Treasury Officials and Investment Firms Cozy Up for Business

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.

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The 2010 Chronic Care and Prevention Congress

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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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Behind the Financial Reform Push

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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.”

networking_0

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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Do We Have A False Sense of HIT Security?

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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How One Hedge Fund Helped Keep the Bubble Going

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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.”

And so, your thoughts and comments on this ME-P are appreciated. Dr. Mike Burry, please opine. All 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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Good Night H. Ed Roberts MD

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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“Go Elsewhere for Health Care”

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

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

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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.

Bank

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

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Queries for the ADA Member Service Center

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?

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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.

IOW: A knowledge seeker asks a question and participants respond.  PeerClip.com is an example of how “wisdom of the crowds” allows you to follow the latest opinions on interesting topics. In the medical practice management arena, you can also participate at the: www.BusinessofMedicalPractice.com, our newest 850 page book available this Fall.

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

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Financial Advisory Reform Going Down in Flames

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!

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

Reporting Recipe

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

cropped-me-p-mast-head-nurses.jpg

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.

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Modern Retirement Planning and “Banding” for Physicians

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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.

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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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***

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

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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Data Show Little-Known Bank Regulator Goes Easy on Enforcement

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

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

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More on Lehman Brothers and Repo 105

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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

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Taxing Sin to Modify Behavior and Raise Revenue‏

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:

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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Understanding Efforts to Promote Lower-Cost Physicians

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

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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.

US capitol

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

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About the Covestor Mutual Fund Portfolio Sharing Service

Certified Medical Planner

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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As the Health Care Vote Passes

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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Need a New Career in Dentistry – Become a Consultant

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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About Guardian24/7 Premium Global Concierge Medical Care

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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VOTE: New Healthcare Reform Legislation

Vote on Healthcare Reform and Tell us What you Think?

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Now that healthcare reform is law, tell us what you think and give us your vote.

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Feel free to answer these queries, in prose form, as well:

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2. How does it affect the condition of the national economy?

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What’s Next with Health Care?

And, Why the Process was Madness

By Staff Reporters

With the House passing health care reform yesterday, resident ProPublica blogger Marian Wang explains what’s next for the bill, and why the process keeps on changing.

Main Concerns

Sometimes things are a little clearer in retrospect. Now that health care reform has passed in the House, it seems there are two main questions in people’s minds:

  • What’s next?
  • Why, procedurally, was the legislative process so confusing and painful to watch?

So, Marian will answer that second question first with some helpful infographics.

Assessment

http://www.propublica.org/ion/blog/item/whats-next-with-health-care-and-why-this-process-was-madness

Conclusion

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On Disruptive Healthcare Innovators and Financial Industry Change Agents

Calling all Young Doctors, FAs and Medical Executives with “FLY”

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

In my real-job travels as a medical management consultant, speaker and physician focused financial advisor, my clients and their healthcare practices / financial services business models run the gamut from the sublime to the ridiculous; from pegboards to eMRs and clinical groupware; from cash/bond holders to hedge fund devotees and IPO junkies.

And, from broker-sharks and commissioned sales agents, to fee-only financial advisors and fiduciary RIAs. Fortunately, we see much more of what’s in-between than the latter [www.MedicalBusinessAdvisors.com and www.CertifiedMedicalPlanner.org

Business Analogy

Nevertheless, I am always struck by the fact that change and disruptive innovation [both positive and negative] seems to be within the realm of the young, rather than the more “mature” [sic].

Why? Younger folks just don’t seem to have the mental baggage and fear of failure that older counterparts seem to harbor. THINK: Janis Joplin: Freedom is just another word for nothing left to loose.

For example, Microsoft, Dell, Google, Yahoo, Facebook, Apple and Twitter, etc. No one told these young founders that “it can’t be done” – or – “we don’t do it that way around here.” Or, they did not listen to such talk. Unfortunately, this hubris [confidence or elan] is often just lost with age in the guise of political correctness.

Nevertheless, although started by folks in their youth, the professional management that most successful companies in the public domain ultimately require is from “older” folks.

Healthcare / Financial Services Analogy

Still, it is not surprising to learn that even some hospitals that house the most accomplished authorities in the fields of IT and quality care do not always follow their own advice when it comes to making improvements in the delivery of healthcare, or in their operational and delivery activities. THINK: Robert Wachter, MD.

And, it is not unusual for industries like the financial services and banking sectors, facing deep structural change, to be slow moving. THINK: Harry Markopolis.

Also, consider the auto industry – public education and labor unions – before the fall. Why – because the leaders of such sectors are typically promoted within, and because of past success, and not any ability to change the current environment?

IOW: They were hired for their ability to maintain the status quo, rather than for their ability to make constructive changes.

Assessment

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Do we call this need for young blood, the “theory of business evolution?” The dinosaur is dead … long live the dinosaur!

Moral: We can’t help getting physiologically old – but we can help getting cognitively old to the extent possible. Be disruptive – champion change – don’t settle and raise a little hell in the dual industries we love and serve!

Conclusion

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A New Survey on Dental Insurance

Come on out Kim E. Volk – CEO of Delta Dental

By Darrell K. Pruitt; DDS

Today, Julie Frey posted “Dentist & Dental Insurance: No Love Lost” on Jim Du Molin’s Blog.

http://www.thewealthydentist.com/blog/1186/dentist-dental-insurance/

Frey hosts dentists’ frank criticism of dental insurance – their harsh sentiments backed up with fresh results from yet another of the blog’s timely studies that nobody else can compete with. Frey writes “Half of dentists have mostly or completely stopped accepting dental insurances, according to this survey.”  One dentist captured the mood of the dentists with the statement, “Do the math … somebody is making hell of a lot of money on these plans, and it is not the dentist!” I smelled blood and posted the following comment.

Bloody Sunday

Anonymous members of the obscure National Association of Dental Plans (NADP) are losing the fat, collective thumb they once oppressed us with – even using our own ADA News to present their non-negotiable terms. Apart from common sense appearing in the marketplace about the same time as transparency, multiple other interconnected factors are causing dental insurance companies to lose business. The bad economy, corporate greed and pride are a few of their more serious handicaps that come to mind. Wasteful, deceptive insurance practices have aggravated my patients and me for decades before modern networked recourse became available on the Internet through progressive Websites like Jim Du Molin’s Blog. I’ll go out on a limb and say it is not unprofessional for us to enjoy protecting those we serve by showing no mercy to unfair stakeholders like the NADP.

There. I said it. In fact, as US citizens and taxpayers I think blowing the whistle on unneeded expense and danger in the nation’s healthcare delivery is the least we can do for meaningful healthcare reform. I say do your part. Make an insurance CEO like Delta Dental Plans Association’s Kim E. Volk feel discomfort on the Internet. Do you know that Kim E. Volk is the only person who has ever refused to accept me as a friend on Facebook?

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Assessment 

We really don’t want to allow Delta Dental, UnitedHealthcare, United Concordia and others to dictate fees for non-covered dental services, do we? I also don’t think they deserve continued protection from FTC anti-trust litigation. I say we punish the NADP hard every chance we get until the repeal of the McCarran-Ferguson Act and finally make such in-your-face collusion illegal for crying out loud.

Conclusion

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Lehman Brothers Autopsy

Repo 105 and Why Auditors Have Some “Splainen to Do”

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[By Staff Reporters]

According to ProPublica on March 16, 2010 on 9:07 am EDT, a post-mortem report on Lehman Brothers revealed a shady accounting maneuver through which the bank hid its financial troubles for nearly a decade.

Pleading Ignorance

In this repot, Marian Wang takes a closer look at the parties pleading ignorance and the auditors who admit they knew, but insist they did no wrong.

Assessment

Link: http://www.propublica.org/ion/bailout/item/lehman-brothers-autopsy-repo-105-explained-auditors-in-trouble

Conclusion

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A Petition to the US Federal Government

For an Individual Opt-Out Request for Healthcare

By MyMillionSite

We The Undersigned Wish To Convey By Their Signatures Below That They Wish To Have The Same Rights Under The Current Health Care Legislation.

That Allows The Individual States That If This Would Place An Economic Burden On That State They Have The Option To Opt Out Of This Mandate.

Currently Over 35 Of The 50 States Have Or Will File A Legal Action Against Washington To Claim This Is An Unconstitutional Bill.

If The States Are At 35 against and 15 Not Yet Heard From, It Would Seem That “We The People” Are More That 51% Against This Health Care Bill.

THIS WOULD BE A CLEAR STATEMENT THAT IF AN UP OR DOWN VOTE WAS HELD TODAY BY THE GENERAL POPULATION OF REGISTERED AMERICAN VOTERS THIS BILL WOULD NOT EVEN SEE THE LIGHT OF DAY AND ANY LEGAL ACTION FILED BY THE INDIVUDAL STATES WOULD NOT EVEN BE REQUIRED.

IF THIS BILL WOULD Place an ADDITIONAL ECONOMIC BURDEN ON THE STATE, it Would Seem Logical That It Should Also Be AVAILABLE TO THE INDIVIDUAL PERSON AS WELL.

We the Undersigned Wish To Opt Out Of the Average $12,000.00 per Year Price Tag The Current System We Have In Place by Law Already Mandates That Any Hospital Cannot Refuse Medical Treatment to Anyone That Is In Need Currently Any One Who Asks For Help Will Receive It.

This Bill Will Be Imposed By A Federal Mandate On Each Man, Woman, Child, And Even Unborn Children That Live In This The United States If This Bill Passes.

That This Mandate Is Actually an Unconstitutional Bill in Many Ways:

The Federal Government Does Not Have the Right to Mandate that it’s Citizens Will Have to Purchase a Product Such As Health Insurance Policy.

To Mandate That An Unborn Child Will Have To Purchase This As Well Is The Same Taxation Without Representation.

We As Citizens Are Now Already Over Taxed the Federal Government It Takes the First 4 Months of Our Income and The States Take Another Two Months Of Our Income.

If You Live You Pay Sales Tax on All Purchase’s And Even More On Other Taxes Such As Property Taxes, City Taxes, Cigarettes, Alcohol, Death Taxes, And Soon Even A Carbon Tax On Breathing.

At The Present Time With All Of The Visible Taxes And The Taxes That Are Hidden In Every Item That Is Purchased We Are Taxed At If Not More Than 50% Of Our Income’s An Additional $1000.00 Per Month $12,000.00 For A Federal Health Care Product That Once Implemented Will Only Cover 60% Of Medical Expenses After An Already High Deductible This Will Place A Large Burden On Any If Not All United States Citizen’s.

WE CITIZENS OF THE UNITED STATE RESPECTFULLY REQUEST TO OPT OUT OF THE CURRENT HEALTH CARE BILL

PLEASE COPY AND EMAIL TO ALL OF YOUR CONTACTS AND ON SUNDAY WHO EVER HAS A COPY FORWARD IT TO THE HOUSE, SENATE, AND THE WHITEHOUSE

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eHRs and Clinical Trials

An Oft Neglected Topic

By Chris Thorman

I wanted to give the ME-P a heads up on an article I just finished about a neglected topic in the eHR debate concerning clinical trial participation.

It’s called: Electronic Health Records and Clinical Trials: An Incentive to Integrate.

The Argument

In the article, I make the argument that clinical trials should play a bigger role in whether or not to purchase eHR software because:

  • The potential profit from participating in clinical trials is so large that it dwarfs the HITECH Act incentives;
  • eHRs make clinical trial participation much easier than in the past; and,
  • eHR software has the potential to solve many of the problems that clinical trials face.

Editors Note: So, let’s try to spark some discussion on this oft-ignored topic. And, feel free to contact the author.

Chris Thorman
Senior Marketing Manager
Software Advice
(512) 364-0118

chris@softwareadvice.com

Conclusion

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About Remember It Now Patient-Centric Health Services

What it is – How it works – Where is it from?

By David Edward Marcinko; MBA CMP™

[Publisher-in-Chief]

RememberItNow was a featured company at the recent 10th annual HIMSS conference. It reports to be the best way for patients to take control of their health, or the health care of loved-ones. Their simple to use, patient-centric eHealth services are available online, anytime. There is no software to download, or upgrades to manage. The firm helps patients remember to take their medications, create a care community, get organized, provide long-distance care, and more. It is designed to be simple to use and make life easier http://www.rememberitnow.com

Mission

The folks at RememberItNow believe patients should spend more time doing the things they enjoy, and less time worrying about taking medications, remembering appointments, tracking prescriptions, reordering supplies and scheduling medical care, etc. RememberItNow is privately funded.

Video: http://prezi.com/irjw0cqiv1cu/introducing-rememberitnow/

My story – Back in the Day

Almost ten years ago, I was invited to attend a venture capitalist technology forum at Georgia Tech University, here in Atlanta. One of the very smallest firms [non-health care] I reviewed was called RememberIt.com. It was billed as a personalized email and online reminder service. I discussed the concept with a very young red-haired man-child named Jeffrey Tacca, president and chief executive officer. He had no employees at the time. Although Jeff was impressive, I was not a fan of his concept.

Nevertheless, if I recall correctly, he received first round funding in the amount of $1.5 million dollars and was accepted into the Georgia Tech start-up business incubator. I tried to keep track of his company throughout the years, to little avail. But, later I learned that RememberIt.com merged with Boardroom, Inc [a large paid subscription firm that publishes newsletters targeting personal, business, health and finance issues], enabling them to enhance users’ experience by providing personalized tips and information from its silo of newsletters. For example, if a RememberIt.com user requested weekly reminders to lose weight, they also received links to related articles on topics such as healthy living or finding the right fitness routine, etc. Users also were able to log-on to track events, special occasions and other commitments. This is no longer a unique concept today, but was state-of-the-art back then.

Assessment

According to my investigations, RememberitNow.com is unrelated to the RemembIt.com of above. The firm is based in Orinda, CA and is headed up by Pamela Swingley [Founder] and Phil Wang [Engineer]. So, if I am mistaken – please tell me. We’d love to share this success story on the ME-P and I’d like to know what ever happened to Jeff Tacca?

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Give em’ a click and tell us what you think? Is this a very sophisticated solution, to a very minor problem?  Do we simply need to exchange bad habits, for good habits, regarding self health responsibility?

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Ease Up – Managing Editor Bob Mitchell

By Darrell K. Pruitt; DDS

[picapp align=”none” wrap=”false” link=”term=doctors+computers&iid=131173″ src=”0127/4caf5e52-a89a-4ddb-a0b2-bf4b6789c92b.jpg?adImageId=11344576&imageId=131173″ width=”414″ height=”413″ /]

Two days ago, ADVANCE for Health Information Executives’ managing editor Bob Mitchell publicly criticized the author of last week’s Parade Magazine article, “Electronic Health Records Face Critics.” Personally, I thought it was cowardly for the editor to accuse Drew Jubera of journalistic recklessness without mentioning his name.

http://community.advanceweb.com/blogs/hx_1/archive/2010/03/16/critics-ehrs-don-t-save-money.aspx

According to Jubera

Jubera wrote:

“A new Harvard Medical School study suggests that electronic health records do not save hospitals money—and in fact often end up increasing costs. The Obama Administration has allocated $19 billion in federal stimulus funds to facilitate the shift from paper to electronic records – a move the Rand Corporation has projected could save up to $80 billion a year. Yet the Harvard study found no evidence of savings so far and little evidence that electronic records improve care.”

http://www.parade.com/news/intelligence-report/archive/100314-electronic-health-records-face-critics.html

Dis-Respects Harvard

Incredibly, Bob Mitchell discounts the Harvard Medical School study as being dated research – even though it is less than 5 months old. “I did some research and found that this study was released back in November 2009, even before meaningful use of an eHR had been defined by [ONCHIT] – or the Office of National Coordinator of Health IT.” As if defining meaningful use was meaningful! That’s humor.

Dis-Respects Parade

Furthermore, editor Mitchell has taken on the responsibility to shield his readers from harm caused by Parade Magazine authors whose ethics fall short of acceptable.

He writes:

“I’m concerned that the public is not being served and they will get the wrong impression of computers in health care, especially if it’s being reported by Parade, which reports celebrity, entertainment and health news.”

Of Healthcare Providers

Not so fast with those tricky pronoun phrases, Bob. Rather than being merely a healthcare stakeholder like you, I’m actually the healthcare provider whom you would have fund your enthusiasm. I think your broad statement that “all of us in healthcare know that digital is much better than paper” is journalistically foolish. In addition, your creativity threatens society much more than alleged exaggerations in Parade Magazine. You not only write about HIT as a career, but people generously call you a managing editor.

eMRs in Dentistry 

The next time you feel important enough to quietly insult writers on behalf of providers like me, remember that eMRs in dentistry will not save money over paper records and will unnecessarily increase the risk of identity theft for my patients … unless you disagree.

It would thrill me if you want to publicly debate the value of electronic dental records (How much do you know about dentistry?)

Assessment

For example, do you realize that if a computer containing thousands of patients’ identifying data is stolen in a burglary, and the dentist, or physician, does the right thing and reports the data breach, he or she will likely be bankrupt even before the HIPAA inspections and lawsuits?

The Ponemon Institute estimates that it will cost about $50 per record just to notify affected patients. A few weeks ago, the HHS was obligated to release information that a burglar stole a computer containing more than 9,000 records from a Missouri dental practice. Just to notify the affected patients will cost the practice almost half a million dollars. But wait. That’s not all. Since the loss involves over 500 individuals, news of the breach must be provided as a press release to the local media. As goes the dentist’s reputation, so goes the dentist’s career – all because of a simple burglary.

Conclusion

So what were you saying about dangerous, biased articles in Parade Magazine? The author whose ethics you criticize has a name. It is Drew Jubera. He’s an award-winning staff member of the Atlanta Journal-Constitution, in Atlanta GA – home of this ME-P.  I’ll make sure he also gets this message.

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Physicians and FAs Dealing with Debt Collaboratively

A Holistic Approach to Financial Health Planning

[By Somnath Basu; PhD, MBA]

Financial Advisers [FAs] often feel helpless in the face of fierce resistance from clients, especially doctors, to rein in their spending, stop living beyond their means and salt away more of their paychecks. Even worse, the financial services industry’s less discerning practitioners are enabling reckless behavior for fear of losing business.

Psychological MoJo

A huge part of the problem is psychological. Look no further than the emerging field of behavioral finance to explain why average Americans of all ages and walks of life feel pressure to keep up with their neighbor. The unfortunate result, of course, is that consumers max out their credit cards, tap equity lines of credit or consolidate loans in pursuit of the American Dream. But, in the process, they often fall victim to over-consumption and under-saving.

Bad Faith Lenders

Unscrupulous lenders are exploiting doctors and consumers with interest-only loans and variable-rate home buying without a down payment – the latter labeled in one recent headline as a car-dealer tactic on the new-home lot. Another gimmick ties a home equity loan to life insurance with the promise of zero premiums, albeit no escape from a lien on equity no matter how it’s sold to an unsuspecting public.

Debt Consolidation Issues

There’s also the issue of determining whether it’s prudent for physicians to consolidate their debt. Many online calculators use the current monthly payment figure as the basis for comparison against monthly payments after debt consolidation, which is erroneous since payments in subsequent periods aren’t compared. This flawed approach is enough to convince unwary people they should consolidate their loans, and in many cases, it justifies a resumption of conspicuous consumption – leading to a vicious cycle.

Need for Discipline

Before a Financial Advisor even gets through a doctor-client’s front door, chances are that the person they’re meeting with might require the services of a psychotherapist and/or credit counselor (or require such a recommendation) to examine the root causes of their propensity for reckless spending and suggest a need for financial discipline.

Wants versus Needs

There must be a clear understanding of the difference between needs (i.e., retiring with peace of mind) and desires (i.e., living the high life), and a willingness to change. It means not eating out five times a week or financing a $75,000 kitchen remodeling makeover, cutting back on entertainment, or making more than the minimum payment on credit card balances. It means not rushing out to buy a house or perhaps finding a local college for children to attend and spare the added expense of housing them in a dormitory. Only then can physician’s and all of us, earmark increasing amounts from each paycheck to build a comfortable savings cushion.

A New Collaborative Approach

What’s needed is a collaborative approach [much like emerging Health 2.0 participatory medicine], since Financial Advisers cannot be the sole catalyst for change. The media too, needs to do much more reporting on the dangers of debt. Politicians need to make difficult choices [a balanced budget, for example] and business leaders need to be more vigilant about adopting ethical practices when it comes to lending, advertising or marketing products and services that feed the vicious cycle of indebtedness.

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The Courage to Deliver Tough Love

Astute Financial Advisers can take on a real collaborative leadership role with regard to helping doctors and other clients avoid or dig out of debt; but the FAs who have the intestinal fortitude tend to have the most affluent clients. So the question becomes, do they have the courage to deliver tough love to their working or upper-middle class, or affluent middle-class clients and prospects?

The Faithful

For doctors to have faith in their FAs, they need to trust their expertise as a financial health practitioner and believe in the power of a diversified investment portfolio. But, they also need to be repeatedly told to stick with their long-term financial plan whenever there’s a downturn in financial markets and not be swayed by fear or the lure of short-term gain.

Financial Advisers who are willing to recognize and treat the symptoms of irrational decision-making, and educate their physician-clients on the follies of making emotion-based decisions, will be able to distinguish themselves in a competitive market. They need to understand investor psychology, as well as identify behavioral biases and offer counsel about the perils and consequences of irrational decisions. They need to know their target physician market-audience, too. This will enhance the results of their long-term planning.

Rethinking Mission

At the end of the day, it’s not just a matter of offering financial planning. It’s as much about life planning as helping get a client’s financial house in order. Just ask Richard Wagner or George Kinder, who describe the movement they created as “the human side of financial planning” and holds workshops that teach advisers client-relationship skills.

But, an even better objective would be to offer financial health planning as part of a more holistic, and arguably, effective approach.

Avoiding Unscrupulous Lending Practices

The best Financial Advisers know how to steer their clients away from unscrupulous lending practices, resist the urge to over-consume and learn financial discipline; but unfortunately they’re a rare breed. Unless the status quo changes, financial planning runs the risk of irrelevance.

How can people possibly expect to amass adequate savings for a home, child’s education and/or retirement if they can’t first dig out of debt? The only possible result will be legions of unhappy clients.

NPOs?

One way to help combat the nation’s difficulty in dealing with debt would be through the creation of a quasi-governmental, nonprofit organization whose educational mission is to better understand the basic issues surrounding the need to borrow money.

But, perhaps the time has come for the some 200 educational institutions that teach financial planning to pool their resources in hopes of becoming a credible watchdog of the nation’s financial health.

Lawmakers increasingly have come to the realization that financial literacy needs to become a higher priority. Advisers should never forget that sound financial health is a necessary condition for good physical and mental health, especially since most married couples argue about money more than anything else and financial distress is a leading cause of depression.

Link: http://www.fa-mag.com/issues.php?id_content=2&idArticle=1640#

Assessment

In the future, Financial Advisers could serve as financial health practitioners in partnership with counselors, behavioralists and psychologists. The very health of financial planning just might depend upon it.

Somnath Basu, Ph.D., 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.

Conclusion

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Electronic Medical Records and Dentistry

A Note to Diane Rehm

[By Darrell K. Pruitt; DDS]

Dear Diane Rehm,

I always enjoy your show.

You add value to my drive to work.

As a dentist, I was especially interested in your March 10 show “Electronic Medical Records.”

http://wamu.org/programs/dr/10/03/10.php?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+WAMU885DianeRehm+%28WAMU%3A+The+Diane+Rehm+Show%29&utm_content=FaceBook#30598

In all the excitement that surrounds the 19 billion dollars our grandchildren have unwittingly granted to physicians and hospitals for “meaningful” adoption of certified eMRs, you probably haven’t noticed that nobody is talking about including dentistry in the conversion from paper to digital. Do you find that odd?

Small and Mid Sized Practices

Like small and mid sized physicians’ practices, small dental practices are intended to be part of the federal mandate for interoperable eMR adoption – even without the help from stimulus money that physicians receive. You probably weren’t aware that the stimulus money will run out before HHS gets around to defining “meaningful use” of eMRs in dental office. That would be impossible, but nevertheless, I anticipate that the attempts will be entertaining. Physicians in small practices typically have tens of thousands of paper charts as thick as phone books. On the other hand, a busy solo dental practice, like the majority of practices in the US, might have 5,000 files that are very thin in comparison to files that involve the whole body instead of just the bottom third of the face. That makes sense, doesn’t it?

Marginal Benefits May Not Exceed Marginal Costs 

I listened to your guest Dr. Carol Horn, who practices internal medicine in private practice, as well as others involved in the actual delivery of healthcare. They list not only the benefits of eMR adoption, but in fairness, they also described the expense and liability of digital records that continue long after the tedious and dangerous conversion from paper to digital. In other words, it appears that the benefits for physicians barely make the effort worth the price, even with 19 billion dollars in help.

Editor’s Note: In economics, we say that the marginal benefits may not exceed the marginal costs; all things being equal.

Assessment 

And so, it occurs to me that if dentists are to be included in the plans for digital interoperability, we will be very, very slow adopters for natural reasons: like eMRs in physicians’ offices, eMRs in dentists’ offices are more expense and trouble than they are worth – even before considering the bankruptcy-level liability of a data breach.

Most of those who champion eMRs for the entire healthcare system in the nation don’t realize that the bottleneck in dental offices isn’t the front desk. It’s the dentist who is hopefully taking his or her time providing care with those hands instead of working a keyboard.

Conclusion

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

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On Employer Based Health Insurance Premium Costs

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One Client’s Comparative Expense Analysis Experience

By Dr. David Edward Marcinko; MBA

[Publisher-in-Chief]

Hospital Costs

A colleague posted an interesting essay recently on his blog The Incidental Economist. Austin Frakt PhD is a health economist with an educational background in physics and engineering. After receiving a PhD in statistical and applied mathematics, he spent four years at a research and consulting firm conducting policy evaluations for various federal health agencies. Here is the post.

Link: http://theincidentaleconomist.com/index.php?s=Kaiser%2FHRET+

The Survey

In his essay, Austin reported these figures from a cited survey:

“The 2009 Kaiser/HRET employer health benefits survey found that employees pay 17% of the $4,824 annual premium for single coverage and 27% of the $13,375 annual premium for family coverage (all average figures)”.

Case Report Model

So, if the survey is correct, it got me thinking about how much a long-time client paid as a doctor-employer, when she last practiced in a certain medical group back in 2000. And, especially about how much she would be paying today if still in business with the same group. This brief case-report with comparative expense analysis [CEA} is the up-shot.

My Client’s Story

Her health insurance premium costs including doctor-partners, was about $13,500 annually, per employee. This was a sunk cost, but an above the AGI line deductible business expense to the practice and entirely employer paid as a fringe benefit [all valid corporate expenses are deductible as there is no AGI line on a business tax return]. She and her three partners were both very magnanimous to their employees, and naïve. They became virtually insolvent a few years later and were bought out by a larger medical group for a pittance. Today, they are grunt employee doctors in a 25 plus physician group practice.

My Numbers

Now, if I crunched the numbers correctly as an citizen economist, on my HP12-C calculator, using health insurance inflation rates of 3%, 5% and 7% respectively for a decade [low], she would be now be paying somewhere between $18,143 and $21,990 and $26,556 in 2010 [dangerously assuming linear economics]. Each of her 15-18 employees at the time was a female, head of household, with 1-4 dependents of their own; no singles. Her own family unit included a professional husband and young daughter in private elementary school. They were the most health conscious of the bunch.

Her Situation

So, she left the group in 2000, and we transitioned her to solo private practice with a HD-HCP indemnity-styled [better] plan that pays 100% after her $5,000, and later $10,000, deductible. She has 100% prescription drug coverage, no OB coverage and no networks, second opinions or pre-certification requirements. Today, she has more than $50-K in the savings portion [cash account earning 3.5%, tax deferred].

Her Reaction

As she just turned age 55, there as was significant jump in her family coverage premiums from about $1,350/quarter to $1,650/quarter! Of course, her carrier offered a ten percent discount to $1,485 quarter, when she pitched a fit, and completed a health and wellness survey which “they” verified.

My Intervention

So, I used my “insider” knowledge as a doctor, financial advisor and insurance agent and went back to the open market place for coverage. Her new direct halth insurance coverage [she used a non-fiduciary insurance agent intermediary previously] is better, and her premium is only $1,248/quarter or about $5,000 annually to age 58. Bye, bye insurance agent. Link:  www.CertifiedMedicalPlanner.com

Now, if we use the non-inflated [a conservative unlikely scenario] 27% employee premium contribution for the present value projections of $18,143 and $21,990 and $26,556 today – each employee would be responsible for about $4,898, $5,937 and $7,170 respectively [please again recall both our conservative nature and the repeat danger of linear economic assumptions].

Where Did the Money Go?

So, under the 3-5% health insurance inflation scenario, my client would have been contributing about $5,417 for her heath insurance. This is very close to what she is annually paying now! So, where did the much larger employer’s contribution portion of the money go? Probably to overhead costs, marketing, advertising, sales and commissions, HR, high-risk pool premiums, ie … down the drain?

What did my client do with the monetary difference? Well, she paid all family doctor and drug bills that were under the high-deductible threshold; some went to her annual family health club membership dues, covered extras and various “wants and nice-to-haves”, and the remainder of course, went into her savings account portion. In other words … not down the drain.

There is an additional $1.000 “catch up” savings provision for those over age 55. She paid it – to herself.

The Road Ahead – More Expensive

I informed my colleague-client that there likely will be another big premium jump when she turns 58, 60 and age 62 respectively. We will report back to ME-P readers on market competition and related health insurance pricing at that time, ceteris paribus.

Assessment

Does the competitive open marketplace find a way to reduce HI costs– sooner or later? High Deductible HealthCare Plans were launched as a temporary pilot project in 1997 and initially sold poorly. In the past few years however, there has been a boom in HD-HCPs and the pilot project was made permanent. What other HI innovations may be in the future?

Of course, President Obama was against them in his original healthcare reform plan. But, now in his weakened political position, they seem acceptable to him. So, go figure. Utility depends on political winds, not economic efficacy, I suppose. 

Conclusion

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

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

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Congratulations Harry Markopolos

A Future SEC Chairman?

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

www.CertifiedMedicalPlanner.com

Harry Markopolos is finally taking his victory lap. He is out hustling a new book about his nearly decade-long pursuit of Bernie Madoff, and rightful criticism of the Securities Exchange Commission [SEC].

And, he’s been on a whirlwind media and PR tour of sorts: CNBC, MSNBC, “The Daily Show with Jon Stewart”, etc. Still, we’ve written about him before on this ME-P

No Schadenfreude

According to one trade magazine essay, Markopolos finally seems relaxed and at peace. Bernie Madoff is in jail. The Feds are closing in on his accomplices. Markopolos clearly is having some fun. After being ignored for so long, he’s finally the center of attention – on his terms.

But to be sure, schadenfreude was not a philosophy taught to Harry and I, while students back-in-the-day, at Loyola University Maryland.

http://www.fa-mag.com/fa-news/5322-harry-markopolos-sec-chairman.html

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. In my opinion, Harry would be a much better SEC chairman than Mary L. Schapiro, the 29th SEC Chairman [January 2009] -or- Christopher Cox, the 28th Chairman [June 2005].

Dare I say it … I’m just wild about Harry.

So, FAs, investors and doctor colleagues; what do you think about Harry? 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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About the Managed Care Digest Series

Where Information Becomes Intelligence™

By Staff Reporters

The sanofi-aventis Managed Care Digest Series® is part of their continuing commitment to provide the healthcare industrial complex with the latest and most essential information on the evolution of medical care.

The Series, available online or in print, provides key benchmarking data that can help assess value, control costs, and develop business strategies.

Assessment

According to ME-P Publisher-in-Chief, Dr. David Edward Marcinko:

I have been a user of the Managed Care Digest series for more than a decade. The depth and breadth of information is astounding. I especially appreciate the data driven and graphical interface nature of the publication; as well as its’ cost—free!

I suggest all medical professionals, healthcare economists, business experts and financial advisors – read it and reap!

And so, give em’ a click www.ManagedCareDigest.com and tell us what you think?

Conclusion

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Letter from the Editor-in-Chief

Help Support the ME-P

You were among of the first; the early adopters if you will. You saw the troubling state of healthcare, medical economics, private practice and the financial services community in our country.

And, you believed in the ME-P and our “new-wave” brand of informed and collaborative investigative journalism to do something about it.

Our History

For the last three years, the ME-P has played the role of educator, watchdog and advocate for medical practice management and financial planning transparency, scrutinizing powerful people, systems and institutions that would prefer to stay out of the spotlight, highlighting the fine print that might otherwise slip past cash-strapped physicians and their consulting advisors.

As newsrooms across the country contract, in-depth investigations are viewed as a luxury that many print publications can’t afford. Journalists are getting kicked off their beats. And, when they do, we are there to help pick up the virtual baton.

The Pioneers

We’re pioneering a new, no-profit e-model, helping spearhead a movement to reinvigorate investigative and non-clinical healthcare administrative and business journalism in this country.

But, we need the support of our most loyal readers – concerned members of the healthcare industrial complex, like you – to spread the word about our mission. If you value our investigations and essays, you will tell five colleagues about the ME-P, today.

Participatory Power

You’ll see our stories in your inbox every day, so you know the types of issues we’re tackling. Our reporting speaks for itself – but we need your help to get the word out about where it’s coming from. We need your participation and collaboration to tell your colleagues.

Our Request

I’ll bet you believe in the power of investigative journalism just as much as I do. So, please tell five [5] of your colleagues that they can stay on the leading edge of the groundbreaking stories that shine a light on the unbiased nexus of medical practice and financial planning, in plain English.

Assessment

In the modern Health 2.0 era, our goal is to “bridge the gap between medical mission and profit margin.”     

Join the ME-P Nation today … and tell us what you think!   Thank you for standing up for investigative healthcare journalism. Thank you for supporting the Medical Executive-Post. Now go; please tell five [5 … or more] colleagues to subscribe. It’s fast, free and secure.

Support Independent Journalism – Donate

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Conclusion

NOTE: If you need a moderator or speaker for an upcoming event, we are available for seminar or speaking engagements.

Contact: MarcinkoAdvisors@msn.com 

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Why eMRs Won’t Improve Patient Care or Reduce Costs

Deus Ex Machina – NOT

By Staff Reporters

Question

Have electronic medical records made a difference in patient care?

Answer

According to a new study looking at the digital medical record adoption of 3,000 hospitals, electronic records have made little difference in healthcare costs or the quality of medical care.

Assessment

That’s discouraging, considering that the government is investing billions of dollars into the technology.  

Related posts from Kevin Pho MD:

Conclusion

Join Our Mailing List

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Healthcare Case Models CD-ROM

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Office Case Models in Healthcare Business 

[A Practice Improvement Compendium]

In Medical Practice? – Buy this CD-ROM

Regardless of specialty, most doctors quickly realize there are few case model guidelines available to steer them through the day-to-day management maze. One solution is to discuss best-of-breed practices with leading practitioners in order to discern what successful doctors are doing [mentoring concept].

The Problem

Of course, this is a costly and time consuming process with no criteria for success. Today, mentors are even loath to assist as competitive advantage can be lost.

A Solution

A better solution may be to use our Case Models in Healthcare [A Practice Improvement Compendium] to appreciate real-world practice situations and develop personalized approaches for an appropriate course of action. These techniques are so powerful that many business schools center their teaching on them. Case studies have been used for one hundred years because of their practical descriptions of actual situations.

Typically, information is presented about a practice’s patients, markets, competition, financial structure, service volumes, management, employees and other factors affecting success. The length of a case study may range from a few pages to 30, or more. And, our Case Models in Healthcare [A Practice Improvement Compendium] is suitable for medical practices, clinics, hospitals and other emerging healthcare entities.

We use three different methods to enhance your knowledge and launch your practice’s success: 

  • Prepared case-specific questions, with detailed answers, to illustrate underlying practice management concepts.
  • Problem-solving analysis, styled after Harvard Business School, to learn intuitive skills for resolving various practice issues.
  • A “no-answer” strategic planning approach to develop your ability to analyze a complex situation, generate a variety of possible strategies, and select the “best” from multiple self-generated solutions. 

 Case Model Topics

We give you more than 25 healthcare administration cases, covering the enterprise wide practice management ecosystem, to champion your financial success: 

  1. Market Competition
  2. Operations Management
  3. Capital Formation
  4. Cash Flow Management
  5. Revenue Analysis
  6. Hybrid Costing
  7. OSHA Model
  8. Economic Order Quantity Costing
  9. USA Patriot Act
  10. Mixed Costing
  11. Managerial Accounting
  12. Cost Volume Profit Analysis
  13. Insurance Contract Analysis
  14. Incurred but Not Reported Claims
  15. Accounts Receivable
  16. Cost Accounting
  17. Medical Contract Negotiations
  18. Workplace Violence
  19. HIPAA
  20. Sarbanes-Oxley Act
  21. Medicare Compliance
  22. Health Information Technology
  23. IRS Form 990
  24. Hospital Valuations
  25. HIT Security
  26. Medical Endowment Funds; and others.

 Bonus Features

 We also include at no additional charge: 

1. Glossary of Insurance and Managed Care

2. Glossary of Health Economics and Finance

3. Glossary of Health IT and Security

To help avoid administrative worries, you need Case Models in Healthcare [A Practice Improvement Compendium].

Sample Case Model: WV 1 

Promo Letter: Letterhead Case Models Compendium

Testimonial:

“I thought about going back to business school to enhance my practice management knowledge – but now I have these case models that help solve many office problems and assist in difficult administrative situations.”  [Dr. Michael Lampkin, MD] 

Product Specifications: Adobe Acrobat Reader® required – both Mac and PC compatible. And, the handsome, sturdy package makes the CD-ROM an ideal gift for the recent graduate, mid-career doctor or mature medical practitioner; office manager, CXO or healthcare administrator.

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

OR – you may order electronically right here: www.e-junkie.com/ecom/gb.php?c=cart&i=641934&cl=109140&ejc=2

Only: $ 99.00 USD [includes SPH & tax]. 

New Regulations Needed For Financial Planners?

So Says New Coalition

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

The Financial Planning Coalition [FPC] is pushing for a law that would require anyone calling themselves a financial planner to meet certain ethical and educational standards and to register with the Securities and Exchange Commission [SEC].

About the FPC

According to its’ website, the Financial Planning Coalition is a collaboration of Certified Financial Planner Board of Standards (CFP Board), the Financial Planning Association® (FPA), and the National Association of Personal Financial Advisors (NAPFA) to advise legislators and regulators on how to best protect consumers by ensuring financial planning services are delivered with fiduciary accountability and transparency. Americans have grown leery of those who work in financial services.

Currently, financial planning (the process of advising individuals and families across a range of personal finance topics in addition to investment advice) is unregulated as a profession, resulting in major gaps in current laws. So, is it really a “profession” many ask – void of any significant barrier to entry?

The Financial Planning Coalition intends to work with Congress to produce legislation that puts the interests of clients first and enables consumers to identify a trusted financial adviser.

To learn more about the Financial Planning Coalition’s purpose and mission, click here to read, or download the Statement of Understanding [PDF].

SEC Wrong Oversight Agency?

According to this report in Financial Advisor magazine, an advertiser-driven trade journal:

the standards would be set by a public oversight board that would be funded by small registration fees paid by the financial planners, said Robert Glovsky, chair of the Certified Financial Planner Board of Standards during a conference call today. The CFP Board, as well as the Financial Planning Association and the National Association of Personal Financial Advisors makes up the coalition.

Exemptions

However, brokers and insurance agents would not be forced to register as financial planners, but those who held themselves out as financial planners would have to meet the required minimum competency and ethics standards or stop using the financial planner title.

Assessment

And so, as we have noted, written, preached and warned for more than a decade – anyone can call themselves a financial planner, or financial advisor; so beware medical colleagues.

More: http://www.fa-mag.com/fa-news/5314-new-regs-needed-for-financial-planners-coalition-says.html

NOTE: The fiduciary definitional standard conundrum was not even addressed in the article or by the committee, as far as I know. Moreover, note that SEC oversight was in place before, during and now after the Bernie Madoff scandal – so enough said about competency! www.HealthDictionarySeries.com

Conclusion

Your thoughts and comments on this ME-P are appreciated. What do you think FAs, and CFPs®? Should all become an RIA or ERISA styled fiduciary? Or, will this be another CFP® lite fiasco?

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.

Disclaimer: I am a former certified financial planner and CEO of the online www.CertifiedMedicalPlanner.com program for fiduciary advisors working in the healthcare space.

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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Sponsors Welcomed

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