Happy New Year 5770 and 5771

Posted on September 19, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

       We wish all our Jewish Subscribers a Happy and Healthy

New Year 5770

 5770 

The Shofar is a ram’s horn blown as a wind instrument, sounded in Biblical times chiefly to communicate signals in battle and announce certain religious occasions and in modern times chiefly at synagogue services on Rosh Hashanah and Yom Kippur.

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Branch Davidian David Koresh is Dead

Posted on September 19, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Take it … from a Forensic Dentist

By Darrell K. Pruitt; DDSpruitt

For those who might be interested, these two plaster models are proof David Koresh died in the Mt. Carmel disaster.

Please allow me to offer I have been a forensic dentist since shortly after graduating from dental school in 1982. I have helped ID victims of two plane wrecks at DFW – Delta 191 in 1985 and Delta 1141 in ’88. I also helped identify the victims of Mount Carmel in 1993.

Some may choose to stop reading now, because I see no need to refrain from describing forensics to this crowd. After all, one sees it on TV these days. For those who stay, it is my wish that you find this adventure interesting.

The Branch Davidian Disaster

At the time of the Branch Davidian disaster, Tarrant County (Fort Worth) had a contract with McLendon County (Waco) for autopsy services. Along with 49 other dentists, I volunteered to help with the ID chores. I spent 8 days at the county morgue sorting through badly burnt and rapidly decaying cadavers of men, women and far too many children. There were so many fragments of ammunition that exploded from the heat, that one could hardly see the skeletons in x-rays of the body bags.

There was a lot of .223 (AR-15) and 7.62 mm (AK – 47) ammunition, both unfired bullets and their exploded casings. I also saw 9 mm and .45 cal. (handgun) ammunition. In addition, I saw the empty casing of a spent 50 mm (not caliber) round. That could also be called a 2 inch artillery shell. It was not fired during the skirmish. It was probably a military souvenir. I witnessed it because it was “melted” into a mass of comingled, badly burnt bodies. Those on site near Waco simply loaded the mass of ammunition and flesh into the body bag in one piece.

Even though the Davidians were not armed with a 50 mm gun, I read a report that there were two .50 cal. semi-automatic sniper guns side-by-side and pointed at the front doors, with ammunition. One thing I immediately found curious about the body-bag x-rays were the numerous “Y” shaped metal pieces, about 3/16″ long. In some bags they were everywhere, while they weren’t present in others. Any guesses? I’ll tell you later.

Plaster ModelsKoresh's_models 

The plaster model on the left is from an impression of Koresh’s teeth post mortem, 33 years of age. The model on the right was from when he was 15 years old. Is it the same person? Notice the inclinations of the front teeth. His lateral incisors are positioned a little more palatally than the centrals in both models. It may be difficult for the layperson to recognize, but there is a stainless steel crown on Koresh’s left second molar that was there when he was 15. Note the consistency of missing teeth. Notice the consistent shapes of teeth. Once a team member opened the right bag, it was an immediate positive ID.

The fresh extraction socket of the bicuspid on Koresh’s right was because the tooth was extracted post mortem for DNA analysis – not to ID Koresh, but to ID the 60 or so kids who were in the compound that burned to the ground. By the way. We could smell the accelerant. It was Coleman fuel, and it was spread from the inside of the compound. From what I saw and sensed, it is my opinion that government forces did not start the fires.

What else can we tell from the models? The gums and soft tissue had been burnt away, leaving only the bone around the teeth. If one looks closely, one can see a fracture line on his right central incisor. It was where the top of the front tooth was fractured off when Koresh fell forward and struck his mouth on a hard object, possibly the floor. The piece of the tooth was found among the fragments scooped up in the body bag. It was super-glued back in place before the impression was taken.

So How Did Koresh Die?

The back half of Koresh’s skull was missing when the bag was opened, but in the bag were found some skull fragments which were burned and others barely scorched. This tells us it wasn’t the fire that killed him. There was a hole in the middle of the forehead almost 1/4 inch in diameter, with a “starburst” – like scoring of the bone radiating from the edges of the wound. This was later determined to be caused by a .223 bullet. The radiating “starburst” means that the barrel of the gun was contacting Koresh’s head when the bullet was fired. Any ideas yet? Was it a self-inflicted wound?

More clues: The body of Steve Schneider, Koresh’s second in command, was found not far from Koresh’s. Schneider had a hole in the roof of his mouth caused by a 9 mm bullet. For those who don’t know, the .223 round is a rifle bullet, while the 9 mm is likely a handgun. So here is the theory: Schneider did Koresh in the hallway with an AR – 15 that was found close by, and then did himself with his pistol. Anybody have any guesses about the thousands of pieces of metal shaped like “Y”s that littered the body bags?

Zipper Teeth

It is my understanding that this spring a dental forensics course will be offered at the Southwest Dental Conference in Dallas, and it is open to everyone. If forensics interests you, there could come a time when your community might desperately need your help, especially if you are trained in the techniques of identifying victims in a mass disaster. I attended the course two years ago. It was fascinating.

Assessment

In closing, let me leave you with this: I remember late in the evening following a long, hard day at the morgue, I witnessed something that struck me as so ironic that I impulsively giggled out loud. In one of the body bags was a military-style vest designed for carrying ammunition and tools of warfare The label on the inside of the collar read “David Koresh Survival Gear.” David Koresh marketed his own signature line of survival Gear. Get it?

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Conclusion

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The ME-Pr [Photo Sharing Feature]

Posted on September 17, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

With Apologies to Flickr

By ME-P Staff Reporters

A New Feature Launch [Beta]

We are proud to introduce an exciting new Medical Executive-Post feature called the ME-Pr. Our goal is to aggregate and help subscribers make their blog related photographs available to those in our ecosystem who appreciate them; comical or sad, interesting or ironic, shocking or banal; or just plain iconoclastic. We hope ME-Pr will make these things possible … and more! To do this, we want you to send us your photos and videos so we can post, redact and make them searchable.

ME-Pr Rules of Engagement

1. You must own your photos or videos.

2. We reserve the right to post them, or not.

3. These terms and conditions may change without notice.

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Assessment

So, check us out daily to stay apprised of the latest developments. The fact that you’ve read this post with nothing but text to keep your interested is our proof-of-concept. What are you waiting for? 

Ann at: MarcinkoAdvisors@msn.com

SAMPLE

Prudential Ambulance

The irony of this Prudential insurance logo on an ambulance in Waltham, a city in Middlesex, MA, is obvious and very cheesy!

Conclusion

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Understanding the Medicare Prospective Payment System

Posted on September 17, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Origins of Diagnostic Related Groups

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]dem21

The Medicare Prospective Payment System (PPS) was introduced by the federal government in October, 1 1983, as a way to change hospital behavior through financial incentives that encourage more cost-efficient management of medical care. Under PPS, hospitals are paid a pre-determined rate for each Medicare admission. Each patient was classified into a diagnosis-related group (DRG) on the basis of clinical information. Except for certain patients with exceptionally high costs (“outliers”), the hospital is paid a flat rate for the DRG, regardless of the actual services provided.

Enter the DRGs

Each Medicare patient is classified into a DRG according to information from the medical record that appears on the bill:

  • principal diagnosis (why the patient was admitted);
  • complications and co-morbidities (other secondary diagnoses);
  • surgical procedures;
  • age and patient gender; and
  • discharge disposition (routine, transferred, or expired).

Medical Records DocumentationMedical Records

Diagnoses and procedures must be documented by the attending physician in the patient’s medical record. They are then coded by hospital personnel using ICD-9-CM nomenclature. This is a numerical coding scheme of over 13,000 diagnoses and more than 5,000 procedures. The coding process is extremely important since it essentially determines what DRG will be assigned for a patient. Coding an incorrect principal diagnosis or failing to code a significant secondary diagnosis can dramatically affect reimbursement.

DRG Categories

Originally, there were more than 490 DRG categories defined by the Centers for Medicare and Medicaid Services (CMS, formerly known as the Health Care Financing Administration [HCFA]). Each category was designed to be “clinically coherent.” In other words, all patients assigned to a DRG are deemed to have a similar clinical condition. The PPS is based on paying the average cost for treating patients in the same DRG.  Each year CMS makes technical adjustments to the DRG classification system that incorporates new technologies (e.g., laparoscopic procedures) and refines its use as a payment methodology. CMS also initiates changes to the ICD-9-CM coding scheme. The DRG assignment process is computerized in a program called the “grouper” that is used by hospitals and fiscal intermediaries. It was last significantly updated by CMS in 2006.

Assessment

Each year CMS also assigns a relative weight to each DRG. These weights indicate the relative costs for treating patients during the prior year.  The national average charge for each DRG is compared to the overall average. This ratio is published annually in the Federal Register for each DRG. A DRG with a weight of 2.0000, for example, means that charges were historically twice the average; a DRG with a weight of 0.5000 was half the average; and so on.

Conclusion

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ME-P Thought-Leader [MD] in the News

Posted on September 16, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Brian J. Knabe MD of Savant Capital Management

By Max Alexander

Dow Jones Newswires; 212-416-2245 Brian J. Knabe MD

Lots of doctors get burnt out dealing with the business end of medicine. But Brian Knabe, a family practice physician in Rockford, Ill., had such a passion for crunching numbers that he became a financial planner.

Knabe, 42 years old, still sees patient’s two half-days a week. He also teaches residents for another half-day at the University of Illinois – College of Medicine.

Most of the week, he’s a certified financial planner with Savant Capital Management.

“I hear all the jokes,” says Knabe, “the most popular being some version of, ‘Hey I guess my portfolio’s doing so badly, they had to bring in the doctor.'”

When the laughter dies down – it doesn’t take long – people often ask what motivated him to transition from medicine into finance.

His short answer is what you’d expect from a wealth adviser: “I wanted to diversify my career.”

The long answer includes a lifelong passion for math that runs in the family. Knabe’s father and brother are both engineers, and the doctor himself majored in bioengineering at Marquette University. “In college, I loved calculus, statistics and differential equations,” he says.

Growing up in Rockford, his best friend was Brent Brodeski, a partner at Savant, and Knabe had been a client of the firm since 1995. “For years, I joked with Brian, ‘If you ever get bored with medicine, you can join us,'” says Brodeski. “Three years ago he called and said, ‘I’ll take you up on that.’ I was floored.”

Knabe wasn’t bored with medicine. “I love taking care of patients, and the intellectual stimulation of the field,” he says. “So I told the partners at Savant that I would only do this if they allowed me to continue practicing medicine part-time.” Meanwhile, he went back to Marquette and got his CFP credentials.

About half of Knabe’s financial clients are doctors, who appreciate his insider’s knowledge of their work and financial issues. Both fields involve privacy and trust, he notes, and both involve planning for the future. They also involve an element of uncertainty.

Sometimes his advice is specifically health-related.

“One client I was working with was a couple where the husband had a terminal illness,” recalls Knabe. “I worked closely with the family in planning living will issues and durable power of attorney for health care. I’ve helped other clients wade through health insurance and disability issues.”

Yes, financial clients do sometimes ask him for medical advice, but he stops them before they can unbutton their shirt.

“If they have a problem and need a diagnosis, I’ll tell them where to go to get a second opinion,” he says.

Link: http://online.wsj.com/article_email/BT-CO-20090914-711325-kIyVDAtMEM5TzEtNDIxMDQwWj.html 

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Dr. Knabe is also enrolled in the www.CertifiedMedicalPlanner.com program in health economics and medical practice management for financial advisors and healthcare consultants.

Conclusion

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About Docs4PatientCare

Posted on September 16, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Politically Involved Physicians

By Staff ReportersUS Senate

Docs4PatientCare is a grassroots organization of concerned physicians committed to the establishment of a health care system that preserves the sanctity of the doctor-patient relationship, promotes quality of care, supports affordable access to all Americans, and protects patients’ freedom of choice.

Mission

According to their website, Docs4PatientCare urges patients and physicians to get involved in the current healthcare debates in order to preserve the good qualities of our healthcare system, address the problems, while preventing their bureaucratic destruction.

Board Members

President: Hal Scherz, MD
Vice President: Fred Shessel, MD
Secretary: Tod Rubin, MD
Treasurer: Joanne Thurston CPA

Board of Directors

Scott Barbour, MD
Carl Capelouto, MD
Ron Anglade, MD
Terry Murphy, MD
Mike Koriwchak, MD
Barry Zisholtz, MD

Assessment

D4PC is a group of practicing physicians uniting to represent the interests and concerns of both patients and doctors in the healthcare reform debate.  D4PC endorses the concept of needed healthcare reform, but recognizes it can only be accomplished by proceeding in a cautious and responsible manner. Their recommendations seek to enable them to reach this goal without requiring the nationalization of the entire American healthcare system.

But, should medical professionals be involved in such political organizations?

Link: http://docs4patientcare.org

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Are these sorts of organizations a form of self-aggrandizement; or not? Can you cite any others? 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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Take the Lost Managed Care Contract Challenge!

Posted on September 14, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Illustrative Case Model – Are You CMP™ Worthy?

By Staff Reporterscmp-logo

The Hope Outreach Medical Clinic (HOMC) is a private, for-profit, single specialty medical clinic in a south-eastern state. It submitted its bi-annual Request for Proposal (RFP) to continue its current managed care fixed-rate contract. Upon review of the RFP, however, Sunshine Indemnity Insurance Company, the managed care organization (MCO), denied the contract request for the upcoming year.

Seeing Economic Estimates

In shock, the clinic’s CEO asked the clinic’s administrator to work with its legal team to develop a defensible estimate of economic damages that would occur as a result of the lost contract. The clinic intended to bring suit against the MCO for breach-of-contract. However, the administrator is not an attorney and is loathe to-enter the fray. After consideration however, he decided to assist in filing the Statement of Claim (SOC) because he realized that changes in patient services (unit) volume would be a valid economic surrogate. He then requested the following information from his controller, in order to develop a change in economic profit [damages] estimate.

Change in patient visits (unit) volume

  1. Fees (price) per patient (unit)
  2. Marginal (incremental) cost per patient (unit)
  3. Change in current fees (prices)
  4. Patient volume (units) affected

Key Issues:

  1. Fee (price) per patient (units) may be obtained from the fee schedule used by the MCO to pay HOMC.
  2. Marginal (incremental) costs per patient (unit) are approximated using variable costs.
  3. Higher cost payors exist because lower patient volumes raise the average cost per patient (unit) due to existing fixed costs.

Assessment

Medical management consultants, are you up to answering this challenge? We dare you to respond!

Visit: www.CertifiedMedicalPlanner.com

Conclusion

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The Largest Purchaser of Domestic Healthcare?

Posted on September 14, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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It’s the Government – Silly

By Ann Miller; RN, MHA

[Executive Director]ERT Prison Healthcare

By far, our federal government is the largest purchaser of healthcare services, according to Robert James Cimasi MHA, AVA, CMP™ of Health Capital Consultants, in St. Louis, MO; and many others.

Obama Care

Although the government faces immense pressure to control healthcare costs, especially during the current HR 3200-3400 debates, it also faces pressure to expend additional funds in order to achieve its ostensible primary mission in its involvement in healthcare, i.e., to expand and improve public health.

Federal Payment Schemes

In many ways the government has led the way for cost control through its development of resource-based reimbursement, prospective payment systems, budget limitations and other payment schemes. However, its conflicting goals have led it to approach these controls in a hesitant and piecemeal manner rather than effecting bold, comprehensive reforms.

Consider, for example, the lack of government intervention in the face of mounting pressure to remove some of the barriers preventing a reduction in US pharmaceutical costs.

Assessment

Today, most experts agree that Uncle Sam pays for at least 51% of domestic healthcare when Medicare, Medicaid, SHIPS, the VA, Indian and Prison Healthcare Systems are considered. In fact, according to our Publisher-in-Chief, Dr. David Edward Marcinko; MBA:

‘We already have a single payer health system in this country, but most folks just don’t realize it.”

Conclusion

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Do Financial Advisors Add Value to Retail Portfolios?

Posted on September 13, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Some Consultants Emphatically Say … No!

By Staff Reportersfp-book1

Nope! So says Andre’ Cappon, Guy Manual, Stephan Mignot and Seth Varnhagen of the CBM Group, Inc; a consulting firm in Manhattan, New York. In fact, while writing in Registered Rep – a trade magazine for FAs in September 2009 – they estimate that long-term real (adjusted for inflation), actual (after taxes, fees and market timing) returns for the average retail investor, to be around 0 percent. That’s right; not the 8-12 percent usually attributed to long term investing trends.

Or; do you simply have the wrong type of Financial Advisor [FA]?

Visit: www.CertifiedMedicalPlanner.com Do you need a fiduciary advisor? Who really knows for sure?

About the CBM Group

Founded in 1992, the CBM Group is a general management consulting firm specialized in the financial services industry. Their goal is to help leading financial institutions, and their financial advisors, create and sustain the competitive advantages necessary to thrive in the global marketplace.

Link: www.theCBMGroup.com

Assessment

Despite the math, and numerics like Ibbotson charts showing impressive long-term gains, on average retail investors — like doctors, medical professionals and ME-P readers — have made very little actual return on their savings; according to CMB.

Link: http://registeredrep.com/advisorland/marketing_selling/0901-small-investment-return/index.html

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Does your FA add value to his/her fees of 1-3%; or are they a drag on your portfolio’s performance. Ever consider “doing it yourself”  like some medical institutions www.HealthcareFinancials.com 

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Soliciting Textbook Peer-Reviewers and Experts

Posted on September 12, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Business of Medical Practice

Ann Miller; RN, MHA

[Executive Director]biz-book

Please contact me if you would like to serve as a peer-reviewer for the third edition of our popular textbook, “Business of Medical Practice”.

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

If interested, please email me and send in a bio. A non-disclosure agreement is required.

Email: MarcinkoAdvisors@msn.com

In return for conscientious industry and expertise, if accepted, we may offer you a possible mention, blog promotion and/or book acknowledgement … such a deal! 

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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Dr. Pruitt Invites Dr. Cohen to Discuss eDRs

Posted on September 10, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Where is the ADA’s Representative?

By Darrell K. Pruittpruitt; DDS

He or she should have been talking with me long ago. I have the audience and I’m giving you that opportunity I promised you, Dr. Donald Cohen.

Rest Easy

I’m aware that I possibly make you uncomfortable, considering how “unprofessionally” I’ve publicly treated lesser devoted HIPAA consultants. Rest easy! As soon as I read your article, I could tell that you’re different from your colleagues I’ve met. First of all, like me, you’re a dentist. That’s very important. Secondly, your credentials are impressive and reveal that compliancy is not a hobby for you like it is for others. Nobody can accumulate a history as impressive as yours without professional dedication. The last point, and the most important of the three, you seem honest about HIPAA compliance.

A Professional

It wasn’t lost on me that in your article you were professionally non-judgmental of the Rule. Instead of trying to justify a defenseless law, your job is to help dentists comply with the mandate as it is written or risk significant fines. Like tax-collecting, someone’s got to do the job of delivering bad news. You have a legitimate purpose to be involved in the dental industry, even if what you teach makes little difference at all if a dentist’s records are breached. I argue that following the inevitable bankruptcy from a breach, HHS fines are hardly a deterrent. And that is the issue: eDRs containing patient identifiers are too risky for the marketplace.

Electronic Dental Records

I think you would have to agree that eDRs are going nowhere until records are safe, and encryption is not going to be sufficient to protect dentists against dishonest employees. Ambitious bureaucrats in waiting, such as HIPAA consultants Travis Criswell, Sharalyn Fichtl, Kelly Mclendon and Olivia Wann – not a dentist among them – hooked their careers to the HIPAA mandate to avoid the tough sales jobs competition otherwise demands in the free market. All four share an authoritarian misconception that since it is the law, dentists will be forced to purchase their products – even if they are utterly senseless. I think we both know that they are oh so wrong. I promised earlier to give you an opportunity to publicly support truth in eDRs if you so choose. Perhaps we could rationally discuss in front of everyone how dentists can wriggle free of the approaching mess. There is no pressure here, other than this is public invitation. Since you haven’t made unrealistic claims about eDRs like others have, I am not interested in hounding you further. I simply ask you to consider responding to the article I posted in your name on PennWell titled “Dr. Donald Cohen’s opportunity.”

http://community.pennwelldentalgroup.com/forum/topics/dr-donald-cohens-opportunity

Assessment

I sincerely appreciate the respect you have shown me, and I pledge to afford you the same. Of all the consultants I have approached with my concerns about HIPAA and eDRs, you are the first to even acknowledge a problem simply by posting my concerns. I think you have the courage to face the realities of the marketplace, while others foolishly think dentists are a captive market.

Note: I submitted this to be posted following an August 28th press release posted by HIPAA consultant Dr. Donald Cohen titled, “Dentists Should Know about New HIPAA Rules.”

http://www.dentalblogs.com/archives/administrator/dentists-should-know-about-new-hipaa-rules/comment-page-1/#comment-35672

If you are interested in discussing the topics of interoperability with fax machines, de-identified eDRs and security that surpasses paper records, in front of you is the opportunity to address your largest audience yet, Dr. Cohen. I’m self-syndicated.

Note: Do you realize that if Dr. Cohen takes me up on the offer, this will be the first time two dentists have openly discussed eDRs on the Internet? Do you think it’s about time?

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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Filed under: Information Technology, Practice Management, Pruitt's Platform, Quality Initiatives | Tagged: , , , , , , , , , , , , , , , , , , , , , | 11 Comments »

Take the DME Inventory Switching Challenge!

Posted on September 9, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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 Calling all Administrators and Management Consultants – Are You CMP™ Worthy?

 [By Staff Reporters]ME-P Logo.2

The new administrator for the ABC Medical Clinic understood that all inventory costing methods were acceptable to use in his Durable Medical Equipment [DME] department. LIFO, FIFO, specific identification, and the average cost method are all attractive methods under different circumstances in the business cycle, and companies may use the method that best fits their circumstances.

Reducing Taxes

For example, if ABC wished to reduce corporate income taxes in a period of inflation and rising prices, it would use LIFO. If matching DME sales revenue with the current cost of DME goods sold was desired, LIFO would also be used. Unfortunately, LIFO may charge against DME revenue the cost of DME not actually sold, and LIFO may allow the ABC Medical Clinic to manipulate net income by varying the time-periods it makes additional DME purchases. On the other hand, FIFO and specific identification method allows a more precise matching of ABC revenue with historic DME costs. However, FIFO too, can promote “paperless-phantom profits,” while specific identification can promote possible income manipulation.  It is only under FIFO that net income manipulation is not possible.

CEO – 2 – CFO [Case Model]

“Let’s go with FIFO,” the new administrator said to his Chief Financial Officer, Bert. “The profits will make us look good to the home office and we can always switch back to LIFO if inflation starts back-up again, right Bert?” He mused, but he was not amused because freedom of choice does not include changing DME inventory methods every few years, especially if only to report higher income. “The switching of methods violates the basic tenet of consistency, which requires the use of the same inventory cost and accounting methods in preparing financial reports and statements,” Bert emphatically stated.

Key Issues

1) Is this sort of inventory costing and maneuvering permissible?

2) What is its justification?

3) How is it notated in financial reports?

4) Is this sort of thing ethical?

Assessment

“The switching of methods violates the basic tenet of consistency, which requires the use of the same inventory cost and accounting methods in preparing financial reports and statements,” Bert emphatically stated.

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

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Improving Patient Control of eHRs

Posted on September 9, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Traditional Command-Control Option Dying Out … Slowly!

[By Staff Reporters]Hospital Access Management

NewYork-Presbyterian Hospital recently introduced a new personal electronic health record [eHR] enabling patients to access medical information wherever and whenever they need it. Called myNYP.org, the system uses Microsoft’s HealthVault and Amalga technologies to offer patients the ability to select and store personal medical information generated during visits to NewYork-Presbyterian.

About NewYork-Presbyterian

NewYork-Presbyterian Hospital is one of the most comprehensive university hospitals in the world, with leading specialists in every field of medicine. The hospital is composed of two renowned medical centers, NewYork-Presbyterian Hospital/Columbia University Medical Center and NewYork-Presbyterian Hospital/Weill Cornell Medical Center, It is affiliated with two Ivy League medical institutions, Columbia University College of Physicians and Surgeons and Weill Cornell Medical College.

Assessment

MyNYP.org uses a “pull model” in which patients proactively opt to copy their medical data into their own personal health record and access that information using a secure username and password with any Web-enabled device. And yes, online bill pay features are available.

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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Off-Road Touring with Dr. Marcinko [Part VIII]

Posted on September 8, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Interview with David B. Lumsden; MD

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Dateline: Baltimore Maryland,Dr. Lumsden Formal August 10, 2009.

About David B. Lumsden MD

Dr. David Lumsden; MS, MA practices general orthopedic surgery and trauma as a board certified surgeon and partner with Orthopedic and Hand Surgery Associates in Baltimore, Maryland. He completed his training in community health at Towson State University, earned Master’s Degree in Anatomy / Neuroanatomy at University of Maryland/Baltimore and Exercise Physiology at University of Maryland, College Park. He is a graduate of Penn State University School of Medicine. Dr. Lumsden completed his internship and residency at Union Memorial Hospital with associative residency training at Johns Hopkins and the world renowned Shock Trauma Center at the University of Maryland, Baltimore City. 

Our Brief Interview

When I caught up with David during a recent house-call visit, we discussed many things; especially the American Affordable Health Choices Act [HR-3200]. Unfortunately; I did not have my audio-recorder with me. So, here are a few points of interest about him that I jotted down, from memory, in my ever-present reporter’s notebook. No doubt, I missed many more:

  • He became a physician as a career change in mid-life.
  • He has read HR 3200 in its’ entirety.
  • He hired an attorney for HR 3200 interpretation and review.
  • He is for healthcare reform, but against HR 3200.
  • He is against a public health care plan.
  • He is against individual insurance mandates.
  • He does 10-12 house-calls every month.
  • He does not charge MC, MD or VA house-call patients; rarely bills them and/or accepts assignment without balance billing.
  • He regularly operates on same, under similar terms.
  • He does other pro-bono work.
  • He practices defensive medicine.
  • He is for tort reform.
  • He is not a member of the AMA with no plans to join.

Assessment

Review and vote for -or- against HR 3200 here: http://www.opencongress.org/bill/111-h3200/text

About Off Road with Dr. MarcinkoDavid Lumsden; MD

These sporadic off-road segments will continue through-out my 2009 summer promotional tour. Formal attendance increased toward the later part of the summer as the Obama Administration’s healthcare debates heated up. Our many local book stores and sponsors noted a spike in our CD and book sales, as well as interest in our online www.CertifiedMedicalPlanner.com program and premier quarterly guide: Healthcare Organizations [Journal of Financial Management Strategies] www.HealthcareFinancials.com

Part VII: https://healthcarefinancials.wordpress.com/2009/09/01/off-road-touring-with-dr-marcinko-part-vii/

Conclusion

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Sponsors Welcomed

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Filed under: Ethics, Health Insurance, Health Law & Policy, Sponsors, Touring with Marcinko | Tagged: , , , , , | 2 Comments »

How Proprietary HIT Vendors May Demolish Health Reform

Posted on September 8, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Top Five Issues from the Longman Report

By Staff ReportersNetwork

Here are the top five quotes from the Longman Report. The author, Phillip Longman, is a senior fellow at the New America Foundation and the author of: “Best Care Anywhere: Why VA Health Care Is Better than Yours as well as The Next Progressive Era: A Blueprint for Broad Prosperity.

http://www.newamerica.net/people/phillip_longman

The List 

1. Twenty years after the digital revolution, only an astonishing 1.5 percent of hospitals have integrated information technology systems. Almost all experts agree that in order to begin to deal with the problems of the health care system, this has to change. 

2. Done right, digitized health care could help save the nation from insolvency while improving and extending millions of lives at the same time. Done wrong, it could reconfirm Americans’ deepest suspicions of government and set back the cause of health care reform for yet another generation. 

3. Thanks to the stimulus bill, $20 billion is about to be poured into buggy, expensive, proprietary software that will not bring the benefits the Obama administration hopes for. Rather, it will amount to a giant bailout of a health IT industry whose business model has never really worked. 

4. The VA’s open-source software allowed a nurse in Topeka, Kansas, to adapt for her own work a bar-code scanner she saw used at a rental-car agency. Her innovation cut the number of medication-dispensing errors in half at some facilities, and saved thousands of lives. 

5. While a few large institutions have managed to make meaningful use of proprietary health IT, these systems have just as often been expensive failures. In 2003, Cedars-Sinai Medical Center in Los Angeles tore out a “state-of-the-art” $34 million proprietary system after doctors rebelled and refused to use it.

Assessment 

http://www.newamerica.net/publications/articles/2004/the_best_care_anywhere 

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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Filed under: Breaking News, Information Technology, Military Medicine, Practice Management, Research & Development | Tagged: , , , , , , , , , | Leave a comment »

Take the Hospital eHR Implementation Challenge!

Posted on September 6, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Illustrative Case Model – Are You CMP™ Worthy?

By Staff Reporters Washington DC

The fictitional Washington Hospital is embroiled in the healthcare reform debate and interested in implementing an electronic health record (EHR) for its major clinic areas. The flagship hospital currently utilizes a legacy-based system and several of the clinics have independently purchased software programs to provide a more inclusive electronic data base particular to that clinic.

Scenario

In addition, each of the software programs purchased in specific clinics has been modified to serve their own needs. The other satellite hospitals and clinics are not linked to the flagship hospital and have independent systems, applications and software in place. The hospital is interested in obtaining one EHR system that can be used in a standardized and uniform methodology and process throughout all of its hospitals and clinics.

Key Issues

Should the Washington Hospital?

1) Abandon the clinic’s software programs in lieu of a more centralized EHR?

2) Assess various EHR systems for healthcare providers available in the marketplace, comparing a series of hospital and clinic developed requirements against vendor capabilities?

3) Obtain an EHR product that provides interface to the existing clinic software products?

4) Assess whether the EHR vendors totally comply with HIPAA and privacy regulations as well as update their systems automatically with HIPAA changes?

5) Have the vendors assess the existing system/applications/software programs currently in use at each of the hospitals and clinics and determine the best application configuration?

6) Utilize the internal Information Technology staff to develop an interface solution?

Assessment

Medical management consultants, are you up to answering this challenge? We dare you to respond! Visit: www.CertifiedMedicalPlanner.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post 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.

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

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

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Our Other Print Books and Related Information Sources:

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Filed under: "Ask-an-Advisor", CMP Program, Information Technology, Practice Management | Tagged: , , , , , , | 1 Comment »

On Regional Extension Centers [RECs]

Posted on September 2, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Another New Governmental Machination?

[By Staff Reporters]

A Regional (health information) Extension Center [REC] is similar to a Health Information Organization [HIO] that brings together healthcare stakeholders within a defined geographic area and governs Health Information Exchange [HIE] among them for the purpose of improving health and care in that community.

Fundamental to this definition is the meaning of Health Information Exchange and Health Information Organization. A Health Information Organization (HIO) is an organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards.

Thus, the goal of an REC is to act as a local support organization to help doctors install electronic health records and use them to achieve improved quality, efficiency, and continuity of care.

Past and Present

The RECs are based on the example of agricultural extension offices, established over 100 years ago by Congress, which offered rural outreach and educational services across the country.

Today, the HITECH Act amends Title XXX of the Public Health Service Act by adding Section 3012, Health Information Technology Implementation Assistance. This section provides supportive services for the rest of the HITECH Act. Section 3012 (a) establishes the Health Information Technology Extension Program (Extension Program). The Extension Program provides grants for the establishment of Health Information Technology 

Assessment

Link: Regional Extension Center

Link: http://www.chhs.ca.gov/initiatives/HealthInfoEx/Documents/SUMMIT%20DOCUMENTS/RECSummitSlides_FinalDraft-7-15.pdf

Link: HIT Extension Program – Regional Centers Cooperative Agreement Program

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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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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Filed under: Breaking News, Career Development, Health Economics, Information Technology | Tagged: , , , , , , , , , , , , , , | 2 Comments »

VOTE: Poll on Rule 206(4) of the IAA of 1940?

Posted on September 2, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

 Please Vote

 

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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Sponsors Welcomed

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

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E. A. Poe and Touring with Dr. Marcinko [Part VII]

Posted on September 1, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Edgar Allan Poe, Church Hospital, Johns Hopkins and Me

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Dateline: Baltimore MarylandPoe, August 7, 2009

To the entire world, Church Home and Hospital, formerly known as the Washington Medical College, was where Edgar Allan Poe died on October 7, 1849. Located in Upper Fell’s Point, it was also where many doctors were trained who served in the Union and Confederate armies during the Civil War. But for me, its emergency room seemed like home, as a local inner city youth, back-in-the-day.

Link: http://www.eapoe.org/balt/poechh.htm

About Fells Point

Fell’s Point is an historic waterfront community just east of Baltimore’s Inner Harbor. The Fells Point Historic District occupies the area from Gough Street south to the water’s edge, roughly between Caroline and Chester Streets. Established in 1763, Fells Point is a city, state and National Historic District and boasts over 161 buildings on the National Register, along with the oldest standing residence in Baltimore City, the Robert Long House at 812 S. Ann Street. The neighborhood is home to dozens of unique retail shops, restaurants and pubs; along with our community Church Home and Hospital; and its more famous behemoth neighbor up the street, Johns Hopkins University Hospital and Medical School.

Link: http://www.fellspoint.us/

It was as a freshman medical student, visiting “the Johns”, where I first met J. Alex Haller Jr. MD – the world famous Children’s-Surgeon-in-Charge of Johns Hopkins Hospital, and pectus excavatum surgical pioneer, from 1964 until 1997. As well as pediatric heart surgeon Helen Brooke Taussig MD (1898 – 1986), developer of a famous operation to alleviate “blue baby” syndrome, and who first warned the public on the dangers of thalidomide. JHU is also where I played stick-ball as a kid, in the hospital parking lot. But, I digress.

Link: http://www.msa.md.gov/msa/educ/exhibits/womenshall/html/taussig.html

Church Home and Hospital and Me

My first visit to the Church Home Hospital ER was to repair a forehead laceration which was sustained after a fall onto one of Baltimore’s famous brick steps.

The second was to re-attach my right hallux [big toe] after almost completely severing it on a piece of glass [broken beer bottle].

My final visit was to repair a thigh laceration. Of course, my younger brother made two subsequent visits, over the years, as well. On all occasions we were sutured and repaired by Raymond Atkins MD; following his career as a junior and senior attending resident, fellow and well into private practice. In a time before eMRs; Dr. Ray would later tell us that just hearing the name “Marcinko” was enough medical history for him to commence his trip to the ER. God bless you Dr. Atkins and Church Home and Hospital.

Assessment

As a student of the city, I knew of Church Home Hospital and Edgar Allan Poe before ever learning of Haller, Taussig or Atkins. But, they all made impressions on me, in one way or another. I just had to revisit the sites and  them, if only in memory

About Off Road with Dr. Marcinko

These sporadic off-road segments will continue through-out my 2009 summer promotional tour. On the one hand, formal attendance at several engagements was a bit sparse because of the death of several recent celebrities and entertainer types.

On the other hand, local book stores and sponsors noted a spike in our  book sales, as well as interest in our online www.CertifiedMedicalPlanner.org program.

Part VI: https://healthcarefinancials.wordpress.com/2009/08/27/off-road-touring-with-dr-marcinko-part-vi/

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think about this trip down memory lane? 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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Events Planner: September 2009

Posted on September 1, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Events-Planner: SEPTEMBER 2009

Staff WritersLobster

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

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

First, a little about us! The Medical Executive-Post is still a newcomer. But today, we have almost 25,000 visitors and readers each month from all over the country, in addition to our growing subscriber base. We have been a successful collaborative effort, thanks to your contributions.  As a result, we are adding new resources daily.  And, we hope the website continues to provide the best place to go for journals, books, conferences, educational resources, tools, and other things you need to establish the value your healthcare consulting and financial advisory intervention. And so, enjoy the Medical Executive-Post and our monthly Events-Planner with our compliments. 

A Look Ahead this Month

Sept 1: Print Edition Healthcare Journalism: If you would like to “step-up-your-game” and be considered as a peer-reviewed contributor to the third print edition of: The Business of Medical Practice [Health 2.0 Profit Maximizing Techniques for Savvy Doctors]; contact Ann at: MarcinkoAdvisors@msn.com. There are several chapter topics still available. Now, the important dates:

Sept 11: New England Healthcare Association Conference, Boston, MA.

Sept 13: Medicare and Medicaid AHIP Conference, Washington, DC.

Sept 13: Schwab Impact, Convention Center, San Diego, CA

Sept 14: Medicare RAC Summit, Washington, DC.

Sept 15: DOL Employees Benefits Conference, Washington, DC

Sept 18: Healthcare Compliance Association Conference, Minneapolis, MN.

Sept 21: Healthcare Financial Management Conference, Chicago, Ill

Sept 21: GIPPS Interactive Workshop, CFA Institute, Boston, MA

Sept 22: Health Plan Innovation Conference, Chicago, Ill.

Sept 24: Executive Forum Public-Private Employer Partnerships, Atlanta.

Sept 25: Family Office Symposium, FINRA, Aventura, FL

Sept 30: Consumer Health Management Conference, Alexandria, VA.

Conclusion

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Guest ME-P Bloggers Welcome

Posted on August 31, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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By Ann Miller; RN, MHA

[Executive Director]Lighthouse

Perhaps you have a great idea for a short article to promote the integration of personal financial planning and medical practice management, including expert posts, humorous stories or interesting news; but don’t want to maintain a blog? We have more than 50 topic channels to consider.

 

Contact me at MarcinkoAdvisors@msn.com and be a guest blogger! 

Conclusion

Be sure to subscribe to the ME-P. It is fast, free and secure.

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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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Tightening Payment Rules for Non-Physicians

Posted on August 30, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding the Medicare “Incident To” Rules

By Staff ReportersGator

Under the “incident to” rules, Medicare Part B pays for some services that are billed by physicians, but performed by non-physicians. And, the Department of Health and Human Services [DHHS] and Office of Inspector General [OIG] says that some of these services might be used improperly.

Suggestions to CMS

The agency recommends the Centers for Medicare & Medicaid Services [CMS] perform the following:

  • Revise the “incident to” rule to require that physicians who bill Medicare, but don’t perform the services themselves, ensure that the services are provided by a licensed physician, or a non-physician with the necessary training, certification or licensure.
  • Require that physicians who use non-physician services identify this with a service code modifier on bills.
  • Take appropriate action to detect when physicians bill for “incident to” services that are not covered under the rule.

Assessment

In the current healthcare reform environment, Medicare services by non-physicians are coming under increased scrutiny. And, the OIG is finding that the “incident to” rule is allowing medical care to be provided by non-physicians who may lack the necessary qualifications. This may be a healthcare financial, insurance and quality breach. So, don’t let this trap “bite” you.

Source: HHS Office of Inspector General (www.oig.hhs.gov/oei/reports/oei-09-06-00430.pdf)

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Has anyone been bitten by the ‘incident to” rules? Tell us what you think. 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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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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On PHI Security Breaches

Posted on August 28, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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New HHS Regulations

[By Staff Reporters]

Effective September 23, 2009, new regulations issued by the U.S. Department of Health and Human Services (“HHS”) will require covered entities to notify affected individuals and HHS following the discovery of a breach of patient information. These regulations are more expansive than other notification laws that may already exist. Under these new regulations, covered entities must analyze every privacy and/or security incident to determine whether a notification requirement exists and then satisfy detailed notice requirements.

Breach Defined 

According to Garfunkel, Wild and Travis PC, a “breach” may be defined as the unauthorized acquisition, access, use or disclosure of unsecured Protected Health Information (“PHI”) which compromises the security or privacy of the PHI. It is important to note that this definition of breach is broader than most state notification laws under which most covered entities have already been operating for a number of years. While state notification laws may only require notification when there is an unauthorized disclosure of social security numbers or other specific kinds of personal information, under these new Federal regulations, unauthorized access, acquisition, use or disclosure of any PHI, not just social security number, is a potential breach. Furthermore; unauthorized uses of PHI, not just access or disclosure, requires notification.

Assessment

For more info: http://www.gwtlaw.com

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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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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Let’s Think about Vitality GlowCaps for a Moment

Posted on August 28, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Lights, Ring Tones and E-mails – Oh My!

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

DEM Thinking

Vitality Inc, is a new firm that reports to address the billion-dollar adherence problem for pharmaceutical brands, retail pharmacies, and healthcare providers with a simple device — an Internet-connected pill cap.

What it Is

Vitality GlowCaps illuminate, play a melody, and even ring a home phone so patients don’t forget to take their pills. They can send weekly emails to remote caregivers, create accountability with doctors through an adherence report, and automatically refill prescriptions. Vitality reports to improve medication adherence, health, and peace of mind.

Video: http://rxvitality.com/glowcaps.html

Name Droppers

According to its website, Vitality is currently working with researchers at Harvard Medical School and the Center for Connected Health on a study to measure the impact of the GlowCaps CONNECT system.

Vitality is the only company with a product designed to tackle the combination of factors that conspire to cause non-adherent behavior.

Overkill

Our society is now at the point of paying obese patients to diet and exercise [they don’t seem to recognize the benefit], paying public school children to study [they don’t seem to recognize the benefit], and now using internet enabled technology to help patients remember to take their own medication [they don’t seem to … yada, yada, yada].

A Reasonable Query?

But, may one reasonably ask; is this admittedly “very cool” technology overkill? THINK: RFID tags for wrong extremity surgery; when common sense and a magic marker might do just as well? Sure, there may be some modicum of benefit here for elderly patients and select other reasons. But, does the marginal cost outweigh the marginal benefit? Or, is this technology really a solution in search of an exaggerated “problem” that just may involve slack personal responsibility? And, most importantly, who will pay for it?  

Assessment

Vitality Inc, leverages deep expertise in customer research, wireless consumer electronics, web services and behavioral psychology. Vitality’s patent pending solution is said offer each patient the optimal mix of intervention, feedback, reminders, accountability, education and incentives to improve their ongoing medication adherence. But, does it really improve health, and at what cost? Can’t we solve the “problem” of pill non-compliance cheaper and easier?

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think. Any early adopters out there, and ready to opine? Or, give em’ a click and tell us what you think! http://rxvitality.com 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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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Filed under: Drugs and Pharma, Ethics, Information Technology, Op-Editorials, Videos | 3 Comments »

HALLOWEEN: Nathaniel Potter MD & Touring with Dr. Marcinko [Part VI]

Posted on August 27, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

About Nathaniel Potter, MD

By Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief]
Dateline: Baltimore MarylandNathaniel Potter MD

While in Washington DC on the second portion of our recent ME-P book “signing and opining” tour, I had the good fortune to visit the gravesite of the noted physician Nathaniel Potter, MD. Dr. Potter was born in Carolina county Maryland in 1770 and died in Baltimore on 2 January, 1843. He graduated from the University of Pennsylvania in 1796, and settled in Baltimore, where he practiced medicine until his death. In 1807, he associated with Dr. John B. Davidge in founding the University of Maryland, School of Medicine where he ultimately served as professor and dean. He died penniless.

THINK Potter’s field!

About Green Mount Cemetery

Green Mount Cemetery is located in Baltimore, MD. Established in 1839, it is noted for the large number of historical figures that have been interred in its grounds as well as a large number of prominent Baltimore-area families. It retained the name Green Mount when the land was purchased from the heirs of Baltimore merchant Robert Oliver. Green Mount is also a treasury of precious works of art, including striking works by major sculptors like William Rinehart and Hans Schuler. The cemetery was listed in the National Register of Historic Places in 1980.

Assessment

In as much as Dr. Potter was a well know figure to me, I was most pleased at the impromptu visit to his grave. You see, although I attended Temple University because of my future specialty, my first medical school choice would have been at University of Maryland if post-graduate education opportunities had been different at the time. And, I passed the medical school, and the imposing Greek themed Davidge Hall Dome, daily for four years as I rode the number 8 public transportation bus to my undergraduate studies at nearby Loyola University, in Townson Maryland. Of course, the fact that Potter was educated at the University of Pennsylvania School of Medicine, the first in the nation, did not elude me when I worked in its ER as a young medical student in Philadelphia, back in-the-day. University of Maryland was the fifth such medical school in the country.

About Off Road with Dr. Marcinko

These sporadic off-road segments will continue through-out my summer promotional tour. Attendance at several formal and informal engagements increased since the early summer. The previously noted sales spike for our texts, handbooks and dictionaries; as well as interest in our online www.CertifiedMedicalPlanner.org  program.

Part V: https://healthcarefinancials.wordpress.com/2009/08/21/off-road-touring-with-dr-marcinko-part-v/

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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About HealthDataRights.org

Posted on August 27, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Mitigating the Unintended Consequences of HIPAA

By Staff ReportersWaiting for Medical Records

Many patients and pundits opine how today’s HIPAA regulations [written in the relative paper based stone age] say that while doctors must provide a copy of your records, they can take a month to do so. And, if they want, they can say that’s not enough and take another month. However, when a patient needs medical care; that time-line is not acceptable.

Enter a Website and Start a Movement

According to the website www.HealthDataRights.org, in an era when technology allows personal health information to be more easily stored, updated, accessed and exchanged, the following rights should be self-evident and inalienable. We the people:

  • Have the right to our own health data.
  • Have the right to know the source of each health data element.
  • Have the right to take possession of a complete copy of our individual health data, without delay, at minimal or no cost; if data exist in computable form, they must be made available in that form.
  • Have the right to share our health data with others as we see fit.

Assessment

These principles express basic human rights as well as essential elements of health care that is participatory, Health 2.0 appropriate and in the interests of each patient. No law or policy should abridge these rights.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Visit the site, join the movement by signing their petition, and tell us what you think. 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

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Henry Louis Gehrig, eMRs and Healthcare Reform

Posted on August 26, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

What’s the “Iron Horse” Got to Do with Health IT?

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]Jacobetti VA

According to UPI reports from Charlestown, WVa on August 24 2009, at least 1,200 veterans across the country were mistakenly told by the Veterans Administration [VA] that they suffered from a fatal neurological disorder.

Link: http://www.msnbc.msn.com/id/32541579/ns/health-health_care/

Panicked Veterans

One of the leaders of a Gulf War veterans group is reported to have said that panicked veterans from the states of Alabama, Florida, Kansas, North Carolina, West Virginia and Wyoming contacted the group about the error. Denise Nichols, the vice president of the National Gulf War Resource Center, reportedly blamed a “coding error” for the mistake. In medicine, we call this a “false positive.”

About Henry Louis “Lou” Gehrig

Henry Louis “Lou” Gehrig (June 19, 1903 – June 2, 1941), born Ludwig Heinrich Gehrig, was an American baseball player in the 1920s and 1930s; chiefly remembered for his prowess as a hitter, the longevity of his consecutive games played record and the pathos of his tearful farewell from baseball at age 36, when he was stricken with a fatal disease. Of course, Gehrig was known as the “The Iron Horse” for his durability. Yet, the irony is that Amyotrophic Lateral Sclerosis [ALS], or Lou Gehrig’s disease [sometimes also called Maladie de Charcot] is progressive and fatal. Lou died in 1941 after developing the illness. Will the same death-spiral happen to eHRs and Obama care?

Link: http://www.lougehrig.com

Assessment

Having rotated through the VA system as a young medical student back-in-the-day, I have never been a fan. It smacked of socialized medicine and government plutocracy, and was never a leading-edge example of domestic healthcare, in my informed opinion. Recent HIPAA administrative, security, IT and clinical medical errors are well known. So, to blame the mix-up on an insurance billing and “coding error” seems somewhat disingenuous. Especially now, at a time when eMRs and the Obama Administration’s healthcare reform itself is being vigorously debated by the citizenry. I mean, are there no human checks and balances? Would there be any human intervention if a public healthcare policy was adopted?

Of course, we have written about military medicine previously on this Medical Executive-Post, and devoted an entire channel to it. And, I do realize that more than fifty percent of us receive similar governmental care in some form, or another [Medicare, Medicaid, CHIPS, the Indian and Prison Healthcare Systems, etc].

Link: https://healthcarefinancials.wordpress.com/category/military-medicine/

Nevertheless, shall we give a new moniker to this mistake? How about “Lou Gehrig’s coding error”, and document it in our www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is it even fair to relate this “isolated incident” to the current healthcare reform debate, the eMR conundrum and/or similar discussions on health Information Technology [IT]? Tell us what you think. 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

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Filed under: Breaking News, Ethics, Health Law & Policy, Information Technology, Military Medicine, Op-Editorials, Touring with Marcinko | Tagged: , , , , , , , , , , , , , , , , , , , , , , , , , | 1 Comment »

Superannuation Demographics for Financial Advisors

Posted on August 25, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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www.CertifiedMedicalPlanner.org

“Live Long and Prosper”

By Dr. David Edward Marcinko; MBA, CMP™

By Thomas A. Muldowney; MSFS, CLU, CFP®, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™Senior Citizens

The words of Mr. Spock!

Recently, during my promotional speaking tour for the summer of 2009, I had the occasion to visit a few nursing and related homes for the elderly, sick, infirmed and aged. This harkened warm thoughts back to my time at Temple University in Philadelphia, PA as a young medical student. So, as a health economist and former certified financial planner, I recruited some folks and did some research on the domestic aging population to refresh my understanding of the facts and figures; especially in light of the current healthcare reform political debates [DEM].

Just the Facts  

According to the U.S. Bureau of the Census, there were almost 49 million people in the United States who were over age 60 in 2001. There are approximately 4 million people over the age of 85 living in the US and there are over 60,000 people older than age 100 estimated as of July 1st 2004. For every100 middle aged persons in the United States there are at present about 114 persons over the age of 65. This statistic will change as we move forward through time. In the year 2025, there will be about 253 people over age 65 for every 100 middle-aged people.

Enter the Baby Boomers

Beginning on January 1, 2006 at midnight and every 12 seconds thereafter for fifteen years, a baby boomer will have a birthday and cross over the age threshold of age 60. In the next 30 years, the 60+ age group will more than double, becoming 25% of the total population, and will have to be supported by a proportionately smaller workforce. Research published in June 2005 by AARP (based on data from 2002) estimates that: ‘‘In 2002, roughly $140 billion was spent on nursing home and home health care, with 24% of these costs being paid out of pocket” (O’Brien and Elias, 2004).

Aging Boomers

As the baby boom generation ages, the care needs will expand precipitously. Add to this, scientific and technological improvements in healthcare. These very same people will need more expensive healthcare and more expensive custodial care, and they will need it for an even longer period of time. Who will pay for this expanded need is not so clear. What is clear is that it will take money and lots of it to make these payments.

Money Preservation Variables

There are only three variables associated with the accumulation or preservation of money: ‘‘time, money and rate of return.’’ Time is reduced to the following two questions ‘‘How long until I will need my money?’’ and ‘‘How long will I live?’’ an uncertainty to be sure. Rate of return is either a function of the financial markets or the successful maintenance of a Long Term Care Insurance [LTCI] plan. Because of the volatility in the financial markets, the ‘‘money’’ question is equally as uncertain. In order to accumulate sufficient assets; an aging physician must ’tradeoff’ many other alternatives such as ’lifestyle.’

Assessment

What is certain is this—financial planning is important. More important is the implementation.

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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Filed under: Ethics, Financial Planning, Health Economics, Insurance Matters, Research & Development, Retirement and Benefits, Touring with Marcinko | Tagged: , , , , , , , , , , , | 2 Comments »

BCBS-TX Reverses NPI Policy

Posted on August 24, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Victory at Last

[By Darrell K. Pruitt; DDS]pruitt

Every now and then, I enjoy little victories. My war with BCBS-TX started when they began declining to pay their clients’ claims if they originated in my office. Since I’m not a HIPAA-covered entity, I didn’t volunteer for an arbitrary National Provider Identification number.

The behemoth insurance company not only successfully drove away some of my long term patients, but their clever policy blocked my access to their pool of clients who were led to believe their dental insurance was good everywhere – until my office manager had to tell them otherwise. BCBSTX is a sleazy company simply because it lies to its clients as policy. 

Successful Claims

In the last two weeks, my office manager has successfully filed a couple of claims and it appears that unless payment is blocked in the next day or so, BCBSTX no longer requires Texas dentists to have NPI numbers.

Asessment

That’s nice, but I want more. I want the state CHIP program to drop its NPI requirement as well. Why limit access to dental care to the poor because of a number that only helps insurers. I’m just getting started, Texas.

Conclusion

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Filed under: Health Insurance, Health Law & Policy, Information Technology, Managed Care, Pruitt's Platform | Tagged: , , , , , , , , | 3 Comments »

More on Doctors and Personal Net Worth

Posted on August 23, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Determinations Using Rules-of-Thumb

[By Staff Reporters]fp-book1

Once the value of all personal assets and liabilities is known, physician net worth can be determined with the following formula: Net worth – assets minus liabilities. Obviously, higher is better.

And, although eschewed in the past, rule-of-thumb determinations are making a comeback because of the recent financial implosion and stock market meltdown.

Benchmarks

In The Millionaire Next Door, Thomas H. Stanley, Ph.D., and William H. Danko gave the following benchmark for net worth accumulation. Although conservative for physicians of a past generation, it may again be more applicable in the future because of the current managed care environment and political turmoil.

Here is the guide: Multiple your age by your annual pre-tax income from all sources, except inheritances; and then divide by ten.

Example

As an HMO pediatrician, Dr. Curtis earned $60,000 last year. So, if she is 35, her net worth should be at least $210,000. How do you get to that point? In a word, consume less and save more. Stanley and Danko found that the typical millionaire set aside 15 percent of earned income annually and has enough invested to survive 10 years, at current income levels if he stopped working. If Dr. Curtis lost her job tomorrow, how long could she pay herself the same salary?

More:

Assessment 

In one non-medical but stark example of inattentiveness to net-worth, John McAfee, the entrepreneur who founded the antivirus software company that bears his name, is now worth about $4 million, down from a peak of more than $100 million, according to the New York Times.

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Product Details  Product Details

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

Filed under: "Doctors Only", Career Development, Financial Planning, Funding Basics, Investing, Recommended Books | Tagged: , , , , , , | 19 Comments »

What is a Zero-Based Budget?

Posted on August 22, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A Most Cruel – but Needed – Endeavor

[By Staff Reporters]fp-book2

A zero-based budget means you start with the absolute essential expenses and then add-back expenses from there until you run out of money. This is an extremely effective, yet rigorous, exercise for most doctors and medical professionals; and can be used personally or at the office.

Triage and Prioritize

Your first personal financial item should be retirement plan contributions, then your mortgage and other debt payments, and then other required fixed expenses. From the office perspective, the first budget item should be salary expenses for both you and your staff. Operating assets and other big ticket items come next, followed by the more significant items on your net income statement. Some doctors even review their P&L statements quarterly, line by line, in an effort to reduce expenses. Then, you add discretionary personal or business expenses that you have some control over.

More Month than Money

Now, do you run out of money before you reach the end of the month, quarter, or year? Then you better cut back on entertainment at home or that fancy new, but unproven piece of office or medical equipment. This sounds Draconian until you remind yourself that your choice is either (1) entertainment now but no money later or; (2) living a simpler lifestyle now as you invest so you’re able to enjoy yourself at retirement.

Assessment

When you were a young doctor, budgeting may have seemed a task needed far into the future; but at midlife, you are staring retirement right in the face.

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

 

Product DetailsProduct DetailsProduct Details

Filed under: Financial Planning, Funding Basics, iMBA, Inc., Retirement and Benefits | Tagged: , , , , | 2 Comments »

Off-Road Touring with Dr. Marcinko [Part V]

Posted on August 21, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

About the Ship USNS COMFORT
By Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief]
Dateline: August 4, 2009USNS Comfort Canton, Maryland

The official Navy ship USNS COMFORT [“Medical Treatment Facility”] has the primary mission to provide a mobile, flexible and rapidly responsive capability for acute medical and surgical care in support of amphibious task forces. These forces include the Marine Corps, Army and Air Force elements, forward deployed Navy elements of the fleet, and activities located in areas where hostilities may be imminent. Operations are governed by the principles of the “Geneva Convention for the Amelioration of the Wounded, Sick, and Shipwrecked Members of the Armed Forces at Sea”, as of August 12, 1949.

Mission

As a secondary mission of the ship COMFORT is providing a full hospital service asset for use by other government agencies involved in the support of relief and humanitarian operations worldwide. These mission statements are accountable to both the Reduced Operating Status (ROS) and Full Operating Status (FOS) military personnel staffed at National Naval Medical Center, Bethesda Maryland until the ship is activated. However, the ROS personnel’s immediate and number one priority is to fully activate the ship to a FOS Echelon III Medical Treatment Facility within a prescribed 5-day time frame.

Functions

In meeting these missions, the ROS personnel perform the following functions:

  • Serve as the nucleus of the critical core required to execute activations;
  • Develop, test, and maintain systems and procedures to support activation process;
  • Orient and train FOS augmenting staff;
  • Monitor/assess the medical treatment facility’s overall ability to fully activate/perform mission.

Leaders

The ship is commanded by CAPT James J. Ware DDS, with Executive Officer Captain Larnerd, and Master Chief Lohner. The home base is Baltimore, Maryland.  Upon arrival at the dock, the ME-P and I planned to meet onboard with Master David Lieberman. But, an interview was cancelled due to a last minute scheduling conflict. However, we were placed in the competent hands of our civilian tour guide, Shaun B. of Virginia. He noted 70 civilian and 700 military personnel.US Comfort

Assessment

Shaun B, informed me that despite advanced age, my application for a four month tour would be gladly reviewed. And, it is under serious future consideration as my nurse sister is a recent Bronze Star Award winner from a Combat Army Surgical Hospital [CASH] unit stationed in Iraq. I also did my trauma surgery training in Martin Army Hospital, at Fort Benning Georgia, back-in-the-day.

About Off Road with Dr. Marcinko

These sporadic off-road segments will continue through-out my 2009 summer promotional tour. Attendance at several formal and informal engagements increased since the early summer. The previously noted sales spike for our texts, handbooks and dictionaries www.HealthDictionarySeries.com continued and interest in our online www.CertifiedMedicalPlanner.com program and premier quarterly guide: Healthcare Organizations [Journal of Financial Management Strategies] www.HealthcareFinancials.com remained high.

Part IV: https://healthcarefinancials.wordpress.com/2009/08/13/off-road-touring-with-dr-marcinko-part-iv/

Conclusion

And so, your thoughts and comments on this Medical Executive-Post 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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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Healthcare Organizations

Filed under: Career Development, iMBA, Inc., Military Medicine, Op-Editorials, Sponsors, Touring with Marcinko | Tagged: , , , , , , , , , , , , , , , , | 2 Comments »

Understanding Deviations in Medical Billing

Posted on August 21, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Appreciating Normative Comparisons

[By Patricia A. Trites; MPA, CHBC, CPC, CHCC, CHCO ]

tritesDeviation in medical billing can be detected through utilization data that insurance companies produce on all providers that submit a claim for payment of services.

Insurance companies track utilization through a variety of parameters, including CPT codes, ICD-9-CM, or number of referrals. Different programs utilize certain benchmarks to trigger a review.

Example

For example, a physician who sees patients in the office from 8:00 a.m. until 8:00 p.m., seven days a week and has the highest billing amounts in the region can be subjected to a review. This doctor’s activities would be scrutinized. The utilization review department would probably flag this doctor’s provider number and request more information on a sampling of his or her claims, based on the volume.

Utilization Review

Some utilization review activities may occur due to the type of services that a doctor may offer. For example, if a cardiologist should suddenly start billing for a large number of incision and drainages of abscesses, this might trigger a review, since that might not be a typical scope of service for this doctor in this locality. The same could be said for a pathologist, triggering a review due to the high volume of wound care or ulcer debridement.

Audit Trigger Thresholds Vary

Thresholds vary from locale to locale regarding what triggers an audit. There are consultants who have suggested querying the local carrier for provider specific information regarding utilization activity to compare against community performance. Some Carrier Advisory Committee (CAC) representatives have indicated that this may bring undesirable attention from the Medicare program and trigger an audit. Consult professional associations. and, if possible; local CAC representatives to obtain most current information in your area.

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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My Favorite Health 2.0 Experience from McDonalds

Posted on August 20, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Meet the Schwieterman’s

By Dr. David Edward Marcinko; MBA, CMP™biz-book

Back in 2005, we published the second edition of our popular textbook: the Business of Medical Practice. And, we are now working on the third edition. At the time however, I was fortunate to have a colleague from the Microsoft Corporation pen our Foreword, now reprinted below for your review.

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

 

What a Family Tradition!

My favorite story came from Dr. Thomas Schwieterman, a fourth-generation physician working in the same medical office his great grandfather established in 1896 in the town of Mariastein, Ohio. From those same historic environs, Schwieterman has used Microsoft Access to create his own physician assistant application.

The Schwieterman Family Physicians practice kept him so busy that he was wondering how he could keep up with his patient caseload. Schwieterman wanted a faster way to handle prescriptions, provide medical information, and record data for his patient records. He walked into a McDonald’s restaurant one day and had an idea.

The Epiphany

“I ordered a cheeseburger and fries and watched the person at the counter touch the screen of the cash register a few times, and realized the order was getting transferred back to the food preparation area, and that by the time I paid, my order was ready,” he said. “I thought to myself: ‘That’s what I need!’” He searched for commercially available solutions, but when he couldn’t find an exact match for his needs, and when he found prices steep for a small private practice, he decided to create his own – using Access. He also called upon a friend with a Master’s Degree in electrical engineering to help on the coding. His creation boosted his income by 20 percent – “Which was important because we pay more than $60,000 a year for malpractice insurance even though our clinic has never been sued since it was founded 107 years ago.”

Assessment

What my friends at Microsoft especially like about this story is that when Dr. Schwieterman’s colleagues tried his program, liked it, and suggested he try to sell it, he put together a PowerPoint presentation – and landed a partnership agreement with a major healthcare supply and services corporation to market his ChartScribe solution.

Conclusion

So, the pressures facing physicians are great, but so are their resources. Information technology is one resource, this book is another, but the greatest of all is the innate curiosity and drive to discover and create that seems to be so much a part of those who are drawn to this noble profession.

Ahmad Hashem; MD, PhD

Global Healthcare Productivity Manager

Microsoft’s Healthcare Industry Solutions Group

Microsoft Corporation

Redmond, Washington 

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think. 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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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Integration of Hospital Automatic Data Collection Technologies

Posted on August 19, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Review of Automatic Data Collection Equipment

By David J. Piasecki, with
Hope Hetico; RN, MHA

While hardware costs of automatic data collection [ADC] equipment continue to come down for hospital and healthcare organizations, the cost of integration will often prove to be the project buster. Software and integration costs will often be several times the cost of the hardware, especially in smaller health system operations where only a few devices will be used. Integration of ADC technologies is also far from standardized.

www.HealthcareFinancials.comHO-JFMS-CD-ROM

Example:

For example, when implementing a system with portable terminals, one integrator may create a program on the terminals that will write directly to the file on the host system, another may create programs on a separate server to do this, another may write or modify a program on your host system and use terminal emulation software, and another may use a screen mapping tool to reformat an existing program to be used on the portable device. So, make sure to speak with several integrators to ensure the best solution. Also, make sure to participate heavily in equipment selection and program/process design (prompts, data input) to ensure a system that provides the highest levels of accuracy and productivity.

Real-Time Locator System 

A real-time locator system (RTLS) uses RFID technology that provides the objects they are attached to the ability to transmit their current location.  The system requires some type of RFID tag to be attached to each object that needs to be tracked, and RF transmitters/receivers located throughout the facility to determine the location and send information to a computerized tracking system. While it sounds like a great way to eliminate “lost” inventory, the systems are still too costly for most inventory-tracking operations and are more likely to be used to track more valuable assets.

Screen Mapping/Screen Scraping

This software provides the functionality to change the arrangement of data fields on a computer screen that accesses a mainframe computer program. Screen mapping is frequently used in combination with terminal-emulation software to “remap” data fields from a standard mainframe program to be used on the smaller screen of a portable hand-held device.

Speech-Based Technology

Speech-based technology, also known as voice technology is really composed of two technologies:  (1) voice directed, which converts computer data into audible commands, and (2) speech recognition, which allows user voice input to be converted into data.  Portable voice systems consist of a headset with a microphone and a wearable computer.

Terminal Emulation

Software used on desktop and portable computers is available that allows the computer to act like a terminal connected to a mainframe system. If you have a networked desktop PC and are accessing mainframe programs (green screen programs) you are using terminal emulation. Terminal emulation is also a common method used to connect portable computers (as in pharmacy bar-code ADC systems) to mainframe software.

Warehouse Management System

Computer software designed specifically for managing the movement and storage of materials throughout the healthcare system warehouse or chain of command generally controls the following three operations:  (1) put-away, (2) replenishment, and (3) picking.  The key to these systems is the logic to direct these operations to specific locations based on user-defined criteria.  Warehouse Management Systems (WMSs) are often set up to integrate with ADC systems. 

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Can you think of any other data integration technologies?  Tell us what you think. 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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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Filed under: Career Development, Experts Invited, Glossary Terms, iMBA, Inc., Information Technology, Practice Management | Tagged: , , , , , , , , , , , , , , | 1 Comment »

ME-P Healthcare Reform Survey?

Posted on August 18, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Off-Road Touring with Dr. Marcinko [Part V]

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

About Marquette, Michigan

As our ME-P readers are aware, Marquette Michigan has a population of 20,714, and is the UP’s largest community. In addition to being a population center, it serves as the regional center for education, health care, and outdoor recreation. This regional draw is particularly evident due to Northern Michigan University and Marquette General Hospital [MGH]. Naturally, during my recent tour there, I was able to visit both small and large medical practices, clinics and hospitals. Everywhere, the topic of conversation was the Obama Administration’s vision of domestic healthcare reform. And so, after unofficially asking local residents on their feelings in the matter, we are pleased to offer this survey to all readers and subscribers to our Medical-Executive Post.

Bell Medical

 

About Off Road with Dr. Marcinko

These sporadic off-road segments will continue through-out my 2009 summer promotional tour. On the one hand, formal attendance at several engagements was a bit sparse because of the death of several recent celebrities and entertainer types. On the other hand, local book stores and sponsors noted a spike in our CD and book sales, as well as interest in our online www.CertifiedMedicalPlanner.com program and premier quarterly guide: Healthcare Organizations [Journal of Financial Management Strategies] www.HealthcareFinancials.com

Part IV: https://healthcarefinancials.wordpress.com/2009/08/13/off-road-touring-with-dr-marcinko-part-iv/ 

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

 

 

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About Practice Fusion and Free eHRs

Posted on August 17, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A Web Based Concept in the Clouds

By Staff ReportersOpen

Practice Fusion is a firm that reports to address the complexities and critical needs of today’s healthcare environment by providing a free, web-based electronic Health Record (eHR) application to physicians.

America’s Fastest Growing EHR community

Practice Fusion is also a fast growing electronic Health Record community. Founded in 2005, they are rapidly expanding and adding new users regularly. Over 18,000 physicians and practice managers in 50 states currently use Practice Fusion’s electronic Health Record.

Online and Free

Practice Fusion stands out in a marketplace dominated by complicated, expensive and often inefficient eHR services. Their user-friendly eHR is reported to be activated in less than five minutes, with no downtime or extensive training; eliminating the difficult conversion process that has become an industry-standard.

Secure and Reliable

The firm understands the mission-critical nature of their application. Practice Fusion’s electronic Health Record is developed for the highest levels of security and performance with world-class data centers equipped with best-in-class technology to securely house sensitive data.

Assessment

Although Practice Fusion is a young company, they are led by a well-established team of healthcare and technology veterans. Practice Fusion is directed by a group of investors and medical practitioners who believe in the power of electronic Health Records. Investors include Band of Angels, Salesforce.com and Felicis Ventures. So, give the site a click, and tell us what you think! www.PracticeFusion.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Comments from users and early adopters are especially 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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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Kelly Mclendon RHIA censors D. Kellus Pruitt DDS

Posted on August 16, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

By Darrell K. Pruitt; DDS

Dateline: 8.15.09

pruitt

Dear Kelly Mclendon, Registered Health Information Administrator

You are beginning to make me feel insulted, and I will not have that. I just noticed that the last two comments I submitted to your Website, www.spacecoastmedicine.com, on August 9 and 10, are still “awaiting moderation.”

http://www.spacecoastmedicine.com/2009/08/electronic-records-for-all-patients-mandated-by-2014.html#comment-89 

(For clarity, the comments which scared Mr. Mclendon are copied below) 

Over five days have passed, and I want you, your readers and my readers to know that I spent a lot of time preparing those two pieces exclusively for you at your invitation for comments. You are as sincere as I am, aren’t you? 

When I’ve caught others in the squeeze you might be experiencing, several have pleaded that the censorship was an innocent oversight, and did the right thing immediately by posting everything I send them (include this comment, please). And then again, there are a few slow-learning, command-and-control types who think they cam still somehow control the content of their Websites. Like you, Kelly, an anonymous dentalblogs.com editor whom I call “Nancy” by default, also informed me that my comments were awaiting indefinite moderation. What a foolish, rookie mistake that proved to be. For example, if you google “dentalblogs.com,” my article “Dentalblogs.com hates D. Kellus Pruitt DDS” is their 4th hit. It seems to be very popular. 

How’s this for the title of a comment that should make it to your first page by Monday: “Kelly Mclendon RHIA censors D. Kellus Pruitt DDS”? Please, no phone calls. 

D. Kellus Pruitt; DDS 

Dateline 8.9.09 

I’m sure physicians’ businesses are no different than dentists’ when it comes to the liability of data breaches – especially considering the giddy, mindless momentum of HITECH-empowered HIPAA. If a computer is stolen in a burglary, compromised by a dishonest employee who sells IDs on the side, or otherwise hacked, and the dentist reports the tragedy according to the letter of the law, it inevitably means bankruptcy even before the feel-good fines are levied by HHS (HIPAA) and the FTC (Red Flags Rule) for not having required irrelevant documentation of administrative trivia in order. What were our lawmakers thinking? 

I guess the HIPAA blunder proves that when politicians, insurers and healthcare IT entrepreneurs get together in vendor clubs like CCHIT, the only government-approved eHR certification authority, they can mandate damn well any law that suits their needs. 

Allscripts CEO Glen Tullman, who is an influential friend of Barack Obama as well as a Trustee of CCHIT told Bloomberg.com reporter Alex Nussbaum in an interview almost a year ago that providers should make the financial commitment “to ensure that doctors have some skin in the game.” 

Glen Tullman is only one reason our nation’s healthcare IT industry stinks from the top down. 

D. Kellus Pruitt; DDS

Dateline: 8.10.09 

Thank you, Kelly Mclendon, for providing a rare venue to possibly clear up a few items of uncertainty about eHRs in dentistry. First of all, if a technological advancement such as eDRs does not pay for itself, even with government subsidies, who pays for it? That seems like a quick way to increase the costs of dental care – and for what? How do dental patients benefit from expensive HIT solutions when the telephone, fax machine and US Mail serve us fine? 

Digitalization of records offers no benefits to dental patients. Only stakeholders who would grab our patients’ money benefit from HIT. Everyone else loses. Trusting, naive dental patients lose the most. 

Electronic dental records are expensive hazards. If you can think of a lame reason for them, please let me hear it. You can bet I’ve crushed it before. I’ve been down this road with others many, many times. 

Within a week, the government will price computerization smooth out of dentistry. Over 90% of dentists have patient identities on their computers today. If HIPAA is enforced, with or without the Red Flags Rule, I predict that less than half of the nation’s dentists will be computerized a year from now. 

As for your argument that eHRs somehow provide up-to-date and otherwise superior medical histories for dental patients, think about this: If someone changes a paper medical history, it leaves a paper trail. If an insurance thief alters allergies on a digital record to suit his or her own needs, nobody in the emergency room can tell. Whoever said “Paper kills,” lied. It is a catchy PR pitch, though.

Conclusion

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Health Plan Management Navigator

Posted on August 16, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

August 2009 Edition

By Douglas B. Sherlock; CFA, MBALibrary

Linked below is the August 2009 edition of Plan Management Navigator. In this month’s edition, we update readers on the results for the Blue Cross Blue Shield universe, and provide product breakouts, summary functional area breakouts as well as expense trends. Cost increases are lower this year than last, though higher if product mix is considered. Twenty-two Blue Cross Blue Shield Plans serving 31.3 million members participated in this year’s benchmarking study.  Growth in Information Systems and Medical Management costs explained more than 40% of the total increase.

Link: Navigator August 09

Sherlock Expense Evaluation Report

This analysis is based on materials from our Sherlock Expense Evaluation Report (SEER) for Blue Cross Blue Shield Plans. Additional information about SEER is available at http://www.sherlockco.com/seer.shtml or by contacting us.

Assessment

In coming weeks, Plan Management Navigator will summarize other results of this year’s performance benchmarking studies. We expect to publish Medicare and Medicaid editions in late August or early September. Independent / Provider-Sponsored plan results were published two weeks ago in Plan Management Navigator and the associated presentation and transcript are found at  http://www.sherlockco.com/

Conclusion

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ME-P Invitational Challenge

Posted on August 15, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Now Open to all Mixed Media Types

By Ann Miller; RN, MHA

[Executive-Director]

people_top

The Medical Executive-Post is now open to all submissions of articles, reviews, artwork, videos, surveys and polls, MP3s and photographs for publication. All unsolicited materials becomes the property of ME-P; and the ME-P will not be responsible for them; for publication, or to return them.

Otherwise; all media submissions and formats are invited.

Channel Surfing

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. 

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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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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BCBS-TX Must Talk to D. Kellus Pruitt DDS

Posted on August 14, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Do My Manners Bother Anyone?

[By Darrell K. Pruitt; DDS ]

I posted this on the Dallas Morning News Website in response to an article about BCBSTX downsizing due to the economy.

http://economywatchblog.dallasnews.com/archives/2009/08/health-care-losing-jobs.html

1-darrellpruittDear Jason Roberson – Reporter – The Dallas Morning News 

As a dentist on the east side of Fort Worth whose patients have been harmed by BCBSTX, I say the fewer clients BCBSTX has, the safer Texans are. Changing dentists causes fillings.

Of HIPAA and the NPI Number

It wouldn’t surprise me that until about now, you and most of your readers have never heard of the HIPAA-mandated National Provider Identifier (NPI) number. And it probably doesn’t make much sense to you when I say that it is BCBSTX policy not to process their clients’ dental claims if they come from a dentist who doesn’t have an NPI number, like me. BCBSTX’s horrible policy has not only decreased my number of new patients, but the arbitrary rule also caused a couple of dozen of my long-term patients – who were perfectly satisfied in the comfortable dental home I provided them – to leave me for dentists with NPI numbers. Please note that the 10 digit identification number does nothing improve the quality of care. It only benefits BCBSTX. And did I mention that changing dentists causes fillings?

Not Accepting Assignment 

Even in these tough economic times, I choose to no longer accept BCBSTX. My ethics-based decision hurts me financially, but that is how much I sincerely despise BCBSTX for its NPI policy. Unless Texas Health CEO Doug Hawthorne or a spokeswoman for BCBSTX like Margaret Jarvis or Ross Blackstone mans up to their deception really soon, I hope to help the wheels fall off of BCBSTX as an example to other insensitive CEOs who harm my patients by selling their clueless bosses discount dental plans with no quality control. Special bastards like me proudly volunteer to clean up the neighborhood, just for grins. As a matter of fact, a few sports fans and I are hoping one of the recently laid off BCBSTX employees is named Wilma, who on May 1, 2008 was known as an “overall supervisor” for BCBSTX in the dental claims department. I’m certain that CEO Hawthorne knows her. Then again, it wouldn’t surprise me to learn that he is unconcerned about dentistry.

A Pubic Invitation 

I am publicly inviting Wilma to come forward – even as whistleblower if she still has her job – and share with us the motivation behind the alleged lies she told me during our conversation. Even now, as I listen to our recording, I consider it an entertaining and educational conversation between two people who both know a BCBSTX overall supervisor who brought talking points to an argument. Nevertheless, even while trapped between honesty and her job, Wilma proved to be a devoted employee – willing to risk her own reputation for her boss. The way she sticks with defending a defenseless policy, at times it sounds like the NPI number actually makes sense to her. Then you think, “Surely she is smarter than that.”

Assessment 

I know that coming at the end of one of the strangest comments you have ever attracted, it is appropriately ballsy that I say that there’s a new sheriff in town, Jason. And disrespect around my niche is no longer tolerated if I have anything to do with it. I’ll shoot holes in BCBSTX to help it crash sooner if it will cause fewer Texans experience unnecessary dentistry. How important to one’s oral and systemic health is continuity of care when virtually all oral problems are caused by neglect? Is BCBSTX dental insurance worth the hidden price? Thank you for the opportunity to air out my opinion.

Conclusion

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Off-Road Touring with Dr. Marcinko [Part IV]

Posted on August 13, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

About Atlas Sports Genetics

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Dateline: July 6, 2009people_top

Did you know that for about $150 bucks, Atlas Sports Genetics [ASG], a company in Boulder CO, offers a DNA test kit to evaluate actinin; a protein found in fast-twitch muscle fibers? Yep; it’s true!

About ASG

ATLAS™ stands for Athletic Talent Laboratory Analysis System and is a leading edge athletic talent identification test that uses enhanced DNA analysis to identify those athletes that are genetically predisposed to either speed/power or endurance characteristics. Through the analysis of a specific DNA gene called ACTN3, the SportGene® Test developed by Genetic Technologies in Australia, is now available in the United States through Atlas Sports Genetics.

The Kit

Using a cheek swab sent to the lab, a report on the gene ACTN3 is received by mail several weeks later. The test is touted to be helpful in determining the best sport, or prefect athletic career, for participants. And, it is highly sought after by helicopter parents wishing to pursue a college scholarship or sports contract for junior [i.e., marathoner versus sprinter, etc].

Just take a look here: http://www.atlasgene.com

AssessmentESPN

How did I learn about all this? Why, from an USOEC parent of course, during my travels to Upper Michigan. And me? I’ve been a middle distance runner for 35 years; even with a dislocated finger! LSD anyone; long-slow-distance.

 

About Off Road with Dr. Marcinko

These sporadic off-road segments will continue through-out my 2009 summer promotional tour. On the one hand, formal attendance at several engagements was a bit sparse because of the death of several recent celebrities and entertainer types. On the other hand, local book stores and sponsors noted a spike in our CD and book sales, as well as interest in our online www.CertifiedMedicalPlanner.com program and premier quarterly guide: Healthcare Organizations [Journal of Financial Management Strategies] www.HealthcareFinancials.com

Part I: https://healthcarefinancials.wordpress.com/2009/07/20/off-road-touring-with-dr-marcinko-part-i/

Part II: https://healthcarefinancials.wordpress.com/2009/07/22/off-road-touring-with-dr-marcinko-part-ii/

Part III: https://healthcarefinancials.wordpress.com/2009/07/24/off-road-touring-with-dr-marcinko-part-iii/

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think about the performance predictive power of ACTN3? 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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