-P is data-driven and action-oriented

Our solutions are grounded in proprietary analytical tools and data. By combining expert insight and data intelligence, we develop recommendations that may empower you to grow top-line and bottom-line performance today and in the future.

ME-P is core to health entity and business process

Through value-added analysis and intelligence, our healthcare business solutions become key tools and drivers for your current and future plans www.HealthcareFinancials.com

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. What benchmarks do you use for consulting engagements? Are doctors and FAs more or less likely to retain a consulting firm in today’s competitive environment? Are these two consulting sectors more or less integrated today than yesterday?

Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Dictionary Series: http://0ga191.web.officelive.com/default.aspx

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Career Development, CMP Program, Experts Invited, iMBA, Inc., Media Mentions and PR | Tagged: david marcinko, financial services, healthcare consultants, ME-P, medical executive post, medical practice management, Practice Management, seminars, speaker's, www.certifiedmedicalplanner.com, www.healthcarefinancials.com | Leave a comment »

Are Hospitals Auctioning Debt?

Posted on July 1, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Modern Cash Flow Strategies

By Ross Filder

By Karen White PhD

www.HealthcareFinancials.com

As a sign of the contracting economic times, some struggling hospitals are using a new method to collect revenue: the Internet. It has become a channel to cut write-offs and bad debt ratios, which lower stock prices if publicly held.

Rather than simply hiring agencies to collect patient bills, hospitals have begun to put their accounts receivable (ARs) up for auction online. Bidders on the debt include the same agencies that serve the hospitals, some of which provide guaranteed payments to hospitals in exchange for access to the debt.

Strategy Attractive to Buyer and Sellers

The auctions are also attracting other companies that buy the debt outright. For example, one method that a facility based medical practice used to auction debt was for the hospital to determine the criteria it would use for selecting the debt to be auctioned. The criteria generally focus on ARs that are a certain age, but demographic regions, legal accounts, and monthly payment accounts were also be considered.

[picapp align=”none” wrap=”false” link=”term=accounting&iid=289186″ src=”http://view4.picapp.com/pictures.photo/image/289186/corporate-details/corporate-details.jpg?size=500&imageId=289186″ width=”335″ height=”480″ /]

Request for Proposal

Once the criteria are determined, a listing of accounts is generated and supplied to potential buyers along with a Request for Proposal that asks each potential buyer to provide information on their experience in servicing hospital-type ARs, as well as details of their expertise, collection techniques, references, and price.

Usually the winning bidder will pay a flat price for the entire AR. It is important for the hospital to understand that when auctioning ARs the winning bidder owns the accounts and their collection tactics will not necessarily comply with the hospital’s standards for collections.

Automation

Automation can lead to decreased paperwork, process standardization, increased productivity, and cleaner claims. In 2004, Hospital & Health Network’s “Most Wired Survey” [1] found that the 100 most wired hospitals — including three out of the four AA+ hospitals in the country — had better control of expenses, higher productivity, and efficient utilization management. These numerics are much higher today. Additionally, these top hospitals tend to be larger and have better access to capital.

Assessment

The positive return on investment in technology increases allocation of funding to technology. This correlation is important because it begins to link the investment in information technology with positive financial returns in all areas of a hospital’s business, including the revenue cycle.

Conclusion

Please comment and opine on this ME-P? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

References:

[1] See http://www.hhnmostwiredsurvey.com. The Most Wired Survey is conducted annually between January and March to “promote the effective use of information technology in achieving clinical and operating excellence.”

Filed under: Health Economics, Healthcare Finance, Insurance Matters, Research & Development | Tagged: ARs, cash conversion cycle, Hospital & Health Network’s, hospital cash conversion, hospital cash flows, karen white, Ross Fidler, www.healthcarefinancials.com | 1 Comment »

Events Planner: July 2010

Posted on July 1, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ADVERTISEMENT

Events-Planner: JULY 2010

Staff Writers

“Keeping track of important health economics and financial industry meetings, conferences and summits”

Welcome to this issue of the Medical Executive-Post and our Events-Planner. It contains the latest information on conferences, news, and relevant resources in healthcare finance, economics, research and development, business management, pharmaceutical pricing, and physician/entity reimbursement! Watch for a new Events-Planner each month.

First, a little about us! The Medical Executive-Post is still a relative newcomer. But today, we have almost 175,000 visitors and readers each month from all over the country, in addition to our growing subscriber base. We have been a successful collaborative effort, thanks to your contributions. As a result, we are adding new resources daily. And, we hope the website continues to provide the best place to go for journals, books, conferences, educational resources, tools, and other things you need to establish the value your healthcare consulting and financial advisory intervention.

So, enjoy the Medical Executive-Post and this monthly Events-Planner with our compliments.

A Look Ahead this Month

Now, the important dates:

July 15: Leadership Summit on Managed Care Contracting, San Diego, CA

July 20: Leadership Summit on Medicare, Washington, DC

July 21: Creating a Multi-Family Office Workshop, Westin, Chicago, IL

July 22: Process Improvement in Healthcare, Chicago, IL

July 25: Healthcare Payments Expo, Chicago, IL

July 27: Innovative Alternative Strategies Conference, Westin, IL

Please send in your meetings and dates for listing in the next issue of our Events-Planner.

MarcinkoAdvisors@msn.com

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

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest E-Ps delivered to your email box each morning? Just subscribe using the link below. It’s free. You can unsubscribe at any time. Security is assured.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Filed under: Events-Planner | Tagged: Events-Planner, ME-P, medical executive post, meetings, professional associations | Leave a comment »

Red Flags Delayed Again – A Poll

Posted on June 30, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Take the Modern Physician Survey Poll
Staff Reporters

The Federal Trade Commission recently delayed the enforcement of its red flags rule until at least December 31^st 2010.

So, do you think the “red flags” rule should apply to physician group practices that offer

creditor payment plans to patients?

Take the Poll Now

Assessment

Conclusion

Feel free to comment and 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.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Health Law & Policy, Surveys and Voting | Tagged: Modern Healthcare, red flag rules | 2 Comments »

On the Credibility of Financial Experts

Posted on June 29, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ADVERTISEMENT

Keys to Protecting your Financial Expert’s Credibility in Court

By Trugman Valuation Associates

Dear Valued Friends and ME-P Colleagues

We hope this e-mail finds you happy and healthy! We have attached our most recent newsletter for your perusal and hope that you will find something of interest in it.

Link: Trugman Summer 2010

Assessment

All of us at Trugman Valuation Associates wish you and yours a happy and safe 4^th of July and remainder of the summer.

www.trugmanvaluation.com

Conclusion

Feel free to comment and 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.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Health Economics, Marketing & Advertising, Practice Management | Tagged: expert financial witness, FAs, financial advisors, financial consultants, financial services, valuation experts | Leave a comment »

On HIT Continuity Planning

Posted on June 28, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Setting Up Your HIT Security System

By Richard J. Mata, MD, CIS, CMP™ [Hon]

In order for a healthcare organization to thrive, it must be able to continue to function no matter what the circumstances are.

When disaster strikes, the organization must mobilize all the talent and resources needed to continue their operations and return to a normal state as soon as possible.

Time is money, and in today’s economy, an hour could be worth thousands of dollars. Every department in an organization has responsibilities during a disaster. Planning for a disaster and then dealing with it is a team effort by all parts of an organization.

Phases of Healthcare Business Continuity Planning

A system is required to realize this objective, and part of this system is healthcare entity business continuity planning (BCP).

Phase One: Set up a BCP Project

The first step is to set up a BCP project, which includes feedback from key members from all departments. Appoint a project manager who has a solid background in the clinical and financial systems and functions that the organization deploys or services it provides. The project manager can work with business and system analysts to document business flow and interactions with computerized systems that may go down, and how the organization will function on a manual system until service returns.

Phase Two: Review Emergencies and Assess Business Risk

The second phase involves reviewing the different types of emergencies that can arise and assessing the risks to the various business processes already documented. This is accomplished following a system or service function.

Phase Three: Prepare for Emergencies

The third phase includes identifying of back-ups and recovery strategies to mitigate the effects of an emergency. A storage area network (SAN) or redundant server could be used as back-ups.

Phase Four: Plan for Disaster Recovery

The fourth phase involves the development of procedures to be followed by a Disaster Recovery Team where human life may be at risk. A disaster might be caused by weather, sabotage, or electrical power and be specific to the particular organization and its business and IT infrastructure.

Phase Five: Plan for Business Recovery

The fifth phase is critical, and involves developing detailed procedures for the recovery of the business. Again, the BCP project manager could use each business or service procedure that was documented in phase two and detail which financial or clinical systems are involved, what would be done if the systems were down, and what the plan for recovering the system might be.

Phase Six: Test Business Recovery Procedures

The sixth phase involves simulating authentic emergencies and testing of the business recovery phase. For example, how would business processes or services be affected by an electrical outage? How fast can a power generator pick up the outage – and what might happen after a timely pause? How would patients who were receiving mechanical support be affected? What would happen to the clinical laboratory?

Phase Seven: Train the Staff

Phase seven covers the training of all employees in the procedures necessary to manage the business recovery process. These are the procedures tested in phase six, which may require modification.

Phase Eight: Maintain the Currency of the Plan

Phase eight includes treating BCP as a dynamic project to be kept up to date to reflect all changes to business processes and employee structure.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Information Technology, Practice Management, Professional Liability | Tagged: business continuity planning, CCHIT, EHRs, EMRs, Health I.T., HIPAA, National Institute of Standards and Technology, ONC, Richard J. Mata, SAN, www.certifiedmedicalplanner.com, www.healthcarefinancials.com | Leave a comment »

Current Outlook for the Hospital Industry

Posted on June 27, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Adaptation is Key in 2010 and Going Forward

By Robert James Cimasi; MHA, ASA, AVA, CBA, CMP™

www.HealthCapital.com

Hospitals today must continually adjust to deal with pressures to contain reimbursement and utilization levels. The continuing cost containment pressures manifest themselves in many patients being shifted not only to lower acuity treatments but also to other providers.

Reimbursement mechanisms are increasingly designed to control costs and access. Managed care insurance plans continue to be a strong influence as payers for acute care hospital services. Medicare’s HOPPS [hospital outpatient prospective payment system] has reduced many of the financial benefits of shifting more care to outpatient settings.

Personnel Shortages

Personnel shortages have plagued the industry, and with the pending retirement of baby-boomers, relief from these shortages seems remote. This population also heavily influences the consumer side of the industry, since healthcare plans are based heavily upon demographics. Aging baby-boomers are the fastest-growing segment of the population; the portion of the population over 65 years old is expected to increase from 20 million in 1970 to 69.4 million in 2030. Following closely behind is the increase in other minority populations. Both groups will influence how healthcare services are dispensed.

Additionally, despite pressure to limit ALOS [average length of stay] and the shift to outpatient and freestanding, off-campus care, there will continue to be demand for acute care hospitals and the demographic trends will support this demand for many years.

Technology

Technological advances always play a central role in changing the medical industry. The issue will be how healthcare providers will adopt new technologies under their current capital constraints.

Currently, health care insurance coverage is a major unfolding issue in the US, and there remains uncertainty about the future level of both public and private insurance coverage. Now, facing the recent economic instability, employers are looking at restraining healthcare benefits for their employees even more as a way to stay profitable.

Assessment

The decline in the healthcare workforce coinciding with the increase in labor costs and resource consumption poses an ongoing challenge. And yet, in the midst of the economic turmoil, hospitals must continue to provide services while remaining aware of the economic threats that may still lie ahead.

More:

Arkansas Medical News Interviews Dr. Marcinko

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Career Development, CMP Program, Health Economics, Managed Care | Tagged: ALS, Hospital industry outlook, hospital outpatient prospective payment system, Medicare’s HOPPS, Patient Protection and Affordable Care Act, Robert Cimasi, St. vincent hospital manhattan, www.certifiedmedicalplanner.com, www.healthcarefinancials.com | 9 Comments »

On Military Brain Injury Treatment

Posted on June 25, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Leader Steps Down Abruptly

By T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR – June 23, 2010 6:33 pm EDT

WASHINGTON, D.C.–The leader of the Pentagon’s premiere program for treatment and research into brain injury and post traumatic stress disorders has unexpectedly stepped down from her post, according to senior medical and congressional officials.

Brig. Gen. Loree Sutton told staff members at the Defense Centers of Excellence [1], or DCOE, on Monday that she was giving up her position as director. Sutton, who launched the center in November 2007, had been expected to retire next year, officials with knowledge of the situation said. The center has not publicly announced her leaving.

Tell Us Your Story [2]

Did you or a loved one suffer a traumatic brain injury while serving? ProPublica and NPR want to hear your story. Tell us about your experiences with TBI. [2]

Sudden Departure

Sutton’s departure follows criticism in Congress [3] over the performance of the center and in recent reports [4] by NPR and ProPublica that the military is failing to diagnose and treat soldiers suffering from so-called mild traumatic brain injuries, also called concussions.

It comes just as the Pentagon prepares to open a new, multimillion-dollar showcase treatment facility outside Washington, D.C., for troops with brain injuries [5] and post traumatic stress disorder, often referred to as the signature wounds of the wars in Iraq and Afghanistan.

Late Wednesday, in a sign of disarray within the program, Sutton cancelled a scheduled appearance at the opening of the National Intrepid Center of Excellence [6], a gleaming new facility of waving glass and futuristic virtual reality treatment rooms in Bethesda.

“The war in Iraq and Afghanistan could end tomorrow; our mission to restore health, hope and humanity will endure for decades,” Sutton wrote in her farewell message [7]. “We simply must uphold our commitment to all who have borne the burdens of war on our behalf.”

Sutton did not respond to requests for comment. Her replacement, U.S. Army Col. Bob Saum, also declined to comment.

DCOE

Cathy Haight, the acting spokeswoman for DCOE, said Sutton’s departure, though apparently well ahead of schedule, was part of a routine command rotation. Haight said Sutton decided to leave after turning down the Army’s offer to take a new position overseeing the military medical system in Europe.

“If a general officer declines (a new position)…they are in a transition to retire,” Haight said.

In recent months, legislators have questioned Sutton’s ability to carry out the mission of the centers, which is to catalyze research and treatment across the military for soldiers returning with brain injuries and psychological wounds.

Congress directed the military in 2008 to create the brain injury center and other facilities for wounded soldiers. At an April hearing [8] of a House Armed Services subcommittee, Rep. Susan Davis [9], D-Calif., said that the center had failed to carry out its role.

“The Defense Center of Excellence, while having achieved some notable small scale successes, has not inspired great confidence or enthusiasm thus far. The great hope that it would serve as an information clearinghouse has not yet materialized,” Davis said.

“The center has also made some serious management missteps that call into question its ability to properly administer such a large and important function,” Davis continued.

Sudden Scrutiny

Scrutiny of Sutton rose another notch earlier this month, when NPR and ProPublica reported on the military’s problems in handling soldiers with mild traumatic brain injuries. Such injuries leave no visible scars, but can cause lasting mental and physical difficulties.

Military statistics show that about 115,000 troops have suffered such injuries since 2002, but in interviews, Army experts acknowledged the true toll may be far higher. Unpublished research we reviewed suggests that tens of thousands of soldiers may have gone undiagnosed. Our reporting also showed that even when soldiers were diagnosed, at one of America’s largest Army bases, they have had to fight to receive appropriate treatment [10].

Veterans’ Shocked

Still, some veterans’ advocates were shocked and saddened that Sutton was leaving. They said she had been a forceful, visible advocate for wounded troops and their families who had never received the full support of the military’s medical establishment.

Assessment

Critics of the military’s health system have noted a power vaccum at the top of the military medical structure. Four people in just over three years have rotated through the Pentagon’s top health policy position, the assistant secretary of defense for health affairs.

“She was always there for the troops,” said one veterans’ advocate, who did not want to be named for fear of criticizing the military. “She’s become the scapegoat.”

In an April interview with NPR and ProPublica, Sutton shrugged off the criticism. “Leading change,” she said, “is a journey not for the faint of heart.”

“We are very proud of the team that we have built, the concept in terms of the center of centers, the network of networks,” she said. “Are we anywhere close to where we want and need to be? No. Of course not.”

Link: http://www.propublica.org/feature/leader-of-militarys-program-to-treat-brain-injuries-steps-down-abruptly

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

LEXICONS: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com

Filed under: Health Law & Policy, Military Medicine | Tagged: Brig. Gen. Loree Sutton, Cathy Haight, Daniel Zwerdling, DCOE, Defense Centers of Excellence, Military Medicine, National Intrepid Center of Excellence, NPR, ProPublica, Rep. Susan Davis, T. Christian Miller, traumatic brain injury, U.S. Army Col. Bob Saum, VA healthcare | 4 Comments »

A New Model for Planing Physician Retirement Needs

Posted on June 24, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Age Banding

By Ann Miller RN, MHA

[Executive Director]

From time to time, our readers send in e-books, files or e-chapters, pamphlets or other material they have created for client, educational or marketing use. Some of it may be worthwhile; some not so. Nevertheless, these publications are often a good place to start the conversation, or thought-process on related topics.

They will be occasionally offered as a complimentary membership feature of the Medical Executive-Post.

Age Banding [author]
Somnath Basu PhD, MBA [www.clunet.edu/cif]
[Director California Institute of Finance]

Link: AgeBander

Disclaimer

No advice offered. We make no copyright claim to these works. Veracity and information should be considered time sensitive. Always consult a professional for your situation.

Assessment

Feel free to send in your own material for the benefit of all Medical Executive-Post readers and subscribers.

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Experts Invited, Op-Editorials, Retirement and Benefits | Tagged: age bander, age banding, agebander, California Institute of Finance, california lutheran university, retirement planning, Somnath Basu | 5 Comments »

Where Are The Health Care Entrepreneurs?

Posted on June 24, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

The Failure of Organizational Innovation in Health Care

Submitted by Ann Miller RN, MHA

[Executive-Director]

The following quote is from a white paper by David M. Cutler

NBER Working Paper No. 16030
Issued in May 2010

Medical care is characterized by enormous inefficiency. Costs are higher and outcomes worse than almost all analyses of the industry suggest should occur. In other industries characterized by inefficiency, efficient firms expand to take over the market, or new firms enter to eliminate inefficiencies. This has not happened in medical care, however.

Therefore, this paper explores the reasons for this failure of innovation. I identify two factors as being particularly important in organizational stagnation: public insurance programs that are oriented to volume of care and not value, and inadequate information about quality of care.

Assessment

Recent reforms have aspects that bear on these problems.

Link: http://papers.nber.org/papers/w16030

Conclusion

The thoughts of all ME-P readers are appreciated. Then, be sure to subscribe. It is fast, free and secure.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: "Doctors Only", Career Development, Health Economics, Practice Management | Tagged: Consumer Healthcare Efficiency Indices, David Cutler, Health Care Entrepreneurs, Health Care Innovators, healthcare efficiency, heathcare costs, Innovation Health Care | 8 Comments »

Benchmarks of Health Plan Administrative Costs

Posted on June 23, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

2010 Edition‏

Sherlock Company
ADVERTISEMENT

By Douglas B. Sherlock, CFA
[Senior Health Care Analyst]
sherlock@sherlockco.com

In the next few weeks we will be releasing our thirteenth annual edition of our administrative performance benchmarks for health plans. It is the culmination of 450 health plan years of experience with all major sectors of the health plan industry. The attached brochure briefly describes our 2010 benchmarks.

Weak Employment Environment

Many health plans are convinced that effective management of operating costs is central to their long-term success. This is especially the case in the current challenging environment. The weak employment environment pressures revenue yields and membership, forcing rationalization of operating costs. The weak credit environment heightens plan sponsor interest in self-insurance, which increases the visibility of administrative expenses.

Finally, health care reform heightens the interest in operating costs by external audiences. Accordingly health plans serving more than one-half of all insured Americans are users of our benchmarks.

Assessment

Our benchmarks enable your plan to quickly determine whether it is operating at best practice and to identify which functional areas provide the highest return on management’s efforts to improve performance. Additional information can be found at http://www.sherlockco.com/seer.shtml or by contacting me directly.

I hope you will not hesitate to contact me if I can answer any further questions.

Link: Sherlock Health Plan Benchmarks Brochure

Sherlock Company
Senior Health Care Analyst
sherlock@sherlockco.com
Ph: 215-628-2289
Fax: 215-542-0690

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Alerts Sign-Up, Health Economics, Health Insurance | Tagged: CFA, Douglas B. Sherlock, Health Plan Administrative Costs, Sherlock Company | 2 Comments »

Implementation of the Healthcare Deficit Reduction Act

Posted on June 23, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Signed by President Bush in 2006

By Gregory O. Ginn; PhD, MBA, CPA, MEd

By Hope Rachel Hetico; RN, MHA, CMP™

The Deficit Reduction Act (DRA), S. 1932, was signed by President Bush on February 8, 2006, and became Public Law No. 109-171. Implementation of the act includes these provisions:

www.CertifiedMedicalPlanner.com

Subtitle A – Provisions Relating to Medicare Part A

hospital quality improvement (section 5001);
improvements to Medicare-dependent hospital (MDH) programs (section 5003);
reduction in payments to skilled nursing facilities (SNFs; section 5004);
phase-in of inpatient rehabilitation facility classification criteria (section 5005);
development of a strategic plan regarding investment in specialty hospitals (section 5006);
demonstration projects to permit gain-sharing arrangements (section 5007); and
post-acute care payment reform demonstration programs (section 5008).

Subtitle B Provisions Relating to Medicare Part B

title transfer of certain durable medical equipment (DME) to patients after 13-month rental (section 5101);
adjustments in payment for imaging services (section 5102);
limitations on payments for procedures in ambulatory surgical centers (ASCs; section 5103);
minimum updates for physician services (section 5104);
three-year extension of hold-harmless provisions for small rural hospitals and sole community hospitals (section 5105);
updates on composite rate components of basic care-mix adjusted prospective payment systems (PPS) for dialysis services (section 5106);
accelerated implementation of income-related reductions in Part B premium subsidy (section 5111);
Medicare coverage of ultrasound screening for abdominal aortic aneurysms; National Educational And Information Campaign (section 5112);
improvements to patient access and utilization of colorectal cancer screening under Medicare (section 5113);
delivery of services at federally qualified health centers (FQHC) (section 5114); and
waiver of Part B Late Enrollment Penalty for certain international volunteers (section 5115).

Subtitle C – Provisions Relating To Parts A and B

home health payments (section 5201);
revision of period for providing payment for claims that are not submitted electronically (section 5202);
timeframe for Part A and B payments (section 5203); and
Medicare Integrity Program (MIP) funding (section 5204).

Subtitle D – Provisions Relating To Part C

phase-out of risk adjustment budget neutrality in determining payments to Medicare Advantage organizations (section 5301); and
Rural PACE Provider Grant Programs (section 5302).[1]

The goal of the act is to save nearly $40 billion over five years from mandatory spending programs through slowing the growth in spending for Medicare and Medicaid. Has it been successful to-date?

Assessment

We know from personal experience that the DRA can be implemented by all healthcare stakeholders to the benefits of the industry sector in the aggregate. But, has it been?

Conclusion

And so, 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, be sure to subscribe to the ME-P. It is fast, free and secure.

Editors Note: Gregory Ginn has been a professor in the Department of Health Care Administration at the University of Nevada, Las Vegas, since 2000. He received his doctorate, MBA, M.Ed., and undergraduate degree from the University of Texas at Austin, and is an inactive Certified Public Accountant registrant in the States of Nebraska and Texas. Before his current position at UNLV, he spent time teaching at Clarkson College, College of Saint Mary, University of Findlay, University of Central Texas, Stephen F. Austin State University, State University of New York at Buffalo, University of Houston at Victoria, University of Texas at Austin, and the Southwest Texas State University. Prior to his academic roles, he was an accountant for Touche Ross & Co., and an Internal Revenue Service Tax Auditor. Dr. Ginn has also been a reviewer for organizations such as: Health Care Management Review and the Health Care Administration Division of the Academy of Management. He is Treasurer for the Nevada Executive Health Care Forum and was a member of the Southern Nevada Wellness Council. His graduate teaching experience in healthcare administration is abundant, having taught courses in: Management of Health Services Organizations, Quantitative Methods, The U.S. Health Care System, Health Care Systems and Policy, Health Care Finance, Group Practice Management, Long-term Care, and Health Care Law. He has been published in numerous journals, including Journal of Healthcare Management, Hospital Topics, Nursing Homes, Journal of Nursing Administration, International Electronic Journal of Health Education, and Hospital and Health Services Administration. His current and former professional memberships include: American College of Healthcare Executives, Nevada Executive Healthcare Forum, Academy of Management, Association of University Programs in Health Administration, Certified Medial Planner (Hon.) and Heartland Health Care Executives.

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Source: www.ncsl.org/statefed/health/ReconDocs0206.htm

Filed under: CMP Program, Health Economics, Health Law & Policy, Managed Care, Practice Management | Tagged: Deficit Reduction Act, durable medical equipment, federally qualified health centers, Gregory O. Ginn, Medicare Integrity Program, Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D, Medicare-dependent hospital, National Educational And Information Campaign, prospective payment systems, Rural PACE Provider Grant Programs, skilled nursing facilities, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.healthdictionaryseries.com | 1 Comment »

Take the National ObamaCare Quiz

Posted on June 21, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Test Your Knowledge

By Jeanette Nordstrom

Dear David,

You feared ObamaCare would be a disaster for America because you signed the Free Our Health Care Now petition from the National Center for Policy Analysis (NCPA) last year to oppose its passage. With more than 1,367,900 signers, it was the largest online policy petition ever delivered to Capitol Hill.

Now as part of the repeal effort, the NCPA is conducting a National ObamaCare Quiz so you can test your knowledge about what’s in the law!

Take the quiz now.

But be warned: The answers may raise your blood pressure! ObamaCare is bigger, badder, and uglier than you probably ever imagined. How bad is it, really? Find out here.

Sincerely,

Jeanette Nordstrom
National Center for Policy Analysis

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Alerts Sign-Up, Health Law & Policy, Voting Polls | Tagged: Jeanette Nordstrom, National Center for Policy Analysis, National ObamaCare Quiz, NCPA, ObamaCare | 13 Comments »

How eMR Vendors May Mislead You

Posted on June 21, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Challenging Assertions

By Shahid N. Shah MS

As the physician executive of your medical practice, it’s your job to challenge any eMR vendors’ assertions about why you need an eMR, especially during the selection and production demonstration phase.

Information Availability [Anytime – Anywhere]

The most important reason for the digitization of medical records is to make patient information available when the physician needs that information to either care for the patient or supply information to another caregiver.

Electronic medical records are not about the technology but about whether or not information is more readily available at the point of need.

Reasons to Purchase?

In no particular order, the major reasons given for the business case of eMRs by vendors include:

• Increase in staff productivity
• Increase of practice revenue and profit
• Reduce costs outright or control cost increases
• Improve clinical decision making
• Enhance documentation
• Improve patient care
• Reduce medical errors

Assessment

So, doctors beware! Challenge vendor “authority.”

Editor’s Note

Shahid N. Shah is an ME-P thought leader who is writing Chapter 13: “Interoperable e-MRs for the Small-Medium Sized Medical Practice” [On Being the CIO of your Own Office] for the third edition of the best selling book: Business of Medical Practice [Transformational Health 2.0 Skills for Doctors] to be released this fall by Springer Publishers, NY. He is also the CEO of Netspective Communications, LLC.

www.BusinessofMedicalPractice.com

Conclusion

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

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Information Technology, Media Mentions and PR, Recommended Books | Tagged: Business of Medical Practice, david marcinko, digital medical records, EHRs, electronic medical records, EMRs, Netspective Communications, Shahid Shah, www.BusinessofMedicalPractice.com | 9 Comments »

GE Violated Danish Drug Reporting Law

Posted on June 20, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

In the Omniscan Case

By Jeff Gerth, ProPublica – June 17, 2010 5:59 pm EDT

General Electric’s health care unit failed to promptly and completely inform regulators about a patient who died after experiencing adverse effects from the company’s MRI drug Omniscan, Danish drug regulators concluded in a ruling last month.

Danish Medicines Agency

The finding by the Danish Medicines Agency comes in the case of a Danish woman who had been injected with Omniscan for a magnetic resonance scan in 2002 and gradually became immobilized and died of a lung embolism the following year. The woman, Birthe Madsen, is believed to be among the first patients whose use of Omniscan and similar medical imaging drugs was associated with a rare and potentially crippling disease now known as nephrogenic systemic fibrosis [1], or NSF. Hundreds of patients became ill after Madsen’s death, before regulators and drug companies learned enough about the risks to begin issuing alerting doctors a few years later.

Government Insurance Agency

Reviewing the reasons Madsen died, a Danish government insurance agency determined in 2004 that Omniscan caused her immobility and in turn her death. Although this was relayed to GE Healthcare, the company did not immediately report it to the medicines agency as required, nor did a follow-up include the insurance agency’s conclusion that Madsen’s death could be attributed to the drug.

Although the reporting lapses violated Danish drug law, the medicines agency told GE Healthcare in a May 21 letter that the statute of limitations had expired and it would not pursue further action against the company. GE Healthcare maintains that its reporting about Omniscan’s side effects has been proper, and spokesman Jeff DeMarrais said in an e-mail that the woman’s death was not initially attributed to Omniscan because the fatal embolism occurred during a lengthy course of treatment “following the patient’s adverse reaction.”

The ruling by the Danish Medicine Agency, coming years after the reporting lapse, appears to have been prompted by an inquiry last October from a member of the Danish parliament about the agency’s response after cases of NSF first came to light in early 2006.

[picapp align=”none” wrap=”false” link=”term=denmark&iid=5207011″ src=”http://view2.picapp.com/pictures.photo/image/5207011/low-angle-view-amalienborg/low-angle-view-amalienborg.jpg?size=500&imageId=5207011″ width=”323″ height=”529″ /]

Contesting Lawsuits

GE currently is contesting more than 400 lawsuits [2] involving U.S. patients who say they contracted the disease after being injected with Omniscan. The company says it acted properly to protect patients and denies its drug causes NSF. Some manufacturers of competing products also have been sued, but in far fewer numbers than GE.

One of the major points of debate in the litigation concerns what GE Healthcare knew [2] and disclosed to regulators about Omniscan’s risks. The company contends it has been proactive and cooperative, while the plaintiffs claim the company failed to disclose damaging information about the drug and put patients in jeopardy.

Critics of GE Healthcare say more forthright disclosure might have helped doctors and regulators respond earlier and more effectively. Among them is Madsen’s son, Casper Schmidt, a Copenhagen lawyer who has carefully documented her case and the actions of various Danish authorities.

“If my mother’s case had been reported more accurately, and if the company had to explain why a patient died,” Schmidt said in an e-mail, “it would have helped enable doctors and regulators to better understand the disease earlier.”

US and European Drug Makers

Drug manufacturers in the United States and Europe are required to promptly report serious adverse reactions so that regulators and medical providers can monitor a product’s safety. They also must update the reports as new information about a case develops. In the U.S., the Food and Drug Administration logs the reports in a database [3].

At the time Madsen was exposed to Omniscan in 2004, tens of millions of patients who had undergone MRIs had been safely injected with such products, known as contrast agents, to enhance the images.

Omniscan [4], approved for use in the United States in 1993, is among a class of such agents that rely on gadolinium, a highly toxic metal. The body normally eliminates the drug quickly after treatment, except in some patients who have impaired kidney function.

Madsen was such a patient. According to Schmidt’s timeline of her treatment, she had at least one dialysis treatment before being injected with Omniscan in January 2002 to evaluate whether her veins were healthy enough for a kidney transplant. She experienced a cascade of crippling symptoms until her death in October 2003 at age 55.

Madsen’s adverse reactions prompted a medical review by a Danish government insurance agency, called Patientforsikringen, or Patient Insurance Agency, to see whether she had suffered drug side effects that might qualify her for state compensation.

The review determined that while Madsen died of a pulmonary embolism, her “immobilization was caused by the acknowledged pharmaceutical injury.”

That conclusion was reported to GE Healthcare on June 1, 2004, but the company failed to relay the information as required, the Danish Medicines Agency said in its May letter. In addition, the agency said a follow-up report from GE Healthcare, while noting several of Madsen’s adverse reactions, was insufficient because it did not repeat the state insurance agency’s finding that she died from an embolism due to being immobilized.

The GE Spokesman

DeMarrais, the GE spokesman, said that at the time, the company’s drug safety experts had a different understanding of Madsen’s death.

“Our filings regarding the case in question reflect that, as of 2004,” DeMarrais wrote, “our (drug safety) unit had not concluded, based on the information available at the time and in good faith, that the patient’s death had been caused by the adverse event that had been linked to the administration of Omniscan, but rather by a pulmonary embolism occurring during a protracted medical course following the patient’s adverse reaction.”

In its May letter, the Danish Medicines Agency said it had combed its files and could find no report from GE about Madsen in June 2004. DeMarrais, however, said the company believes a report was sent that month “at the same time as it was sent to other regulators, as confirmed by the FDA’s receipt of this filing.”

ProPublica Inquiry

At ProPublica’s request, Conor McKechnie, another company spokesman, provided a copy of the FDA filing [5] with Madsen’s name and some other information redacted. (The filing was on the letterhead of Amersham Health, the British maker of scanning drugs that GE acquired in late 2003 and early 2004.)

The filing references “new information” from the Danish insurance agency and states that the patient involved “suffered pulmonary embolism due to immobilization and died.” But it does not quote the insurance agency’s conclusion that “pharmaceutical injury” was to blame for Madsen’s immobility.

McKechnie said the FDA filing is accurate and mentioned immobilization, the embolism and death. DeMarrais said GE Healthcare also has submitted half a dozen more supplemental filings on the case over the last six years. “It would be a mistake,” he added, “to attach unwarranted significance to this particular case at this juncture.”

“It is our position that, consistent with the relevant health risk communication protocols, we provided complete and timely reports to the DMA and other global authorities regarding the adverse events associated with Omniscan that were reported to us,” DeMarrais said in his e-mail.

Dr. Sidney Wolfe, director of the health research group at the consumer watchdog organization Public Citizen, said GE should have been more forthcoming in 2004.

“Incomplete and misleading reports such as this undermine the ability of the government to make decisions more quickly to improve the public health,” said Wolfe, who is on an FDA advisory committee [6] that late last year reviewed Omniscan and other contrast agents.

In May 2006, following the disclosure of 20 NSF cases in Copenhagen, GE Healthcare issued a safety alert to the DMA and regulators around the world. It discussed the new cases and attached a brief description of each one. In the section involving Madsen, the company reported her death as “unrelated to Omniscan.”

By 2007, at the urging of regulators, the manufacturers of gadolinium-based agents put warnings about NSF on their labels. Three years later, much about the disease remains a mystery [7], including the exact cause. Patients experience a painful hardening or thickening of skin around the joints. The disease can be disfiguring and may attack internal organs.

Current Updates

As of last fall, the Patientforsikringen had reviewed 38 cases in which people exposed to Omniscan had suffered injury or death. In 26 cases, the insurance agency determined that GE Healthcare’s drug was the likely cause, according to a spokesman. In those cases, including Madsen’s, the agency made payments to the victims or their relatives.

[picapp align=”none” wrap=”false” link=”term=General+Electric&iid=8962953″ src=”http://view2.picapp.com/pictures.photo/image/8962953/general-electric-ceo-and/general-electric-ceo-and.jpg?size=500&imageId=8962953″ width=”380″ height=”537″ /]

Assessment

GE Healthcare has the opportunity to appeal the insurance agency’s decisions but has not done so, the Patientforsikringen spokesman said in an e-mail last fall. McKechnie said the company did not appeal because it was not a direct party to the agency’s decision.

DeMarrais said the company would respond to the Danish Medicines Agency’s finding of a reporting violation, which can be appealed.

Madsen’s name is redacted in the May 21 letter from the agency, but it was confirmed by her son and by matching the details in the letter with other public information.

Link: http://www.propublica.org/feature/ge-violated-danish-drug-reporting-law-in-omniscan-case

Conclusion

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

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Drugs and Pharma, Health Law & Policy, Professional Liability, Research & Development | Tagged: Birthe Madsen, Casper Schmidt, Danish Medicines Agency, FDA, GE Healthcare, Jeff DeMarrais, Jeff Gerth, MRI, NSF, omniscan, OnmiScan, Patientforsikringen, ProPublica | Leave a comment »

On this Blogging and Writing Lifestyle

Posted on June 19, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

About My Morning Routine

[By D. Kellus Pruitt; DDS]

For lack of anything else to write about at the moment, let me describe my morning routine on the weekends.

I like to get up early – 5:30 am yesterday morning. More often than not, Bo, our sheltie, is waiting to greet me because he knows we get to go after the newspaper. That’s exciting. Bo is a morning dog as well. I brew up some coffee, read the newspaper – headlines mostly – and then I sit down in an overstuffed chair with my laptop to check my Google alerts and email before I start writing on whatever strikes me as interesting.

Commencing this Lifestyle

Many writers; like my friend Jill Kring Carter who writes professionally for DentalTown and other publications, do their best work late at night. My mom, who painted professionally, liked the hours between 10 pm and 2 or 3 am for her art when she didn’t have to teach school the next day.

My sons, Ryan and Kellus, like the late hours as well. Sometimes on the weekends, I’m getting up when they are going to bed after having played online video games with friends across the nation all night. That means that while they are sleeping, and before Marci gets up and turns on electrical appliances, I sit nice and cozy, hammering away – constructing sentences out of words and then rearranging it to say with surgical precision what I intend to say. I enjoy it.

Shutting off the Laptop

About the time I run out of battery for my laptop is when dogs start whining and barking, the TV comes on and the day springs to life. After I turn off my computer, sometimes Ryan and I go out for breakfast and sometimes Marci fixes eggs and bacon, pancakes or French toast. Otherwise I heat up a bowl of oatmeal to eat, visit some, and then head to the office where it’s quiet all day long.

Assessment

If you are a doctor, medical management consultant, or any sort of accountant, economist or financial advisor; please tell us how you spend your non-professional time /day. Is this post appropriate for a professional forum like the ME-P. Or, is it TMI and better suited for a social network site? Does anyone even care?

Conclusion

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.

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

Filed under: Pruitt's Platform | Tagged: Darrell Pruitt, DentalTown, human interest, Jill Kring Carter, lifestyle | 4 Comments »

ME-P E-mail White List Instructions

Posted on June 19, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Making Sure You Get the ME-P Every Day!

Ann Miller RN, MHA

[Managing Editor]

Dear ME-P Subscribers

Increasingly, Internet Service Providers [ISPs] are using filtering systems to try and keep spam out of customers’ inboxes. Sometimes, they accidentally filter the e-mail that you want to receive. In many cases, neither party is notified that the e-mail didn’t get through.

Assessment

So, to make sure that ME-P newsletters, publications, special reports and e-mail alerts etc, are not filtered into your “junk” or “bulk” folder, please add the ME-P to your list of trusted senders.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Alerts Sign-Up, iMBA, Inc., Monthly Reports | Tagged: filtering systems, Internet Service Providers, ISPs, spam blockers | Leave a comment »

Short Term Doctor Fix Achieved

Posted on June 18, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ME-P News Flash Alert!

Moments ago, the Senate reached a deal and passed a short-term six month physician pay cut, blocking the 21 percent reimbursement cut scheduled to go into effect today.

Assessment

This update comes after failing on Thursday to pass the larger H.R. 4213, which not only would have provided the physician payment relief, but also included provisions to extend tax and jobless benefits.

Link: http://www.healthcapital.com/hcc/newsletter/june2010_newsalert/alert6_2010b.pdf

Conclusion: Your comment are appreciated.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Alerts Sign-Up, Breaking News | Tagged: doctor fix, HR 4213, physician payment relief, SGR | Leave a comment »

Is the Texas Dental Association too Authoritarian?

Posted on June 18, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

About Employee Mary Kay Linn

[By Darrell Kellus Pruitt; DDS]

Texas Dental Association Executive-Director Mary Kay Linn seems to think that TDA members owe her respect for some reason. I don’t see it. You get what you give TDA employee Mary Kay Linn.

Link: TDA response to Pruitt

I’ve attached the partially answered, authoritarian response from the TDA. I think it speaks for itself. And, I posted the following Twitterpoem today.

Mary Kay Linn, the executive director of the TDA just doesn’t get it.

@theTDA, I received the responses to some of the 30+ questions that were invited by the TDA. Linn’s evasion is transparent and regrettable.

@theTDA, when a Judicial Committee member delivered the PDF, he said Linn told him to tell me that “This is it. No more questions.”

Assessment

He added that: “There will be no follow up responses and that the very busy TDA staff spent far too much time on my questions already.”

TDA Executive Director Mary Kay Linn, this will not end well for you.

Assessment

How responsive was the TDA; just right, under or overwhelming when pushed? Or, was Dr. Pruitt over-the-top? Does he expect too much from his professional association? Does almost every DDS except him know that the “emperor has no clothes?” Or, is he one member with critical thinking skills instead of blind [misplaced] faith?

Finally, is there an analogy here for the AMA, ADA, APMA, ANA, AOA, etc? Are the aging command-control medical association monopolies crashing down in the era of internet connectivity and professional networking? Do we need new norms and etiquette models of communication? Please opine.

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Filed under: Career Development, Health Law & Policy, Information Technology, Pruitt's Platform | Tagged: ADA, American Dental Association, Darrell Kellus Pruitt, EMRs, HIPAA, Mary Kay Linn, TDA, Texas Dental Association | 29 Comments »

Doctors Helping Seniors Avoid Financial Fraud?

Posted on June 17, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

The Elder Investment Fraud and Financial Exploitation Project

By Staff Reporters

A new program created in Houston and tested in Texas will teach medical professionals nationwide to identify and report signs of elder financial abuse.

The EIFFE

The Elder Investment Fraud and Financial Exploitation project includes a new survey and prevention campaign to help people 65 year, and older, avoid being fleeced. The program is designed to help geriatric health professionals and financial regulators work more closely to identify, and report and investigate elder financial abuse.

Assessment

And still, FINRA, the SEC and others are procrastinating on fiduciary responsibility for financial advisors.

http://blogs.chron.com/medblog/archives/2010/06/houston_program.html

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. FAs, and CSAs, are you embarrassed by this program? Are you a fiduciary – much like a physician or lawyer? Doctors, how do you feel – burdened, resentful, empowered, etc?

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.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: "Advisors Only", "Doctors Only", Ethics, Financial Planning, Health Law & Policy | Tagged: Elder Investment Fraud and Financial Exploitation Project, finance reform, financial fiduciary, FNRA, SEC | 11 Comments »

Understanding Patient-Focused Healthcare

Posted on June 17, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Emerging Trend Focuses on the Patient

By Gregory O. Ginn; PhD, MBA, CPA, MEd

By Hope Rachel Hetico; RN, MHA, CMP™

One swelling competitive medical administration and clinical trend is patient-focused and holistic healthcare, which centers on patient needs and attempts to humanize patient care.

Definition

www.HealthDictionarySeries.com

Patient-focused healthcare therefore incorporates the following concepts, among others:

patient education;
active participation of the patient;
involvement of the family;
nutrition;
art; and
music.

These are thought to improve patient outcomes. Further, some think that patients will benefit from learning how to cope with healthcare processes before they enter into those processes and that this knowledge will result in better outcomes.

www.CertifiedMedicalPlanner.com

An example of this would be classes to prepare couples for childbirth. These classes teach prospective parents the different stages of labor and strategies for dealing with the challenges associated with each stage. They cover options for pain management such as breathing and relaxation techniques and/or analgesics. The classes also provide education about clinical options such as induced labor and caesarian sections, and they cover practical issues such as what to wear and what kind of car seat to buy to transport the newborn home.

Assessment

We know from personal experience that this type of education is enormously beneficial in reducing stress and improving the decision-making ability of patients who are involved in healthcare processes.

www.HealthcareFinancials.com

Conclusion

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Career Development, CMP Program, Practice Management | Tagged: collaborative medicine, Gregory O. Ginn, health 2.0, hope hetico, participatory medicine, Patient centered healthcare, patient focused healthcare, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.healthdictionaryseries.com | 1 Comment »

What is M-Health for Physicians?

Posted on June 16, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

On “Smart Phones” and Mobiles Devices

By Shahid N. Shah MS

M-Health or “mobile health” is an industry term for collectively defining those tools and technologies that can be used on “smart phones” like iPhone, Blackberry, Android, or on traditional mobile phones from various vendors.

Unlike traditional computers, almost every patient that walks into your medical office, as well as all your own staff, have mobile devices already. If you can find mobile applications that can help your practice you can immediately put to use without large capital expenses, network configuration, and other technical tasks.

www.MedicalBusinessAdvisors.com

The M-Health Initiative

According to the mHealth Initiative, there are 12 major “application clusters” in mobile health: patient communication, access to web-based resources, point of care documentation, disease management, education programs, professional communication, administrative applications, financial applications, emergency care, public health, clinical trials, and body area networks.

www.CertifiedMedicalPlanner.com

The Applications

Almost all of these applications are focused around the patient but most of them will be directly useful to you and your staff as well. Here’s how:

Improving physician-patient communications. You can get your staff to send out text messages, e-mails, photos, and other information about your practice to the patient before their visit. You can remind them about appointments, tell them what to expect, ask them for their insurance and check-in information, or let them send you their personal health record link. During the visit you can send them patient education information directly to their phones instead of handing out paper. After the visit you can send medication reminders, additional educational resources, and update to their personal health record, or ask them to join a Health 2.0 social network. PumpOne, GenerationOne, Intouch Clinical, Life:Wire, and Jitterbug phones all have great patient user experiences and you should tell your patients about them.
Faster access to information for you and your patients. There are countless web-based resources that are now at your fingertips on a phone. Patients can lookup providers, labs, testing services, etc. that you can refer them to; you can help them join clinical trials, and manage their health records online. None of these require a computer either in your office or in their home, it can all be done on the phone. Check out companies like Healthagen and iSeek.
Real-time documentation of office or hospital visits. Most of the things you want to do in your EMR are possible on a smart phone today. You can get your patient profiles, document an encounter with basic order management and lab results review capabilities, and immediate storage into either your own EMR or your hospital’s information system.
Help those patients with the most time-consuming treatments. You already know that disease management is an important part of managing the health of chronic patients; diabetes and hypertension are two perfect examples. Help enroll your patients into Diabetes Connect, MediNet, HealthCentral, and similar applications that can help track compliance with your medical treatment guidance. If they use these applications they can simply give you printouts or login credentials so that you can track their progress without doing any data entry yourself. There are patient tools for most common diseases.

Editor’s Note

Shahid N. Shah is an ME-P thought leader who is writing Chapter 13: “Interoperable e-MRs for the Small-Medium Sized Medical Practice” [On Being the CIO of your Own Office] for the third edition of the best selling book: Business of Medical Practice [Transformational Health 2.0 Skills for Doctors] to be released this fall by Springer Publishing, NY. He is also the CEO of Netspective Communications, LLC.

www.BusinessofMedicalPractice.com

Conclusion

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: CMP Program, Information Technology, Media Mentions and PR, Recommended Books | Tagged: Android, blackberry, Business of Medical Practice, CIO, CMIO, EHRs, EMRs, iPhone, M-Health Initiative, mobile devices, Mobile Health, Netspective Communications, Shahid Shah, smart phones, www.BusinessofMedicalPractice.com, www.certifiedmedicalplanner.com, www.medicalbussinessadvisors.com | 1 Comment »

Customer Service in Medicare and Medicaid Plans

Posted on June 15, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

June Edition of Plan Management Navigator

By Erin Sawchuk

erinsawchuk@sherlockco.com

Please find attached by the link below, the June 2010 Edition of Plan Management Navigator. In this month’s edition, we estimate the strength of cost drivers for “Customer Services in Medicare and Medicaid Plans.”

We quantify the relationships of customer services costs to simple algebraic and other operational metrics within the Customer Services function. We also identify and test some of the potential interrelationships between customer services costs and other functions for Medicare and Medicaid Plans. This analysis draws on data from the 2009 Sherlock Expense Evaluation Report.

Benchmarks

Also included in this analysis is an update on our progress on our various benchmarking universes. Participation is up this year, we think due to public policy changes and economic weakness. While benchmarks for Independent / Provider-Sponsored plans will be published shortly, please let us know if you are interested in joining our 2010 Medicare, Medicaid or TPA universes.

Link: Navigator June 2010[1]

Assessment

Finally, we summarize the operating and financial trends identified in our recent Dashboard.

Sherlock Company

P.O. Box 413

Gwynedd, PA 19436

www.sherlockco.com

215-628-2289

Conclusion

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: Credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Alerts Sign-Up, Career Development, Health Economics, Health Insurance, Practice Management, Research & Development | Tagged: Erin Sawchuck, Medicaid, medicare, Plan Management Navigator, Sherlock Company, Sherlock Expense Evaluation Report, TPA | 4 Comments »

Personalizing the Doctor or Client’s Living Will

Posted on June 14, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Helping Financial Advisors Plan Future Medical Decisions

By Ann Miller RN, MHA

[Executive Director]

From time to time, our readers send in e-books, files or e-chapters, pamphlets or other material they have created for client, educational or marketing use. Some of it may be worthwhile; some not so.

Nevertheless, these publications are often a good place to start the conversation, or thought-process on related topics. They will be occasionally offered as a complimentary membership feature of the Medical Executive-Post. We trust they are beneficial to you.

Your Life – Your Choices [authors]

Robert Perlman MD
Helen Starks MPH
Kevin Cain PhD
William Cole PhD
David Rosengren PhD
Donald Patrick PhD

Link: Your life – your choices

Disclaimer

No advice is offered. We make no authorship nor copyright claim to these works. Veracity and information should be considered time sensitive. Consult a professional for your situation.

Assessment

Feel free to send in your own material for the benefit of all Medical Executive-Post readers and subscribers. All works will be considered; but not necessarily published.

Conclusion

And so, your thoughts and comments on this ME-P feature appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Estate Planning, Ethics, Experts Invited, Op-Editorials | Tagged: allow natural death, Estate Planning, Helen Starks MPH, Kevin Cain PhD, living wills, natural death, Robert Perlman MD | 2 Comments »

On Hospital CPOE Systems [Part Two]

Posted on June 13, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Computerized Physician Order Entry Systems

By Brent Metfessel; MD, MIS

A significant initial cost outlay for an organization-wide CPOE system is necessary, which for a large hospital may run into the tens of millions of dollars. Understandably, the majority of the hospitals that have installed a CPOE system are large urban hospitals. The up-front cost outlay may be prohibitive for smaller or rural hospitals unless there is an increase in outside revenue or third-party subsidies.

However, although it may take a few years before a positive ROI becomes manifest, there can be a significant financial return from such systems.

www.CPOE.org

Potential Benefits

The potential benefits of a CPOE system go beyond quality. Significant decreases in resource utilization can occur. In one study, inpatient costs were 12% lower and average Length of Stay (LOS) was 0.89 day shorter for patients residing on general medicine wards that used a CPOE system with decision support. Rather simple decision support tools can reap cost benefits as well. When a computerized antibiotic advisor was integrated with the ordering process, one institution realized a reduction in costs per patient ($26,325 vs. $35,283) and average LOS (10.0 days vs. 12.9 days), with all differences statistically significant.

Studies have shown that CPOE systems can significantly reduce medication error rates, including rates of serious errors.

For example, one large east coast hospital saw a 55% reduction in serious adverse medication errors after the system was installed. However, on occasion errors can actually be introduced due to the computing process; in particular, errors can be introduced if the provider accidentally selects the wrong medication from the list or drop-down menu.

Accordingly, a CPOE system should not be viewed as a replacement for the pharmacist in terms of checking for medication errors. In addition, proper user interface design such as highlighting every other line on the medication screen for better visibility and having the provider give a final check to the orders before sending are some ways of reducing this kind of error. Overall, error rates from incorrect order entry on the computer are much smaller than other medication errors prior to introduction of the system.

Appropriate use of a CPOE system helps prevent errors and quality of care deficiencies due to problems with the initiation of orders. However, errors can also occur in the execution of orders, particularly with the administration of medications to patients. Bar coding of medications, discussed previously, is a simple way to close the loop in medication error prevention as well as further increase the efficiency of workflow.

Despite its advantages, a CPOE system has been implemented on an organization-wide basis in only about 45% of all US hospitals and growth in implementations has been relatively slow, although about 67% plan to add a CPOE system in the next few years. Implementing a CPOE system is not an easy task, and there is a significant risk of failure. Most hospitals utilize vendors for implementation rather than attempting to develop the system in-house given the difficulty of hiring full-time IT talent that specializes in CPOE systems.

One critical feature of any CPOE system is to obtain physician buy-in to the technology, since they will be doing most of the ordering. Actually, unless the system is of the highest sophistication, physicians may claim it takes more time to write orders using a CPOE system than using the paper chart, as there may be a number of drop-down menus to negotiate prior to arriving at the appropriate drug. Real-time retrieval of information and electronic documentation, provision of on-line alerts, and the ability to use standard order sets (prepackaged sets of orders pertaining to a particular clinical condition or time period in an episode of care), when relevant, can make the net time spent on writing orders similar to using paper charts.

Doctor Acceptance

It is also important, for physician acceptance, to not overwhelm them with on-line alerts. Clearly, the system needs to point out the more serious errors, but if the physician’s process is frequently interrupted by alerts, they may increasingly resist the system.

For example, medication allergy alerts may warn physicians not only of potential problems with medications that have an exact match to the allergen, but also, as a defensive maneuver (“better safe than sorry”), to other medications that have a related molecular structure,, even though the patient may already be taking such medication and tolerating it well. Furthermore, allergies to medications that may result in life-threatening anaphylactic shock may not be distinguished from “sensitivities” that consist of side effects that are not true allergies and are usually much less serious.

Thus, the potential exists for frequent alert generation that would interrupt the work flow and require time spent to override the alerts, making the system difficult to use and leading to user resistance. One suggested solution is to have a hierarchy of importance, with alerts for potentially life-threatening situations being allowed to interrupt the work flow and requiring specific override or acknowledgment, and alerts for less serious problems being “noninterruptive,” allowing easy visibility of the alert without requiring stoppage of the work flow.

CPOE Pitfalls

Other pitfalls with respect to CPOE systems include the following:

crowded menus making it easy to select the wrong patient or wrong drug with the mouse;
fragmented information necessitating navigation through numerous screens to find the relevant information;
computer downtime (scheduled or unscheduled); and
location of terminals in busy places, which can lead to distractions and resulting incomplete or incorrect entries.

Intelligent, well-thought-out system designs can serve to mitigate many of these problems. It is important that such difficulties appear on the systems designers’ “radar screen” and are explicitly considered in the implementation.

Pharmacists

As for pharmacists, a CPOE system will not take them out of the process. Although a CPOE system has the capability to capture many drug errors and remove the need for manual order entry, there will always be a need for pharmacists to not only give a second look at possible errors, but to take a more active role in patient care, including going on ward rounds for complex cases, defining optimal treatment, and giving consultative advice.

www.MedicalBusinessAdvisors.com

Assessment

A CPOE system has the potential to give physicians ready access to patient data anywhere in the hospital as well as at home or on the road, especially with Internet-based connections. This is significant given the difficulty in obtaining patient charts for mobile providers.

In today’s environment of high expectations for care quality and pay-for-performance initiatives, enhanced quality of care can translate into financial gain. Although there is a significant up-front allocation of funds for CPOE systems, given present trends the time may arrive where there is no longer a choice but to implement such a system.

On Hospital CPOE Systems [Part One]

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Filed under: "Doctors Only", CMP Program, Information Technology, Practice Management | Tagged: Brent Metfessel, Computerized Physician Order Entry Systems, CPOE, eHR, eMR, LOS, pharmacists, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.healthdictionaryseries.com | 5 Comments »

Coordination, Switching Costs and the Division of Labor in General Medicine

Posted on June 13, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

An Economic Explanation for the Emergence of Hospitalists in the United States

Submitted by Hope Rachel Hetico RN, MHA

[Managing Editor]

From a white paper by David O. Meltzer, Jeanette W. Chung

NBER Working Paper No. 16040
Issued in May 2010

General medical care in the United States has historically been provided by physicians who care for their patients in both ambulatory and hospital settings. Care is now increasingly divided between physicians specializing in hospital care (hospitalists) and ambulatory-based care primary care physicians. We develop and find strong empirical support for a theoretical model of the division of labor in general medicine that views the use of hospitalists as balancing the costs of coordinating care across physicians in the hospitalist model against physicians costs switching between ambulatory and hospital settings in the traditional model.

Assessment

These findings suggest opportunities to improve care.

Link: http://papers.nber.org/papers/w16040

Conclusion

All ME-P readers are invited to opine.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Health Economics, Managed Care, Practice Management | Tagged: David O. Meltzer, hospital based physicians, hospitalists, Jeanette W. Chung | 1 Comment »

Sponsorship Opportunities

Posted on June 12, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Advertise on the ME-P

By Ann Miller RN, MHA

[Executive Director]

Become a sponsor on the #1 resource for medical management consultants and financial advisors in the healthcare space.

[picapp align=”none” wrap=”false” link=”term=economics&iid=254766″ src=”0251/ee927eb2-7cea-467f-8a10-21ba2c3c6504.jpg?adImageId=13102461&imageId=254766″ width=”380″ height=”257″ /]

About Us: https://medicalexecutivepost.com/2007/10/08/hello-world/

The “Deal”

The Medical Executive-Post is offering sponsorship opportunities to market leaders in the fields of practice management, financial planning, health economics, business, HIT and pharma.

Advertise with Us: https://medicalexecutivepost.com/2007/11/11/advertise/

Sponsors will gain visibility for their companies, products and services – demonstrate their support for our 50 related field topics in the healthcare industrial complex – and be afforded unique opportunities to interact with medical professionals, doctors, nurses, CXOs, each other and healthcare executives of all types.

Assessment

We reach more than 5,000 dedicated medical executives each week, and thousands more visitors.

But, the ME-P has limited sponsorship and advertising opportunities available. Reserve your space today.

MarcinkoAdvisors@msn.com

Conclusion

Be sure to subscribe, too. It is fast, free and secure.

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

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Filed under: Sponsors | Tagged: ME-P, medical executive post, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.HealthDictionaySeries.com, www.medicalbusinessadvisors.com | Leave a comment »

On Hospital CPOE Systems [Part One]

Posted on June 12, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Computerized Physician Order Entry Systems

[By Brent Metfessel MD, MIS]

Since the late 1990s, there has been increasing pressure for hospitals to develop processes to ensure quality of care. The Institute of Medicine (IOM) has estimated the number of annual deaths from medical error to be 44,000 to 98,000. Manual entry of orders, use of non-standard abbreviations, and poor legibility of orders and chart notes contribute to medical errors. They also concluded that most errors are the result of system failures, not people failures.

www.CPOE.org

Other studies suggest that between 6.5% and 20% of hospitalized patients will experience an adverse drug event (ADE) during their stay. Both quality and cost of care suffer. The cost for each ADE is estimated to be about $2,000 to $2,500, mainly resulting from longer lengths of stay. The National Committee on Vital and Health Statistics reported that about 23,000 hospital patients die annually from injuries linked specifically to the use of medications.

The Joint Commission and the Leapfrog Group

In addition, the Joint Commission and the Leapfrog Group, a consortium of large employers, have pushed patient safety as a high priority and hospitals are following suit. The Leapfrog Group in particular highlighted CPOE systems as one of the changes that would most improve patient safety. These patient safety initiatives have further advanced CPOE systems, since these systems have the reduction of medical errors as a prime function. State and federal legislatures have also stepped up activity in this regard.

For example, back in July 2004, the federal government strongly advocated for electronic medical records, including the creation of the Office of the National Coordinator for Health Information Technology to develop a National Health Information Network. Consequently, regional health information organizations have been established in many states, and these are used for the purpose of expediting the sharing and exchange of healthcare data and information, although there still remain issues in terms of providing adequate funding to these programs.

In addition, consideration was given to the allocation of grants and low-interest loans to aid hospitals in implementing healthcare technology solutions. In 2000, California first enacted legislation (Senate Bill 1875) stating that as a condition of licensure, acute care hospitals, with the exception of small and rural hospitals, submit plans to implement technological solutions (such as CPOE systems) to substantially reduce medication-related errors by January 1, 2002. Hospitals in California had until January 1, 2005, to actually implement their medication error-reduction plans and make them operational. Unfortunately, many are still not in compliance today.

Health plans also entered the patient safety stage. In 2002, one large health plan in the northeast provided a 4% bonus to hospitals implementing a CPOE system and staffing intensive care units (ICUs) with “intensivists.” Today, this goal is almost the norm, but not yet reality for all.

More than Data Retrieval

Many hospitals have “data retrieval” systems where a provider on the wards can obtain lab results and other information. A CPOE system, however, allows entry of data from the wards and is usually coupled with a “decision support” module that does just that — supports the provider in making decisions that maximize care quality and/or cost effectiveness.

In this application of HIT, physicians and possibly other providers enter hospital orders directly into the computer. Many vendors of such systems make special efforts to create an intuitive and user-friendly interface, with a variable range of customization possibilities. The physicians can enter orders either on a workstation on the ward or in some cases at the bedside.

Features of a True CPOE System

Basic features of CPOE should include the following:

Medication analysis system — A medication analysis program usually accompanies the order entry system. In such cases, either after order entry or interactively, the system checks for potential problems such as drug-drug interactions, duplicate orders, drug allergies and hypersensitivities, and dosage miscalculations. More sophisticated systems may also check for drug interactions with co-morbidities (e.g., psychiatric drugs that may increase blood pressure in a depressed patient with hypertension), drug-lab interactions (e.g., labs pointing to renal impairment that may adversely affect drug levels), and suggestions to use drugs with the same therapeutic effect but lower cost. Naturally, physicians have the option to decline the alerts and continue with the order. In fact, if there are alerts that providers are frequently overriding, providers will often provide feedback that can lead to modification of the alert paradigms. Encouraging feedback increases the robustness of the CPOE system and facilitates continuous quality improvement.
Order clarity — Reading the handwriting of providers is a legendary problem. Although many providers do perfectly well with legibility, other providers have difficulty due to being rushed, stressed, or due to trait factors. Since the orders are accessible directly on the workstation screen or from the printer, time is saved on callbacks to decipher illegible orders as well as preventing possible errors in order translation. A study in 1986 by Georgetown University Hospital (Washington, D.C.) noted that 16% of all manual medical records are illegible. Clarifying these orders takes professional time, and resources are spent duplicating the data; thus, real cost savings can be realized through the elimination of these processes.
Increased work efficiency — Instantaneous electronic transmittal of orders to radiology, laboratory, pharmacy, consulting services, or other departments replaces corresponding manual tasks. This increase in efficiency from a CPOE system has significant returns. In one hospital in the southeast, the time taken between drug order submission and receipt by the pharmacy was shortened from 96 minutes (using paper) to 3 minutes. Such an increase in efficiency can save labor costs and lead to earlier discharge of patients. The same hospital noted a 72% reduction in medication error rates during a three-month period after the system was implemented. Alerting providers to duplicate lab orders further saves costs from more efficient work processes. And, in another instance, the time from writing admission orders to execution of the orders decreased from about six hours to 30 minutes, underscoring CPOE system utility in making work processes more efficient; thus positively affecting the bottom line.

Assessment

On Hospital CPOE Systems [Part Two]

Conclusion

Although a Computerized Physician Order Entry system alone will reap significant benefits if intelligently implemented, in order to realize the greatest benefit a CPOE system should be rolled up into a fully functioning EMR system where feasible.

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: "Doctors Only", CMP Program, Information Technology | Tagged: ADE, Brent Metfessel, CPOE, EHRs, EMRs, IOM, Leapfrog Group, National Coordinator for Health Information Technology, National Health Information Network, The National Committee on Vital and Health Statistics, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.healthdictionaryseries.com, www.medicalbusinessadvisors.com | 4 Comments »

Why Hospital IT is Almost like a Retail Mall

Posted on June 11, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Hospital Bar-Coding Systems

By Brent A. Metfessel; MD, MIS

www.HealthcareFinancials.com

Given anticipated benefits in patient safety, the FDA required in April 2006, that bar codes be installed on all medications used in hospitals and dispensed based on a physician’s order. The bar code must contain at least the National Drug Code (NDC) number, which specifically identifies the drug.

Unfortunately, by 2008 only about 18% of hospitals used bedside bar coding systems. Nevertheless, this ruling heightened the priority of implementing hospital-wide systems for patient/drug matching using bar codes and implementation that is still growing rapidly today.

Procedures

Conceptually, the procedure for bar coding is as follows:

The drug is given to the nurse or other provider for administration to the patient.
Once in the patient’s room, the provider scans the bar code on the patient’s identification badge, which positively identifies the patient.
The medication container is then passed through the scanner, which then identifies the drug.
The computer matches the patient to the drug order. If there is not a match, including drug, dosage, and time of administration, an alert is displayed in real-time, enabling correction of the error prior to drug administration.

Enter the FDA

The FDA estimates that over 500,000 fewer adverse events will occur over the next 20 years, a result of an expected 50% decrease in drug dispensing and administration errors. The decrease in pain, suffering, and lengths of stay from drug errors is estimated to result in $93 billion in savings over the next 20 years.

Avoidance of litigation, decreased malpractice premiums, reduction in inventory carrying costs, and increase in revenue from more accurate billing result from the improvement in quality and efficiency of care.

This makes implementation of bar coding technology relatively low-risk, although there needs to be sufficient informatics capability to capture and store drug orders.

Estimated Cost Savings

For a bar coding system, a 300-bed hospital may expect up-front costs of $700,000 to $1.5 million with about $150,000 in maintenance fees annually. The returns, however, in terms of improved patient safety and cost of care make an investment in bar coding technology one of the more cost-effective information systems investments.

Assessment

Also, given the increasing consumerism in healthcare, prospective patients will be more assured of care quality from a hospital investing in state-of-the-art technology in this area, giving the medical center a competitive advantage.

Conclusion

Thus, hospitals are becoming more like retail businesses every day … finally!

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: "Doctors Only", Health Economics, Information Technology, Quality Initiatives, Risk Management | Tagged: Brent A. Metfessel, FDA, hospital bar codes, medical bar codes, National Drug Code Number, NDC, www.certifiedmedicalplanner.com, www.healthcarefinancials.com | 2 Comments »

Ending Employer Sponsored Health Insurance

Posted on June 11, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Or … at Least as We Currently Know It

By Staff Reporters

The latest Kaiser Health News column bids farewell to employer-sponsored health insurance. It will supposedly erode. And that’s a good thing, according to some experts.

Of Criticisms

The KHN news begins by saying that one of the latest criticisms of the new health overhaul law is that it will encourage employers to stop offering health insurance. And, in fact, it may.

http://www.kaiserhealthnews.org/Columns/2010/May/052710Frakt.aspx

Alternatives Must Exist

According to economist Austin Frakt PhD, we should welcome this, provided the decline in employer coverage is gradual and good alternatives like HSAs, exist. So, there are several advantages to the way in which the new law promotes severing the connection between employment and health insurance.

http://theincidentaleconomist.com/the-end-of-employer-sponsored-health-insurance-as-we-know-it/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+TheIncidentalEconomist+%28The+Incidental+Economist+%28Posts%29%29

[picapp align=”none” wrap=”false” link=”term=health+insurance&iid=102664″ src=”0099/8461586d-cbd6-48d8-b6bc-0620b4303fad.jpg?adImageId=13084712&imageId=102664″ width=”380″ height=”253″ /]

Assessment

One of them is that it will make more visible the biggest looming health care problem: costs.

https://medicalexecutivepost.com/2010/01/25/why-health-savings-accounts-are-no-longer-a-pariah-in-the-banking-industry/

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Is there a difference of opinion between employers and employees; recall doctors and financial advisors [FAs] often are both at some career inflection point?

And, feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Contact us for a rate card: MarcinkoAdvisors@msn.com

Filed under: Health Insurance | 3 Comments »

« Previous Page — Next Page »

Subscribe MEDICAL EXECUTIVE-POST?

Member Statistics

ME-P Information & Content Channels

Ann Miller RN MHA [Managing Editor]

CERTIFIED MEDICAL PLANNER® program

Most Recent ME-Ps

PodiatryPrep.org

ME-P Free Advertising Consultation

Medical & Surgical e-Consent Forms

iMBA Inc., OFFICES

ME-P Publishing

SEEKING INDUSTRY INFO PARTNERS?

Reader Comments, Quips, Opinions, News & Updates

Start-Up Advice for Businesses, DRs and Entrepreneurs

Up-Trending ME-Ps

Capitalism and Free Enterprise Advocacy

OIG Fraud Warnings

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Share this:

Calendar

Advertising Info:

Book Offerings:

Dictionary Offerings:

Dr. David Marcinko [Publication List]

Education Online:

Health Dictionary Series Wiki Project

Lower Extremity Medicine & Surgery

Pending NIHCM Grant Applications:

Practice Lists:

Professor Marcinko

Related Blogs:

Speaker's Bureau: