Dr. David Edward Marcinko MBA MEd CMP™

Disorganization at Banks

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

Causing Mistaken Foreclosures

By Paul Kiel, ProPublica – May 4, 2010 9:20 pm EDT

Millions of people face losing their homes in the continuing foreclosure crisis, but homeowners often have more than the struggling economy and slumping house prices to worry about: Disorganization within the big banks that service mortgages has made a bad problem worse.

ProPublica is matching local journalists with homeowners having trouble getting loan mods.

Are you a homeowner with a story to tell?
Are you a reporter and want to cover it?

Sometimes the communication breakdown within the banks is so complete that it leads to premature or mistaken foreclosures. Some homeowners, with the help of an attorney or housing counselor, have eventually been able to reverse a foreclosure. Others have lost their homes.

“We believe in many cases people are losing their homes when they should not have,” said Kevin Stein, associate director of the California Reinvestment Coalition, which counts dozens of nonprofits that work with homeowners among its members.

In the worst breakdowns, banks — and other companies that service loans — actually work at cross-purposes, with one arm of the company foreclosing on the home while the other offers help. Servicers say such mistakes are rare and result from the high volume of defaults and foreclosures.

The problems happen even among servicers participating in the administration’s $75 billion foreclosure-prevention program [1]. Servicers operating under the year-old program are forbidden from auctioning someone’s home while a modification decision is pending. It happens anyway.

Consumer advocates say the lapses continue because they go unpunished. “We’ve had too much of the carrot, and we need a stick,” Stein says. The Treasury Department has yet to penalize a servicer for breaking the program’s rules. The program provides federal subsidies to encourage modifications.

Treasury officials overseeing the program say they’re aware of the problems and have moved to fix them. But some states are going further to protect homeowners, with recent rules that stop the foreclosure process if the homeowner requests a modification.

Many homeowners, seeing no other option, have gone to court to reclaim their homes. At least 50 homeowners have recently filed lawsuits alleging the servicer foreclosed with a loan mod request pending or even while they were on a payment plan.

Homeowners have long waits for help

In good times, banks and other servicers — Bank of America is the biggest, followed by Chase and Wells Fargo — were known mainly to homeowners simply as where they sent their monthly mortgage payments. But the companies have been deluged over the past couple of years by requests for help from millions of struggling homeowners.

Homeowners commonly wait six months for an answer on a loan mod application. The federal program for encouraging loan mods includes a three-month trial period, after which servicers are supposed to decide whether to make the modifications permanent. But some homeowners have waited as long as 10 months [2] for a final answer.

Communication breakdowns occur because of the way the servicers are structured. One division typically deals with modifications and another with foreclosures. Servicers also hire a local trustee or attorney to actually pursue foreclosure.

“Often they just simply don’t communicate with each other,” said Laurie Maggiano, the Treasury official in charge of setting policy for the modification program. Such problems were particularly bad last summer, in the first few months of the program, she said. “Basically, you have the right hand at the mortgage company not knowing what the left hand is doing,” said Mark Pearce, North Carolina’s deputy commissioner of banks. Communication glitches and mistakes are “systemic, more than anecdotal” among mortgage servicers, he said.

“We’ve had cases where we’ve informed the mortgage company that they’re about to foreclose on someone.” The experience for the homeowner, he said, can be “Kafkaesque.”

“We’re all human, and the servicers are overworked and trying their best,” said Vicki Vidal, of the Mortgage Bankers Association. She said foreclosure errors are rare, particularly if struggling homeowners are prompt in contacting their servicer.

The Human Face

Frances Gomez, of Tempe, Ariz., lived in her house for over 30 years. Three years ago, she refinanced it with Countrywide, now part of Bank of America, for nearly $300,000. The home’s value has declined dramatically, said Gomez, who put some of the money from the refinancing into her hair salon.

Last year, the recession forced her to close her shop. Gomez fell behind on her mortgage, and after striking out with a company that promised to work with Bank of America to get her a loan mod, she learned in December that her home was scheduled for foreclosure.

So Gomez applied herself. She twice succeeded in getting Bank of America to postpone the sale date and said she was assured it would not happen until her application was reviewed. Gomez had opened a smaller salon and understood there was a good chance she would qualify.

She was still waiting in March when a Realtor, representing the new owner of her home, showed up. Her house had sold at auction — for less than half of what Gomez owed. “They don’t give you an opportunity,” she said. “They just go and do it with no warning.”

It’s not supposed to work that way.

Federal Programs

Under the federal program, which requires servicers to follow a set of guidelines for modifications, servicers must give borrowers a written denial before foreclosing. When Gomez called Bank of America about the sale, she said she was told there was a mistake but nothing could be done. She did get a denial notice [3] — some three weeks after the house was sold and just days before she was evicted.

“I just want people to know what they’re doing,” Gomez, now living with family members, said.

After being contacted by ProPublica, Bank of America reviewed Gomez’s case. Bank spokesman Rick Simon acknowledged that Gomez might not have been told her house would be sold and that the bank made a mistake in denying Gomez, because it did not take into account the income from her new salon business. Simon said a Bank of America representative would seek to negotiate with the new owner of Gomez’s house to see if the sale could be unwound.

Simon said the bank regrets when such mistakes happen due to the “very high volume” of cases and that any errors in Gomez’s case were “inadvertent.”

Timeline: How Michael Hill Almost Lost His Home [4]

Even avoiding a mistaken sale can also be a stressful process.

One day in February, a man approached Ron Bermudez of Emeryville, Calif., in front of his house and told him his home would be sold in a few hours. This came as a shock to Bermudez; Bank of America had told him weeks prior that he’d been approved for a trial modification and the papers would soon arrive. He made a panicked phone call to an attorney, who was able to make sure there was no auction.

Last November, Michael Hill of Lexington, S.C., finally got the call he’d been waiting for. Congratulations, a rep from JPMorgan Chase told him, your trial mortgage modification is approved. Hill’s monthly payment, around $900, would be nearly halved.

Except there was a problem. Chase had foreclosed on Hill’s home a month earlier, and his family was just days away from eviction.

“I listened to her and then I just said, ‘Well, that sounds good,’” recalled Hill, who is married and has two children. “‘Tell me how we’re going to do this, seeing as how you sold the house.’” That, he found out, was news to Chase.

Hill was able to avoid eviction — for now. Chase reversed the sale by paying the man who’d bought the home an extra $19,500 on top of the $86,000 [5] he’d paid at the auction.

After the mistaken foreclosure, he began the trial modification last December. He made those payments, but two months after his trial period was supposed to end, Hill is still waiting for a final answer from Chase.

The miscommunications have continued. He received a letter in January saying that he’d been approved for a permanent modification, but he was then told he’d received it in error.

His family remains partially packed, ready to move should the modification not go through. “I’m on pins and needles every time someone’s knocking on the door or calling,” he said.

Christine Holevas, a Chase spokeswoman, said that Chase had “agreed with Hill’s request to rescind the foreclosure” and was “now reviewing his loan for permanent modification.” She said Chase services “more than 10 million mortgages — the vast majority without a hitch.”

HOPE Hotline

To contest a foreclosure under the federal program, Maggiano, the Treasury official, said a homeowner should call the HOPE Hotline, 888-995-HOPE, a Treasury Department-endorsed hotline staffed by housing counselors. Those counselors can escalate the case if the servicer still won’t correct the problem, she said.

That escalation process has saved “a number” of homeowners from being wrongfully booted out of their homes, Maggiano said. Hill, the South Carolina homeowner, is an example of someone helped by the HOPE Hotline.

Of course, the homeowner must know about the hotline to call it. Gomez, the Arizona homeowner who lost her home to foreclosure, said she’d never heard of it.

Many homeowner advocates say the government’s effort has been largely ineffective at resolving problems with servicers.

“I uniformly hear from attorneys and counseling advocates on the ground that the HOPE Hotline simply parrots back what the servicers have said,” said Alys Cohen, an attorney with the National Consumer Law Center. Cohen said she’d voiced her concerns with Treasury officials, who indicated they’d make improvements.

New rules to offer more protection

Under the current rules for the federal program, servicers have been barred from conducting a foreclosure sale if the homeowner requested a modification, but are allowed to push along the process, even set a sale date. That allows them to foreclose more quickly if they determine the homeowner doesn’t qualify for a modification.

As a result, a homeowner might get a modification offer one day and a foreclosure notice the next. As of March, servicers were pursuing foreclosure on 1.8 million residences, according to LPS Applied Analytics.

Maggiano, the Treasury official, said that’s been confusing for homeowners. Some “just got discouraged and gave up.”

New rules issued by the Treasury in March say the servicer must first give the homeowner a shot at a modification before beginning the process that leads to foreclosure.

They also require the servicer to adopt new policies to prevent mishaps. For instance, the servicer will be required to provide a written certification to its attorney or trustee that the homeowner does not qualify for the federal program before the house can be sold.

Maggiano said the changes resulted from visits to the servicers’ offices last December that allowed Treasury officials to “much better understand (their) inner workings.”

The rules, however, don’t take effect until June. Nor do they apply to hundreds of thousands of homeowners seeking a modification for whom the process leading to foreclosure has already begun. And Treasury has yet to set any penalties for servicers who don’t follow the rules.

Maggiano said Treasury’s new rule struck a balance to help homeowners who were responsive to servicer communications to stay out of foreclosure while not introducing unnecessary delays for servicers. Some borrowers don’t respond at all to offers of help from the servicers until they’re faced with foreclosure, she said.

States Differ

Some states, such as North Carolina, have recently gone further to delay moving toward foreclosure if a homeowner requests a modification. State regulators there passed a law that requires a servicer to halt the process if a homeowner requests a modification.

Pearce, the North Carolina official, said the rule was prompted by the delays homeowners have been facing and puts the burden on the servicers to expeditiously review the request. “They’re in total control.”

Stopping the process not only removes the possibility of a sudden foreclosure, he said, but also stops the accumulation of fees, which build up and can add thousands to the homeowner’s debt as the servicer moves toward foreclosure.

In California, state Sen. Mark Leno, a Democrat from San Francisco, is pushing a bill that would do something similar. The servicers “should be working a lot harder to keep homeowners in their home,” he said.

Assessment

Original article: http://www.propublica.org/feature/disorganization-at-banks-causing-mistaken-foreclosures-050410

Conclusion

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Filed under: Breaking News, Financial Planning, Interviews | Tagged: bad mortgages, bank, Bank of America, banking reform, California Reinvestment Coalition, Chase, foreclosures, JPMorgan Chase, Kevin Stein, Laurie Maggiano, loan modifications, Mark Pearce, Mortgage Bankers Association, Paul Kiel, ProPublica, Vicki Vidal, Wells Fargo | 18 Comments »

Are Primary Care Doctors Becoming More Like Financial Advisors?

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

Hospitals [BDs] “versus” Family Practitioners [FAs]

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

The Big Mistake

Those who believe that hospitals need medical specialists like radiologists, pathologists and oncologists, more than primary care doctors, are mistaken. And, those doctors who believe that the majority of “financial advisors” work for their clients are also mistaken. Here’s why in analogy format.

Why Hospitals Need PCPs

Hospitals generally need primary care physicians, more than specialists, because insurance contracts can be negotiated from a position of strength. A solid [large] primary care panel is a must-have for most insurance contracts. Just recall more than a decade ago – when PCPs were told of an emerging new renaissance where they would reign in place of the medical specialists? It never happened then, but it may happen now following healthcare reform.

Also, recall that the growth of fiduciary Registered Investment Advisors [RIAs] was slow until the stock market collapse of 2008. The pace is accelerating today with the political dawn of financial reform.

Patient’s Love their PCPs – Not their Hospitals

Moreover, please realize that few patients shop around for specialists, or hospitals, as they do for PCPs. OK, the OB-GYNs are unique in that they can play a dual role – as specialist and primary care doctor – just ask my wife who would rather eat nails than change her [female] female doctor.

Hospitals also need PCPs as referring physicians to generate business through their ERs, admissions department, outpatient centers, and/or by ordering invasive and non-invasive radiology tests, images, scans or laboratory tests, and/or sending patients to specialists who will do expensive procedures or surgery in their ORs, hospital and/or related facilities.

Doesn’t this sound like a stock broker working for his wire-house or broker-dealer?

www.HealthcareFinancials.com

The PCP Loss Leader

Primary care is a loss-leader to hospitals as they make little money directly off medical practices, but can generate a great deal from the referrals and procedures the grass-roots docs generate; especially if they “play the game” like commissioned stockbrokers. And, consider brilliant medical diagnosticians, like TV’s Gregory House MD, and all those tests and procedures they can do – just to be sure!

No wonder that physician-executives and hospital administrators like Dr. Lisa Cuddy of the Princeton-Plainsboro Teaching Hospital, in New Jersey, love them.

Ditto for wire-house office managers and stock-brokerage OSJs [Office of Supervisory Jurisdiction] who love their “top producers”, brokers and FAs.

[picapp align=”none” wrap=”false” link=”term=operating+room&iid=288202″ src=”0284/9dbd59b4-ffc4-49c4-8b2e-3b568f74dc9d.jpg?adImageId=12660700&imageId=288202″ width=”380″ height=”253″ /]

Conflicted Missions

Unfortunately, this shifts the mission of PCPs from keeping patients out of the hospital – as physical and fiscal advocate – to sending them to the hospital as a “heavy admitter-referrer” with resulting perks and swagger.

Thus, “success” of the PCP from a hospital perspective is not to avoid referrals or costly procedures, but to gather them. However, success is a matter of perspective that may be very unfortunate for the patient, state or federal payer, private employer and/or insurance company.

Financial Advisor Analog

Does this PCP conundrum sound like the conflicted situation found with many “independent” financial advisors today? Are PCPs becoming mere patient gatherers, or profit generating shills, for their hospitals, employers or healthcare systems? Where does one’s duty rest? Are we doctor’s or medical product/procedure merchants?

www.CertifiedMedicalPlanner.com

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Is this analogy correct, or not. Is it too harsh or too gentle – and for whom?

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Filed under: CMP Program, Ethics, Op-Editorials | Tagged: broker-dealer, family practitioners, fiduciary, financial advisors, managed care contracts, OSJ, PCPs, stock broker, wire-house, www.certifiedmedicalplanner.com, www.healthcarefinancials.com | 4 Comments »

Why Practicing Medicine is More than just a Paycheck

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

Your Healthcare Career Evaluation

By Eugene Schmuckler PhD, MBA

By Dr. David E. Marcinko MBA

www.MedicalBusinessAdvisors.com

Studs Turkel, in his outstanding book Working, makes the comment that work is the mechanism by which many of us get our daily bread and our daily purpose. If this is to be the case then the workplace needs to offer us something more than a paycheck. The Wilson Learning Corporation surveyed 1500 people asking “If you had enough money to live comfortably for the rest of your life, would you continue to work? Seventy percent said that they would continue to work, but 60 percent of those said they would change jobs and seek “more satisfying” work.

Auto Career Advisor

Each of us has in fact been put in charge of our own careers. Our personal career management is a lifelong process. Our task is to be able to discover our place in the world where we will be able to enjoy a high level of wellness. This requires us to now assess our career, not from the eyes of the sixteen year old who initially chose the career. The career you are now pursuing needs to be compatible with your own unique skills, knowledge, personality and interests. It is important to keep in mind that no one is married to his or her job. When it comes to the workplace most of us are in dating relationships.

A Medical Career Worth Examined

As part of your examining your current medical career, answer the following questions: Why do you work? What does work mean to you? What do you want from work?

Research shows that most people work for three major reasons. The first of these is money. Not only is this necessary for our most basic needs it also serves as a means of determining our self-image. A second reason is to be with other people. Being at work enables us to belong, to be part of something beyond ourselves. We become part of a team. Some offices consider co-workers to be part of an extended family. The work setting affords us the opportunity for receiving feedback, recognition and support. The third most often given reason is that work validates us as people if we consider what we do as having meaning. “I chose the medical profession so as to make a difference.” Individuals with career success have a sense of purpose, a feeling that their work has meaning and contributes to a worthwhile cause. This is not a trick question. How well does what you do in your office every day meet your needs for money, affiliation and meaning?

Job Purpose

Without a sense of purpose on the job the chances are that your performance while adequate will not place you in the excellent category. Therefore, it is necessary for each and every one of us to be able to succinctly answer the question, “What is the purpose of your job?” That is a tough question to answer.

As a medical professional you may have seen what you considered to be the purpose of your job radically changed due to changes in the way services are now delivered. While we cannot bring back the past we can work around the present. Think about this for a moment, “If you want something to happen make a space for it.”4 What this means that whether you remain in your current profession or move elsewhere there is a need for you to establish long-range, medium-range, short-range, mini, and micro goals.

Long Term

Long-range goals are those concerned with the overall style of life that you wish to live. Regardless of your current age these goals are necessary. Long-range goals don’t need to be too detailed, because like the federal budget surplus, changes will come along. Just as the government is making projections into the future you too need to be making projections including but not limited to retirement.

Medium Term

Medium-range goals are goals covering the next five years or so. These are the goals that include the next step in your career. These are goals over which we have control and we are able to monitor them and see whether we are on track to accomplishing them and modify our efforts accordingly.

Short Term

Short-range goals generally cover a period of time about one month to one year from now. These are goals that can be set quite realistically and we are able to see fairly quickly whether or not we are on track to reaching them. We don’t want to set these goals at impossible levels but we do want to stretch ourselves. After all, that is the reason you are probably reading this chapter.

Mini-Goals

Mini-goals are those goals covering from about one day to one month. Obviously we have much greater control over these goals than you do over those of a longer-term. By thinking in small blocks of time there is much more control over each individual unit.

Micro-Goals

Micro-goals are goals covering the next 15 minutes to an hour. These are the only goals over which you have direct control. Because of this direct control, micro-goals, even though modest in impact, are extraordinarily important, for it is only through these micro-goals that you can attain your larger goals. If you don’t take steps toward your long-range goals in the next 15 minutes, when will you? The following 15 minutes? The 15 minutes after that? Sooner or later, you have to pick 15 minutes and get going. At some point procrastination has to be put aside.5

Personal Assets Evaluation

In thinking of your goals it now becomes necessary to evaluate your personal assets. Conducting this personal inventory requires you to identify your assets as well as your shortcomings. First, look at a time in your life when you were performing at your best. What were your thoughts and feelings? How did you behave? What were you doing? Now look at the reverse when you were doing poorly. What were your thoughts and feelings at that time? How did you behave? What were you doing?

If you are like others when you were at your best you described yourself as being confident, enthusiastic, organized, relaxed, focused, in control, friendly and decisive. The flip side, when at your worst you were fearful, apathetic, messy, anxious, lacking direction, out of control, argumentative and frustrated.

As you can see the emotions when we are at our best are all positive. This leads to the conclusion that it is to our advantage to be at our best as much as possible. Being at our best derives from working in those areas where we contribute our talents to something we believe in. As we continue our own personal inventory we need to look at our special abilities. That is, what are you good at and find easy to do. Think of the following questions. It’s not necessary to write down you answers just think about them.

How would you like to be remembered?
What have you always dreamed of contributing to the world?
Looking back on your life, what are some of your major contributions?
When people think of you, what might they say are your most outstanding characteristics?
What do you really want from your life and your work?
In what way may you still feel limited by the past? If so, by what?
What will it take to let go of what has happened, no matter how good or bad? Are you willing to let go?
How might the rut of conformity or comfort be limiting you? Why?
How different do you really want life to be? Why.
Have you ever stated what it is you truly desire? If no, why not?
How good could stand life to be?

doctors

Career Changers

Thinking about remaining in your present career or moving into another one is not easy. You are at the edge of a cliff and need to decide if you are going to turn back or to trust in yourself to successfully make it down to the bottom. People who are afraid of the dark lose their fear with just the slightest of a light in the room. As you have been going through this chapter you have been shining a light, however dim it may appear to you. You can see all of the items around you. The obstacles are there but with your advance knowledge you can anticipate ways to avoid them.

Personal Analysis

Having looked at and possibly re-evaluated your plans you can now do a thorough analysis of your assets. The assets requiring the most scrutiny are the following:

Your talents and skills
Your intelligence
Your motivation
Your friends
Your education
Your family

Your talents and skills are more than likely what has gotten you to the point you are at in your present career. For purposes of definition talents are innate, skills are acquired. Some have talent in interpersonal relations and some in artistic pursuits. Skills may be selected to complement the already present talents. It is skills that are necessary for expanding your options. As you seek out new skill areas ask yourself these questions. Do the skills provide occupational relevance? Might you be able to get others to pay you to teach them the skill? Will the skill be useful throughout life? Will the skill help you conquer new environments and gain new experiences? And, of course, Is it something you like to do?

Intelligence

Intelligence is considered to be the ability of the individual to cope with the world. Originally, intelligence focused primarily in the area of cognitive skills. Recently attention has been directed to what is called emotional intelligence, a concept that directs attention to social skills. Whether you were able to breeze through your courses in college or you truly had to work hard, earning your degrees demonstrates a better than average amount of cognitive intellectual ability. In order to maximize your brainpower, challenge yourself regularly.

Motivation

Motivation looks at how hard you are willing to work, your level of persistence, and the degree to which you want to do well. Different things motivate each of us and our personal motivators can vary from day to day. How many times have you had people say that they could not do your job? What are the activities that are attractive to you? More than likely an important motivator for you is to do something worthwhile. It has also been found that we tend to perform at about the same level as those people who are close to us. What this means is that those people with whom you work are going to have s substantial impact on your motivation.

Friends

Friends of course are invaluable assets. We use our friends as models for our own behavior. Those persons we consider friends share many of our attitudes, actions and opinions. With time we will change to be like our friends and they will change to become like us. Associating with those like us tends to temper our behavior. We try not to associate with the “wrong crowd” lest we become like them.

Education

Education needs to be ongoing. Recently, it was reported “all careers and businesses will be transformed by new technologies in often unpredictable ways. The era of the entrepreneur will make ‘boutique’ businesses more competitive with the behemoths, as mid-sized institutions get squeezed out. And medical break-throughs and the ongoing health movement will enhance-and extend-people’s lives.”[1] The implication of these changes is that new technologies often require a higher level of education and training to use them effectively and new biotechnology jobs will open up. The authors state that all the technological knowledge we work with today will represent only 1 percent of the knowledge that will be available in 2050. The half-life of an engineer’s knowledge today is only five years; in ten years, 90 percent of what an engineer knows will be available on the computer. In electronics, fully half of what a student learns as a freshman is obsolete by his or her senior year. The implication here is that all of us must get used to the idea of lifelong learning.

Assessment

Finally, family influences who and what we are and do. They can be a support group or they can be a deterrent to your goals. It is incumbent on every individual reading this chapter to consult with immediate family members at all stages of your career planning process.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. What career stage are you in currently; and are you satisfied-why or why not? Is practicing medicine more than a paycheck?

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.

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Note Dr. Gene Schmuckler is director of behavior economics for www.CertifiedMedicalPlanner.com, as well as www.MedicalBusinessAdvisors.com. He is an expert on physician career re-engineering, and a retired Professor of Organizational Behavior who taught Dr. Marcinko [our Publisher-in-Chief] in business school, almost two decades ago. He contributed the chapter on physician leadership and personal branding in the third edition of the upcoming book: www.BusinessofMedicalPractice.com to be released in the autumn of 2010.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko and Dr. Schmuckler, are available for seminar or speaking engagements.

Contact: MarcinkoAdvisors@msn.com

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Sponsors Welcomed

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

4 Campbell, D. If You Don’t Know Where You are Going You’ll Probably End Up Somewhere Else, Niles, IL: Argus Communications, 1974.

5 Campbell, D. op. cit.

[1] The Futurist, March–April 2001.

Filed under: "Doctors Only", CMP Program, Ethics, iMBA, Inc., Op-Editorials | Tagged: doctors, Eugene Schmuckler, healthcare workers, medical career, medical career management, nurses, Studs Turkel, Working | 1 Comment »

The International Health Care Rationing Conference

Posted on May 4, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

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Appreciating Parallels for the Emerging US Healthcare System?

By Mahsa Ghari

Aim of the Conference

In the late 1990s, the Dutch government started to experiment with ‘regulated competition’ in social health insurance. A milestone was the new Health Insurance Act in 2006 introducing a compulsory health insurance scheme for the entire population, carried out by (for-profit) health insurers, contracting individual and institutional health professionals. Safeguarding equal access, the new health insurance scheme introduced several preconditions like compulsory insurance, a basic benefit package, the prohibition of risk selection, a risk-equalization fund, etc. The idea of competitive health insurance was combined with deregulating hospital planning and liberalizing health care tariffs.

Merit Considerations

In the new scheme medical need is still decisive in health care access decision-making, but merit-considerations are becoming important too. Shortening waiting times, priority arrangements were considered and/or introduced, based on non-medical criteria. Simultaneously, in terms of financing, health status has become important due to own payments-arrangements, limited insurance package options, etc. At the same time, health status disparities due to socioeconomic inequalities seem to be increasing.

Under these circumstances, confronted with increased health spending, we can expect the “R” word becoming more eminent in the Dutch health care debate.

Relevant Rationing Questions

Emerging relevant questions are:

Who is responsible for rationing (markets, governments, bureaucrats, MDs or others)?
How does it function (explicit or implicit)?
What are relevant selection criteria (QUALYs, DALYs, health status, sex, age, etc)?
To what extent is current rationing just?
What can be done to make it more just?
How will health care rationing affect equal access to health care?
What is the relationship between rationing and differences in health status etc?

There is a wealth of literature in political theory, as well as in health care policy, economics, social medicine and law addressing these issues. What is needed is a consideration of the values involved, and the impact of, policy decisions on the expression of these values.

The Erasmus Observatory

Therefore, the Erasmus Observatory organized an international conference to discuss health care rationing from a wide range of perspectives.

Speakers

The following speakers have confirmed their contribution:

Dr. Bert Boer, Executive member of the Health Care Insurance Board (ethics)
Prof. Werner Brouwer (Erasmus University Rotterdam) (economics)
Prof. Norman Daniels (Harvard University) (philosophy, medical ethics)
Prof. Leonard Fleck (Michigan State University) (philosophy)
Prof. Colleen Flood (Toronto University) (law)
Dr. Anand Grover (Special Rapporteur United Nations) (law)
Prof. John Harris (University of Manchester) (bioethics)
Prof. Frances Kamm (Harvard University) (philosophy)
Prof. Johan Mackenbach (Erasmus University Rotterdam) (public health)
Prof. Alan Maynard (University of York) (economics)
Prof. Chris Newdick (University of Reading) (law)
Prof. Erik Nord (University of Oslo) (economics)
Prof. Bettina Schöne-Seifert (Münster University) (medical ethics)
Dr. Keith Syrett (University of Bristol) (law)

Assessment

The conference language will be in English, in Rotterdam on 9 – 10 December 2010, The Netherlands: info@erasmusobservatoryonhealthlaw.nl

Registration: CONFERENCE REGISTRATION FORM[1]

Conclusion

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What About DNA Day?

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

Real Celebration or Promotional Stunt

[By Staff Reporters]

Did you know that last week, in celebration of DNA day, the personal genomics company 23andme offered a sizable discount for its complete edition kit?

The Kit

The information provided to consumers is extensive. With the kit, the company promised access to the following kinds of data and information:

Ancestry information – relative finder, maternal lines
Healthcare – Disease risk, carrier status, drug response, traits
Raw genetic data

Assessment

Read more by Phil Baumann RN, right here:

http://philbaumann.com/2010/04/29/is-your-genome-a-controlled-substance/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+PhilBaumann+%28Phil+Baumann%29

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

***

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Geithner Talks Tough about Banks’ Loan Modification Efforts

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

But – More Bark Than Bite

By Paul Kiel, ProPublica – April 30, 2010 11:30 am EDT

For nearly a year now, we at ProPublica have been reporting on the problems [1] homeowners have encountered when seeking a mortgage modification [2] under the administration’s program [3].

Yesterday, Treasury Secretary Tim Geithner for the first time acknowledged the depths of the problems, but didn’t offer any new solutions. He committed to release more detailed data on how banks and other servicers are faring—a promise Treasury first made six months ago.

Geithner Speaks

“We are concerned by the wide variation in performance we see across servicers and by the countless frustrated phone calls we receive from borrowers,” Geithner testified yesterday before Congress. He added that the Treasury was “troubled” by “reports that servicers have foreclosed on potentially eligible homeowners” and frequent complaints from homeowners that servicers lose their documents. He said servicers are “not doing enough to help homeowners” and that it was not “acceptable.”

From the Treasury Department

This isn’t the first time Treasury Department officials have directed some tough talk [4] at servicers, including vague threats [5] of penalties [6]. But it remains to be seen whether, as Geithner says, the Treasury will follow through and punish servicers that break the program’s rules. Under the program, which involves paying incentives to servicers, investors and homeowners to encourage modifications, the Treasury has the power to punish servicers by withholding those payments. But Treasury has never issued any such penalties. Nor has the government outlined how much such penalties might be.

Geithner did promise to publish within a month or two more detailed information about each servicer’s performance, data that could give a much clearer picture of how servicers are treating homeowners. Treasury officials have actually been promising to release this sort of data since last year [7]. In December, Herb Allison, the official in charge of the TARP, said [8] it would be released in January. Like everything else with the government’s loan mod program, it’s taken several months longer than it was supposed to.

More Granular Data

The new, more detailed data will show how long it takes each servicer to answer calls from homeowners, how long they take to process applications, and the number of customer complaints each receives. A Treasury spokeswoman also said the reports will provide some sort of breakdown of how many people have been denied mods for which reasons, but it’s not clear yet if that data will be made available by servicer.

Up until now, the Treasury has only been releasing basic information for each of the largest servicers. And each month, we’ve transformed that data into an easy-to-digest breakdown [9].

Assessment

One major problem, the data show, has been the large volume of homeowners in limbo (376,000 as of March). A trial period under the program is supposed to last three months, but for those homeowners, it’s stretched longer, sometimes as long as ten months [6]. In total, 1.2 million homeowners have started trials since the program launched a year ago, but only 231,000 have made it to a permanent modification.

Link: http://www.propublica.org/ion/bailout/item/geithner-talks-tough-about-banks-loan-mod-efforts-but-more-bark-than-bite

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Understanding the Medical Career Choice!

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

Regrets and Recriminations – or Joy and Bliss?

By Eugene Schmuckler PhD, MBA

http://www.CertifiedMedicalPlanner.org

By Dr. David E. Marcinko MBA

www.MedicalBusinessAdvisors.com

Jimmy’s mother called out to him at seven in the morning, “Jimmy, get up. It’s time for school.” There was no answer. She called again, this time more loudly, “Jimmy, get up! It’s time for school!” Once more there was no more answer. Exasperated, she went to his room and shook him saying, “Jimmy, it’s time to get ready for school.”

He answered, “Mother, I’m not going to school. There are fifteen hundred kids at that school and every one of them hates me. I’m not going to school.”

“Get to school!” she replied sharply.

“But, Mother, all the teachers hate me, too. I saw three of them talking the other day and one of them was pointing his finger at me. I know they all hate me so I’m not going to school,” Jimmy answered.

“Get to school!” his mother demanded again.

“But mother, I don’t understand it. Why would you want to put me through all of that torture and suffering?” he protested.

“Jimmy, for two good reasons,” she fired back. “First, you’re forty-two years old. Secondly, you’re the principal.”

Similar Physician Sentiments

Many of us have had conversations with medical colleagues at which time sentiments of those expressed by Jimmy have been voiced. The career choice that was made many years ago is now, for some reason, no longer as exciting, interesting and enjoyable, as it was when we first began in the field. The career that was undertaken with great anticipation is now something to dread.

The reason for this is occurrence is not that difficult to understand. Two of the most important decisions individuals are asked to make are ones for which the least amount of training is offered: choice of spouse and choice of career. How many college students receive a degree in the field they identified when they first enrolled at the college or university? In fact, how many entering freshmen list their choice of major as undecided? It is only during the sophomore year when a major must be declared is the choice actually made. So, career choices made at the age of 19 might be due to having taken a course that was interesting or easy, appeared to have many entry level jobs, did not require additional educational or professional training requirements, or was a form of the “family business.” Now as an adult, the individual is functioning in a career field that was selected for him or her by an eighteen-year-old.

Judging Career Success

How do we judge career success? A career represents more than just the job or sequence of jobs we hold in a lifetime. The typical standard for a successful career is by judging how high the individual goes in the organization, how much money is earned, or one’s standing attained in the medical profession.

Yet, career success actually needs to be judged on several dimensions. Career adaptability refers to the willingness and capacity to change occupations and/or the work setting to maintain a standard of career progress. Many of you did not anticipate the managed care, Health 2.0, or political changes in your chosen medical profession, or specialty, when you began your training.

A second factor is career attitudes. These are your own attitudes about the work itself, our place of work, your level of achievement, and the relationship between work and other parts of your life.

Medical Career Identity

Career identity is that part of your life related to occupational and organizational activities. This is the unique way in which we believe that we fit into the world. Our career is only one part of our being. We play many roles in life each of which combine to make up or totality. At any point in time one role may be more important than another [life saving physicians versus retail sales clerk]. The importance of the roles will generally change over time. Thus at some point you may choose to identify more with your career, and at other times, with your family.

Career Performance

A final factor is career performance, a function of both the level of objective career success and the level of psychological success. How much you earn and your reputation factor into, and reflect, objective career success. To be recognized as a “leader” in a medical field and asked to submit chapters for inclusion in text-books, medical journals or new-wave blogs such as this may be a more important indicator of career success than money.

Psychological success is the second measure of career performance. It is achieved when your self-esteem, the value you place on yourself, increases. As you can see, there is a direct relationship between psychological success and objective success. It may increase as you advance in pay and status at work or decrease with job disappointment and failure. Self-esteem may also increase as one begins to sense personal worth in other ways such as family involvement or developing confidence and competence in a particular field, such as consistently shooting par on the golf course. At that point, objective career success may be secondary in your life. This is why many people choose to become active in their church or in politics. Even though one may have slowed down on the job, or in their professional career they can be extremely content with their life.

Case Model Scenario

Consider the following situation.

You are traveling on business. Although you are on a direct flight, you have a one-hour layover before the second leg of the flight and your final destination. Leaving the plane, after having placed the “occupied” card on your seat you walk down the concourse. On the way, you encounter a friend that you knew in high school. The two of you sit to have a cup of coffee and then you realize that your departure time is rapidly approaching. In fact, you will be cutting it quite close. Running down the concourse you return to the gate only to find that the door has been closed, the jetway is being retracted and the plane is being backed away from the gate. You stare out the window watching the plane go to the end of the runway and then begin its takeoff. Something goes horrible wrong and the plane crashes on takeoff, bursting into flames. It is apparent that there will be no survivors.

Assessment

To the world you are on that plane (remember the occupied card). Traveling on business your generous insurance policy will be activated. In anticipation of being in a location where they may not have ATM machines you have a good deal of cash, sufficient for at least a month.

Conclusion

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McNally, D. Even Eagles Need A Push, New York, NY: Delacorte Press, 1991.

Invite Dr. Marcinko

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Filed under: "Doctors Only", Career Development, CMP Program, Ethics, iMBA, Inc., Op-Editorials | Tagged: CMP, CMP www.CertifiedMedicalPlanner.com, DDS, DO, Eugene Schmuckler, HMOs, job performance, job self esteem, MD, medical career, medical career identity, medical jobs, medical students, P4P, pre-med students, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.medicalbusinessadvisors.com | 3 Comments »

Late April 2010 Edition of Plan Management Navigator

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

ADVERTISEMENT

On Medicare and Medicaid Plan Processing Costs

By Erin Sawchuk

Dear ME-P Readers

Please find attached the late April 2010 Edition of Plan Management Navigator.

Medicare and Medicaid Plans

In this month’s edition, we identify and test some of the potential interrelationships between claims processing costs and other functions for Medicare and Medicaid Plans. This analysis draws on data from the 2009 Sherlock Expense Evaluation Report.

Bench Mark Updates

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.

Link: Navigator Late April 2010[1]

Assessment

Please let us know if you are interested in joining our Medicare, Medicaid or TPA universes.

Sherlock Company

P.O. Box 413

Gwynedd, PA 19436

www.sherlockco.com

215-628-2289 – Phone

erinsawchuk@sherlockco.com

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Events Planner: May 2010

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

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Events-Planner: MAY 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:

May 04: Healthcare Stimulus Exchange, Chicago, IL

May 06: Health Literacy Conference. Irvine, CA.

May 12: Medicare Rebates Conference, Lake Buena Vista, FL

May 13: Leadership Conference on Healthcare Fraud, Washington, DC

May 17: National Patient Safety Conference, Orlando, FL.

May 20: Best Practices in Healthcare, Houston, TX

Please send in your meetings and dates for listing in the next issue of our ME-P 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

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More On Meaningful Use for eMRs

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

The Economic Sticks

By MedeAnalytics

The HITECH Act specifies both economic carrots and sticks in future years to motivate hospitals to meaningfully use electronic health records (EHRs).

The Sticks

Economic sticks are negative adjustments to Medicare’s market basket update to the Inpatient Prospective Payment System (IPPS), with adjustments pertaining to meaningful use of EHRs and quality measure reporting and constitute a major financial downside risk for hospitals.

Assessment

Read this whitepaper to find out how your organization may be effected by these economic sticks and to prepare for the scheduled adjustments to these incentives and penalties.

Meaningful Use

Conclusion

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Speakers: 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

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Filed under: Alerts Sign-Up, Health Law & Policy, Information Technology, Practice Management | Tagged: ARRA, EHRs, EMRs, HITECH, IPPS, Ken Perez, meaningful use | 10 Comments »

On Medicare and Medicaid Cost Drivers

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

The Health Plan Management Navigator

By Douglas B. Sherlock; CFA

Dear ME-P Readers

Please find attached below the Mid April 2010 Edition of Plan Management Navigator.

In this month’s edition, we estimate the strength of cost drivers for claims processing in Medicare and Medicaid plans. We quantify the relationships of claims processing to simple algebraic expressions and operational metrics within the Claim and Encounter Capture and Adjudication function.

Assessment

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. Please let us know if you are interested in joining our Medicare, Medicaid or TPA universes.

Erin Sawchuk

Sherlock Company

P.O. Box 413

Gwynedd, PA 19436

www.sherlockco.com

215-628-2289 – Phone

erinsawchuk@sherlockco.com

Conclusion

Link: Navigator Mid April 2010

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Filed under: Alerts Sign-Up, Health Economics, Health Insurance, Healthcare Finance | Tagged: Douglas B. Sherlock CFA, Erin Sawchuk, Health Economics, health plans, Medicaid, medicare, Plan Management Navigator, Sherlock Company | 4 Comments »

How to Evaluate a Managed Care Contract Proposal?

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

ASK AN ADVISOR

To Join -or- Not to Join is the Question

By Staff Reporters

www.HealthcareFinancials.com

A new-wave West-Coast managed care organization (MCO) wanted a multi-specialty medical group to contract with them to provide medical services to all subscribers. Compensation would be in the form of a fixed-rate capitated payment system, a.k.a. per member / per month (PM/PM).

Ask an Advisor

The medical group practice administrator reviewed their request for proposal (RFP) very carefully, but is still not sure what to do. So, allow us to “crowd-source” as we ask ME-P readers, advisors and management consultants for a solution.

Key Issues

Facts to know for an informed PM/PM capitated reimbursement decision:

annual frequency or service-rate per 1,000 patients
unit cost of medical services per unit-patient
co-payment dollar amount per patient
co-payment frequency rate per 1,000 patients
variable cost per patient
under-capacity medical group office utilization rates, and
fixed overhead office-cost coverage [+/-].

Assessment

Visit: www.CertifiedMedicalPlanner.com

More case models: https://medicalexecutivepost.com/2010/03/12/healthcare-case-models-cd-rom/

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. What is your solution; accept or reject the contract proposal? 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.

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Overhauling Health Care Oversight

Posted on April 26, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Union Pressure Exacts a Toll on California Bill

By Charles Ornstein and Tracy Weber, ProPublica – April 20, 2010 11:19 am EDT

A California Senate committee postponed a vote last Monday on legislation [1] to speed up the investigation and discipline of health professionals accused of misconduct, even as the bill’s author removed some provisions opposed by labor unions.

[picapp align=”none” wrap=”false” link=”term=nurses+rally&iid=6651770″ src=”f/e/8/5/Public_Employees_Rally_ecde.jpg?adImageId=12607523&imageId=6651770″ width=”380″ height=”253″ /]

Two Bills Advance

Separately, the committee advanced two other bills to address problems raised in articles last year [2] by ProPublica and the Los Angeles Times. One bill [3] would require that temporary staffing firms perform certain checks before sending nurses to hospitals; the second [4] would mandate that substance-abusing health workers be barred from practice if they test positive for drugs while participating in a treatment program. The bill to overhaul the disciplinary process for California’s nearly 1 million health professionals is the most contentious. It would require that employers report workers who are fired or suspended for serious wrongdoing, a mandate in place in 36 states already. Some California licensing boards already require this, but the Board of Registered Nursing [5], which oversees more than 350,000 nurses, does not.

A Controversial Provision

Another controversial provision could result in closure of state-run recovery programs for substance-abusing health professionals. The Senate Business, Professions and Economic Development Committee heard testimony—including objections from unions and professional trade associations—during a hearing Monday but postponed a vote until Thursday. Even if the legislation clears the committee, it still must get through several others and the full Assembly and Senate.

Critical Response

In response to critics, the bill’s author, Democratic Sen. Gloria Negrete McLeod [6], agreed to remove a provision that would have allowed the director of the state Department of Consumer Affairs to quickly suspend the license of a practitioner who is believed to pose an imminent risk to the public.

She also stripped language to allow licensing boards to deny a license based on a mental or physical disability.

Negrete McLeod

Negrete McLeod said the bill is urgently needed to keep dangerous and incompetent nurses from being able to continue practicing, sometimes for years, regardless of misconduct allegations. “There was enough blame to go around that we could all get painted with the same brush,” she said. Critics said the changes made the bill better, but the still oppose major elements. It is unclear whether the measure has the votes to pass.

Leland Yee

Democratic Sen. Leland Yee said the bill may have an “overemphasis” on consumers at the expense of the rights of professionals. “Some people may say we can throw away” the due process rights of professionals, Yee said. “But that’s not the way we do things in this country.”

Assessment

Finally, Negrete McLeod said she found arguments against the bill “ironic.” Each of the representatives of the various professional groups had “averred that only 1 percent” of their members were getting into trouble. If that is true, she asked, why was there such a “hue and cry” over the proposed reforms?

Conclusion

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Filed under: Alerts Sign-Up, Career Development, Health Law & Policy, Practice Management | Tagged: Board of Registered Nursing, Charles Ornstein, discipline health professionals, Gloria Negrete McLeod, health professional misconduct, Leland Yee, Professions and Economic Development Committee, ProPublica, Senate Business, Tracy Weber | 1 Comment »

How to Post on the ME-P

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

A Post is not a Comment

By Ann Miller; RN, MHA

[Executive Director]

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About URAC

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

Accrediting Healthcare Organizations

By Staff Reporters

URAC, formerly known as the Utilization Review Accreditation Commission, promotes healthcare quality by accrediting healthcare organizations.

An Independent Nonprofit

URAC, an independent, nonprofit organization is well known as a leader in promoting healthcare quality through its accreditation, education, and measurement programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the healthcare system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability.

Mission

URAC’s mission is to promote continuous improvement in the quality and efficiency of health care management through processes of accreditation and education.

Assessment

Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire healthcare industry.

For more information, visit www.urac.org.

Conclusion

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Retirement Plan Risks for Physician-Employers

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

Advantages Well Known – Disadvantages Not So

By Brian J. Knabe, MD

[Certified Medical Planner™ candidate]

A source of risk often overlooked by the physician-employer is the risk involved in offering a retirement plan.

Medical practice owners, like other small business owners, find several advantages to starting a retirement plan. The plan can be used to allow the owners to save money in a tax-advantaged manner, and a generous retirement plan can help to attract and retain quality employees.

Administration Risks

The recent “Great Recession” and turbulence in the stock market have highlighted the risks involved in administering these plans. There is a long history of fraud and neglect in the field of retirement savings plans, and a series of legislative efforts have been enacted to counter these abuses.

Current standards are based primarily on four federal laws, the Employee Retirement Income Security Act (ERISA), the Uniform Prudent Investors Act (UPIA), the Management of Public Employee Retirement Systems Act (MPERS), and the Pension Protection Act of 2006 (PPA).

ERISA Standards

According to ERISA standards, you may be considered a fiduciary for a retirement plan if you meet any of the following tests:

You exercise discretionary authority or control over plan assets or plan management.
You are specifically identified in the written documents of a plan as a named fiduciary.
You have discretionary responsibility in the administration of the plan.
You manage the plan or its assets or render investment advice for a fee.

Recent court decisions have found fiduciaries to be personally liable, even for acts of which they were unaware or in areas not considered within their scope of responsibility. Acting with good intentions or in good faith is not an acceptable defense. Neither is ignorance of your responsibilities.

www.CertifiedMedicalPlanner.com

Liability Mitigation

The liability of the administrator (or business owner) can be diminished by taking these steps:

Act in a procedurally prudent manner.
Diversify investments to minimize the risk of large losses.
Provide sufficient information and education to employees to enable them to exercise control over their investments.
Offer a broad, diversified investment menu having at least three (preferably five or six) “core” alternatives, each of which must be diversified.

Assessment

The most efficient way to meet these and other requirements is to hire a retirement plan provider which is a certified as a fiduciary, and which accepts “co-fiduciary” status along with the practice owner. The Centre for Fiduciary Excellence (CEFEX) offers certification as a fiduciary.

For more information, see www.savantcapital.com/cefex.

Savant Capital Management, Inc^®

190 Buckley Drive

Rockford, IL 61107

Tel 815-227-0300

Fax 815-226-2195

bknabe@savantcapital.com

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FINANCE: Financial Planning for Physicians and Advisors
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Dictionary of Health Economics and Finance
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Filed under: Financial Planning, Portfolio Management, Retirement and Benefits, Risk Management | Tagged: brian knabe, CEFEX, Centre for Fiduciary Excellence, certified medical planner, CMP, Employee Retirement Income Security Act, ERISA, fiduciary, Management of Public Employee Retirement Systems Act, MPERS, Pension Protection Act of 2006, PPA, retirement plans, savant capital management, Uniform Prudent Investors Act, UPIA, www.certifiedmedicalplanner.com | 3 Comments »

Internet Marketing for Physicians

Posted on April 22, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ADVERTISEMENT

Vital Checklist for Website Re-Design

By Theo Bennett

Dear Dr. Marcinko

MoreVisibility has been developing and implementing successful online marketing programs since 1999.

So, please accept this whitepaper on modern web re-design at no cost or obligation to your readers.

Link: Website-Redesign-Checklist

Assessment

Those interested in learning more may contact me at the address below.

Client Strategist
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Suite 750
Boca Raton, FL 33432
800.787.0497
tbennett@morevisibility.com

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Filed under: Career Development, Information Technology, Marketing & Advertising, Practice Management | Tagged: MoreVisability, Theo Bennett, web design | 2 Comments »

Bank Deals Similar to Goldman Sach’s Gone Awry

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

Other Major Banks Participated, Too?

By Marian Wang, ProPublica – April 16, 2010 1:36 pm EDT

As you may have heard, or read on this ME-P, Goldman Sachs is being sued for fraud [1] by the Securities and Exchange Commission [2] for allegedly misleading investors about a deal that Goldman helped structure and sell. In the civil suit, the SEC specifically faulted Goldman for failing to disclose that a hedge fund was helping create the investment while betting big the deal would fail.

According to the SEC, Goldman Sachs knew about the hedge fund’s bets, knew it played a significant role in choosing the assets in the portfolio, and yet did not tell investors about it. (Goldman Sachs has called the SEC’s accusations “completely unfounded in law and fact.” And in another more detailed statement [3], it said it “did not structure a portfolio that was designed to lose money.”)

[picapp align=”none” wrap=”false” link=”term=Goldman+Sachs&iid=8541566″ src=”0/4/f/8/The_Goldman_Sachs_7d6f.jpg?adImageId=12513388&imageId=8541566″ width=”380″ height=”568″ /]

In ProPublica

As we reported at ProPublica last week, many other major investment banks were doing a similar thing [4].

Investment banks including JPMorgan Chase [5], Merrill Lynch [6] (now part of Bank of America), Citigroup, Deutsche Bank and UBS also created CDOs that a hedge fund named Magnetar was both helping create and betting would fail. Those investment banks marketed and sold the CDOs to investors without disclosing Magnetar’s role or the hedge fund’s interests.

Here is a list of the banks that were involved [7] in Magnetar deals, along with links to many of the prospectuses on the deals, which skip over Magnetar’s role. In all, investment banks created at least 30 CDOs with Magnetar, worth roughly $40 billion overall. Goldman’s 25 Abacus CDOs — one of which is the basis of the SEC’s lawsuit — amounted to $10.9 billion [8].

One reporter Jake Bernstein explained the investment banks’ disclosure failures on Chicago Public Radio’s This American Life [9]:

On the Magnetar Hedge Fund

The role of Magnetar, both as equity investor and in their bets against the very CDOs they helped create were not disclosed in any way to investors in the written documents about the deals. Not the marketing materials, not the prospectuses, not in the hundreds of pages that an investor could get to see information about the deal was it disclosed that it was in fact Magnetar who’d helped create the deal, and who’d bet against.

That is, of course, along the lines of what the SEC is suing Goldman Sachs for now. The SEC’s suit also says CDOs like the ones Goldman built “contributed to the recent financial crisis by magnifying losses associated with the downturn in the United States housing market.”

Notably, the SEC did not sue the hedge fund [10] involved in Goldman’s Abacus deals — Paulson & Co. — or its manager, John Paulson. Instead, it’s going after Goldman. And as we pointed out in our reporting, there’s no evidence that what Magentar did was illegal [11].

Assessment

We’ve called the major banks involved in Magnetar CDO deals to see if they were concerned about similar lawsuits. Thus far, Bank of America, Citigroup, Deutsche, Wells Fargo (which bought Wachovia) and UBS have responded and have all declined our requests for comment. Here is Magnetar’s response [12] to our original reporting.

Conclusion

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Filed under: Accounting, Breaking News, Ethics, Investing, Portfolio Management | Tagged: Abacus, Bank of America, CDOs, CitiGroup, Deutsche Bank, Goldman Sachs, Jake Bernstein, JPMorgan Chase, Magnetar, Marian Wang, Merrill Lynch, ProPublica, SEC, UBS, Wachovia, Wells Fargo | 10 Comments »

PR Firm Behind Propaganda Videos Wins HIT Stimulus Contract

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

Ketchum Deep in Controversy

By Sebastian Jones and Michael Grabell

ProPublica – March 30, 2010 12:26 pm EDT

President Obama’s push for electronic medical records [1] has faced resistance from those who question whether health information technology systems can protect patient privacy. So last week, the U.S Department of Health and Human Services hired a public relations firm to try to win consumer trust.

The irony?

The firm chosen for the job — Ketchum Inc. [2] — was hip-deep in controversy a few years ago for producing a series of fake TV news stories that violated a federal ban on propaganda. The company also drew fire for channeling taxpayer funds to a conservative pundit to promote the Bush administration’s education policies.

About Ketchum

Ketchum, based in New York, is one of the world’s largest public relations firms, with a host of large corporate clients and a history of winning government contracts. Company spokeswoman Alicia Stetzer declined to answer questions about the $25.8 million contract, funded by the federal stimulus package. Nancy Szemraj, a spokeswoman for the government’s health IT initiative, said the PR firm won the contract over four other companies because of its ability to attract public acceptance. “Ketchum has a long rich history of doing outstanding communication outreach work for large social marketing endeavors,” Szemraj said. “They are very capable of moving the needle, with has to happen here.”

She noted that Ketchum’s work helped HHS enroll 35 million people in the Medicare prescription drug program. And she said all of the firm’s marketing ideas would be reviewed by senior managers at HHS.

Consumer advocates warned that the PR contract will only heighten skepticism about the security of online health records. A poll [3] conducted last year by NPR, the Kaiser Family Foundation and the Harvard School of Public Health found that roughly six in 10 Americans lack confidence in the privacy of online health records.

Public Suspicions

“The public has always been very suspicious over whether electronic health information will be safe,” said Dr. Deborah C. Peel, a physician and founder of the Coalition for Patient Privacy, which includes consumer, privacy and health groups. Peel called Ketchum a “very, very troubling choice because the last thing the public needs are more tricks being pulled on them.”

During the Bush administration, Ketchum and its former lobbying arm, the Washington Group, had several prominent Republicans on the payroll, including former New York Rep. Susan Molinari. In the last year, it has beefed up its Democratic credentials, hiring Jonathan Kopp, a member of the Obama campaign’s national media team, and Donald J. Foley, a longtime Democratic strategist.

Ketchum has continued to draw government work – particularly from HHS – despite a series of reports in 2004 [4] and 2005 [5], in which Government Accountability Office investigators found it had produced a series of video news releases that constituted “covert propaganda” because they did not disclose they were paid for by the federal government.

The segments aired during local television broadcasts on at least 40 stations across the country. Designed to look like news reports, each concluded with a paid actor posing as a journalist reporting from Washington.

One series was produced for HHS in an effort to promote the Medicare prescription drug program to seniors. The others were paid for by the Department of Education. Overall, video news releases have become increasingly common, used by large public relations firms and companies to repackage advertisements as news. [6]

Prior Controversy

Ketchum was involved in a separate controversy in 2005, when reports surfaced that it had used taxpayer funds to pay syndicated columnist Armstrong Williams $240,000 to promote the No Child Left Behind [7] education bill during radio broadcasts as part of outreach to the African-American community.

In both instances, Ketchum defended its tactics. Stetzer referred reporters to a 2005 PR Week article, in which CEO Ray Kotcher said, “There is no indication that it was ever the intent of Ketchum or any of our people to mislead anyone.”

This time around, HHS has hired Ketchum to provide a “comprehensive campaign for communications and education,” to encourage doctors and hospitals to adopt health IT and to assure the public that their information will be safe.

Assessment

The campaign is part of the administration’s $26 billion health IT program, also backed by the stimulus package, which aims to spearhead the transition to online medical records through grants, bonuses to doctors and hospitals, and the development of national standards.

Link: http://www.propublica.org/ion/stimulus/item/pr-firm-behind-propaganda-videos-wins-stimulus-contract

Conclusion

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Filed under: Breaking News, Healthcare Finance, Information Technology | Tagged: Alicia Stetzer, Coalition for Patient Privacy, DHHS, Donald J. Foley, Dr. Deborah C. Peel, EHRs, electronic medical records, EMRs, Harvard School of Public Health, health information technology, Jonathan Kopp, Kaiser Family Foundation, Ketchum, Michael Grabell, Nancy Szemraj, Ray Kotcher, Sebastian Jones, Susan Molinari | 7 Comments »

Treasury Officials and Investment Firms Cozy Up for Business

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

The State of Oregon

By Marian Wang, ProPublica – April 12, 2010 4:13 pm EDT

Over the weekend, several stories about troubled state and local pension funds were published. In Seattle, officials are chasing down information about $20 million the city invested in a now-insolvent hedge fund [1]. And, in California, cities’ investments have not paid off as expected [2], forcing some local governments to cut other programs to pay for pensions. Across the country, the downturn has put a strain on many states’ fiscal health, and has caused extreme losses in higher-risk investments like pension funds. But, not so in Oregon, where investments are doing well, and state investment officers are doing even better.

[picapp align=”none” wrap=”false” link=”term=hedge+fund&iid=6715184″ src=”2/0/7/9/Swiss_Village_Becomes_85fc.jpg?adImageId=12469045&imageId=6715184″ width=”380″ height=”262″ /]

Why Oregon?

The Oregonian reports that state investment officers are being wined and dined by the private investment firms [3] whose services to the state they oversee. State Treasury officers, paid on average “just shy of $200,000 last year,” were treated to resort hotels, first-class airfare and high-end dinners—“all in the name of public service.”

The cozy relationship, reports the Oregonian, raises questions about whether the first-class treatment skews officers’ ability to oversee the investment firms that treat them so lavishly. For their part, the firms stand to gain quite a bit if they stay in the good graces of state Treasury officers:

Public investors such as Oregon are lucrative customers. Besides the cash to invest, investment firms collect huge fees for their day-to-day work. Oregon’s pension system alone paid $335 million in investment fees and expenses last year … The concept is much like an individual investor figuring out how to put spare cash to work in profitable ways. Except Oregon has billions in cash. Profits from investments cover state retiree pensions and care for Oregon’s injured and disabled workers.

Assessment

Oregon Treasurer Ted Wheeler announced last week that he was reviewing travel protocols, though Oregon Treaury’s chief investment officer Ron Schmitz has said high-end travel is “necessary normal business practice.” “We consider none of it luxurious,” he told the newspaper. But that’s not what it sounds like from communications between investment officers and the investment firms.

“I’m only packing my swimsuit, Tevas, and sun tan lotion and you guys will just have to find me on the beach or surfing the waves,” one Treasury employee wrote to a firm representative. The firm ended up paying for his stay in a Four Seasons Resort in Mexico.

Conclusion

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Filed under: Alternative Investments, Breaking News, Investing | Tagged: hedge funds, Marian Wang, Oregon State Treasury, Oregon’s pension system, Ron Schmitz, Ted Wheeler | 1 Comment »

The 2010 Chronic Care and Prevention Congress

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

ADVERTISEMENT

The Future of Population Health and Disease Management in 2010, and Beyond

[By Ann Miller; RN, MHA]

According to our two new books, Forward contributor David B. Nash MD MBA FACP Dean, Jefferson School of Population Heath at Thomas Jefferson University, states that chronic diseases are the nation’s most overwhelming healthcare cost drivers.

The Statistics

In fact, we’ve all heard the statistics which suggest that 75% of health care costs are spent on chronic care treatments.

Chronic Care and Prevention

And so, the upcoming Chronic Care and Prevention Congress will seek to lead the nation in developing best practices for the treatment and prevention of chronic disease. David will give the Opening Keynote Address on Thursday, May 13th 2010 entitled The Future of Population Health and Disease Management in 2010 and Beyond.

Other Topics and Issues to be Addressed

Aligning Reimbursement Models and Financial Incentives
Physician Engagement and the Patient-Centered Medical Homes
Consumer Engagement and Behavioral Modification
Innovative Health Information Technology Applications
Best Management Practices in Diabetes, Obesity, Cardiology and Renal Disease

The Themes

We believe you will walk away from the Congress with the ability to connect the dots, drawing together the key themes of population health, disease management, chronic care coordination, and much more.

Registration Information

For more information regarding the Congress or to register with the $895 rate, please contact World Congress directly at 800-767-9499 or visit http://www.worldcongress.com/Events/

Assessment

We hope to see you there and report back to us on your thoughts and impressions.

Foreword.Nash

Conclusion

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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: "Doctors Only", Sponsors | Tagged: Chronic Care and Prevention Congress, David B. Nash, Disease Management, HIT, medical homes, Medical Reimbursement Models, Population Health, Thomas Jefferson University, www.healthcarefinancials.com | 1 Comment »

Behind the Financial Reform Push

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

Of Worries on Warring Regulators

By Jeff Gerth, ProPublica – April 14, 2010 12:07 pm EDT

Backers of financial regulatory reform are gearing up for the final stretch in a yearlong effort to construct a new, streamlined architecture. But, recent reports and testimony about the financial crisis suggest a crucial ingredient in any new structure is in short supply: cooperation among the watchdogs.

Office of Thrift Supervision

A proposal to eliminate one regulator seen by many as particularly weak—the Office of Thrift Supervision—could alleviate some friction. A soon-to-be-released federal examination of the Washington Mutual collapse found that OTS resisted efforts by a more skeptical regulator, the Federal Deposit Insurance Corporation, to take a closer look at WaMu, according to an account in The New York Times [1].

Reform legislation pending in the Senate [2] (PDF) would also create new agencies, including a financial stability council to assess risk and a consumer protection watchdog. To work as envisioned, the agencies would need new levels of information sharing and decision making. By contrast, history suggests agencies can be stingy with what they know and eager to point blame at sister regulators.

Fall of the House of Lehman

Lehman Brothers, the investment bank that collapsed in September 2008, presents a case in point.

A lengthy examiner’s report [3] for the judge overseeing Lehman’s bankruptcy found that the Federal Reserve Board and the Securities and Exchange Commission kept crucial data from each other even though they had “overlapping” functions. The heads of the Federal Reserve and the SEC reached a formal sharing agreement in July 2008, but the two regulators “did not share all material information that each collected about Lehman’s liquidity.”

SEC Queries

The SEC, asked by the Federal Reserve Bank of New York to provide data on Lehman’s commercial real estate exposure and liquidity, “affirmatively declined to share” the information because it was still in draft form, the bankruptcy report found. The reserve bank never turned down an information request from the SEC, but bank officials “did not perceive any duty to volunteer” information about a $7 billion shortfall in Lehman’s liquidity they uncovered in August 2008.

The reason? The report says it was “because the SEC did not always share information” with them. One official at the Federal Reserve Bank of New York told the examiner “there was not a warm audience” for information sharing between the New York Fed and the SEC.

Lehman fell under the scrutiny of the Fed after it was allowed to tap Fed lending facilities, normally reserved for banks, in the spring of 2008.

Oh … the Irony

Ironically, examiners at the Office of Thrift Supervision, which regulated Lehman’s bank subsidiary, concluded in July 2008 that Lehman had violated its own risk limits by placing an “outsized bet” on commercial real estate. But, the OTS appears as a bit player in the autopsy of Lehman’s collapse; top Federal Reserve officials “considered the SEC to be Lehman’s regulator,” the bankruptcy report found.

One of those officials, Timothy Geithner, was president of the Federal Reserve Bank of New York from 2003 until early 2009, when he became secretary of the Treasury. Shortly after he joined the cabinet, Geithner was asked by a senator about the Fed’s supervisory responsibility [4] in connection with the collapse of institutions like Lehman and the insurance giant AIG.

“I just want to point out,” Geithner told the Senate Finance Committee, “the Federal Reserve was not given responsibility for overseeing investment banks, insurance companies, hedge funds, non-bank financial systems that were a critical part of making this crisis so intense.”

Fed Responsibilities

The Fed is responsible for supervising bank holding companies, such as Citigroup. Those holding companies include investment banks and, as a sister regulator quietly pointed out last week, the Fed shared responsibility with the SEC for overseeing the risky practices of Citigroup’s broker dealer.

John C. Dugan, who oversees nationally chartered banks as comptroller of the currency, told the Financial Crisis Inquiry Commission [5] (PDF) last week that most of the problems that led to a massive bailout for Citigroup took place under the umbrella of the weaker holding company regulated by the Fed—not at Citibank, the banking subsidiary under Dugan’s authority.

Most of the losses, Dugan said at the end of a lengthy report to the commission, were in subprime lending, leveraged loans and the structuring and warehousing of CDOs (collateralized debt obligations) that are supervised, either all or in part, “by the Federal Reserve.”

Geithner has acknowledged [6] that he could have done a better job of supervising Citigroup during his tenure at the New York Fed.

Assessment

If the Senate bill becomes law, Geithner would sit atop the new financial stability council, whose members will include representatives of several different agencies—including the Fed, the SEC and the Office of the Comptroller of the Currency.

Conclusion

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FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Breaking News, Investing, Research & Development, Risk Management | Tagged: AIG, CDOs, CitiGroup, collateralized debt obligations, Federal Reserve, Federal Reserve Bank of New York, Financial Crisis Inquiry Commission, Jeff Gerth, John C. Dugan, Lehman Brothers, Office of Thrift Supervision, SEC, Timothy Geithner | 5 Comments »

Do We Have A False Sense of HIT Security?

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

Data Breaches More Common than Realized

By Darrell K. Pruitt; DDS

Here is an article titled “Report: Healthcare Organizations may have a False Sense of Data Security,” written by Neil Versel for FierceHealthIT.

http://www.fiercehealthit.com/story/report-healthcare-organizations-may-have-false-sense-data-security/2010-04-12?sms_ss=twitter#ixzz0kzNS6lq

Versel describes the results of a study commissioned by Nashville, Tenn-based Kroll Fraud Solutions. Kroll estimates that 19% of healthcare organizations in the nation suffered a data breach in the last 12 months. That number is up from 13% a year ago. It is based on this information that I estimate that in the last year, at least 24 million dental patients in the nation have been unknowingly exposed to the danger of identity theft. Everyone agrees that the only ethical thing for a dentist to do if he or she knows that patients’ identities have been exposed is to notify the patients and HHS. The shameful fact is, data breaches in dentistry are not being reported.

Enter the Dentists

But, who can blame American dentists for underreporting breaches without first blaming the heavy-handed, stakeholder-friendly system that forces honest professionals to be dishonest? If a dentist self-reports a breach of 500 or more patients’ Protected Health Information (PHI) it can easily bankrupt a practice. The harm to one’s reputation in the community is just too great a disincentive for even the best of us, even without the added expense of patient notification, subsequent fines and lawsuits. It’s ugly, but that’s the hard, hidden truth about HITECH-HIPAA in dentistry – a piece of lame, one-sided “feel good” legislation that rather than preventing data breaches in dentists’ offices, it drives them underground. As healthcare providers, we should have warned our patients about the growing danger from electronic dental records long ago. Besides me, there are no practicing dentists discussing the topic. Why?

Accepting Ownership of the Dilemma

Would anyone like to argue that the bi-partisan federal mandate for an interoperable, national eHR system relieves dentists of their obligations to the Hippocratic Oath? Let’s face it: Dentists’ computers continue to threaten up to 20% of dental patients in the nation. We cannot ignore it any longer, doctors. Once we finally accept ownership of our problem, what are we going to do about it? I’ve suggested that we use common sense and simply remove the dangerous information from dental patients’ files. Anyone see any problem with this idea? Anyone have a better solution?

Assessment

So what do the leaders of the ADA think of de-identification?

Conclusion

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Filed under: Information Technology, Pruitt's Platform | Tagged: ADA, Darrell Pruitt, eDRs, EMRs, HHS, HIPAA, HITECH, Kroll Fraud Solutions, protected health information | 7 Comments »

Share your Mind and Thoughts with Us

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

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How One Hedge Fund Helped Keep the Bubble Going

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

On the Magnetar Trade

By Jesse Eisinger and Jake Bernstein, ProPublica – April 9, 2010 1:00 pm EDT

In late 2005, the booming U.S. housing market seemed to be slowing. The Federal Reserve had begun raising interest rates. Subprime mortgage company shares were falling. Investors began to balk at buying complex mortgage securities. The housing bubble, which had propelled a historic growth in home prices, seemed poised to deflate. And if it had, the great financial crisis of 2008, which produced the Great Recession of 2008-09, might have come sooner and been less severe.

Precise Timing

At just that moment, a few savvy financial engineers at a suburban Chicago hedge fund [1] helped revive the Wall Street money machine, spawning billions of dollars of securities ultimately backed by home mortgages.

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When the crash came, nearly all of these securities became worthless, a loss of an estimated $40 billion paid by investors, the investment banks who helped bring them into the world, and, eventually, American taxpayers.

Yet the hedge fund, named Magnetar for the super-magnetic field created by the last moments of a dying star, earned outsized returns in the year the financial crisis began.

The Magnetar Trade

How Magnetar pulled this off is one of the untold stories of the meltdown. Only a small group of Wall Street insiders was privy to what became known as the Magnetar Trade [2]. Nearly all of those approached by ProPublica declined to talk on the record, fearing their careers would be hurt if they spoke publicly. But interviews with participants, e-mails [3], thousands of pages of documents and details about the securities that until now have not been publicly disclosed shed light on an arcane, secretive corner of Wall Street.

According to bankers and others involved, the Magnetar Trade worked this way: The hedge fund bought the riskiest portion of a kind of securities known as collateralized debt obligations — CDOs. If housing prices kept rising, this would provide a solid return for many years. But that’s not what hedge funds are after. They want outsized gains, the sooner the better, and Magnetar set itself up for a huge win: It placed bets that portions of its own deals would fail.

Chance Enhancement

Along the way, it did something to enhance the chances of that happening, according to several people with direct knowledge of the deals. They say Magnetar pressed to include riskier assets in their CDOs that would make the investments more vulnerable to failure. The hedge fund acknowledges it bet against its own deals but says the majority of its short positions, as they are known on Wall Street, involved similar CDOs that it did not own. Magnetar says it never selected the assets that went into its CDOs.

Magnetar says it was “market neutral,” meaning it would make money whether housing rose or fell. (Read their full statement. [4]) Dozens of Wall Street professionals, including many who had direct dealings with Magnetar, are skeptical of that assertion. They understood the Magnetar Trade as a bet against the subprime mortgage securities market. Why else, they ask, would a hedge fund sponsor tens of billions of dollars of new CDOs at a time of rising uncertainty about housing?

Key details of the Magnetar Trade remain shrouded in secrecy and the fund declined to respond to most of our questions. Magnetar invested in 30 CDOs from the spring of 2006 to the summer of 2007, though it declined to name them. ProPublica has identified 26 [5].

Independent Analysis

An independent analysis [6] commissioned by ProPublica shows that these deals defaulted faster and at a higher rate compared to other similar CDOs. According to the analysis, 96 percent of the Magnetar deals were in default by the end of 2008, compared with 68 percent for comparable CDOs. The study [6] was conducted by PF2 Securities Evaluations, a CDO valuation firm. (Magnetar says defaults don’t necessarily indicate the quality of the underlying CDO assets.)

From what we’ve learned, there was nothing illegal in what Magnetar did; it was playing by the rules in place at the time. And the hedge fund didn’t cause the housing bubble or the financial crisis. But the Magnetar Trade does illustrate the perverse incentives and reckless behavior that characterized the last days of the boom.

Major Players

Magnetar worked with major banks, including Merrill Lynch, Citigroup, and UBS. At least nine banks helped Magnetar hatch deals. Merrill Lynch, Citigroup and UBS all did multiple deals with Magnetar. JPMorgan Chase, often lauded for having avoided the worst of the CDO craze, actually ended up doing one of the riskiest deals with Magnetar, in May 2007, nearly a year after housing prices started to decline. According to marketing material and prospectuses [5], the banks didn’t disclose to CDO investors the role Magnetar played.

Many of the bankers who worked on these deals personally benefited, earning millions in annual bonuses. The banks booked profits at the outset. But those gains were fleeting. As it turned out, the banks that assembled and marketed the Magnetar CDOs had trouble selling them. And when the crash came, they were among the biggest losers.

Assessment

Of course, some bankers involved in the Magnetar Trade now regret what they did. We showed one of the many people fired as a result of the CDO collapse a list of unusually risky mortgage bonds included in a Magnetar deal he had worked on. The deal was a disaster. He shook his head at being reminded of the details and said: “After looking at this, I deserved to lose my job.”

Magnetar wasn’t the only market player to come up with clever ways to bet against housing. Many articles and books, including a bestseller by Michael Lewis [7], have recounted how a few investors saw trouble coming and bet big. Such short bets can be helpful; they can serve as a counterweight to manias and keep bubbles from expanding.

Magnetar’s approach had the opposite effect — by helping create investments it also bet against, the hedge fund was actually fueling the market. Magnetar wasn’t alone in that: A few other hedge funds also created CDOs they bet against. And, as the New York Times has reported, Goldman Sachs did too. But Magnetar industrialized the process, creating more and bigger CDOs.

Conclusion

Several journalists have alluded to the Magnetar Trade in recent years, but until now none has assembled a full narrative. Yves Smith, a prominent financial blogger who has reported on aspects of the Magnetar Trade, writes in her new book, “Econned,” [8] that “Magnetar went into the business of creating subprime CDOs on an unheard of scale. If the world had been spared their cunning, the insanity of 2006-2007 would have been less extreme and the unwinding milder.”

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Filed under: Alternative Investments, Ethics, Investing, Portfolio Management, Risk Management | Tagged: CDOs, CitiGroup, Federal Reserve, Goldman Sachs, hedge funds, Jake Bernstein, Jesse Eisinger, JPMorgan Chase, Magnetar, Merrill Lynch, Michael Lewis, Mike Burry MD, ProPublica, UBS, Yves Smith | 16 Comments »

Good Night H. Ed Roberts MD

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

Medical Inventor, Bio-Engineering Pioneer and Colleague

[September 13, 1941 – April 1, 2010]

By Dr. David Edward Marcinko; MBA

[Publisher-in-Chief]

According to Wikipedia, Henry Edward “Ed” Roberts MD was an American engineer, entrepreneur and medical doctor who designed the first commercially successful personal computer in 1975. He is most often known as the “father of the PC.” He founded Micro Instrumentation and Telemetry Systems [MITS]) in 1970 to sell electronics kits to model rocketry hobbyists, but the first successful product was an electronic calculator kit that was featured on the cover of the November 1971 issue of Popular Electronics magazine. The calculators were very successful and sales topped one million dollars in 1973. But, a brutal calculator price war left the company deeply in debt by 1974. Roberts then developed the Altair 8800 personal computer that used the new Intel 8080 microprocessor. This was featured on the cover of the January 1975 issue of Popular Electronics, and hobbyists flooded MITS with orders for this $397 computer kit. Bill Gates and Paul Allen joined MITS to develop software and Altair BASIC was Microsoft’s first product. Roberts sold MITS in 1977 and retired to Georgia where he farmed, studied medicine and eventually became a small-town doctor after commencing medical school at age 39.

Link: http://en.wikipedia.org/wiki/Ed_Roberts_(computer_engineer)

My Connection to Ed

Almost 20 years ago, I co-founded a small medical education software company, for a tiny niche market. My partner was a computer “whiz kid”. I was the chief executive, brain-child and enfant terrible. We are still in business today.

Nevertheless, I decided to contact Ed because I had just received my first PC [Intel® 286 microprocessor] from a publishing company who had contracted with me to write a medical textbook; remember DOS and WordPerfect? I was also very familiar with Microsoft lore, especially relative to business thought and competitive analysis. Regular readers of the ME-P may even recall my mention of attending lectures by Michael Porter PhD [father of competitive analysis] while dating a girl who was attending Wharton Business School while I was a medical student in Philadelphia, back-in-the-day.

Anyway, I took it upon myself to write Ed for some advice. Remember, this was before the commercial internet was widely available. I used medicine as a mutual point of interest. Anyway; after no response, the incident was quickly forgotten because of a busy lifestyle, new medical practice, book-project, etc. I follow-upped about a year later and this time received an encouraging written reply from Ed. I treasure the letter to this day, almost as much as the ones I have from Louis Rukeyser [TV fame-died in 2006] and his uber-investor guest, Sir John Marks Templeton [son is a surgeon] who died in 2008. In 2005, Templeton wrote a brief memorandum predicting that within five years there would be financial chaos in the world. It was eventually made public in 2010.

Assessment

Ed practiced as an internist until his death, in Cochran – a city near Macon, GA. The population was 4,455 at the 2000 census. It is a very poor county in South Georgia, and many, if not most of Ed’s patients were on Medicaid and/or Medicare. He loved them dearly, and they loved him, too!

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Although perhaps not as famous as Gates and Allen; we say with all due respect and admiration – good night Dr. Roberts – and thank you for the personal computer … your love of medicine and mankind … and for reaching out to me so very long ago!

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Filed under: Information Technology, Op-Editorials, Touring with Marcinko | Tagged: Altair 8800, Altair Basic, Basic, Bill Gates, david marcinko, DOs, Ed Roberts, Intel, Intel 286, Intel 8080, John Templeton, Louis Rukeyser, microsoft, Mike Porter, MITS, Paul Allen, PC, Popular Electronics | 2 Comments »

The Financial Crisis Panel’s Huge Task

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

Small Budget – Unanswered Questions

By Marian Wang, ProPublica – April 6, 2010 11:21 am EDT

[picapp align=”none” wrap=”false” link=”term=Alan+Greenspan&iid=8449279″ src=”0/0/f/b/Financial_Crisis_Inquiry_bc5a.jpg?adImageId=12219077&imageId=8449279″ width=”380″ height=”523″ /]

The Financial Crisis Inquiry Commission, a 10-person panel tasked with investigating the causes of the financial crisis, is gearing up for when it shortly begins a second round of public hearings with financial executives, regulators and experts.

The Panel’s Mission

As has been reported [1] but bears repeating, the panel has a big job [2] and a small budget. The commission’s chairman, Phil Angelides [3], has pointed out that the Lehman Brothers examiner’s report—an investigation into what happened with a single company—cost $38 million and took 15 months. By comparison, the commission, whose job is to investigate the entire financial crisis for the public record, has an $8 million budget and Dec. 15 deadline for reporting its findings to Congress. Recent reports say the crisis panel has been beset with internal disagreements and staffing delays [4].

Deceptive Accounting by Bankers?

As part of its formidable to-do list [2], the panel has promised to look into the bankers [5], into the extent of deceptive accounting [6] ($) at financial firms, into the mortgage bubble [7] and into subprime lending at Citigroup [8]. Among the people to be questioned this week are former Fed chairman Alan Greenspan, former Citigroup CEO Chuck Prince and former Citi chairman Robert Rubin—who as Treasury secretary during the Clinton administration played a “key role in financial deregulation [9].” Current and former heads of the Office of the Comptroller of the Currency [10] will also face questioning, as will former executives from mortgage giant Fannie Mae and two former Fannie regulators.

Being Alan Greenspan

As for what to expect: Alan Greenspan has laid out his position on the financial crisis in a paper for the Brookings Institution (read the summary [11]). In recent interviews [12] he has stressed that the problem is not the markets, but that no one understood the risks that were being taken enough to step in. “We have to work our way back to understanding what went on,” he told ABC News—troubling, coming as it does from someone who spent more than two decades as the nation’s chief financial regulator. He also stressed “more required capital” for financial firms, an idea that seems to be popular in principle [13], but only so long as regulators have discretion and specific numbers aren’t written into legislation [14].

Assessment

Former Citi execs Prince and Rubin will likely be in the headlines as well, as the panel questions them on the risky lending practices that led to $45 billion in government bailouts for Citigroup (see our bailout page on Citi [15]). In 2007, shaking off concerns about the mortgage lending boom, Prince famously told the Financial Times, “When the music stops, in terms of liquidity, things will be complicated. But as long as the music is playing, you’ve got to get up and dance. We’re still dancing.”

Here’s the full agenda [16] (PDF) for the last half of the week.

Original link: http://www.propublica.org/ion/blog/item/preview-financial-crisis-panels-huge-task-small-budget-unanswered-questions

Conclusion

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Filed under: Accounting, Alerts Sign-Up, Ethics, Financial Planning, Investing | Tagged: Alan Greenspan, Chuck Prince, Financial Crisis Inquiry Commission, Financial Times, Lehman Brothers, Marian Wang, mortgage bubble, Office of the Comptroller of the Currency, Phil Angelides, ProPublica, Robert Rubin, subprime lending at Citigroup | 1 Comment »

“Go Elsewhere for Health Care”

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

What One Doctor Tells Obama Supporters

By Staff Reporters

[picapp align=”none” wrap=”false” link=”term=tea+party&iid=8445957″ src=”5/e/f/6/Tea_Party_Express_6ebb.jpg?adImageId=12359612&imageId=8445957″ width=”380″ height=”253″ /]

According to Stephen Hudak, of the Orlando Sentinel, a Mount Dora doctor [Jack Cassell MD] posted a sign telling Obama health care supporters to go elsewhere for medical care.

http://startthinkingright.wordpress.com/2010/04/02/doctor-cassell-if-you-voted-for-obama-seek-urologic-care-elsewhere/

Timeline for Healthcare Implementation

Timeline of Major Provisions in the Democrats’ Health Care Package

Conclusion

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Filed under: "Doctors Only", Career Development, Ethics, Health Insurance, Health Law & Policy | Tagged: Jack Cassell MD, Mount Dora, OmamaCare, Orlando Sentinel | 3 Comments »

Donald M. Berwick MD to Head CMS?

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

Obama Selects Health Policy Scholar as the Director for Medicare and Medicaid

By Staff Reporters

President Obama has named Dr. Donald M. Berwick, an iconoclastic scholar of health policy, to run Medicare and Medicaid, the programs that serve nearly one-third of all Americans.

Assessment

New York Times: http://www.nytimes.com/2010/03/28/health/policy/28health.html?scp=1&sq=Berwick&st=cse:

Berwick on: “Reducing the Harm from Medical Care” http://www.nihcm.org/pdf/ExpertVoices_Berwick_HR_final.pdf

Berwick on: “Curing Health Care”

http://www.amazon.com/Curing-Health-Care-Strategies-Improvement/dp/0787964522/ref=sr_1_1?ie=UTF8&s=books&qid=1271007422&sr=1-1

Wachter on: “Is Don Berwick the One”

http://community.the-hospitalist.org/blogs/wachters_world/archive/2010/03/26/is-don-berwick-the-one.aspx

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Is this the right man for the job? 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.

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Filed under: Alerts Sign-Up, Book Reviews, Breaking News, Health Insurance, Health Law & Policy | Tagged: CMS, Donald M. Berwick, Medicaid, medicare, obama | 13 Comments »

Tim Geithner’s Letter Shows Opposition to Fixed Capital Requirements for Banks

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

In Financial Reform Bill

By Marian Wang, ProPublica – April 2, 2010 2:10 pm EDT

Remember how earlier this week, in a post about financial reform and liquidity requirements [1], we noted how vague [2] Treasury Secretary Tim Geithner was being with The New York Times about setting hard and fast rules about how much cash should be required to hold?

Here’s what we excerpted from the Times on Tuesday: Mr. Geithner insists that if there is one change that needs to be made to the banking system to protect it against another high-stakes bank run like the one that claimed the life of Lehman Brothers, increasing capital requirements is it.

Pinning Down Geithner

But try pinning down Mr. Geithner, or anyone else in the Beltway, on how much capital banks should be required to keep, or even how the word “capital” should be defined, and certainties disappear.

Turns out he had a lot more to say on the subject than what he told the Times. Mike Konczal [3], blogging for Ezra Klein, unearthed a letter Geithner sent to a lawmaker in January, explaining his hesitancy—really, his opposition—to setting fixed capital requirements in current financial reform proposals. From the letter [4]:

Although the Administration strongly supports imposing a simple, non-risk-based leverage constraint on banks, bank holding companies, and other major financial firms, we do not believe that codifying a specific numerical leverage requirement in statute would be appropriate.

Assessment

So when Geithner said, “We have not made a judgment yet on the number,” what he really was thinking—if this letter is any indication—is that as far as financial reform legislation itself goes, he doesn’t want a number, period. And when it comes to actually imposing tighter capital requirements on financial institutions, he wants the Treasury, the Fed or some combination of regulators to have a free hand to pick and change the number. In other words, pretty close to the way things are now.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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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: Accounting, Breaking News, Investing | Tagged: bank reserve requirements, Ezra Klein, Federal Reserve, Financial Reform, Lehman Brothers, Marian Wang, Mike Konczal, obama, Tim Geithner, Treasury Department | 3 Comments »

Queries for the ADA Member Service Center

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

Four Questions for Consideration

[By Darrell K. Pruitt; DDS]

Dear ME-P Readers

I’m considering these four questions for the ADA Member Service Center to break the ice. What do you think?

Question 1 – The FTC’s Red Flags Rule is due to be enforced on June 10. If the Rule is not delayed for a fifth time and a dentist has a contractual relationship with CareCredit/GE or similar healthcare financing service, will that mean he or she will become a covered entity obligated to additional paperwork, liability and expense?

Question 2 – According to the “ADA National Oral Health Agenda” found on the Advocacy page, it states that one of the ways the ADA intends to reduce the cost of dental care is to promote health information technology. This goal was first posted several years ago. Considering the ever increasing liability of data breaches in healthcare, can consumers still expect to save money in dental care by visiting a paperless practice?

Question 3 – Am I correct to assume that soon the ADA.org Website will include the capability for direct discussions between members and leadership?

Question 4 – If interactive functions are indeed to be included in the new ADA Website, will there be any topics concerning ADA policy that will be closed to questions from membership?

Editors Note: The incredible power of the internet is illustrated with this post relative to the phenomenon of “crowd-sourcing.” In this context, the term means to harvest the reach of social networking, like this ME-P, to solve a problem, or ask for input or opinions.

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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

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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: "Ask-an-Advisor", "Doctors Only", Healthcare Finance, Information Technology, Op-Editorials, Pruitt's Platform | Tagged: ADA Member Service Center, ADA National Oral Health Agenda, ADA. DDS, ADA.org, CareCredit/GE, Darrell K. Pruitt, dentists, eDRs, EMRs, FTC, red flag rules | 9 Comments »

Financial Advisory Reform Going Down in Flames

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

A [False] Hobson’s Choice*

By Staff Reporters

In political Washington DC, according to Ian Salisbury, almost anything will fly if you can make an argument it will benefit the middle class. It worked in the fight against requiring advisors to act in clients’ best interests … Say what?

Is this the case of a classic Hobson’s choice?

[picapp align=”none” wrap=”false” link=”term=bank+reform&iid=8227139″ src=”c/3/0/3/Sen_Dodd_Discusses_655e.jpg?adImageId=12270785&imageId=8227139″ width=”380″ height=”570″ /]

The Strategy

Yep, its true! At least, this strategy worked for the National Association of Insurance and Financial Advisors [NAIFA], which fought a recent proposal that would have made all financial advisors act in clients’ best interests … you know – the “F” word.

Assessment

It seems that there are few protections for the public from unscrupulous FAs, stockbrokers, and insurance agents. And, few wish to become fiduciaries.

http://www.fa-mag.com/online-extras/5406-a-phony-argument.html

*A Hobson’s choice is a free, usually economic, choice in which only one option is offered.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Please visit: www.CertifiedMedicalPlanner.com

As former certified financial planner, insurance agent, stockbroker, surgeon and this ME-P publisher Dr. David Edward Marcinko MBA, CMP™ has always opined to physician colleagues: it is “buyer-beware” out there!

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Filed under: "Advisors Only", "Doctors Only", Career Development, Ethics, Financial Planning, Insurance Matters, Portfolio Management | Tagged: CFP, Chris Dodd, CMP, fiduciary, financial fiduciary, Financial Reform, Hobson's choice, Ian Salisbury, insurance agent, National Association of Insurance and Financial Advisors, registered representative, RIA, Series 7, stock broker, www.CertifiedMedicalPlanner | 4 Comments »

Tax Freedom Day

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

Celebrating April 9th, 2010

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Each day the Tax Foundation reports the date when Americans have on average worked enough to cover taxes. For the year 2010, today the 99th day of the year, or April 9th, is Tax Freedom Day.

2007’s Comparison Triad

Tax Freedom Day this year is two weeks earlier when compared with 2007. This occurs for three principal reasons. First, the recession has reduced tax revenue. Second, there were temporary tax cuts for 2009 and 2010. Third, in 2010 the partial loss of itemized deductions and the exemption phase out for higher-income taxpayers are both eliminated. In addition, there is at present no estate tax.

Now Consider the Debt Burden

However, if the $1.3 trillion deficit is considered, the picture changes substantially. If the government were to collect sufficient revenue to balance the budget, then Tax Freedom Day would be May 17, 2010.

Assessment

As the $1.3 trillion US budget deficit is financed; all taxpayers will either be required to pay interest on that amount or eventually pay off that debt. With the deficit considered, Tax Freedom Day would be the latest since World War II.

Conclusion

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Filed under: Accounting, Alerts Sign-Up, Taxation | Tagged: david marcinko, IRS, Tax Foundation, tax freedom day, US deficit | 1 Comment »

Update on Medicaid and Medicare Advantage Plans

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

The Impact of Health Care Reform

[By Christopher de Garay]

Please find attached below, the Early April 2010 edition of Plan Management Navigator.
Link: Navigator April 2010

Review

In this month’s edition, we review how health care reform will impact the top line of plans offering government managed care programs such as Medicare Advantage and Medicaid. Combined with new minimum health benefit ratios, these pressures will force health plans to look at their administrative expenses. In the next several issues of Navigator, we will look at specific operational metrics and their impact on functional areas such as claims processing.

2010 Benchmark Studies

This edition of Navigator also summarizes the timing for the 2010 benchmarking studies, which includes a new Third-Party Administrator universe.

Christopher de Garay
Senior Health Care Analyst
Sherlock Company
www.sherlockco.com
215-628-2289 Phone
215-542-0690 Fax
cgaray@sherlockco.com
P.O. Box 413
Gwynedd, PA 19436

Editor’s

If your plan would like to consider participation, we invite you to give Chris a call at 215-628-2289 or email him at sherlock@sherlockco.com.

Conclusion

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Filed under: Alerts Sign-Up, Health Economics, Health Insurance, Managed Care, Research & Development | Tagged: Christopher de Garay, DHHS, Managed Care, Medicaid, medicare, Medicare Advantage, Sherlock Company, TPA | 12 Comments »

How You Can Investigate Your State’s Oversight of Its Nurses

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

Reporting Recipe

By Charles Ornstein and Tracy Weber, ProPublica – March 3, 2010 5:38 pm EDT

Nursing boards – and other agencies that oversee such professionals as pharmacists, dentists and mortgage brokers – do not get nearly enough scrutiny. These boards are charged with protecting consumers from unscrupulous or incompetent professionals, but some provide almost no public information about what they do or how they’re run. They are sometimes led by ill-qualified political appointees and lack sufficient personnel. But should these boring bureaucracies fail, the implications for your health, finances, and home can be dire.

Assessment

We realize that many newsrooms face competing priorities and limited resources, so we’re making our reporting recipe public.

Visit our special site with our complete how-to investigation guide [1], with information on all 50 states.

Conclusion

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Filed under: Ethics, Health Law & Policy, Quality Initiatives, Risk Management | Tagged: Charles Ornstein, dentists, nurse, Nursing boards, pharmacists, ProPublica, RN, Tracy Weber | 3 Comments »

Modern Retirement Planning and “Banding” for Physicians

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

The “AgeBander” Approach Presents a More Accurate Portrayal

[By Somnath Basu, PhD, MBA]

A convergence of mega-trends will forever change the face of retirement planning and raise its importance in the pantheon of physician retirement planning and most all employee benefits. Chief among them: longer life expectancy, advances in medicine, healthier lifestyles and mounting concern about years of abysmally low savings rates.

What it all Means in Practical Terms

What this means in practical terms for future retired physicians and most all retirees is the need for employers, service providers and financial advisers [FAs] to plot a more accurate and thoughtful course to planning for retirement that acknowledges the necessity of pursuing an “age-banded” approach. The idea behind this new approach is that individuals undergo various changes in lifestyles during retirement that last for finite or “age-banded”, periods.

Example:

For example, doctors like most people spend more time and money on leisurely activities early on in retirement, while health care needs dominate the latter years. Further, the costs associated with these lifestyles also change at differential inflation rates than from the basic inflation rate. While the basic inflation rate is about 3%, the U.S. Census Bureau noted that annual recreation costs increased at 7.14% though most of the 1990s. Health care costs also increased by much higher rates than the basic rate. Since the traditional model bundles all costs (including leisure, health care, basic living, etc) and extrapolates at the basic rate, it tends to underestimate retirement expenses. The traditional model’s “static” approach to retirement can have dangerous implications since it may lead to under-funded retirement plans, especially those earmarked for the critical years.

A Flawed Model?

In a research paper published by the Association for Financial Counseling and Planning Education, I detailed the reasons why an age-banded approach is superior to the traditional view of retirement planning. This new model provides for a more accurate portrayal of retirement expenses and an algorithm to calculate the income-replacement ratio, as well as smaller resource requirements and greater flexibility in managing risk. It also allows easier incorporation of long-term care insurance (LTCI) and significantly reduces funding needs. Indeed, the funding needs of a husband and wife who are both age 60 and presumably five years away from retirement are reduced by more than 16% and contributions for a 35-year-old single woman are reduced by 42% compared with previous approaches.

Traditional Retirement Planning Weaknesses

There are five inherent weaknesses to the traditional approach to retirement planning. They include the assumption that all living expenses will increase at the overall rate of inflation as measured by the Consumer Price Index (CPI), bundling all expenses together and not allowing them to change based on the life-cycle, estimating those expenses as a fixed percentage (replacement ratio) of pre-retirement costs, investing in low-return assets and failing to consider contingencies such as LTCI benefits, which can have a significant impact on the amount of funding required for retirement.

Financial Advisory Estimates

When financial planners estimate how much income a client needs in retirement, the calculation hinges on their income just prior to retirement. The pre-retirement income is adjusted downward by 10% to 35%. This adjustment reflects the income necessary to maintain one’s standard of living and incorporates reductions in taxes and other work-related expenses that cease upon retirement. Unfortunately, there’s no objective way to estimate the replacement ratio. Aggressive financial planners typically use large ratios and conservative planners use smaller ones.

30-year Retirement Window

Under the age-banded model, an individual typically lives about 30 years in retirement (e.g., age 65 to 95) and experiences a lifestyle change every 10 years at 65, 75 and 85. Of course, both the retirement period and the width of the age bands are arbitrary but can be subjectively changed to fit each retiree as closely as possible. In addition, a number of steps are taken to produce a clearer picture of retirement costs by categorizing them based on taxes, living expenses, health care and leisure, as well as calculating anticipated expenses using the appropriate rate of inflation for each category, which is adjusted to reflect post-retirement lifestyle changes.

Those expenses are extrapolated through 30 years of retirement and the present value of post-retirement expenses are calculated at an amount deemed sufficient to finance the three following decade (each age band). Instead of discounting these values to the year of retirement (the traditional model), the age banding considers them to be three retirement portfolios that require funding.

Since the portfolio required to fund the expenses during the years 86 to 95 is 20 years behind the first band (66 to 75), investors can seek marginally higher rates of return to reflect the longer terms. Contributions toward these amounts can now be calculated.

Example:

For example, the couple mentioned earlier is able to seek higher rates of return for longer-term investment portfolios which more than mitigate the effects of escalating health care costs. In the case of the 35-year-old single woman, since the funds required for these three portfolios are 30, 40 and 50 years away she should be willing to take on more risk since she has ample time to manage the portfolio risk.

The expenses for the age-banded method become considerably higher at the latter stages of retirement as compared to the traditional model. This is desirable since the over-funding is associated with an age at which one cannot afford to be out of funds. The higher estimate of the age band comes from higher inflation rates for health care and the incorporation of lifestyle changes that imply accelerated costs such as increased leisure spending upon retirement and higher health care costs in the latter years.

Thus, these higher costs are not only more realistic but they incorporate the dynamics of a retired life, unlike the traditional model. Incredible as it might seem, the ability to assume a marginally higher risk leads to an actual decrease in the funding requirements versus the traditional plan.

Assessment

One caveat that doctors need to know, and that financial planners will need to keep in mind, is that their clients may be reticent to buy equities when markets are underperforming. Clear explanations are required regarding why it may still be beneficial for the long run and that the risk will be managed on an ongoing basis. But, the results will be well worth the effort for the multiple stakeholders involved in assuring that tomorrow’s retirees are able to live more comfortable after their working years. It’s a small price to pay for the peace of mind associated with knowing retirement expenses will be portrayed more accurately and plan participants will be afforded greater flexibility in managing their risk.

Table [Comparison of growth in retirement expenses]

Link: Age-Banded Retirement Planning FINAL[1]

Editor’s Note: Somnath Basu PhD is program director of the California Institute of Finance in the School of Business at California Lutheran University where he’s also a professor of finance. He can be reached at (805) 493 3980 or basu@callutheran.edu. See the agebander at work at www.agebander.com

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Financial advisors please chime in on the debate? Is Basu correct; why or why not? 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.

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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: Financial Planning, Investing, Research & Development, Retirement and Benefits | Tagged: Association for Financial Counseling and Planning Education, California Institute of Finance, CFP, CPI, financial advisors, LTCI, retirement planning, School of Business at California Lutheran University, Somnath Basu, www.certifiedmedicalplanner.com | 7 Comments »

Dr. Deborah Peel vs. Ms. Mary Grealy on Patient Privacy

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

Physician versus Lobbyist

By Darrell K. Pruitt; DDS

On March 23, 2010 Dr. Deborah Peel, a psychiatrist in private practice and the founder of Patient Privacy Rights (www.patientprivacyrights.org) posted an opinion piece titled: “Your Medical Records Aren’t Secure” in the Wall Street Journal.

http://online.wsj.com/article/SB10001424052748703580904575132111888664060.html

Her still popular article soon picked up 217 comments – reflecting respectable interest in the conundrum. Since then, her message of caution has gained momentum on the Internet in the security industry, and has even spilled over into appearances on Fox News, MSNBC and PBS in the last week.

Dr. Peel’s Case

Dr. Peel argues that even though the President claims digital health records will reduce costs and improve quality, they could undermine safe and effective care if patients become afraid to confide in their doctors.

“The solution is to insist upon technologies that protect a patient’s right to consent to share any personal data. A step in this direction is to demand that no federal stimulus dollars be used to develop electronic systems that do not have these technologies.”

It is easy to understand why Dr. Peel’s opinions draw the ire of HIT stakeholders both inside and outside government.

Dr. Peel concludes:

“Privacy has been essential to the ethical practice of medicine since the time of Hippocrates in fifth century B.C. The success of health-care reform and electronic record systems requires the same foundation of informed consent patients have always had with paper records systems. But if we squander billions on a health-care system no one trusts, millions will seek treatment outside the system or not at all. The resulting data, filled with errors and omissions, will be worth less than the paper it isn’t written on.”

Dr. Peel is currently on a campaign to encourage Americans to sign her “Do not disclose” petition.

http://patientprivacyrights.org/do-not-disclose/

HIT Stakeholders Speak Up

Recently, the Wall Street Journal featured an opposing opinion to Dr. Peel’s in an article titled “Industry Rep Calls Patient Privacy ‘Overblown’ Worry”

http://online.wsj.com/article/SB10001424052748704094104575144110418562490.html?mod=googlenews_wsj#articleTabs%3Darticle

Ms. Grealy’s Case

Mary R. Grealy, President of the Healthcare Leadership Council, a coalition of chief executives from the health-care industry, posted her objections to Dr. Peel’s warnings about the dangers of digital records versus paper:

“Dr. Peel seeks to frighten people into believing electronic health records are more vulnerable than paper ones, which is not the case. She fails to acknowledge the important role of the HIPAA in protecting health information, or the extraordinary steps hospitals, health plans and physicians have taken to assure confidentiality. Building upon HIPAA, federal laws adopted this year strongly encourage encryption of data included in electronic health records and have imposed new criminal and civil penalties for violating an individual’s privacy.”

“More importantly, though, if Dr. Peel’s prescription for this hyperbolic problem were to be followed, it’s actually our health that will be less secure. Burdening patients with the responsibility of deciding what health information should be divulged and what should be shielded from medical professionals brings an infinite array of possible consequences. Would the average patient know what information a surgeon needs in order to perform a complex procedure? It’s highly doubtful”.

“In a broader sense, draconian restrictions on the essential flow of medical information would have society-wide repercussions. It would affect the ability of public health officials to report and track incidences of disease. It would undermine the Food and Drug Administration’s capability to monitor the quality and safety of medical products, and product recalls would be hampered”.

“Perhaps most importantly, medical research into lifesaving cures and treatments would be severely hindered by restricted access to health information. Stymieing the necessary transfer of data contained in one diagnosis, one prescription or one lab test could mean the difference between life and death. That is a very high price to pay in order to address overblown privacy concerns”.

Mary R. Grealy

[Washington]

_____________________________________

Assessment

Mary Grealy doesn’t have a petition to sign.

Whereas Dr. Peel turns to patients for support, Ms. Grealy, President of the Healthcare Leadership Council, a coalition of chief executives from the health-care industry, turns to Washington.

Conclusion

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Filed under: Ethics, Health Insurance, Health Law & Policy, Information Technology, Point-Counter Point, Pruitt's Platform, Risk Management | Tagged: Darrell Pruitt, Deborah Peel, EHRs, EMRs, FDA, Healthcare Leadership Council, HIPAA, HIT, Mary R. Grealy | 12 Comments »

Data Show Little-Known Bank Regulator Goes Easy on Enforcement

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

Office of the Comptroller of the Currency

By Marian Wang, ProPublica – March 29, 2010 12:51 pm EDT

The New York Times business section had a piece recently about a little-known bank regulator [1] called the Office of the Comptroller of the Currency. It points out that while the Federal Reserve has shouldered most of the criticism directed toward bank regulators, because of its relative obscurity, the OCC [2] has escaped much of the scrutiny.

[picapp align=”none” wrap=”false” link=”term=John+C.+Dugan&iid=5559429″ src=”b/6/1/5/House_committee_examines_a74a.JPG?adImageId=11861248&imageId=5559429″ width=”380″ height=”500″ /]

John C. Dugan

The Times piece focuses mostly on John C. Dugan, the former bank lobbyist who heads the agency. It highlights criticism that Dugan is too pro-bank, and goes back and forth between criticism and Dugan’s response. Mr. Dugan bristles at the notion that he is too easy on banks and says his agency’s record on consumer protection has been “vigorous and sustained.” He says it is a “cheap shot” to suggest that his lobbying years color his viewpoint and that it demeans his employees and his years of public service. In point-counterpoint situations, what’s often helpful is hard data [3]. The Times brings it into the story later on, with statistics on the OCC’s formal enforcement orders against banks.

Assessment

The OCC has both formal and informal enforcement orders against banks. The Times’ chart shows that the agency rarely takes formal enforcement action against banks, and even more rarely doles out actual penalties to the banks in the form of fines, restitutions or refunds to consumers. The agency defended its small number of enforcement actions, saying it works closely with banks [4] to fix problems while they’re small, so as not to require stronger measures.

Conclusion

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Filed under: Breaking News, Ethics, Health Law & Policy, Research & Development | Tagged: bank lobbyist, bank regulators, banking, Federal Reserve, John C. Dugan, Marian Wang, OCC, Office of the Comptroller of the Currency, ProPublica | 3 Comments »

Podcast: How the Health Care Bill Comparison News Application Came Together

Posted on April 4, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

A Problica Podcast

By Mike Webb, ProPublica – March 26, 2010 12:32 pm EDT

Last week, Olga Pierce and Jeff Larson created a side-by-side comparison of the health care bills [1] to help people see the exact changes in the legislation. Larson developed a news application that highlighted the changed, added or deleted provisions of the bill and Pierce had the unenviable task of going through the 2,000-plus page bill to decipher what the changes were.

[picapp align=”none” wrap=”false” link=”term=insurance&iid=8337859″ src=”9/d/c/c/President_Obama_Signs_196b.JPG?adImageId=11862302&imageId=8337859″ width=”380″ height=”454″ /]

Assessment

We talked to the pair, as well as to ProPublica’s editor of news applications, Scott Klein, about how and why they did it and the challenges they faced in turning it around so quickly.

Articles related to this podcast:

Why You Should Check Out the Health Care Bills Side by Side [2]

Eye on Health Care Reform [3]

Download this episode

Conclusion

And so, your thoughts and comments on this ME-P and prodcast 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.

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Sponsors Welcomed

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Filed under: Health Insurance, Health Law & Policy, Healthcare Finance, Research & Development, Videos | 1 Comment »

More on Lehman Brothers and Repo 105

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

The Auditors Attempt to Explain

By Marian Wang, ProPublica – March 25, 2010 4:18 pm

Ever since we began following the storyline of “Repo 105”, a sly balance-sheet maneuver performed by Lehman Brothers that helped it hide billions in dodgy assets, we noted that Lehman auditor Ernst & Young had some explaining to do. That explaining has begun.

The Contrarian Pundit

Contrarian Pundit posted a letter that Ernst & Young sent out yesterday, defending itself: not to the media, but to its clients. Check out both pages of the letter (PDFs).

A Few More Choice Bits

Lehman’s bankruptcy was the result of a series of unprecedented adverse events in the financial markets. The months leading up to Lehman’s bankruptcy were among the most turbulent periods in our economic history. Lehman’s bankruptcy was caused by a collapse in its liquidity, which was in turn caused by declining asset values and loss of market confidence in Lehman. It was not caused by accounting issues or disclosure issues.

Assessment

While no specific disclosures around Repo 105 transactions were reflected in Lehman’s financial statement footnotes, the 2007 audited financial statements were presented in accordance with US GAAP, and clearly portrayed Lehman as a leveraged entity operating in a risky and volatile industry. In other words, we at Ernst & Young didn’t point out that Lehman was doing things to hide its risks, but you should’ve known Lehman was in trouble anyway. Felix Salmon points out that at least they’re no longer denying that they knew about Repo 105.

Link: http://www.propublica.org/ion/blog/item/more-on-lehman-and-repo-105-the-auditors-attempt-to-explain

Conclusion

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Filed under: Ethics, Investing, Portfolio Management, Research & Development | Tagged: Contrarian Pundit, Ernst & Young, Felix Salmon, GAAP, Lehman Brothers, Lehman’s bankruptcy, Marian Wang, Repo 105 transactions, Richard Fuld | 5 Comments »

ME-P PodCasts Coming Soon

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

First Audio – Then Video

By Staff Reporters

The Medical Executive-Post will soon begin producing pod-casts featuring interviews with interesting physicians, financial advisors and/or management consultants.

So, if you are in the healthcare administrative space, or have a related product or service to offer, and/or would like to be interviewed, or want to recommend a physician, advisor or consultant to be spotlighted, please send your suggestions to us.

Assessment

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Filed under: Alerts Sign-Up, iMBA, Inc., Monthly Reports, Sponsors | Tagged: david marcinko, ME-P, Medical Execuitve Post, PodCast, www.medicalbusinessadvisors.com, www.MedicalExecutivePost.com | Leave a comment »

Taxing Sin to Modify Behavior and Raise Revenue‏

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

NIHCM Expert Voices

By Nancy Chockley PhD [President & CEO]
[NIHCM Foundation]

Sin taxes on tobacco and alcohol have a long history in the U.S., and many credit cigarette taxes as being the single most effective strategy in achieving our dramatic reductions in smoking. Similar taxes have been proposed in recent years as one weapon in our fight against rising obesity rates, and a new study has just added support for this policy by showing that higher prices for sweetened sodas are associated with lower caloric intake, lower weight, and better health.

Rationale Reviews

In his essay, Dr. Jonathan Gruber reviews the rationales for and experience with sin taxes for cigarettes and alcoholic beverages, and offers his insights on using sin taxes to combat obesity.

http://www.nihcm.org/pdf/ExpertVoices_Gruber_April2010.pdf

Related Others

Other recent “Expert Voices” essays on health reform include:

William Vogt, RAND Corporation, “Hospital Market Consolidation” (November 2009)http://www.nihcm.org/pdf/EV-Vogt_FINAL.pdf
Genevieve Kenney, Urban Institute, “Uninsured and Eligible for Public Coverage” (November 2009) http://nihcm.org/pdf/EV-Kenney_FINAL.pdf
Eric Jensen, Consultant, and Lenny Mendonca, McKinsey & Company, “Why America Spends More on Healthcare” (November 2009)http://nihcm.org/pdf/EV_JensenMendonca_FINAL.pdf

Assessment

I hope you enjoy reading these essays and those that follow, down-line.

Phone: 202-296-4426
email: nihcm@nihcm.org
Website: www.nihcm.org

Conclusion

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Filed under: Ethics, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Taxation | Tagged: alcohol tax, cigarette tax, Dr. Jonathan Gruber, Eric Jensen, Genevieve Kenney, Lenny Mendonca, Nancy Chockley, NIHCM Foundation, William Vogt | 8 Comments »

Events Planner: April 2010

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

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Events-Planner: APRIL 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:

April 07: NAIBD Symposium, Newport Beach, CA,
April 12: World Congress on Healthcare, Washington, DC
April 15: Implementing HI-TECH Summit, Washington, DC
April 16: Pro-Active Medical Management Summit, Jacksonville, FLA
April 18: Healthcare Compliance Institute, Dallas, TX
April 23: SIFMA Private Conference, Grand Hyatt, NY
April 25: AALU Meeting, Marriott Wardman Park Hotel, Washington, DC
April 30: ACPE Meeting, National Harbor, Washington, DC.

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

MarcinkoAdvisors@msn.com

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Filed under: Alerts Sign-Up, Career Development, Events-Planner | Tagged: AALU, ACPE, Healthcare Compliance Institute, HI-TECH, NAIBD Symposium, Pro-Active Medical Management Summit, SIFMA, World Congress Healthcare | Leave a comment »

Understanding Efforts to Promote Lower-Cost Physicians

Posted on March 31, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

May Be Based on Misleading Profiles – According to Rand Study

By Staff Reporters

It is increasingly common for insurance plans to encourage patients to receive care from physicians who keep medical costs lower. However, this ethos may be based on unreliable estimates of doctor performance and may not achieve the intended savings, according to a new RAND Corporation press release and study.

PR Link: http://www.rand.org/news/press/2010/03/17/?ref=homepage&key=t_doctor_cash

About the Study

Funding for the study was provided by the U.S. Department of Labor. Other authors of the study are Elizabeth A. McGlynn PhD of RAND, Dr. Ateev Mehrotra of RAND and the University of Pittsburgh School of Medicine, and J. William Thomas of the University of Southern Maine.

About Rand Health

RAND Health, a division of the RAND Corporation, is the nation’s largest independent health policy research program, with a broad research portfolio that focuses on quality, costs and health services delivery, among other topics. RAND Health is the developer of COMPARE (Comprehensive Assessment of Reform Efforts), a one-of-a-kind online resource that provides objective analysis about national health care reform proposals. Visit www.randcompare.org to learn more.

Conclusion

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Filed under: "Doctors Only", Career Development, Health Economics, Managed Care, Practice Management | Tagged: DOM, Dr. Ateev Mehrotra, Elizabeth McGlynn, Health Economics, J. William Thomas, Rand, USDOL | 2 Comments »

Senior Public Health Official [Dr. Howard Frumkin] is Reassigned

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

In Wake of Congressional Inquiries

By Joaquin Sapien, ProPublica – January 22, 2010 5:56 pm EDT

Dr. Howard Frumkin, the embattled director of a little-known but important division of the Centers for Disease Control and Prevention, has been reassigned to a position with less authority, a smaller staff and a lower budget.

Agency for Toxic Substances and Disease Registry

Frumkin had led the CDC’s Agency for Toxic Substances and Disease Registry (ATSDR) and the National Center for Environmental Health since 2005. For the past two years he had endured scathing criticism from Congress and the media for ATSDR’s poor handling of public health problems created by the formaldehyde-contaminated trailers that the government provided to Hurricane Katrina victims. The agency, which assesses public health risks posed by environmental hazards, also was criticized for understating the health risks of several other, less-publicized cases.

Internal CDC e-Mail

An internal CDC e-mail sent by Frumkin on Jan. 15 and obtained by ProPublica said he was leaving his position that day and would become a special assistant to the CDC’s director of Climate Change and Public Health. His old job will be temporarily filled by Henry Falk, who led ATSDR from 2003 to 2005. In the e-mail, Frumkin praised his staff and described more than 20 ATSDR accomplishments during his tenure. They include strengthening the agency’s tobacco laboratory and creating the Climate Change and Public Health program.

A Change of Function

A CDC spokesman said Frumkin’s transfer shouldn’t be considered a demotion but rather a change of function and responsibilities that the CDC’s director, Dr. Thomas Frieden, said would benefit both the agency and Dr. Frumkin, who is a recognized expert on climate change. But Frumkin’s authority has been sharply reduced, even though his salary won’t change. Previously, he oversaw two departments with a combined budget of about $264 million and 746 full-time employees. Now he will be an assistant to the director of a new program that has a budget of about $7.5 million, five full-time employees and five contractors, two of whom are part time. Through a CDC spokesman, Frumkin declined a request to be interviewed for this story.

A 2008 ProPublica Report

In 2008, ProPublica reported [1] that Frumkin and others failed to take action after learning that ATSDR botched a study [2] on the trailers provided to Katrina victims. The Federal Emergency Management Agency used the study to assure trailer occupants that the formaldehyde levels weren’t high enough to harm them. ATSDR never corrected FEMA, even though Christopher De Rosa, who led ATSDR’s toxicology and environmental medicine division, repeatedly warned Frumkin that the report didn’t take into account the long-term health consequences of exposure to formaldehyde, like cancer risks. Frumkin eventually reassigned De Rosa to the newly created position of assistant director for toxicology and risk analysis. De Rosa went from leading a staff of about 70 employees to having none. He has since left the agency and is starting a nonprofit that will consult with communities close to environmental hazards.

The involvement of Frumkin and ATSDR in the formaldehyde debacle was the focus of an April 2008 Congressional hearing held by a subcommittee of the House Science and Technology Committee. A report [3] by the subcommittee’s Democratic majority, released that October, concluded that the failure of ATSDR’s leadership “kept Hurricane Katrina and Rita families living in trailers with elevated levels of formaldehyde … for at least one year longer than necessary.”

About six months after the report came out, the same panel, the Subcommittee on Investigations and Oversight, held another hearing [4] that touched on other problems at ATSDR.

Flawed Data

Before that hearing, the Democrats on the subcommittee released a report [5] that revealed other cases in which the agency relied on scientifically flawed data, causing other federal agencies to mislead communities about the dangers of their exposure to hazardous substances.

For example, an ATSDR report about water contamination at Camp Lejeune, a Marine Corps base in North Carolina, said the chemically tainted drinking water didn’t pose an increased cancer risk to residents there. The report was used to deny at least one veteran’s medical benefits for ailments that the veteran believed were related to the contamination. A month after the subcommittee hearing, ATSDR rescinded [6] some of its findings, saying it didn’t adequately consider the presence of benzene, a carcinogen that it found in the water. Eight months later, the agency said it would modify another report that was criticized at the hearing, about a bomb testing site in Vieques, Puerto Rico. For decades, the U.S. military used the site to test ammunition that contained depleted uranium and other toxins. In a 2003 report, ATSDR said that heavy metals and explosive compounds found on Vieques weren’t harmful to people living there. But Frumkin decided to take a fresh look at those findings because ATSDR hadn’t thoroughly investigated the site.

Assessment

Subcommittee investigators acknowledged that Frumkin inherited many of the problems in the report from previous ATSDR directors — the original Vieques and Camp Lejeune reports were both done before Frumkin was named director in 2005. But the investigators said he was aware of the agency’s problems and did little to fix them unless he was under political pressure. A CDC spokesman said that Frumkin’s reassignment had nothing to do with the congressional inquiries.

“Americans should know when their government tells them that they have nothing to worry about from environmental exposure that they really have nothing to worry about,” Rep. Brad MillerHouse Science and Technology Committee, D-N.C., the subcommittee’s chairman, said in a statement to ProPublica regarding Frumkin’s reassignment. “The nation needs ATSDR to do honest, scientifically rigorous work. There are many capable professionals at ATSDR who are committed to doing just that.”

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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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: Ethics, Health Law & Policy, Quality Initiatives, Risk Management | Tagged: Agency for Toxic Substances and Disease Registry, ATSDR, CDC, Centers for Disease Control and Prevention, Christopher De Rosa, Dr. Howard Frumkin, Dr. Thomas Frieden, Federal Emergency Management Agency, FEMA, formaldehyde-contaminated trailers, Henry Falk, House Science and Technology Committee, Joaquin Sapien, National Center for Environmental Health, ProPublica | 1 Comment »

About the Covestor Mutual Fund Portfolio Sharing Service

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

What it is – How it works

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Covestor, with offices in New York and London, is a web platform started by entrepreneurs Perry Blancher, Richard Tachta and Simon Veingard http://www.covestor.com. Their belief was that salaried mutual fund managers have no monopoly on investment talent and shouldn’t have a lock on the rewards that come with investment success. As financial services, and online netizens, they also believed in democratizing the investment management industry and helping proven self-investors compete with the large institutions. This is known as the power of “crowd-sourcing.” All core philosophies seem to be shared by this ME-P.

What it is

According to their website, Covestor is both a portfolio sharing service for proven self-investors and for those wishing to track them; where data is private, secure and anonymous. With Covestor, one can coat-tail successful investors and follow their real trade activity. Or, have their moves auto-traded for you by Covestor Investment Management. Members can also keep track of their investments andBuild a free track record comparable to professional mutual funds. Members earn fees for their hard work, and Manage a model that their clients can mirror thru shared management fees.

Profit Sharing Investors

Covestor investors sharing portfolios include professionals, full time amateurs and industry specialists. They are a serious bunch with an average reported portfolio size of over $200,000 (excluding cash). Positions are typically held in over 5,000 different equities; are based in 50 countries and span the full range of ages, backgrounds and styles.

Issues

As a doctor-investor, health economist and former certified financial planner, there are at least three issues needed to be raised about this firm.

The first is SEC/NASD/FINRA rules and applicable SRO and state regulations for brokers, RIAs, FAs and related others? The status of suitability versus fiduciary accountability for ERISA regulated plans is also questioned. The third [and least important] is the potential negative impact on traditional financial services “professionals.”

In other words, is this another example of how technology will flatten the “intermediary curve” and reduce the profit of middle sales-men and sales-women? Oh! What about medical specificity for our target audience?

www.CertifiedMedicalPlanner.org

Assessment

I am sure there are other issues as well. Your thoughts and comments on this ME-Pare appreciated; especially from financial services “professionals”, lawyers and FAs, etc, Give em’ a click and tell us what you think http://www.covestor.com?

Conclusion

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Filed under: "Ask-an-Advisor", Breaking News, Career Development, CMP Program, Ethics, Information Technology, Investing, Practice Management | Tagged: certified financial planner, CFP, CMP, covestor, Covestor Investment Management, ERISA, FINRA, NASD, Perry Blancher, RIA, Richard Tachta, SEC, Simon Veingard, www.CertifiedMedicalPlanner | 4 Comments »

As the Health Care Vote Passes

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

Another Troubling Insurance Story

By Marian Wang, ProPublica – March 17, 2010 2:03 pm EDT

[picapp align=”none” wrap=”false” link=”term=health+insurance&iid=8337843″ src=”c/e/5/3/President_Obama_signs_baf7.JPG?adImageId=11734822&imageId=8337843″ width=”380″ height=”484″ /]

Reuters filed a stunning report [1] recently about a health insurance company that targeted policyholders with HIV to drop their coverage. It opens with the case of Jerome Mitchell:

Patient Jerome Mitchell

Previously undisclosed records from Mitchell’s case reveal that [health insurance company Fortis [now known as Assurant Health] had a company policy of targeting policyholders with HIV. A computer program and algorithm targeted every policyholder recently diagnosed with HIV for an automatic fraud investigation, as the company searched for any pretext to revoke their policy. As was the case with Mitchell, their insurance policies often were canceled on erroneous information, the flimsiest of evidence, or for no good reason at all, according to the court documents and interviews with state and federal investigators ….

Insurance companies have long engaged in the practice of “rescission,” whereby they investigate policyholders shortly after they’ve been diagnosed with life-threatening illnesses. But, government regulators and investigators who have overseen the actions of Assurant and other health insurance companies say it is unprecedented for a company to single out people with HIV.

The Three Minute Rule

A South Carolina judge who ruled on the case noted that in the meeting in which the rescission committee [2] reviewed Mitchell’s case and decided to cancel his policy, there were more than 40 other customers whose cases were up for review, and “an average of three minutes or less” was spent per customer. Assurant Health told Reuters [1] it doesn’t comment on individual customer claims, while a spokesman added the company disagreed with “certain of the court’s characterizations of Assurant Health’s policies and procedures.”

Link: http://www.propublica.org/ion/blog/item/as-health-care-vote-nears-another-troubling-insurance-story

Assessment

As the story notes, it’s not just this one insurance company that has been engaging in aggressive rescission. In California, state regulators fined five major health insurance providers—Health Net, Anthem Blue Cross, Blue Shield of California, PacifiCare and Kaiser Permanente—for dropping more than 6,000 sick policyholders. The terms of those settlements, reached in 2008 and 2009 [3], have yet to be implemented in most cases, according to news reports [3] from last week.

Industry Indignation Index: 39

Conclusion

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Filed under: Ethics, Health Insurance, Industry Indignation Index | Tagged: Anthem Blue Cross, Assurant Health, Blue Shield of California, Fortis, Health Insurance, Health Net, HIV, Jerome Mitchell, Kaiser Permanente, Marian Wang, PacifiCare, rescission | 5 Comments »

Support the Medical Executive-Post

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

Donations, Advertisements, Classifieds and Sponsorships Appreciated

By Staff Reporters

Please donate to support our efforts to integrate financial planning with medical practice management for financial advisors, business consultants and their physician clients. Your contribution will help us print materials, mail information, and much more.

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Need a New Career in Dentistry – Become a Consultant

Posted on March 26, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Or – Maybe Just a Hobby

By Darrell K. Pruitt; DDS

One might ask how much knowledge of dentistry is required before a person is qualified to call oneself a “dental practice management consultant” – beyond maybe being able to spell HIPAA with only one P, and Hippocrates with two.

Meet Jill Coon, Inc

An anonymous management consultant who works for Jill Coon, Inc of Florida posted this brave suggestion on the company Facebook today:

“Why not take 3 max anterior PA’s and 1 mandibular PA once a year with bitewings to check for caries in front teeth? We actually bill insurance for 3 PA’s not 4. Hygiene production just increased!”

My Translation

Here is a translation of her question from dental-speak to English:

“Why don’t dentists take routine x-rays of front teeth like they do for back teeth, when doing so increases hygiene production and payments from the insurance companies?”

[Dental team members, please sit on your hands for this one].

Bonus Round

Bonus question: Can anyone think of any reason why one might not want additional routine x-rays – even if insurance pays for it at 100% (of usual and customary fees)?

Hint: It can be trickier to avoid irradiating the thyroid when taking anterior x-rays than while taking routine bitewing x-rays.

Assessment

I’ll be back soon with the tricky opinion I will have posted on Jill Coon, Inc Facebook. It will be her first if nobody beats me to it.

http://www.facebook.com/home.php#!/pages/West-Palm-Beach-FL/Jill-Coon-Inc/125510596754?v=wall&ref=mf

Conclusion

Is there anyone out there with almost no knowledge of dental care who wants to match wits with a sales rep for a consulting company that “specializes in dental insurance billing and treatment planning for dental practices”?

Industry Indignation Index: 47

How about it – HHS Secretary Kathleen Sebelius, JD?

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Filed under: Career Development, Ethics, Health Insurance, Industry Indignation Index, Practice Management, Pruitt's Platform | Tagged: ADA, bitewing X rays, Darrell Pruitt, DDS, dental consultants, dentist, dentistry, HIPAA, ionizing radiation, Jill Coon Inc, Kathy Sebelius, thyroid gland | 5 Comments »

About Guardian24/7 Premium Global Concierge Medical Care

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

What it is – How it works

[By Staff Reporters]

According to their website and TV infomercials, the principals of www.Guardian247.com developed the medical systems and protocols for the President of the United States [POTUS], senior White House officials and members of the President’s cabinet to ensure the best possible medical care anywhere in the world.

Today, the convergence of telemedicine technologies and reliable telecommunications has enabled a business model for this same level of service to be brought to the private sector – for the first time.

Telemedicine Enabled

Utilizing state of the art telemedicine broadband capability, and pre-positioned medical equipment, a team of former White House physicians administer services that are purportedly nearly as effectively as if they were on location, saving hours of time and anxiety for routine medical needs – and possibly saving a life in an emergency situation.

Like an Emergency Room

The company favors a core concept known as A ReadyRoom™ that is an installation of medical equipment, supplies and medications pre-placed and installed in a client’s primary residence and/or remote vacation home, jet or yacht. Custom-tailored to the needs and the client and his/her family and location, the ReadyRoom’s™ state of the art technology allows Guardian’s physicians to direct the proper use of the medicine, supplies and equipment either via telephonic or through advanced video teleconferencing links. The model is reminiscent of an emergency room; always on-call, available for use and expensive.

Assessment

For those who recognize that their most important asset – is their health – this company has a serious concierge medicine type solution that is not available to the masses. As CEO of Guardian 24/7, Jonathan Frye leads the company’s efforts to provide presidential-level medical care to clients; anywhere and anytime.

Conclusion

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Filed under: Career Development, Ethics, Health Economics, Information Technology, Media Mentions and PR, Research & Development | Tagged: A ReadyRoom™, concierge medicine, Jonathan Frye, POTUS, telemedicine, www.Guardian237.com | 7 Comments »

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Dr. David Marcinko [Publication List]

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Lower Extremity Medicine & Surgery

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