Dr. David Edward Marcinko MBA MEd CMP™

Using Home Mortgage Brokers

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

Advantages and Disadvantages

By Staff Reporters

A physician or other medical professional may consider using the services of a home mortgage broker when s/he does not want to spend much personal time searching for the best loan. Other reasons include poor credit history, low credit ratings level; or similar. Of course, this will cost the doctor-client money, but the expense may be worth it; or not.

Duties and Responsibilities

A mortgage broker’s main responsibility is to represent a physician-borrower to different lenders and to take the borrower through the process of acquiring a loan. These brokers are usually aware of the best lending institutions and where to get the best deals.

Disadvantages

However, using a broker has three disadvantages. First, a fee will be charged. Second, some lenders will not work with some brokers. Third, some lenders will add extra fees to their loans to pay the broker’s commission.

Assessment

During the current financial crisis, the use of this intermediary may be a necessity in some cases.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. What has been your experience using the services of a mortgage broker; if any?

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Independent Medical Practitioner as Solo Primary Care Surrogate

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

Doctors Facing a Bleak Future Business and Financial Planning Model

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

According to Physicians News, on March 19, 2009, the demand for family physicians is growing. Proposals for health system reform focus on increasing the number of primary care physicians in America. Yet, despite these trends, the number of future physicians who chose family medicine dipped this year, according to the 2009 National Resident Matching Program. What gives?

NRMP

The National Resident Matching Program [NRMP] recently announced that a total of 2,329 graduating medical students matched to family medicine training programs. This is a decrease in total student matches from 2008, when 2,404 family medicine residency positions were filled.

Primary Care Demand Explodes

Meanwhile, demand for primary care physicians continues to skyrocket. For example, in its most recent recruitment survey, Merritt Hawkins, a national physician recruiting company, reported primary care physician search assignments had more than doubled from 341 in 2003 to 848 last year.

The Decline of Solo Medical Practitioners

Regular readers and subscribers to this Medical Executive- Post are aware of the declining number of solo medical practitioners; we have been sounding the alarm here, in our books, journal, speaking engagements and elsewhere for years now.

In fact, the statistic that we often cite is that more than 40% of the nation’s physicians are employed doctors; not employers as in the past. This business model shift has occurred over the past decade or so, and has accelerated of late. The decline in solo and independent doctors has occurred elsewhere as well, but much more slowly [i.e., dentistry, podiatry and osteopathy] as these specialties have been somewhat isolated from the traditional allopathic mainstream.

Going forward, this solitary model seems to be a good thing, and a fortunate result of the un-intended consequence of previously keeping these folks out of the healthcare mainstream.

The Decline of Independent Medical Practitioners

Now, in the March 2009 issue of Healthcare Finance News, we learn that the number of hospital owned physician practices has been climbing over the last four years, according to the Medical Group Management Association [MGMA]. Think: PHOs back-in-the-day.

And, while this trend only marginally affects patients and patient care, it is quite disruptive to physicians, their families, personal wealth accumulation, retirement and estate planning endeavors.

For example, according to Professor Hope Rachel Hetico, RN, MHA, CMP™ of our firm www.MedicalBusinessAdvisors.com

“The professional good-will valuation component of a medical practice is being decimated. Today, some practices are being bought and sold for tangible asset value, only.

Assessment

Therefore, allow me to identify this emerging trend which suggests independent medical practice as reflective of solo primary medical care. In other words, as independence goes the way of the “dodo-bird”, so goes primary care practitioners precisely at a time when the later is needed more than the former.

Why? Employed doctors stay that way by making money for their employer and hospital-bosses. Specialists make more money than primary care doctors. So, if you want to stay an employed doctor; which specialty would you pursue?

Answer: The NRMP class this year spoke out loud and clear. Any specialty but primary care!

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Conclusion

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Medical Practice Financial Statement Valuation Adjustments

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

Why Benchmarks are Out – and Scrutiny is In

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

CEO: www.MedicalBusinessAdvisors.com

As discussed elsewhere on this ME-P, the medical practice appraiser’s primary goal is to determine the value of the business based on its expected earnings or cash flow. To accomplish this, the medical practice appraiser looks to the company’s historical financial statements to see how it has been reporting its earnings. Because of differences in accounting practices across organizations, the appraiser must analyze how the medical practice’s financial statements differ from those of other practices and how those differences might have an effect on the practice’s value. This is particularly true when the appraiser is comparing the performance of the medical practice company being valued with those of so-called industry benchmarks. In all instances, it is important that the appraiser compare numbers that have been accounted for in the same way. Below is a discussion of the most common adjustments.

Nonrecurring or Extraordinary Items

Nonrecurring or extraordinary items of income or expense reported by the practice will be eliminated from the profit and loss statement. These include the following:

• Insurance settlements (income or expense) or life insurance proceeds on the death of the key physician-partner.

• Large payments in settlement of lawsuits (either as income or as expense).

• The gain or loss on the sale of certain assets or portions of the practice which are not likely to be repeated.

• Expenses related to the start-up or discontinuance of a new or old segment of the practice.

• Moving and related expenses.

• Expenses relating to fire or flood damage not covered by insurance.

• Adjustments to prior years’ financial statements when the practice discontinued an employee benefit (such as eliminating the company’s pension or profit-sharing plan).

• Adjustments for income and/or expenses related to non-operating assets, such as a portfolio of marketable securities not used in the practice or medical real estate held for investment purposes.

Valuation Calculations

The appraiser needs to gather the following facts regarding the financial statements of the practice and may need to make adjustments to account for these differences. The information will give the appraiser an understanding of the company’s normalized earnings and will be used to make valuation calculations.

• How does a specialty practice [such as physiatry’s DME] value its inventory—LIFO or FIFO? In certain specialties, inventory is accounted for on the LIFO or “last-in, first-out” basis. When prices are rising, profits are reduced because the DME items being sold are presumably bought most recently at higher prices. The “old” or lower-cost inventory is held in reserve while the higher-cost inventory is sold off. This situation may reverse in times of recession and low or no inflation. At that point, profits will be distorted by the low-cost items. Recognizing these facts, practice owners have more commonly used FIFO or “first-in, first-out,” inventory accounting to value their inventory.

• What kind of reserves has the practice been taking for doubtful accounts receivable? Some doctors will not – or very slowly – write off bad debts or take reserves for them, and thus the income is improperly overstated. The appraiser will look at the actual bad debt expenses relative to the doubtful accounts receivable booked to determine if the practice’s adjustments are reasonable.

• How does the practice depreciate its hard assets? A variety of approved methods are used to depreciate assets over their useful lives. It is important for the appraiser to recognize the impact these methods have on corporate earnings. Some assets can be depreciated over a short time frame, which will mean higher annual write-offs; others, such as real estate, must be depreciated over a much longer period and thus will have a smaller impact on annual expenses.

Asset-Related Issues

The appraiser must address asset-related issues, such as:

• Has the practice’s assets been valued recently? If not, will current appraisals be required?

• Are any non-operating assets carried on the books of the practice? These assets may have to be valued separately and added to the operating value of the business.

Assessment

In our experience valuating medical practices, adjustments made for excess compensation and perquisites paid to the physician-owner and other family members, are the most common items of contention between buyer and seller.

For example, above average physician income usually equates to lower medical practice transferrable enterprise value; and vice versa.

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Conclusion

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Dictionary of Health Economics and Finance
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Reflections on Evidence Based Dentistry

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

My Search for Truth – 2009

[By Darrell Kellus Pruitt; DDS]

Do the leaders of the American Dental Association [ADA] encourage critical thinking by membership? Or; do they fear my opinion of what appears to be destructive and self-serving institutional bias in my ADA that favors businesses peripheral to the care of dental patients, and at patients’ expense? I think it is clear that there are a few good ol’ boys imbedded in the fat ADA who prefer to hide behind a comfortable, but obsolete command-and-control ADA business model. The mighty ostrich stuck its head in the sand. Then along came a noisy, gasoline-powered weed-whacker. Never saw it coming.

Evidence-Based Dentistry Champion Conference

On May 29-30, the First Annual “Evidence-Based Dentistry (EBD) Champion Conference” will be convened in ADA Headquarters in Chicago. Just like last year, the meeting with a brand-new name is sponsored by Procter & Gamble and The Journal of Evidence-Based Dental Practice with Dr. Michael G. Newman as its Editor and Chief. Even though this effort is enthusiastically supported by large corporations with products to sell, like P&G, managed care insurance companies such as Delta Dental, and electronic health records vendors such as Allscripts, the power of the reclusive stakeholders is further amplified by bureaucrats inside and outside the ADA – siphoning off my professional organization’s credibility. That is my opinion based on actual contact with a few characters in this group.

Evidence-Based Dentistry: 3rd International Conference

I attended the meeting last year when it was called “Evidence-Based Dentistry: 3rd International Conference” – I assume that in the last year, it lost its “international” status, and now caters only to “EBD Champions” (cheerleaders). Last year, they were also looking for Champions for their EBD ideas, but the bias was better concealed. I reported on the meeting in an article called “Evidence-Based Dentistry – My search for truth.”

http://community.pennwelldentalgroup.com/forum/topics/evidencebased-dentistry-my

Shortly into the meeting on May 4, 2008, I could tell by a show of hands from attendees that as a dentist who actually puts his hands in patients’ mouths as a regular part of his job; I was virtually alone in the auditorium. This was confirmed by the volume of “Boo” directed at me later that day. The Champions who had been selected months before the conference had already met that week and they were pumped. One could smell the zeal for EBD – whatever it means.

Journal of Evidence-Based Dental Practice

In his introduction to last year’s conference, Dr. Michael G. Newman, Editor in Chief of the Journal of Evidence-Based Dental Practice, told attendees that P&G is providing all the information about EBD to all the dental schools in the nation. I will be honest with you. Being booed last year for addressing what I think is the inferior quality of managed care dentistry during the final discussion period may have affected my attitude about EBD. In addition, being subsequently blocked from responding to a hurt and angry managed care discount dentistry broker by an ADA employee named Dr. Ron Zentz also disappointed me in my ADA. Dr. Zentz told me “This is not the place for this” as he stood between me and the microphone. Later I could not get Zentz to concede the indisputable fact that quality is proportional to reward. When I pressed him for an answer to the managed care question, he stoically repeated exactly what the insurance representative said: “Whether the dentistry is managed care or not, it makes no difference in the quality of care.” Here is something cute: The event was an “Evidence-Based” conference on the second floor of the Headquarters of the ADA, and Dr. Zentz is employed in the ADA’s “unbiased” science department. Get it? Now that’s funny!

Trouble-Makers Don’t Get Invited Back

My bad behavior last year may have something to do with why I was not invited to attend this year, even though I worked hard on the prerequisite essays which I will share with you later. Nevertheless, I have to warn that ADA-approved propaganda from P&G doesn’t strengthen this dentist’s confidence that our leaders are protecting the future of dentistry, friends. Take a look at what healthcare parasites have quietly done over the last decade or so to physicians’ practices with the blessing of the AMA, and counter to the interests of patients. Those same parasites were in ADA Headquarters on May 4, 2008. Our house at 211 East Chicago Avenue reeked.

EDB Vagueness

Like the HIPAA Rule on which Newman’s favorite interpretation of EBD leans hard, the beauty of EBD is in its vagueness. Both HIPAA and EBD can mean damn well anything one needs them to mean, and stakeholders with lots of influence have their fingerprints and drool all over the plans. For example, Dr. Robert Ahlstrom, a stakeholder and one of the speakers at last year’s conference uses HIPAA to support EBD and vice-versa according to closed-circuit, cause-I-said-so science that he evidently makes up as he goes. It is difficult for me to imagine that Ahlstrom’s eleven reasons that HIPAA benefit dentistry – which he presented as testimony for HHS Secretary Michael Leavitt over a year ago – were approved by a committee. I think Ahlstrom made up his reasons while waiting in the hall for the NCVHS meeting to begin. If the reasons were indeed approved by an ADA committee, I extend my sympathy. It must be difficult for challenged people like that to safely find their way home from work every day.

(See “HIPAA and Dentistry – About Ahlstrom’s Controversial HIPAA Testimony”)

https://healthcarefinancials.wordpress.com/2009/01/08/hipaa-and-dentistry/

Where is the Evidence?

A few hours before Dr. Ahlstrom, an ADA NHII (National Health Information Infrastructure) Task Force member, took the podium, Dr. Newman pleaded with dentists to always ask, “Where is the evidence?” I know Dr. Ahlstrom heard Dr. Newman’s words because Ahlstrom was sitting on the first row, next to ADA Senior VP Dr. John Luther, who is in charge of the ADA Department of Dental Informatics – a major beneficiary of EBD and HIPAA.

***

Buzzwords

I have come to the conclusion that EBD is a buzzword for a scheme supported by avaricious stakeholders who seek to regulate dentistry using healthcare IT. I assume it will be left to Dr. Robert Ahlstrom to present the plan to the next administration in his special, fanciful way. It is clear to me that the ADA is using Ahlstrom to lead American dentists down a computerized, cook-book path initially promoted several years ago at ADA Headquarters by none other than Newt Gingrich. The path ends with the NPI, NPPES and Ingenix-style Pay-for-Performance instead of free-market competition and consumers’ desires. Like Ahlstrom, EBD is little more than a tool.

Living with Rejection

I learned a couple of days ago that my application for this year’s conference was rejected. A PDF letter signed by Dr. Michael Newman, Editor and Chief of the Journal of Evidence-Based Dental Practice stated that the competition for seats was intense this year, and that I just didn’t have what the selection committee was looking for in a “champion” – even though one can see by their essay questions that the EBD stakeholders desire dentists who can draw audiences.

My Responses

Below are my responses to this year’s questions that I posted on September 23, even before I hooked up with PennWell, and the ME-P. I’m even more widely read now.

Q: Are you involved in the treatment of populations with limited access to care?

Counseling people who have big problems and little money is part of the job. Almost every day I help patients make hard decisions that affect their appearance as well as health. Compromises are always difficult, especially when it involves children. I do my best to provide my patients with the information they need concerning their specific problems in a personal manner. In that respect, I am no different than almost all other dentists I know.

Q: Given the opportunity, how do you plan to disseminate the information and knowledge of EBD?

For dentistry-related news, I am arguably the most popular commentator on the Internet. If I am convinced that EBD is in patients’ best interest, I can promote the concept to a wider audience than anyone else in dentistry and it will not cost a thing. I can use any number of websites in addition to a private network of colleagues that has been in place for almost three years.

If I leave the conference suspecting that stakeholders ambushed EBD to manipulate dentist-patient relationships for selfish reasons, I will work even more effectively to undermine it. Fair is fair.

Q: Are there any specific examples that demonstrate your ability to be a good disseminator?

Apart from having an increasingly popular column about healthcare matters on this ME-P https://healthcarefinancials.wordpress.com/?s=darrell+pruitt+dds ), I am always seeking new and innovative ways to attract attention to dentistry. I am very good at what I do.

Here is a simple demonstration of my talent: Googlesearch “Darrell Pruitt DDS.” You will discover that I’ve got what they call “googlejuice.” I create interesting content. People you need to reach read me.

The question is; does the ADA have the confidence to subject EBD to my critique? On the other hand, does the ADA have the courage not to?

Since I will not be allowed to keep colleagues in my neighborhood as informed in real-time and in detail as they should be, I invite one or more “EBD Champions” to describe what they learned following the Conference in May right here on this ME-P and PennWell forums. And as always, I invite Dr. Robert Ahlstrom to discuss what he plans to do with my dental practice.

Assessment

Tomorrow, as part of “Transparency and the ADA – a dissecting experiment,” I intend to post another question on the EBD link following my weekly report. I will ask if Dr. Robert H. Ahlstrom will be addressing the audience before having my name put on a short-call list to replace late-cancellations. Depending on the answer, I may go camping instead.

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Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: "Doctors Only", Career Development, Ethics, Op-Editorials, Quality Initiatives, Research & Development | Tagged: ADA, Allscripts, American Dental Association, delta dental, Dr. John Luther, Dr. Michael G. Newman, Dr. Robert Ahlstrom, Dr. Ron Zentz, EBD, eDRs, evidence based dentistry, Evidence-Based Dentistry: 3rd International Conference, HIPAA, Ingenix, National Health Information Infrastructure, Newt Gingrich, NHII, NPI, NPPES, P&G, P4P, Pay-for-Performance, PennWell, Procter & Gamble, The Journal of Evidence-Based Dental Practice | 7 Comments »

About Healthcare Employee Cash-Balance Plans

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

What they Are – How they Work

By Staff Reporters

Motivated by cost savings, an increasing number of hospitals, healthcare systems and large healthcare organizations are converting their traditional legacy defined benefit pension plans to cash balance plans. While the trend seems sudden, it is not surprising. Healthcare related companies are reaping substantial savings from cash balance plans. And for the most part, younger doctors and other employees are enthusiastic about the plans.

However, older employees (age 50 or above) realize that in switching from a traditional defined benefit [legacy] plan to a cash balance plan, their retirement benefits decreased, initiating an onslaught of overwhelmingly negative publicity. Indeed, several years ago, Congress rushed to pass legislation requiring employers to provide benefits computations to affected employees.

Overview

Even though many defined-benefit plans are under/over-funded, they are calculated on an actuarial basis and are quite costly to maintain. And because plan costs can vary from one year to the next, budgeting is difficult.

However, if a healthcare company terminates a pension plan, replacing it with a defined contribution plan such as a profit sharing plan, all employees must be 100% vested, any surplus is subject to income tax, and a portion of the surplus is subject to an additional excise tax even if all of it is transferred to a succession plan. A cash balance plan is a pension plan, so the change is viewed as an amendment to the pension plan. This is true even though in many respects the cash balance plan operates like a defined contribution plan.

The Cash Balance Plan

A cash balance plan works in the following manner: The sum accrued in a hospital’s employee’s defined benefit plan is converted to a lump sum cash value; the employer agrees to make specified contributions to the employee’s account based on compensation; and the account earns a specified rate of interest, say 5%. The employee receives regular statements showing the current cash value of his or her account. [The amount is listed as a lump sum amount even though it is usually paid as an annuity].

If the hospital or other employer already has a defined benefit pension plan and converts it to a cash balance plan, there is no tax on the surplus. The reason, as noted above, is that a cash balance plan is treated as a pension plan. Thus, the employer merely amended its pension plan and can use the existing surplus to provide the required contributions, which are usually less than the actuarial costs of maintaining a traditional pension plan. And, in the former bull market this recent decade, many employers did not have to make contributions at all. Today, of course, the opposite may be true.

Example

Let’s say the average earnings on an investment is 15%, and the rate of interest payable to the plan is 5%. In recent years, many funds have earned 15% or more if they invested in an index fund. It was thought that, if continued, it would be quite some time before some employers are required to make any contributions out of their own funds. Not so today, however.

Clearly, the savings can be substantial, and the costs of maintaining the plan are easily budgeted for. These advantages convinced some public utilities, telephone companies, financial, hospitals and healthcare institutions to convert their plans to cash balance plans.

Impact on Employees

The cash balance plan is actually a hybrid plan—a cross between a traditional defined benefit pension plan and a defined contribution plan. But one of the key differences between the cash balance plan and a defined benefit plan is the manner in which the benefits are calculated. In a traditional defined benefit plan, an employee’s retirement benefit grows slowly in the early years and more rapidly as he or she approaches retirement. By contrast, a cash balance plan increases growth in the early years and decreases growth in later years of employment.

Youngsters

Younger healthcare employees usually liked the change; before the recent financial meltdown. Their accounts were portable; they grew quickly; and could be rolled over into an IRA or into a new employer’s plan. And, their account balances were listed as lump sums, so they know precisely how much they’ve accumulated. Today unfortunately, they have mostly been decimated.

Oldsters

Older healthcare employees initially liked the concept because the values of their pensions (on an actuarial basis) were converted to dollar amounts so they could see how much had accrued in their accounts without having to calculate an anticipated pension award. But, after further review, it was evident that upon retirement the cash bonus plans would yield smaller pensions than the defined benefit plans. Opinions differ today?

Health Workers in the Middle

When a hospital or similar entity converts from a defined benefit plan to a cash balance plan, employees their late 40s may see their pensions reduced by 25% or more while older employees see reductions of up to 50%. If the formula for calculating benefits under the defined benefit plan is 2% times years of service, and high-five compensation, then each year of service increases an employee’s pension. More importantly each time high-five compensation increases, the amount is accrued back to the employee’s original date of employment. So, as a hospital employee gets older, the high five-has tremendous impact. An employee who is age 60 can actually accrue most of his or her pension in the last five years of employment.

www.HealthDictionarySeries.com

No “Mo”

Cash balance plans don’t have that type of momentum [“Mo”]. The company contributes a certain amount based upon compensation and a specified interest rate. Usually, the interest rate is based on the 30-year treasury rate (approximately 2.5%).

Closing the Gap

Some employers are offering a grandfathered benefit designed to reverse the penalty for older workers. For example, employees within 10 years of retirement (usually age 65) will receive the greater of the cash balance plan or the pension under the original plan. This reduces the cost savings for the company.

Some employers increase the contribution percentage for employees based on age (i.e., 7% of compensation is contributed for employees aged 40—rather than the standard 5%—and 9% of compensation for those aged 50).

Assessment

Finally, some hospital employees are offered special “sweetners” in the form of additional lump sum credits when converting from an existing plan to a cash plan. The best benefit provides that all existing employees will receive the greater of the old plan or the new plan upon retirement. Only a small number of employers typically adopt this approach.

Conclusion

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Filed under: Accounting, Career Development, Financial Planning, Investing, Retirement and Benefits, Taxation | Tagged: 401(k), 403(b), cash balance plans, defined benefit plans, defined contribution plans, fringe benefits, IRA, oth IRA, retirement planning | Leave a comment »

Consultants and Hospital Employment Statistics

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

Economic Conditions Better than Other Major Industries

By Staff Reporters

According to Richard Pizzi, on March 9th, Healthcare Finance Newsweek reported that employment at US hospitals climbed 0.14 percent in February to a seasonally adjusted 4,719,300 people.

Bureau of Labor Statistics

Responding to just issued BLS data, the number employed was 6,800 more than in January and 131,800 more than in February 2008. Without seasonal adjustments, which remove the effects of fluctuations due to seasonal events, hospitals employed 4,703,700 people in February 2009, 2,200 more than in January and 130,100 more than a year ago.

Impact on Healthcare Consultants

This was good news for financial advisors, insurance agents and accountants; medical management consultants and health economists; HIT suppliers and related DME vendors, etc.

Assessment

The news was not so good in other areas of the American economy, however, as the national unemployment rate rose from 7.6 percent to 8.1 percent. The US economy shed an additional 651,000 jobs in February 2009. But, according to Rachel Pentin-Maki; RN, MHA of www.MedicalBusinessAdvisors.com

“Employment continues to be strong in almost all aspects of the healthcare industrial complex. This includes professionals, technicians, nurses and para-professionals, as well. However, in the long-term, we believe that medicine will not attract the best and brightest young minds in the future. The economic, political and competitive demographics are just not favorable.”

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is healthcare really a recession proof industry? What about those bright young minds; where will they go for professional careers, instead?

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Filed under: Career Development, Health Economics, iMBA, Inc., Managed Care, Research & Development | Tagged: BLS, healthcare CPAs, healthcare jobs report, hospital employment, medical careers, medical consultants, medical jobs, medical school | Leave a comment »

Apply to our Financial Advisor Consultant Listing Service

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

We’re collecting information on financial advisors, financial planners, accountants, attorneys and/or related folks in the Health 2.0 space who have a particular affinity or expertise advising doctors, nurses, medical professionals, and related others. And, we have been for some time, now.

New Channel Development for Medically Focused Financial Advisors and Management Consultants*

Beta-in-Progress

By Ann Miller; RN, MHA

[Executive Director]

A New Approach

Unfortunately, this usually means that some really interesting and smart folks, who purchase our books, dictionaries, print-journal, blog or email us; may get lost in the confusion. The result is that too many great medically focused consultants that we’d love to hear about are getting lost in the shuffle. And so, we’re trying something else instead.

Tell us about your Practice

Tell us about your financial advisory practice, and you may end up being mentioned in dispatches, or featured on a separate channel that we are developing. Selection and inclusion criteria include but are not limited to the following credentials:

Undergraduate or Graduate degree
Industry acknowledged certification or designation
Clean CRD record
Clean criminal record
Insurance agents need not apply
Stock brokers need not apply
Fiduciaries are encouraged
RIAs and independent advisors are encouraged
Published authors or educators are encouraged
Mission statement on physician niche focus required.

Assessment

So, if you want our readers to pay attention to your financial advisory practice or firm, this will get it into a systematic review process starring our crack staff. Otherwise you may face the peril of lost notoriety to other non-specific niches; or referral sources.

Publisher’s Note: The inclusion or rejection decision is final; but not set in stone and our terms and conditions may change without notice; the beta project may also be cancelled at any time. We reserve the right to reject anyone, at any time, for any reason or no reason at all. This is a beta project-in-development. The advisors listed are not affiliated or endorsed by iMBA Inc., in any way. This is an advertisement opportunity only.

*NOTE: There is a $120 annual fee for this listing service. It is waived for subscribers of our two volume companion print journal, upon request. www.HealthcareFinancials.com

List Link: https://healthcarefinancials.wordpress.com/schedule-a-consultation/financial-advisor-listings/list-of-advisor-consultants/?preview=true&preview_id=8633&preview_nonce=a3203ab9f9

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. What do you think about this idea to develop a new promotional channel for truly physician focused financial advisors?

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Filed under: "Advisors Only", Breaking News, Career Development, CMP Program, Ethics, Financial Advisor Listings, iMBA, Inc., Marketing & Advertising, Sponsors | Tagged: CFA, CFP, CPA, Financial Advisor Listings, financial advisors, financial consultants, financial planners, MBA, PhD, wealth managers | 1 Comment »

Advetising in “Worth” and “Bloomberg” Magazines

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

Advertisers – Give Me a Break!

By Dr. David Edward Marcinko; MBA, CMP™

Did you know that financial advisor Judith Zabalaoui, age 71, considered a pioneer of the fee-only business-model of financial services sales, pleaded guilty to using a Ponzi scheme to embezzle more than $3 million from her New Orleans area clients between 1993 and 2007? Yep, it’s true, but this is not really noteworthy to many pundits considering the current financial meltdown on Wall Street. But, do you know … the rest of the story?

Resource Management Inc.

Most of Zabalaoui’s clients came from Resource Management Inc. in Metairie, La., which she founded in 1974, according to the Times Picayune. Apparently, she became a Certified Financial Planner® in 1979, but the certification expired in 1999.

Link: http://www.nola.com/business/t-p/index.ssf?/base/money-1/1233728420253000.xml&coll=1

Assessment

So, here’s the rub. According to reports, Resource Management Inc. was the only firm in the country where each of the principals were allegedly “selected” by Worth [1996 to present], Money [1987] and/or both magazines as one of the top financial consultants in the country. The company also made Bloomberg Wealth Manager’s list of top wealth managers in 2004.

Industry Indignation Index: 55

Now, with all due respect and humility, I have been asked several times by Worth and Bloomberg to “promote yourself” in their “advertiser-driven” publications as a top financial consultant; but never Money magazine. I have always refused their selection charges for same of $12-18,000.

Full disclosure: I am the Founder of www.CertifiedMedicalPlanner.com and a reformed insurance agent, registered investment advisor and Certified Financial Planner™.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Was Judith Zabalaoui a fiduciary and what about these magazine “best-of” awards? Are they worthwhile monikers or worthless sales advertisements? What about all the so-called financial certifications, designations and charters; meaningful or meaningless? What is your opinion?

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Filed under: Career Development, Ethics, Financial Planning, Industry Indignation Index, Marketing & Advertising, Media Mentions and PR, Op-Editorials, Quality Initiatives | Tagged: Bloomberg, certified financial planner, certified medical planner, david marcinko, insurance, insurance agent, Money magazine, RIA, Worth | 2 Comments »

Integrating Financial and Medical Practice Succession Planning

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

Some Steps to Consider

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Medical practice succession planning is a dynamic process requiring current physician ownership and management to plan for the future and implement the resulting plan. Many doctors approach succession planning initially through retirement planning. Once they understand the issues and realities of the tax laws, they are much more amenable to working out a viable succession plan. At the Institute of Medical Business Advisors Inc, we find that some physician-clients have not clearly articulated their goals, but have many pieces of the plan that need to be organized and analyzed to meet their objectives; including both personal and financial issues.

Link: www.MedicalBusinessAdvisors.com

A Step Wise Process

The steps necessary for successful succession planning are as follows:

Gathering and analyzing data and personal information
Contacting the doctor’s other advisors
Valuing the practice according to USPAP and IRS guidelines
Indentifying the right qualified physician purchaser
Projecting estate and transfer taxes
Presenting liquidity needs
Gathering additional corporate information
Identifying dispositive and financial goals
Analyzing the needs and desires of non-key employees

An Integrated Approach

Succession planning can help address financial and nonfinancial issues in a timely manner. Proper planning can also help the doctor accomplish goals with effective, appropriate strategies that satisfy family needs as well as tax issues. Here is a triad approach:

1. First: Address financial and nonfinancial issues in a timely manner

As with other estate planning engagements, there is no due date for succession planning. The owner of a medical practice is busy growing and managing the office. S/he is often not focused on the desirable outcomes in an orderly practice succession. For example, if family members are involved in the practice, there is a good chance that personal issues will need to be addressed. These nonfinancial issues can be just as important as financial concerns when building a comprehensive, workable succession plan.

2. Next: Focus on taxes

Taxes are important because the medical practice probably represents the largest concentration of wealth in the doctor’s estate. When planning for estates with large amounts of wealth, doctors frequently ignore personal issues. It’s important not to make the critical error of maximizing tax savings but destroying the practice through a poor succession plan.

3. Finally: Identify and reach goals

When the physician-owner has addressed succession planning issues in a timely manner, s/he has the opportunity to develop the most effective objectives to accomplish goals. Given enough time, the doctor can even modify goals to reflect changes in the economic environments, as well changes in his or her personal life.

Assessment

Medical practices exhibit particular strengths and weaknesses not typically found in publicly owned companies or non-professional family businesses. For example, many times the doctor doesn’t realize the type and amount of planning that needs to be done to transfer the business to a new doctor for maximum value. That is why doctors often need the advice of professionals to define goals and formulate medical practice succession strategies.

Conclusion

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

Filed under: Career Development, CMP Program, Estate Planning, Financial Planning, iMBA, Inc., Practice Worth, Research & Development, Retirement and Benefits, Taxation | Tagged: certified financial planner, certified medical planner, Financial Planning, IRS, medical appraisal, medical practice succession planning, medical practice worth, succession planning, USPAP | 1 Comment »

Avoiding an IRS Appraisal Audit

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

Valued Friends and Colleagues

By Linda Trugman; CPA, CVA

We hope this e-mail post finds you well. We have attached our most recent newsletter “Valuation Trends” for your perusal and hope you find something of interest in it; especially “20 Ways to Avoid an IRS Appraisal Audit.”

Link: trugman-valuation

Assessment

As a reminder, our updated website at www.trugmanvaluation.com includes a resource center which provides additional information that might be useful to you including sample reports, various conference presentations and podcasts.

Conclusion

We are available to assist you, and your clients, with your valuation and litigation support needs and look forward to hearing from you. And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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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: "Advisors Only", Accounting, Practice Management, Practice Worth, Taxation | Tagged: CPA, CVA, medical appraisals, medical practice value, medical practice worth, medical valuations, Trugman Valuation Associates | 2 Comments »

Challenging Standard & Poor’s 500 Index

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

Dr. Jeremy Siegel Opines

[By Staff Reporters]

According to Financial Advisor News – an electronic trade magazine on March 17 2009 – Standard & Poor’s underestimate the earnings of its S&P 500 Index. So says, Jeremy Siegel PhD, a finance professor at the University of Pennsylvania’s Wharton School of Business and author of Stocks for the Long Run.

The Dilemma

The problem started when the Wall Street Journal ran an op-ed piece by Siegel that argued Standard & Poor’s uses a “bizarre” methodology for calculating the earnings and P/E ratio for the S&P 500. In it, Siegel explained that the earnings of S&P 500 companies are currently treated equally, but should instead be weighted in proportion to their market capitalization. Market capitalization weighting, he noted, is used to measure the S&P 500 returns. Such a system gives larger weight to the earnings of a company such as Exxon-Mobil, and lower weight to an S&P 500 member such as Jones Apparel.

Siegel’s Example

For example, “a 10% rise in Exxon-Mobil’s price would boost the S&P 500 by 4.64 index points, while the same fall in Jones Apparel would have no impact since the change is far less than the one-hundredth of one point to which the index is routinely rounded,” Siegel wrote.

Outcome

As a result of the above, if capitalization weightings were applied to 2008, the earnings of S&P 500 companies would have been $71.10 per share instead of $39.73 per share.

S&P’s Support

In response, an S&P official said Siegel’s argument “fails the test of both logic and index mathematics.”

Conclusion

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Filed under: Career Development, Financial Planning, Investing, Portfolio Management | Tagged: common stock, David E. Marcinko, financial advisor, Financial Planning, Investing, Jeremy Siegel, Market capitalization weighting, S&P 500 Index, S&P companies, stock broker, stock index, stock market, Wharton School of Business | 3 Comments »

Understanding Money Market Account Risks

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

Terms and Definitions for Physician Investors

By Staff Writers

The recent banking industry debacle has prompted several of our cost-conscience doctor-clients to rethink money market account risks and related products. We trust this brief review is helpful to all concerned.

Money Market Deposit Accounts

First, the term “money market account” must be defined.

Link: http://www.HealthDictionarySeries.org

There are two types of money market accounts [MMAs] that most people refer to when using this term. The first is a money market deposit account (MMDA). This is an account at a bank designed to compete with money market mutual funds (MMMF). MMDAs usually pay less interest than money market mutual funds and in return offer federal insurance on balances, now up to $250,000 with convenience through check writing and access through ATMs [reverts back to $100,000 after December 31, 2009]. MMDAs under this amount do not have any risk of failure because they are insured by the US government.

Money Market Mutual Funds

Money market mutual funds are mutual funds that invest in short-term instruments with maturities of less than one year, and usually offer check writing on the account. They are not federally insured, but are considered safe in stable economic times. Net Asset Value [NAV] is one dollar; USD. Nevertheless, a few have “broken-the-buck” with NAV at some increment below $1.00 USD.

Evaluation Methods

The first way to evaluate the MMMF risk is to look at the average length of maturities in the portfolio. The shorter the maturity – the safer the MMMF. The second way is to look at the type of security owned by the fund. Government securities are generally less risky than corporate securities. Interested investors can also contact a rating service that evaluates the securities in a MMMF’s portfolio.

And now – a few related words about “so-called” high-yielding CDs.

High Yielding Brokered Bank CDs

First, the physician-investor should determine if the CD is issued by a federally insured institution. If the answer is yes, the investor knows that a portion of his money is safe if the institution fails. If the answer is no, the doctor should obtain the institution’s ratings from the appropriate rating agencies and analyze the institution’s financials. Second, the physician-investor should investigate the volatility of the CD’s return.

Assessment

When interest rates fluctuate, the price of MMAs and CDs fluctuate much like bonds. Therefore, short-term securities are less risky than long-term securities; all things being equal.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Are you looking at these terms and conditions more closely during this national economic crisis? Please opine and advise.

Filed under: Financial Planning, Insurance Matters, Risk Management | Tagged: ATM, banks, CD, certificate of deposit, FDIC, MMDA, MMMF, money market deposit acount, money market mutual funds, NAV, net aset value | Leave a comment »

This Time the Hospital Financial Crisis is Different

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

Oh Really … No so Fast!

Submitted by J. Wayne Firebaugh, Jr; CPA, CFP®, CMP™

Dr. Malcolm T. MacEachern, Director of Hospital Activities for the American College of Surgeons, presciently observed that:

… Our hospitals are now involved in the worst financial crisis they have ever experienced. It is absolutely necessary to all of us to put our heads together and try to find some solution. If we are to have effective results we must have concerted and coordinated immediate action. … Repeated adjustments of expenses to income have been made. Never before has there been such a careful analysis of hospital accounting and study of financial policies. It is entirely possible for us to inaugurate improvements in business methods which will lead to greater ways and means of financing hospitals in the future … It is true that all hospitals have already trimmed their sales to better meet the financial conditions of their respective communities. This has been chiefly through economies of administration. There has been more or less universal reduction in personnel and salaries; many economies have been affected. Everything possible has been done to reduce expenditures but this has not been sufficient to bring about immediate relief in the majority of instances. The continuance of the present economic conditions will force hospitals generally to further action. The time has come when this problem must be given even greater thought, both from its community and from its national aspect…

Source: Steinberg, C. Overview of the US Healthcare System; American Hospital Association 2003.

Many hospital CXOs, healthcare administrators and physician executives would agree that Dr. MacEachern accurately describes today’s healthcare funding environment. However, they might be startled to learn that Dr. MacEachern made these observations in 1932! There is the old truism that there is nothing new under the sun.

American Hospital Association Statistics

Healthcare statistics suggested that the financial crisis is much the same today as it was for hospitals during the Great Depression. The American Hospital Association’s (AHA) reported gloomy statistics for hospitals include:

In 2001, 29% of hospitals had negative total margins.
Approximately $101.3 billion of uncompensated care was provided between 1997 and 2001 with an average annual increase of 16% during that time period.
Emergency departments in 62% of all hospitals report operating at, or over, capacity.
Technology costs are soaring as traditional technologies such as X-Ray machines, for $175,000, are being replaced by contemporary technologies such as CAT Scanners at $1 million that are in turn being replaced by CT Functional Imaging with PET Scans costing $2.3 million. Even such a “simple” instrument as a scalpel that costs $20, is being replaced by equipment for electrocautery costing $12,000, that is then being replaced by harmonic scalpels costing $30,000.
Between 2000 and 2002, 33% of hospitals reported increases in liability premiums of more than 100%.
The average age of hospital plants has increased 21% from 7.9 years to 9.6 years in just one decade.
In the four years ending 2002, hospital bond downgrades have outpaced hospital bond upgrades by almost 5 to 1.

Editor’s Assessment

As editor’s of the premium subscription, two volume, 1,200 pages, institutional print-guide Healthcare Organizations [Financial Management Strategies], we prefer engaged readers and contributors like Mr. Firebaugh, who demand and create compelling content like the above. Please review these links for same.

www.HealthcareFinancials.com

Info: http://www.stpub.com/pubs/ho.htm

TOC: http://www.stpub.com/pdfs/toc_ho.pdf

Purchase: Call 1-800-251-0381 or email orders@stpub.com

Conclusion

Always beware the words: “this time it’s different;” as it rarely is. And so, your thoughts and comments on this Medical Executive-Post are appreciated. Please opine and subscribe to the ME-P here; it’s fast, free and secure.

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Healthcare Organizations: www.HealthcareFinancials.com

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Filed under: Career Development, Health Economics, Health Insurance, Healthcare Finance, Managed Care, Marketing & Advertising, Media Mentions and PR, Recommended Books | Tagged: AHA, American College Surgeons, American Hospital Association, CAT, CT, david marcinko, financial crisis, hope hetico, hospitals, medical crisis management, MRI, PET, Wayne Firebaugh | 4 Comments »

Understanding Life Insurance Sales Compensation

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

How Agents and Brokers are Paid for Selling Policies

By Dr. David Edward Marcinko; MBA, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™

[ME-P Publisher-in-Chief and Managing Editor]

The recent AIG, and related insurance debacles, have prompted several of our cost-conscience doctor clients to rethink insurance agent sales commissions and related perks. We trust this brief review is helpful to all concerned.

Life insurance company agents

Life insurance agents are appointed by the insurer with the authorization to solicit and deliver contracts of insurance. The agent’s power under life insurance is more limited than that of a property and casualty agent because an agent cannot bind a life insurance carrier to an individual risk, as opposed to a property and casualty agent who can bind his or her insurance company.

Agent Commissions

Agents are compensated primarily on a commission basis from the insurance company they represent. Compensation is higher for the first year a policy is in force. Thereafter, the agent may receive compensation for renewal—a percentage of the annual premiums—and much smaller compensation during subsequent years. If the agent achieves a certain level of production, the agent may receive additional bonuses or other types of compensation. Think: Million Dollar Round Table; or Million Dollar Club Producer.

Commission Rates

Commissions for agents typically run 50% to 55% on cash value products and 40% on term products. Agents’ commissions generally are lower than brokers because they are housed by the insurer, and therefore most of the agents’ expenses are reimbursed or paid by the insurance company.

The Fringe Benefits

The agent also receives fringe benefits from the company, such as health insurance, life insurance, disability insurance, a retirement plan, or a cafeteria-type plan. Usually, agents must maintain a specified level of first-year commissions in order to continue employment with the company.

Life Insurance Brokers

A broker represents the client directly and can show illustrations from many different companies because theoretically there is no allegiance to any one particular company.

Dual Agent-Managers

Some brokers who may act both as general agents and agency managers (individuals who oversee an office of insurance representatives) usually earn commissions as stated above and overrides on first-year premiums to as much as 40%. There is a separate scale on renewals from the sales staff. These overrides are in addition to basic commissions earned either through the broker selling a product on his or her own or as manager of the office. In addition, brokers may earn subsidies for their office and production bonuses.

Assessment

One advantage that life insurance agents have is that some direct writing companies employ only agents to represent them and sell their products. A broker may not have access to sell certain lines of companies that an agent does.

Disclaimer: Both contributors are former licensed insurance agents and financial advisors.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Filed under: Ethics, iMBA, Inc., Insurance Matters, Retirement and Benefits | 9 Comments »

Consulting for the ME-P

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

Talk to Us

By Ann Miller; RN, MHA

[Executive Director]

We would like to better understand who is visiting the Medical Executive-Post, and what you like, or do not like, about our blog site, print journal and/or communications forum. Most of all, we wish to know who is just visiting versus who is posting, commenting and subscribing; and why?

Assessment

Your responses are confidential, and will only be used for internal use to improve the website blog. We will not sell your information to anyone, ever!

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Please send in your considered responses to me at: MarcinkoAdvisors.@msn.com

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Filed under: "Advisors Only", "Doctors Only", Experts Invited, Media Mentions and PR | Tagged: david marcinko, Financial Planning, Health Economics, healthcare consultants, Healthcare Finance, healthcare financials, hope hetico, medical executive post, medical management | Leave a comment »

About the Convenient Care Association

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

Developing Best Medical Practices and Retail Operating Standards

By Staff Reporters

The Convenient Care Association [CCA] is comprised of companies, medical providers and healthcare systems that provide patients and consumers with accessible, affordable and quality healthcare in retail-based locations. The CCA works primarily to enhance and sustain the growth of the convenient care industry through sharing of best practices and common standards of operation. It was founded in October 2006.

About CCA

According to their website, the first Convenient Care Clinics [CCCs] opened in 2000, and the industry grew quickly since then. Today there are approximately 1,060 clinics in operation, and CCA member clinics represent more than 95% of the industry. To date, CCCs have served more than 3.5 million patients with its nurse practitioners [NPs] and physician assistants [PAs].

Link: http://www.ccaclinics.org/index.php?option=com_content&view=article&id=4&Itemid=11

Growth and Expansion

With this rapid expansion, and projected continued growth, it quickly became clear that the shared concerns and needs of both providers and patients could best be served through an association that allowed for:

Sharing best practices, common standards of operation, experiences and ideas.
Developing common standards of operation to ensure the highest quality of care.
A united voice to advance the needs of CCCs and their customers
A unified effort to promote the concept of CCCs, and to respond to questions about this evolving industry.
Reaching out to the existing medical community and creating new partnerships.
Building synergies with traditional medical service providers.

Assessment

The Public Health Management Corporation [PHMC], a nonprofit public health institute, provides executive management and administrative support for the Convenient Care Association. For more information, contact Tine Hansen-Turton at (215) 731-7140.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Have you ever used a retail medical clinic and what was your experience? Will this business model save primary care medicine?

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Healthcare Organizations: www.HealthcareFinancials.com

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Filed under: Career Development, Health Insurance, Managed Care, Practice Management, Quality Initiatives | Tagged: CCA, convenient care association, convenient care clinics, NPs, nurse practitioner, PAs, physician assistant, primary care, rimary care medicine | 9 Comments »

Medical Office Cash Collection Procedures

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

Going Green and Getting the Cash

[By Staff Reporters]

According to Shannon Doyle, an independent consultant for the MGMA Health Care Consulting Group on March 9, 2009, the continued growth of high-deductible health insurance plans and health savings accounts has caused medical practices to increasingly rely on front-desk personnel to collect from patients.

Three Modern Collections Rules

The following medical practice procedures will markedly increase upfront office collections:

Train staff to handle exceptions. What is your policy if the patient payment is significant? Will you allow 25% payments—one today and three over the next three months? Communicate your policy to all staff. What will you do if a patient shows up without an insurance card? There will be other exceptions. Train employees to call the appropriate practice-management contact when an exception does not fit in the categories you provide and make sure those managers are responsive.
Understand that not everyone will shine in collections. The value of this new front-desk function should be reflected in job descriptions and wages. Track staff performance and hold employees accountable for collection goals. The most successful practices collect in the 90% range.
Provide professional signage that states your basic policy: “Payments are due at time of service.” Avoid typewritten, lengthy explanations taped to walls or desks that look like clutter.

Assessment

Furthermore, Mr. Doyle suggested that physician-executives and office managers recognize that significant changes in front-desk procedure require staff training. But, even before that, you must develop a template to help employees quickly get the information they need.

For example, according to Rachel Pentin-Maki; RN, MHA of www.MedicalBusinessAdvisors.com make and update a matrix-guide reflecting the health plans that cover 80% of office patients. Include each plan’s variable components like co-insurance, deductibles and services that require pre-authorization. Then, create a list of names and phone numbers for staff to verify coverage and amounts. Be sure to include examples of plans’ insurance cards and highlight the pertinent information. By following these few guidelines, it is hoped that collection percentages can be improved in the challenging future.

Link: http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090309/MODERNPHYSICIAN/303019984/-1/newsletter06&nocache=1

Does this post change the meaning of the term “going green?”

Conclusion

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ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Career Development, Health Insurance, iMBA, Practice Management | Tagged: cash medical practice, cash value practice, HDHPs, Health Insurance, health savings account, HSAs, Inc., institute of medical business advisors, medical savings account, MSAs, rachel pentin-maki | 2 Comments »

AHRQ Report on Uninsured Hospitalizations

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

Differs from Insured Hospitalizations

By Staff Reporters

According to Tracey Walker, Senior Editor of Healthcare Executive News on March 13, 2009, the number of uninsured hospitalizations increased by 34%, over the last 10-year period, and the number of Medicaid hospitalizations increased by 36%. However, a newt report from the Agency for Healthcare Research and Quality (AHRQ) suggests the number of privately insured hospitalizations remained about the same.

AHRQ Report

According to the report, hospital charges increased for the uninsured faster than for overall hospital charges (76% for compared with 69% for all hospital stays). The average hospital charge for an uninsured stay in 2006 was $19,400 compared to $11,000 in 1997 (after adjusting for inflation). The average length of stay for the uninsured remained the same at about 4 days per hospital visit. Other findings included:

Compared to all hospital stays, uninsured hospitalizations begin in the emergency department much more frequently (60% for the uninsured compared to 44% for all hospital stays).
The number of uninsured hospitalizations for skin infections rose sharply over the 10-year period, increasing from about 28,000 stays in 1997 to about 75,000 stays in 2006. Early appropriate outpatient treatment for skin infections can usually prevent the need for hospitalization.
There was a 36% increase in hospitalizations billed to Medicaid during the 10-year period.

Assessment

According to AHRQ, on average the costs (not charges) to provide hospital care to the uninsured are about $1,500 less expensive ($6,800 vs. $8,400 per hospital stay) than costs for all other hospital stays.

Assessment

Lack of health insurance has serious consequences on individuals and societies. For example, the uninsured may be more likely to delay or forgo necessary medical care until eventual hospitalization makes care much more expensive. And philosophically,

“As spending on Medicaid increases; the number of uninsured hospitalizations ought to decrease proportionally—adjusted for population increases”

So says, Hope Hetico; RN, MHA, CMP™ of www.HealthcareFinancials.com.

“But, this was not the case, and determining exactly why will require more studies.”

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Does a similar inverse relationship hold for public versus private education, housing and transportation?

Why or why not? Some pundits wonder if it is due to private entities having more “skin-in-the game?” Please opine?

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Filed under: Health Economics, Health Insurance, Healthcare Finance, Insurance Matters, Surveys and Voting | Tagged: Agency for Healthcare Research and Quality, AHRQ, Health Insurance, hospital admissions, hospital charges, hospital costs, hospital stays, hospitalizations, insured patients, uninsured patients | 2 Comments »

Battered Health Journalists

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

9 of 10 Would Repeat Career Choice

By Staff Reporters

According to the Association of Health Care Journalists on March 12, 2009 pia@healthjournalism.ccsend.com, and on behalf of the Association of Health Care Journalists news@healthjournalism.org; a new survey cited newsroom cutbacks, lack of time for research and travel, and fewer opportunities for training at their news organization as factors making their jobs more challenging than ever; so says the recently released survey in conjunction with the Kaiser Family Foundation.

Fewer Drawbacks in Health Reporting

Moreover, while about 3 in 4 respondents said that US journalism was headed in the wrong direction, just more than half felt that way about health journalism. And two-thirds of respondents said health care journalism was headed in the right direction at their media outlet.

A Hardy Career

Fortunately, health journalists are a hardy bunch. Nearly three-quarters of health journalists surveyed said the amount of coverage given to health care topics has stayed the same or increased at their news organization and two-thirds said the quality of coverage has been stable or gotten better over the past few years.

Link: http://www.healthjournalism.org/resources-articles-details.php?id=94

Assessment

Despite the challenges and the uncertain times, 88 percent of respondents said if they had to make their career choice over again they would still go into health journalism. Interestingly, that was the same percentage of respondents who said they had health insurance.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Does this positive career choice percentage for health journalists match that of physicians today? Was this career choice query even asked of doctors two decades ago?

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Filed under: Career Development, iMBA, Inc., Interviews, Media Mentions and PR | Tagged: Association of Health Care Journalists, healthcare journalists, healthcare reporters, journalists, Kaiser Family Foundation, reporters | 2 Comments »

Consumer Directed Health Plan Survey

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

Costs Hold Steady

[By Staff Reporters]

According to Tracey Walker, Senior Editor of Healthcare Executive News on March 13, 2009, US employers expect healthcare cost increases to hold steady at 6%. Additionally, more plan to adopt consumer-directed health plans [CDHPs] in 2010, in an effort to control health cost increases.

Watson Wyatt – National Business Group Survey on Health

And, a survey by Watson Wyatt and the National Business Group on Health, found that:

Approximately half of companies now offer workers a CDHP, up from 47% in 2008, and another 8% are expected to adopt a CDHP by 2010.
CDHPs are helping employers control costs—companies with at least half of their workers enrolled in a CDHP have a two-year cost trend (4.6%) that is 25% lower than non-CDHP sponsors (6.1%).
Two-thirds of employers (67%) cite the poor health habits of their employees as a considerable challenge to managing their health costs.
While companies will be taking a close look at benefit offerings because of the recession, most do not plan major changes.
Nearly 30% of employers have revamped their healthcare strategy with another 30% planning to do so in 2009.

Assessment

The growth in CD-HPs has made it more important than ever for health plans to provide their members actionable information and pricing transparency to navigate the healthcare system. According to Dr. David Edward Marcinko;

“Members like our firm – and many others – are incented to be savvy consumers, but that’s a difficult task if not provided with the pricing and related information we need to make wise choices. And, to make matters even worse for lay patients; providers and hospitals are not often keen to supply information about same.”

But, there is some hope according to Hope Rachel Hetico; RN, MHA, CMP™ of www.MedicalBusinessAdvisors.com

“The overall transparency milieu today has definitely improved this last decade as we have participated in CDHPs for all our employees.”

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Filed under: Health Insurance, iMBA, Inc., Monthly Reports, Surveys and Voting | Tagged: CDHCPs, CDHPs, consumer directed health plans, consumer directed healthcare plans, National Business Group, Watson Wyatt | 4 Comments »

Attention Tipsters and Insiders

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

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Filed under: Alerts Sign-Up, Breaking News, Career Development, iMBA, Inc., Marketing & Advertising, MAST-HEAD, Media Mentions and PR | Tagged: ann miller, david marcinko, Health Insurance, healthcare economics, Healthcare Finance, healthcare industrial complex, hope hetico, insider information, medical management, Practice Management, tipsters | Leave a comment »

Wal-Mart’s Health Information Technolgy Game Plan

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

CCHIT Meet Sam Walton

By Darrell K. Pruitt; DDS

Dana Blankenhorn posted an article recently on zdnet titled “Wal-Mart Selling Windows Health Records.”

Link: http://healthcare.zdnet.com/?p=1966

After reading it, I opened a good, cost-effective fortified breakfast wine and began hammering out my comment that I copied below, long before the sun came up. Hope you enjoy it. I’m going to get some sleep.

Looks Like Rein

Coach Glen Tullman’s traditionally favored and tough Allscripts-Misys team originating in CCHIT meets Walton’s consumer-supported, nimble team from Arkansas in front of Sam’s home town crowd. As a sports fan and occasional off-color commentator standing on the sidelines, Dana, I think this ball game could get exciting. The weather is perfect for sloppy, poor conditions and heaven knows that these two ideologies share history.

Wal-Mart HIT

Some odds-makers say Wal-mart’s success in selling healthcare IT at Sam’s Club prices and quality is likely to take off in their patented free-market style in the next few months.

The big question is; could this threaten federally-favored Allscripts’ early advantage?

For example; if things get competitive, and the value of MDRX starts to falter under natural pressure, will Trustee Tullman call on the reserve strength of his exclusive Club CCHIT to out-flank the quick and slippery Sam’s Club wide-ended attorneys? Some say that if CCHIT suddenly selects surprising, deceptive and occasionally lame applications for certification requirements – that happen to already reflect Allscripts pre-determined game plan – it is a cinch to give Tullman’s team a head start around their strong side with a pulling guard or three from the right (weak side) to lead interference.

Assessment

Will Sam protest such a rule? You bet. It could get messy. Snot could fly.

Here is the question on this reporter’s mind. If close calls are occasionally ruled in the home team’s favor, will Tullman move on down the road? I like to watch the cheerleaders.

Conclusion

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

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

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RIP Retail Financial Services Industry

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

Demise Predicted for Many Financial Advisors

[Greed Induced and Wholly Self Inflicted]

By Dr. David Edward Marcinko; FACFAS, MBA, CMP™

Publisher-in-Chief

[Founder, CEO, Managing Partner and Editor-in-Chief]

www.HealthcareFinancials.com

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MADOFF PLEADS GUILTY [March 12, 2009] NOW IN JAIL

Stock brokers, financial advisors, investment advisors, Certified Financial Planners®, Wall Street broker-dealers, wealth management firms and their related practitioners and business models are obsolete and physicians investors, like everyone else, must finally wake up to the fact that these entities have incentives to sell financial products to benefit the seller; not the buyer.

Paretto’s Rule

OK; to not sound harsh, let’s use the 80/20 rule of Paretto; 80% of financial “advisors” seek self-interest over investor interest, despite industry ethical protests otherwise. And, I don’t want to indict everyone as there are some decidedly good folks out there; just not very many [<20%] – apparently. But first, a bit of history!

Brief Historical Review

In the 1970s, full-service brokers were compensated largely by steep commissions. This ended with the May Day decision of 1975 to allow market competition and transparency [Think Charles Schwab]. In the 1980s, mutual funds were all the rage, complete with their sales charges [loads] and fees, etc. When no-load companies began taking market share later that decade, Wall Street firms and big banks looked towards more creative offerings like private equity, gas and oil limited partnership, all sorts of commodities, annuities and closed-end funds. By the late 1990s, financial advisors marched their clients like lemmings into the tech craze. Every mature doctor remembers the physician practice management corporation [PPMC] aggregator, and practice roll-up model of 2000, as well. For their best customers – renamed and repositioned financial salesman – would offer a few shares of the latest hot IPO that could be flipped for a hefty profit in matter of days, or hours or minutes [Think PhyCor].

The Flawed AUM Compensation Model

Throughout, the asset under management [AUM] compensation model evolved, as well. Of course, this was simply a cheaper marketing and sales derivation [1% versus 3%] of the older “wrap-fee” stock-broker discretionary commission model; now renamed “advisory-fees under management”. Yet, money is money, “juice is juice”, and fee commission slippage is just that – slippage. Others may wax more eloquently on this evolution than me, but you get the idea.

Products Sold; Not Purchased – That’s Why It’s a Retail Business

Retail financial products are sold, not purchased. These retail sales folks get paid. This is their job and source of making a living. They are not charity minded; they are not saints. They do not work for you. Financial advisors and Wall Street [like domestic healthcare] is conflicted, biased, and often not to be trusted. The SEC, FINRA-NASD, State and Federal agencies; certification firms and various SROs have been proven impotent, sleeping or incompetent in their protection of the individual investor. And, the current economic meltdown in virtually all asset sectors and classes worldwide, finally suggests same to even the most dimwitted among us.

Doomsday Scenario of Modernity

I believe the retail financial sales industry as we know it, is doomed. Firms are collapsing as FAs leave the business for other [sales] sectors. Can retail sales be replaced; sure? Should it be replaced; only if there is a better model out there; otherwise dis-intermediate, or DIY and fergetaboutit! In fact, according to outspoken Jim Rogers, of the legendary Quantum Fund and now based in Singapore;

“Stockbrokers will be driving taxis. The smart ones will learn to drive tractors, because they’ll be working for the farmers.”

Source: BusinessWeek

March 9, 2009.

My Triad of Recommendations

And so, these three simple, but not so easy to implement steps, would go a long way to restoring confidence in the retail financial services industry. Older miscreants are purged, and new entrants raise the bar; evolution at its best:

1. Define the term “financial advisor”. Make them possess at least a college degree; in some field. Although there is nothing magically intrinsic to a BA/BS degree, most suggest it signifies a certain ability to evaluate information properly and to think and critically analyze, rather than blindly accepting the “recommendations” of corporate sales managers, BD firms, OSJs, Wall Street and their employers. Independent thinkers tend to be less like lemmings, than not; more like leaders, than followers, etc. IOW: They may actually start working more for the client-investor.

2. Make financial advisors accept fiduciary accountability in the ERISA sense. No opt-out clauses, no BD exemptions or brokerage arbitration clauses; etc. No more word-games, definitional parsing or related shenanigans. Allow clients to sue financial advisor personally; not just the company. End the agency relationship model.

3. Eliminate or modify AUM and all compensation schemes. For example, why should investors give “advisors” cash to manage, and then pay some percentage of it to them in a negative interest rate environment; or trading discretion during a crashing stock market? The risk-tolerance flaws in this system are well known. And, higher net worth clients with more AUMs, do not mean more work, time or effort for the FAs; nor should there always be higher fees. Remember, the average FA has 78 clients; so you are not a special client. As flailing financial advisors exit the business, let’s replace the AUM compensation model with flat engagement fees, retainers, hourly fees, hybrid or composite fees, and/or claw-back AUM hurdles.

End the Long-Term Investing Marketing Hype

The long-term marketing hype goes something like this, “if you make money, I make money” relative to most compensation arguments which are simply unidirectional shams. As is this emotional inflation argument for long-tem investing; “What keeps me up at night is that you will outlive your assets”. Which really translates to; “I hope you live long and prosper so that I don’t loose your cash flows, commissions and/or revenue streams.” PS: Wanna buy a variable annuity? Well, the outrageous incentive fees paid to those financial advisors who levered client portfolios 20 to 1 in the past, or brokers who bought/sold furiously when things were good, got blown up in 2008 and will not soon be the same.

Assessment

To most laymen, the implication in the retail financial services industry was that its’ purveyors “added-value” to client relationships and somehow helped investors fundamentally, technically or through timing machinations that beat the market. Or, that a FA “seer” with strategic alliance partners would somehow help clients ascertain when to jump between stocks, bonds, cash or the dozens of other asset class tranches – and new fangled products – based on some superior knowledge, analysis or insight; OR, because of what they see – or can’t see – in their crystal balls. Yet, even the blind now know that the advisor-emperor has no clothes and the seer’s crystal ball has gone dark. Sales, not counsel, ruled the day. But, hopefully not any more; at least not for medical professionals, colleagues and those of us in the healthcare space! We know better; or should!

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How can we reform the retail financial services sales industry; or should we? IOW: How do we make the financial advisor “earn his money every time” – just like the medical professionals they often try to portray; but can not. Is this the end for retail financial advisors – or another new beginning?

Full disclosure: I am a former insurance agent, registered investment advisor; board certified surgeon and Certified Financial Planner™. I am also the founder of www.CertifiedMedicalPlanner.com, the only educational certification agency that requires a college degree, fiduciary accountability and peer-reviewed publishing for licensure. Talk to me, today!

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Video: Protecting Protected Health Information

Posted on March 11, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The eEHR Privacy Debate Continues

[By Staff Reporters]

According to our colleague Richard Mata; MD, MIS, writing in the premium print-journal Healthcare Organizations [Financial Management Strategies], a critical feature of any healthcare information system [HIS] is compliance with privacy requirements. Of course, the most important compliance regulation is the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

The key here is to have computer systems, terminals, workstations, servers and hand-held systems fully in communication with each other — including the ability to send data outside the fire-walls of the institution; interoperability as needed — while ensuring the confidentiality of protected health information (PHI), which is health information where the person to whom it belongs is identifiable

Federal Privacy Regulations

The federal government required hospital and healthcare entity compliance with HIPAA security regulations since April 2005. Briefly, the following are features of HIPAA which concern HIS:

· HIPAA presents a unique opportunity for automation of information since it is easier to protect secure information electronically as compared to having a paper chart that can be lost or open in front of patients and visitors.

· Secure password protection must be in place at multiple levels to ensure that access to PHI is restricted to those who need the information at that time.

· Appropriate encryption of data is essential for transmission between systems in order to prevent the interception of data.

National Spotlight

Yet, in this video clip, CNN’s Campbell Brown and Elizabeth Cohen examined how easy it is for someone to obtain private medical information online by simply using someone’s Social Security number and date of birth www.HealthDictionarySeries.com

Assessment

Whenever the subject of proliferating eHRs catches the national spotlight, you can bet that debates about privacy aren’t far behind. Indeed the privacy issue has already started to gain some traction in the media with the above video, and more.

Conclusion

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Filed under: Health Law & Policy, Information Technology, Professional Liability, Risk Management, Videos | Tagged: Campbell Brown, CNN, EHRs, Elizabeth Cohen, EMRs, health information technology, HIPAA, HIS, PHI, protected health information, Richard Mata | 1 Comment »

Frank Gehry, Health Reform and the Cleveland Clinic

Posted on March 11, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Las Vegas Hospital Uses Celebrity Architecture to Fight Disease?

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

According to the Las Vegas Sun Newspaper on March 2, 2009, the Cleveland Clinic is the newest top-tier player in Sin-City with an emerging health care system that will shake up the status quo, supposedly creating a multitude of direct and residual benefits for patients throughout the region.

Lou Ruvo Center for Brain Health

In its role as partner with the Cleveland Clinic’s Lou Ruvo Center for Brain Health, the hospital — ranked fourth best nationally by U.S. News & World Report — is projected to influence medical care in Nevada on the strength of its immense organization. And, it is being designed by, none other than esteemed architect, Frank Gehry.

A Huge Project

And, if you believe numerous websites, the behemoth project will include office towers, a park, a 60-story tower for jewelry trading, a hotel conceived by celebrity chef Charlie Palmer, thousands of apartments and a $360 million performing arts center. Of course, in typically flamboyant Gehry fashion, the highly embellished main facility is said to model curvy metallic shapes and “folds of the brain.” Other nescient drawings of the Ruvo Center show it divided in two sections. Offices and examination rooms will be housed in stacked rectangular blocks set slightly off kilter, like a fortress wall built by children.

The Architect

Gehry used this method to design his world famous Guggenheim Museum in Bilbao, Spain (1997) and his Peter B. Lewis Building for the Weatherhead School of Management at Case Western Reserve University in 2002. His style is well known.

Misplaced Priorities

But, with an estimated 40 million uninsured citizens, one only can wonder if this facility could have been built more cost effectively and/or more utilitarian?

Assessment

Moreover, some Clevelanders are grumbling about the clinic’s involvement in such a glamorous project far away, and imagine that the project will drain local resources just as sun-parched Western states have fantasized about tapping the Great Lakes.

Industry Indignation Index: 70

Conclusion

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Filed under: Ethics, Health Economics, Health Law & Policy, iMBA, Inc., Industry Indignation Index, Op-Editorials, Quality Initiatives | Tagged: Charlie Palmer, Cleveland Clinic, executive physical, executive physical examination, Frank Gehry, Guggenheim Museum, HMO, hospitals, Las Vegas, Lou Ruvo Center, MCO, Medicaid, medicare, Peter B. Lewis Building, Weatherhead School | 10 Comments »

A Physician by Any Other Name

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

Enter the Weekendalists and Laborists

[By Dr. David Edward Marcinko; MBA]

Publisher-in-Chief

More than a decade ago, in another career, I wrote a few articles for Richard L. Reece MD when he edited a print and emerging electronic trade publication for medical professionals. All very “fly”, at the time.

The Laborists

Now – according to Dr. Reece who cites the Boston Globe, in “The Birth of a Notion”, a Cape Cod and some other Massachusetts hospitals are hiring “laborists”; aka board-certified obstetricians to work regular shifts for the sole purpose of delivering babies.

www.MedicalBusinessAdvisors.com

New Causitive Drivers

What drives these new-wave specialists? The answer, of course, is the next-generation of physicians and their emerging new medical business and practice models. Much like my 12 year old daughter, it is a way of professionally breaking away from past generations, and asserting some independence and leadership. And, as Martha Stewart might say; “that’s a good thing.”

Many Reasons

But, according to Reece, the real drivers are a combination of other things – the desire of doctors for regular hours, the shortage of specialists, physician burnout, the search for a safer hospital environment, the need for consistent, immediately available physician services, fear of dreaded malpractice suits, and consolidation of hospital-physicians services due to regulatory and economic pressures; etc.

Blended Generations

Dick is correct, of course, because it is not uncommon today to have three generations represented in healthcare. We have the Baby-boomers, Gen X and now, Gen Y. The Baby Boomer generation is saying with some sense of sadness that, “Medicine sure isn’t want it used to be!”, while Generation Xers are saying “It’s about time things changed!”, and the latest generation to enter the medical workforce, Gen Y’s, are saying “Ready or not, we’re here”.

http://www.BusinessofMedicalPractice.com

The Leadership Evolution

Each generation is extraordinarily complex, bringing various skills, expertise and expectations to the modern medical work environment. Determining the best method to unite such diverse thinking is one of the many challenges faced by physician executives and healthcare leaders. Is it any wonder that many medical leaders and executive in the Baby Boomer generation find themselves at a loss? The days of functional leadership are gone and suddenly, no one cares about the expertise of the Baby Boomers or how they climbed the corporate ladder, in medicine or elsewhere. Leadership in the era of Health 2.0 is no longer about command-control or dictating with intense focus on the bottom line; it is about collaboration, empowerment and communication. And, it is not about titles and nomenclature.

Linguistic Evolution

As the linguistic evolution of terms progresses, the nomenclature of hospitalist was followed by that of intensivist, proceduralist, nocturalists, in-situ physician and even weekendalists. Think I’m kidding?

Link: http://medinnovationblog.blogspot.com/2009/02/hospital-based-doctorists.html

Assessment

I still like the causative analogy of my pre-teen daughter; it’s much simpler to understand. What do you think?

References

1. Wachter, R and Goldman, R: “The Emerging Role of ‘Hospitalists’ in the American Health System’. In, New England Journal of Medicine; 335, 514-517, 1996

2. Kowalczyk, L: The Birth of a Notion: Hospitals Turning to Laborarists. Boston Globe, February 23, 2009

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

***

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]

***

Filed under: Career Development, iMBA, Inc. | Tagged: david marcinko, hospital medicine, hospitalists, hospitals, in-situ physician, intensivist, Marth Stewart, nocturalists, proceduralist, Richard L. Reece, rural hospitals, weekendalists | 2 Comments »

On the HITECH Act of 2009

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

The American Recovery and Reinvestment Act

By Staff Reporters

On February 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act [ARRA]. According to some, the law provides an opportunity to transform healthcare in the United States.

HIT

The law also provides $19 billion in health information technology [HIT] funding to ensure widespread adoption and use of interoperable HIT systems like the electronic health records funding provision. But, as ME-P readers are aware; this is not apparently for electronic Dental Records [eDRs]; and CCHIT is no advocate of professional diversity.

Link: https://healthcarefinancials.wordpress.com/2009/03/02/cchit-is-prejudiced-and-lacks-diversity-%e2%80%93-an-indictment

HITECH

Obama’s signing of the Health Information Technology for Economic and Clinical Health (HITECH) Act [a portion of the stimulus package] recognized the importance of HIT as the foundation for health care reform and cost savings.

Assessment

Is this report correct? Read all 187 pages and decide.

Link: HITECH http://democrats.science.house.gov/Media/File/Commdocs/HealthIT%20Bill.pdf

Conclusion

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

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Filed under: Health Law & Policy, Information Technology | Tagged: ADA, American Recovery and Reinvestment Act, ARRA, CCHIT, Darrell Pruitt, dentistry, eDRs, EHRs, EMRs, Health I.T., Health Information Technology for Economic and Clinical Health, HIT, HITECH, obama | 6 Comments »

The No Insurance Club

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

Emerging Pre-Paid Cash-Based Medicine

By Bob Grove

Healthcare in America is in Turmoil. The No Insurance Club [NIC] feels private contracts may be the solution. More and more Americans are going without healthcare especially preventative healthcare. The reasons – costs are too high, patients can’t get accepted due to a pre-existing condition, companies are cutting back on benefits, people have been laid off from work; and the list goes on.

Governmental Solutions

What’s being done to improve healthcare? Barack Obama and the Government want more control and regulation and the system seems to be leaning toward socialized care. Private insurance companies continue to increase premiums, which prices healthcare out of reach for the average American. Employers can no longer float the cost of insurance so they pass it on to their employees. Patients aren’t the only ones being affected by the current state of healthcare. More and more doctors are going out of business and hospitals are cutting back due to escalating costs and payment defaults.

Private Solutions

The current remedy; Americans are taking out private major medical policies for catastrophic events with high-deductibles [MSA/HSAs] to keep monthly premiums down, or are turning to Medicaid, mini retail-clinics at grocery stores/pharmacies, and emergency room visits for common illnesses.

Innovative Solutions

What about prevention and maintenance? More than 90 percent of health related issues can be taken care of with preventative care and maintenance but only a small percentage of Americans currently enjoy the benefit of preventative healthcare.

The No Insurance Club

The NIC has come up with a fresh look at healthcare by offering an affordable alternative to traditional insurance options.

NIC Benefits and Features

The No Insurance Club connects patients with participating board certified physicians that will treat and care for preventative healthcare needs for a one-time prepaid annual membership fee:

NIC patients make a one-time annual payment that is typically less than a one-month premium with traditional insurance.
Patients receive up to 12 office visits per year that also include immunizations, $4 or less in-office prescriptions, and additional services including blood tests.
No deductible, no co-pays, no premiums.
No surprise bills to patients.
Viable alternative to COBRA for employees laid off from work.
Low cost option for the self-employed.

Assessment

What’s in it for the doctors? How about no insurance clerks, no need to snail mail medical insurance claims or use expensive electronic claims submission clearinghouse services, no bad debts or bad expense write-offs, no ARs; and fast cash!

Link: http://www.noinsuranceclub.com/

I would be happy to speak with and connect ME-P readers, participating doctors and even patients for interviews to learn more about the NIC network and its benefits.

Bob Grove

Wild West PR

(801) 651-0290

bob@wildwestpr.com

Conclusion

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Filed under: Career Development, Health Insurance, Information Technology, Managed Care, Media Mentions and PR | Tagged: ARs, bad debt expenses, BDE, cash medical visits, COBRA, david marcinko, HMO, Medicad, medical ARs, medicare, no insurance club, obama, PPO, pre paid health care, private pay health care | 3 Comments »

Healthcare Experts versus Health Journalists

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

Appreciating the Distinction

By Dr. David Edward Marcinko; MBA

Publisher-in-Chief

As the healthcare reform, and eMR controversy unfolds, I am struck by the more-than-linguistic distinction between the terms “healthcare expert” and “health journalist.”

Link: www.HealthDictionarySeries.com

Historical Perspectives

Historically, as a peer-reviewed writer, editor, medical expert witness and now electronic publisher for almost four decades, I always sought the journalist’s title. I think the longing began in my formative years when I read that after the French Revolution, Sir Edmund Burke, looked up at the Press Gallery of the House of Commons, and said, ‘”Yonder sits the Fourth Estate, and they are more important than them all.”

Link: www.MedicalBusinessAdvisors.com

Expert versus Reporter

However, I no longer covet this title. Why? I’ve finally realized that it is far better to be a real subject-matter expert, than a journalist [read reporter]. The former creates news through knowledge, informed deeds and thought-leadership; while the later simply writes about various topics without same.

Link: www.HealthcareFinancials.com

Assessment

And so, in light of the eHR controversy, perhaps a word to the “wise” AMA, ADA, APMA, AOA and CCHIT leadership is sufficient; with apologies to Sir Edmund? Regardless of specialty, our guiding medical principles should always be; Omnia pro Aegroto [all for the patient].

Link: https://healthcarefinancials.wordpress.com/2009/01/31/about-the-ahcj/

Conclusion

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Filed under: Ethics, Experts Invited, Health Insurance, Managed Care, Research & Development | Tagged: david marcinko, healthcare experts, healthcare reporters, hope hetico | 7 Comments »

Tele-Medicine is Growing

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

About SwiftMD.com

[By Staff Reporters]

According to its website, SwiftMD isn’t just better telemedicine; it’s better medicine because of its physicians’ quality. Patient telephone calls are usually returned within 30 minutes, any time of the day or night. They employ a powerful eHR that is secure, HIPAA-compliant and keeps patients informed about their care. And, it is all done at an affordable price.

Link: www.SwiftMD.com

Features

Here is the prioritized way in which the telemedicine service is said to work:

Request – Call 1-877-WWW-SWIFT or request a consultation online.
Assess – No emergencies are accepted.
Response – A physician calls back, day or night, usually within 30 minutes.
Consult – The doctor discusses your condition, consults your eHR, diagnoses and recommends treatment.
Record – A SwiftMD health record is also available 24/7 for updated references.

Assessment

According to SwiftMD, the service is easy to us; no more driving across town; or sitting in waiting rooms. Just high-quality medical care when and where needed. Group, individual and family plans are available.

Link: http://www.swiftmd.com/xres/uploads/documents/SwiftMD-WhitePaper20080819a.pdf

UPDATE 2015

Why Teladoc Needs Medical Attention
The Wall Street Journal, October 4, 2015

Only 45% of Diabetes Patients Use Mobile Health Tools
mHealth Intelligence, October 2, 2015

AAFP Still Searching for Right Stance on Telemedicine
MedPage Today, October 2, 2015

Walgreens Expanding Telemedicine on Its App in the Next Month
MedCity News, October 1, 2015

Mobile Health Apps Fall Short in Protecting Data Privacy
Medscape, September 29, 2015

Mental-Health Apps Make Inroads With Consumers and Therapists
The Wall Street Journal, September 27, 2015

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Filed under: Career Development, Information Technology, Quality Initiatives | Tagged: EHRs, EMRs, HIPAA, swiftmd.com, telemedicine, www.swiftmd.com | 10 Comments »

Physician Household Borrowing and/or Investing

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

Deciding What Works?

[By Staff Reporters]

Another way of asking the above titled question might be, “Is it smart for a doctor’s household to build savings while they are getting out of debt?”

Financial Priorities

In the first instance, the doctor already has debt and would be increasing the terms of any loans by deferring some of the payments to savings, which is equivalent to borrowing the same amount.

In the second instance, the doctor would be taking on debt to save more money. The answer is that it makes sense to borrow money for investment purposes only if the financial gains derived from the investment are larger than the financial benefits of paying off the debt. But, who can know for sure?

www.MedicalBusinessAdvisors.com

Minimum Account Payments

Assuming that a medical professional has more debt than needed, and doesn’t make contributions to a retirement account, the concern becomes: [1] should he/she make minimum payments to the debt and contribute to a retirement account; or [2] should he/she make the maximum payments toward the debt or loans, etc?

Downside Risks

It is important to understand the downside risks of a lower payment strategy. Just as stocks return more than bonds due to their higher risk, the lower payment strategy returns more because of its’ higher risk. Taking on debt to finance an investment is riskier than paying off debt for a number of reasons.

First, the US economy may continue its’ current depressionary spiral, and investments and savings could disappear as financial institutions fail. This would leave the doctor with debt that he or she could not service.

Second, the rate-of-return required to decide whether or not to borrow for investment purposes may not be achieved, leaving the doctor in worse financial shape than if he or she had just paid off the debt.

Assessment

Ultimately, the doctor must decide if the added risks are worth the possible gain. But, the services of a fiduciary financial advisor may also be required. However, some doctors may not be ready to receive the sort of “tough-love” required in this case.

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Filed under: Financial Planning, Funding Basics, Investing, Recommended Books | Tagged: cash management, certified financial planner, certified medical planner, CFP, CMP, david marcinko, debt, depression, financial planner, Financial Planning, Investing, physician debt, US economy | 1 Comment »

Video about Gaming4Health

Posted on March 7, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A Health Care – Gaming Industry – Social Network

By Staff Writers

Gaming4Health is an interactive social network for the health care industry. The company provides its’ community with the information, resources and services to support the adoption of healthy gaming as a means to improve health education, condition management, fitness and quality of life.

The Social Network

The communities established by the users of the network site allow people with similar health goals, conditions, research ideas or challenges to communicate with other like-minded people from all over the world. It also facilitates interaction and commerce between researchers and developers of healthy games, devices and resources and health and wellness organizations.

The Experts

The G4H network of experts in the medical, fitness, rehabilitation, weight-loss, simulation and other fields supposedly provide the most up-to-date information, resources, research and solutions in the healthy gaming industry.

The Competitor

Games for Health is a competitor. And, in business circles, it is said that competition makes a market. Games for Health develops best practice platforms for the numerous games being built for health care applications. To date the project has brought together researchers, medical professionals, and game developers to share information about the impact games on medicine.

Link: www.gamesforhealth.org

Assessment

Additionally, the firms’ GameBase is the most robust and current database of healthy games available – including basic information on every game (company, contact, price, etc.), demos and other downloads, as well as plenty of community feedback, ratings and reviews.

Videos: http://www.gaming4health.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Virtual reality and related simulation software, especially when used to desensitize patients with various phobias and obsessive compulsive disorders, is an accepted theory and clinical psychological practice. Will this gaming concept become same? Is it cost effective with a positive ROI? Should it be a covered service under health insurance policies? Any input or thoughts from our early adopter ME-P subscribers?

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Filed under: Health Insurance, Information Technology, Quality Initiatives, Research & Development, Videos | Tagged: g4h network, gamebase, games 4 health, games for health, gaming4health, medical virtual reality treatments, virtual reality | Leave a comment »

Sherlock Health Plan Management Navigator

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

Information System Implications on Health Plans

By Douglas B. Sherlock; MBA, CFA

Messrs. and Mesdames

Attached, please find the February 2009 edition of our Health Plan Management Navigator.
Link: sherlock-company

The Sherlock Expense Evaluation Report

In this month’s edition, we endeavor to better understand the functional area of information systems [IS] and its implications on health plans. Information systems, based on the results from out 2008 Sherlock Expense Evaluation Report (SEER) displayed overall anti-scalability in costs. In order to better comprehend IS and its influence on health plans overall, we performed numerous analyses that looked at relationships between IS and other aspects, such as scalability, variety of product offerings, commitment to ASO products and other functional areas.

Assessment

The results suggest that scale does not appear to play a role in IS costs and that more of a concentration in ASO products seemed to lower IS costs. It also appears that management of information systems, in the context of its support to other functional areas, is an inexact science.

Conclusion

Additional information about SEER is available at www.sherlockco.com/seer.shtml or; by contacting me at: sherlock@sherlockco.com

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Debt Consolidation for Physicians

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

Advantages and Disadvantages

By Staff Reporters

The main advantage of debt consolidation is that it allows a doctor to make one payment instead of many, and this helps avoid late fees for missed payments. The doctor may save time by having to make only one payment per month instead of many.

Other Advantages

Another advantage is that debt consolidation promotes self-discipline by transferring credit card debt (and other lines of credit) that does not require mandatory principal payments into a fixed-term loan – with mandatory payments that include both principal and interest. This is a useful tool for doctors who may find it difficult to make more than the minimum payments on their loans because they spend too much. It should be obvious that budgeting should go hand-in-hand with this process, because if the doctor continues to spend at the former level, yet now has a mandatory payment, the result can be financially devastating.

A final advantage to debt consolidation is it may result in a lower overall interest rate. This is, of course, conditional on the lender providing the consolidation.

Disadvantages

One disadvantage of debt consolidation is that it can lock a doctor into mandatory payments. Depending on the situation, this can be either a blessing or a curse. It becomes a curse when the fixed payments are so high that he/she can no longer make the full debt payments each month. Depending on the lender, and the terms of the consolidation loan, this could result in the loan being called. The effects of this are obviously detrimental to the doctor.

Other Disadvantages

A second disadvantage is that the doctor loses flexibility when he or she takes on a fixed payment that is larger than the combination of all smaller minimum payments. The fixed-payment schedule becomes detrimental when h/she has an unexpected reduction in income. The doctor without a fixed-payment schedule can increase payments to many small individual loans, and if income reduction occurs, drop the payments back down to the lower level. Then; when normal levels of income return, the higher payments can be resumed.

Assessment

Making larger payments requires discipline; because a lack of same was likely causative of the debt in the first place.

Conclusion

Your thoughts and comments on this Medical Executive-Post are appreciated. Have you ever been in this situation? Feel free to opine anonymously.

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Filed under: Financial Planning, Funding Basics, Investing, Risk Management | Tagged: cash management, certified financial planner, certified medical planner, CFP, CMP, david marcinko, debt consolidation, doctors, financial planners, Financial Planning, hope hetico, loans, medical payments, physician debtors, physician investors, physicians | 2 Comments »

Problems with HIT in Minnesota

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

The Continuing eHR Saga

By Darrell K. Pruitt; DDS

If you were one of fifty governors who decide to jump off a cliff because flying looks so cool, would you proudly race to be the first to grab the air? Blissfully, Minnesota Governor Tim Pawlenty is way ahead of the pack. He’s so confident in healthcare information technology [IT] that he doesn’t even have to watch where he’s going – leaving him free to smile for the cameras. Now that’s cool.

Initial Ambitious Plans

Attention ME-P readers! Please gather around to watch a world-class belly-flop of a gutsy statewide eHR mandate. A few years ago, Governor Pawlenty had ambitious plans to lead the nation with an interoperable eHR system that was touted to include all providers – that means Minnesota dentists as well. Your landing could be vertical and abrupt, Pawlenty.

CCHIT Approved?

In fairness to a brick, back in 2005 Pawlenty could not have predicted the economic collapse that began three years later, nor could he have known about the subsequent $19 billion eHR money that would be made available to providers – but only if they purchase healthcare IT software that is approved by the Certification Commission for Healthcare Information Technology (CCHIT).

CCHIT Laggards

Even if the descending Pawlenty could have predicted the recent changes in the terrain, including the CCHIT qualification, he would have never guessed that to this day in March of 2009, the certifying commission would still be yet to certify even one single electronic dental record – thereby blocking Minnesota dentists from copious federal help in their efforts to become compliant in Pawlenty’s brave new state.

“The government is actually looking for places to spend the money where there is a strong likelihood of success stories”.

–Mike Ubl

Executive Director Minnesota Health Information Exchange

[Owned by Blue Cross Blue Shield of Minnesota, HealthPartners, Medica, Fairview Health Services, UCare and the Minnesota Department of Health].

Link: http://www.twincities.com/ci_11830085

“And that after this is accomplished, and the brave new world begins – When all men are paid for existing and no man must pay for his sins”.

-Rudyard Kipling

The CCHIT qualification was incredibly bad luck for Pawlenty’s nifty ideas of interoperability with all providers. When Minnesota dentists discover that they must pay $30 thousand for software they don’t want in order to practice in paradise, some may just swallow their pride, sell the portable ice-fishing house, and move to slow-moving Iowa.

Dentists, MDA and the ADA News

Why the surprisingly quick landing? If Pawlenty actually gave any consideration for dentistry at all, just like everyone else, he must have assumed that dentists’ concerns about digital records would be adequately attended to by the Minnesota Dental Association [MDA] and the American Dental Association. It was easy to make that mistake because of the enthusiasm for eDRs radiating from ADA Headquarters and expressed in confident terms in ADA News Online articles that have since stopped appearing. Most eDR enthusiasts naturally assumed that by now the majority of dentists in the nation would be saving money, lives and trees with paperless practices. However, the ADA has been nowhere to be found for a long time. As it turns out, the professional organization has still not yet even contacted the certifying commission. We know this, because when I personally contacted CCHIT a few weeks ago, it caught them off guard. I was told that I was one of the first to ever mention dentistry.

Link: https://healthcarefinancials.wordpress.com/2009/03/02/cchit-is-prejudiced-and-lacks-diversity-%e2%80%93-an-indictmen

No Endorsements

To show how far the ADA has slipped, and as an example of its flagging influence on membership, I doubt that more than 5% of American dentists have made the ADA-endorsed leap from paper to digital. Why should they? It makes good business sense to wait, and most dentists are not techno-silly. Consider this; Even if a dentist is happy with a costly eDR system that demanded unanticipated time and effort to learn, in less than a year, CCHIT could determine that his or her favorite system is not worthy of certification because it does not integrate with physicians’ one-size-fits-all, CCHIT-certified eMRs. Tough luck, Minnesota dentists! Uncertified eDRs will be outlawed, while favored, large healthcare IT companies in Madison and Chicago will profit and pay more state taxes with Twin-Cities’ dollars. By then, all the stimulus money will be gone and lawmakers will no longer be giddy about eHRs due to the imminent explosion of data breaches everywhere caused by moving too fast. No return on investment [ROI] there.

Assessment

Still, Tim Pawlenty could have never known, yet away he sails with a stupid grin on his face.

Conclusion

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

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Filed under: Career Development, Health Insurance, Information Technology, Op-Editorials | Tagged: ADA, American Dental Association, Blue Cross, Blue Shield of Minnesota, CCHIT, Certification Commission for Healthcare Information Technology, Darrell Pruitt, david marcinko, DDS, DMS, eDRs, EHRs, EMRs, HealthPartners, HIPAA, HIT, IT, MDA, Medica, Mike Ubl, Minnesota Department of Health, ROI, Tim Pawlenty, UCare | 1 Comment »

Defining “Deep” Physician Debt

Posted on March 5, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Exiting the Quagmire

By Staff Reporters

There is no magical method or SIMPLE button that a physician or lay household can use to get out of debt. The two most critical factors in this process are budgeting and discipline, as discussed elsewhere on this ME-P blog forum. And, a payment plan that pays off debt by a selected target date will help. Debt consolidation can also be of assistance in this regard.

Defining “Deep-Debt”

According to Eugene Schmuckler PhD, MBA, of the Institute of Medical Business Advisors Inc:

“deep debt” is any financial burden that produces negative daily thoughts, interferes with professional work and/or keeps the doctor awake at night.”

www.MedicalBusinessAdvisors.com

Payment Plans and Budgets

Once a payment plan has been computed, the doctor should develop a budget that will free up enough money to make the payments. If this isn’t possible because the monthly payments are too high, the payoff period should be lengthened until the amount available for debt payment is equal to (or greater than) the readjusted monthly payment. After this, the doctor should set up a more disciplined approach to spending, budgeting and investing, going forward.

www.HealthDictionarySeries.com

Consumer Credit Counseling Services

Unfortunately, more than a few doctors get themselves so deeply into debt that they can’t make the minimum payments required by lenders. This is a very serious situation and usually involves negotiation for payment adjustments. Unless the doctor or his fiduciary financial advisor has experience in this area; it is a good idea to seek help from to an organization like the Consumer Credit Counseling Service.

The CCCS

The CCCS is an organization that works with those who are struggling to manage their financial debt through counseling in the areas of budgeting, understanding credit reports, and debt management. CCCS also provides educational courses for the public, with fee services ranging from $0 to a few hundred dollars. The counseling sessions focus on developing a budget that allows the client to pay all of his/her monthly expenses. The debt management program teaches about debt and also negotiates with lenders for adjusted monthly payments. CCCS tries to get the payment reduced by spreading the payments over a longer period of time and has been successful at getting lenders to reduce or even waive interest on the loans, in some cases.

Bill Consolidation

Another service of the debt-management program is bill consolidation. The debtor sends one payment a month to CCCS, who in turn pays the client’s bills. The education service provides seminars at which various speakers address different financial issues. A medical professional can find the location of the nearest CCCS office (or similar organizations) by calling the National Foundation for Consumer Credit referral line at 800-388-2227.

Assessment

In the climate of today, the above post is no longer one that some physicians might not heed. In fact, the days of the financial super-specialist with arcane products or sophisticated strategies that depend on a perfect storm of economic indicators, is long over. It is time to call in the financial primary care doctor and get back to basics; live on less than you make, and invest prudently, watching all costs.

www.CertifiedMedicalPlanner.com

Conclusion

Your thoughts and comments on this Medical Executive-Post are appreciated. Have you ever used the serves of CCCS, or similar? Feel free to opine anonymously.

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Filed under: Financial Planning, Funding Basics, iMBA, Inc. | Tagged: cash management, CCCS, certified financial planner, Certified Medical Planner™, Consumer Credit Counseling Services, debt, Eugene Schmuckler PhD, institute of medical business advisors, www.medicalbusinessadvisors.com | 1 Comment »

Introducing Douglas B. Sherlock MBA CFA

Posted on March 5, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

About Our Newest Thought-Leader

By Ann Miller; RN, MHA

Douglas B. Sherlock CFA is President of Sherlock Company which assists health plans, their business partners and their investors in the treasury and control functions of finance.

Resume

Prior to the founding of Sherlock Company, Mr. Sherlock was Vice President of Financial Analysis of U.S. Healthcare, Inc. where he directed the company’s merger and joint venture activity, its investor relations program and its HMO product for Medicare beneficiaries. Sherlock was formerly Vice President of Salomon Brothers, Inc where he specialized in the financial research of prepaid health plans and hospital systems, and assisted in the capital formation and merger activities of health care companies. He was the Greenwich Survey First Place HMO Analyst and a runner-up in the Institutional Investor polls.

Professional Associations and Memberships

Mr. Sherlock is a Chartered Financial Analyst. He has been a member of the Financial Accounting Policy Committee of the CFA Institute. He has served on the Editorial Board of Inquiry, a journal of health care organization, provision and financing published by the Blue Cross Blue Shield Association, and is a reviewer for Chartered Financial Analyst. He has been a member of the Financial Accounting Policy Committee. Sherlock is a frequent speaker before health care groups including the American Association of Health Plans, the HealthCare Financial Management Association, and the Blue Cross Blue Shield Association. The research of Sherlock Company has recently been cited in such periodicals as The New York Times, Forbes, Investor’s Business Daily, Modern Healthcare, Hospitals, The Wall Street Journal, HMO Managers Letter, Business Week and The Medical Business Journal.

Educational Background

Mr. Sherlock holds an M.B.A. in finance from Loyola College in Maryland. He received his bachelor’s degree in economics from Franklin and Marshall College, Lancaster, Pennsylvania.

Conclusion

We look forward to his contributions and now professionally welcome him warmly, as our newest ME-P thought-leader.

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Filed under: Breaking News, Health Economics, Health Insurance, Healthcare Finance, Managed Care, Op-Editorials, Practice Worth, Research & Development | Tagged: American Association of Health Plans, Blue Cross Blue Shield Association, Business Week, CFA, Chartered Financial Analyst, Douglas B. Sherlock CFA, Financial Accounting Policy Committee, financial analyst, Forbes, HMO, HMO Managers Letter, hospitals, Investor’s Business Daily, Modern Healthcare, Salomon Brothers, Sherlock Company, The Medical Business Journal, The New York Times, The Wall Street Journal | 1 Comment »

About the Hospital Debt Justice Project

Posted on March 5, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Aggressive Debt Collectors Take to the Web

By Staff Reporters

Thousands of patients face crippling debt to hospitals and healthcare systems across the country; even though they may have qualified for free care.

www.HealthcareFinancials.com

Yale-New Haven Health System

Now, the Yale-New Haven Health System, Yale-New Haven Hospital and Bridgeport Hospitals are pursuing aggressive debt-collection practices—including liens, wage garnishments and foreclosures—even though they have millions of dollars set aside for free care for patients who can’t pay. Others have colossal endowments as well, and often pay their CEOs handsomely.

Assessment

But, according to their website, the Hospital Debt Justice Project is only fighting for fair treatment and accountability from our community hospitals.

Link: http://www.hospitaldebtjustice.org

Industry Indignation Index: 85

Conclusion

Your thoughts and comments on this Medical Executive-Post are appreciated. Isn’t it a charity hospital standard that not-for-profits typically charge the poor and indigent up to four times the UCR of insured patients? Your experiences are welcomed.

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Filed under: Health Insurance, Health Law & Policy, Healthcare Finance, Industry Indignation Index, Information Technology | Tagged: Bridgeport Hospital, charity care, debt collectors, Health Insurance, healthcare systems, hospital debt, hospital debt collectors, Hospital Debt Justice Project, hospitals, medical debt collectors, UCR, Yale-New Haven, Yale-New Haven Health System | 1 Comment »

Physician Cash Maximization Rules

Posted on March 4, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

One Doctor- Advisor’s [How-To] Diatribe

[By Dr. David Edward Marcinko; MBA]

[Publisher-in-Chief] www.CertifiedMedicalPlanner.org

For some doctors – even more than laymen – cash management is the pivotal issue in the financial planning process. Accumulation of investment assets cannot occur if cash inflows do not exceed cash outflows. On the other hand, accumulated assets are eventually spent to fund expenses during planned time periods when cash outflow exceeds inflow.

Inflation

Traditionally, financial advisors have opined that inflation has a dramatic impact on both ends of the cash management spectrum because inflation has a compounding effect. That compounding effect means that a mere ¼% change in planning assumptions about anticipated inflation can have more significant influence over long-term projected outcomes than a 5% change in the amount of a particular item of budgeted income or expense. Well, true enough if projected linearly using some Monte-Carlo type software simulation. But, in the real word, economists appreciate cost and efficiency improvements [email over snail mail] and the potential for substitution of goods [diesel fuel for gasoline – chicken for steak, etc].

Be More Like … my Dad

On the other hand, far too few of my fellow medical colleagues – and financial advisors – are like my dad. Not well educated by academic standards, but with common sense that seems a precious commodity, today.

Dave, he used to tell me – and still does at age 84:

“Invest your money for growth carefully – and take some risks – but don’t be too afraid of inflation.”

Why not, dad?

“Because; if you’re not a conspicuous consumer, you’ll have less to worry about.”

Cash Management

Well, most of us are not like my dad; me included. But, his depression-mentality has never completely worn off. A doctor’s household can maximize the cash available for investing by setting up the account in this manner.

1. The first step is to open a checking account, money market account, and a brokerage account. The money market account is often included in a brokerage account.

2. The second step is to initiate electronic direct deposit of the paycheck into the money market account.

3. The third step is to determine the amount of cash reserve needed. As mentioned elsewhere on this ME-P, we are suggesting 3-5 years of cash-reserves on-hand, as an emergency fund for most medical professionals.

Once, when, and if, the amount of the reserve is determined and achieved, any extra money should be transferred to the brokerage account and invested according to personal goals, objectives and risk-tolerance. A small balance of a few thousand dollars can be kept in the checking account to prevent overdrafts. Beyond the few thousand dollars, the checking account should serve as a pass-through account where money is transferred from the money market account to cover checks written for the budgeted expenses.

Example of Managing Cash Reserve Amounts

A physician client recently asked me to help him increase his savings. He explained that he had a very detailed realistic budget, but had a hard time staying within the budget when cash was available; as he lectured occasionally and was fortunate to have a few extra dollars every now and then.

Recommendations

As a financial planner, and the founder of an online educational-certification program for physician focused advisors, I recommend that he set up his checking, money market and investment accounts and have his medical practice directly deposit his paycheck in the money market account. He then was to transfer only enough money to his checking account each month, to cover his very carefully budgeted and spread-sheet driven expenses. Furthermore, his money market account was to be equal to our predetermined cash reserve needs, with any excess cash transferred to his investment account and according to his financial and investing plan.

Assessment

Of course, his carefully constructed budget included no cash reserves or emergency fund! He forgot to budget cash! And so; the usual conundrum ensued.

Conclusion

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Filed under: "Ask-an-Advisor", Financial Planning, Funding Basics, iMBA, Inc., Op-Editorials | Tagged: American Institute of Certified Public Accountants, cash flow, cash management, cash reserves, Certified, certified medical planner, CFP, CIMA, CMP, david marcinko, Financial Planning, investment adisors, physician investors, reserve fund | 7 Comments »

Don’t Rush Into eHRs

Posted on March 4, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Address Medical ID Theft

[By Darrell Pruitt; DDS]

Yesterday, an important message titled “Don’t Rush eHRs Without Addressing Medical ID Theft” was posted on ModernHealthcare.com by Martin Ethridgehill, a provider training specialist with Blue Cross and Blue Shield of New Mexico.

Link: http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090302/REG/303029965

Mr. Ethridgehill points out that if a patient’s electronic medical identity is stolen by someone for health insurance benefits, critical information about the patient can be imperceptibly altered, leading to accidental death in an emergency room for any number of reasons. Furthermore, he points out that even if the real patient is aware that his or her record is tainted by a false patient’s data, it is very difficult to get the comingled record cleared up.

I have also read elsewhere that HIPAA actually impedes resolution of the nightmare because the Rule also protects the privacy of the false patient – prohibiting the real patient from examining his or her own health record.

Reasons to Go Slow

Ethridgehill is particularly critical of the EHR industry which lately has downplayed the importance of patient privacy in order to sell dangerous products. He gives these reasons for the need to slow down in the rush for interoperability:

“Adding safety and records mitigation protocols ensures patient safety as an ongoing concept and practice.”
“No industry would be allowed to operate, where the officials in charge of it stated that the market or other bodies would be responsible for creating safety procedures. Can you imagine if the auto industry stated, “We make cars, let the market figure out how to regulate safety”? I doubt that Congress or any other body would consider these people as remotely credible, yet I hear time and time again these statements being made in public and private forums by executives, lobbyists, and even so-called healthcare leaders.”
“For the public and providers to embrace a product that has no regulation, no built-in safeguards and obviously no importance to safety from the makers of these products, why would Congress expect the American public or healthcare providers to embrace a product or concept that involves the unregulated risk of injury, death, or staggering liability opportunities, let alone without any hope of remedy or proper relief?”

Conclusion

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

Filed under: Health Law & Policy, Information Technology, Research & Development | Tagged: ADA, CCHIT, Darrell Pruitt, david marcinko, dentists, eDRs, EHRs, EMRs, HIPAA, HIT, IT, Martin Ethridgehill, ModernHealthcare | 20 Comments »

Agenda for Financial Healthcare Change

Posted on March 4, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Quality Guru John Wennberg MD Targets Health Economics

By Staff Reporters

According to the New England Journal of Medicine, and as reported by blogger Matthew Holt in December 2008, the Dartmouth Atlas team has offered an “Agenda for Change” which laid out some practical tactics – for reducing medical practice variation – leading to more standardized care patterns and rational economic spending.

Link: http://www.healthcarefinancenews.com/news/controlling-variations-spending-critical-healthcare-reform

The Original Pioneer

Written by oft cited John Wennberg MD (the godfather of medical practice variation research), Shannon Brownlee [author of the seminal book “Overtreated”] and colleagues, the “Agenda” includes financial incentives for Medicare providers that would share savings resulting from better organizing patient care and improving outcomes and efficiencies especially for people managing chronic conditions.

www.MedicalBusinessAdvisors.com

Note: Efficiency here means the best outcomes and quality at the lowest cost and resource utilization; and we might add at the most appropriate venue, delivery vehicle and time.

www.HealthDictionarySeries.com

Assessment

Until now, experts have blamed the healthcare growth in spending on advances in medical technology, but Elliott Fisher MD, another one of the study’s authors, says that differences in financial growth rates across regions show that advancing technology is only part of the explanation.

IOW: Controlling financial variations in spending, like those clinical variations in medical care via EBM, is critical to any type of healthcare reform.

Be sure to download and read the 25 page report here.

Link: http://www.dartmouthatlas.org/topics/agenda_for_change.pdf

Conclusion

Your thoughts and comments on this Medical Executive-Post are appreciated.

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Filed under: Uncategorized | Tagged: Agenda for Change, david marcinko, Elliott Fisher MD, John Wennberg MD, Matthew Holt, NEJM, Shannon Brownlee, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.healthdictionaryseries.com, www.medicalbusinessadvisors.com | Leave a comment »

On Emergency Funds for Physicians

Posted on March 3, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Cash Reserves Now More Important Than Ever!

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

CEO: www.MedicalBusinessAdvisors.com

This is a basic question in financial planning circles that has generated much activity in the medical community, of late. Previously considered so mundane – as to be dismissed by some haughty physicians – it has acquired increased urgency with the current financial meltdown.

What Security Level Desired?

Yet, the answer to this question is dependent upon the security level desired by the medical provider and his/her family. Traditionally, financial planners suggested most people with solid employment, and transferrable skills, have at least three months of living expenses (not including taxes) in a reserve fund that is easily accessible (i.e., liquid). The amount needed for a one-month reserve is equal to the amount of expenses for the month, rather than the amount of monthly income. This is because during no-income months – there is no income tax.

The Usual Checklist

We suggest the following questions as helpful in determining the amount of reserve needed by medical professionals:

1. How many incomes do you have in your household?

2. How secure is your current practice, or medical job?

3. Do you have other unrelated sources of income; medically or non-medically related?

4. How long would it take you to find another position in your specialty, if suddenly unemployed? [Hint: Assume one month per ten grand of income; at $150-k annually, this means searching for 15 months].

5. How much money do you spend, and save, each month?

6. Would you be willing [able] to lower your monthly [fixed or variable] expenses, if you were unemployed?

Many Factors to Consider

But, many other factors come into play when determining how much money a particular physician and his/her family should have on hand. Does the family have one income or two? How stable is this income source? Does the doctor work for himself [managing partner], or is she employed [minority partner, associate, etc]? What kind of firm, company or hospital employs him; private, HMO, MCO, Federal or State entity? Does the family use all of the income each month? What about, life, health, disability or LTC insurance as fringe benefits? Does the family anticipate the possibility of large liability exposures and expenses occurring in the future (i.e., medical school or practice start-up debt, private tuition for the kids, medical expenses, liability suits etc.)? Are you willing to relocate for a new job?

Family Situation Appraisal

If the doctor is in a dual-income family – with stable incomes – and/or lives on a single income – the need for a liquid reserve is minimal; but still much more than for the average layman. On the other hand, if the doctor is a single individual, with an unstable income and she spends everything each month, the need for a liquid cash reserve is higher.

In the previous example, and in the stable past, the doctor may have opted for a six-to-nine month reserve if the need for security was high; and a three-to-six month reserve if the need for security was low. For the last five to seven years however, we have suggested to our medical clients that they expand this reserve cash corpus to 12-24 months; and as a blanket rule of thumb for all medical professionals. Of course, I was roundly criticized for it; until now.

Today, we are suggesting 3-5 years; with considerably less criticism. Cash is power, choice, swagger, potency, freedom and represents options. Acquire it!

Stashing the Cash

Once the amount of reserve is determined, the doctor should consider the appropriate investment vehicles for the reserve fund. At minimum, the reserve should be invested in a money market mutual fund with NAV @ 1.00 USD. Larger income earners may opt for tax-exempt money market mutual funds, as needed. For larger reserves, an ultra-short term, no-low bond fund, might be appropriate for amounts over three months – in periods of deflation; not so during inflationary periods.

Assessment

Today, we recommend doctors keep 3-5 years of cash-on-hand. Yes, I am aware of the “paradox-of-thrift” conundrum. But, do you want to help the domestic GDP, or your family; you decide? Personally, my own concern is not the macro-economic milieu.

Full disclosure: I am a former insurance agent, registered investment advisor; board certified surgeon and Certified Financial Planner™

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How stressed out are you, right now? You are sleepless if previously considered cash, as trash.

But, if sitting on a little pile; you should be sleeping like a baby.

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***

Front Matter with Foreword by Jason Dyken MD MBA

“BY DOCTORS – FOR DOCTORS – PEER REVIEWED – FIDUCIARY FOCUSED”

***

Filed under: "Ask-an-Advisor", Book Reviews, Career Development, Experts Invited, Financial Planning, Funding Basics, Investing, Op-Editorials, Recommended Books, Research & Development | Tagged: CFP, CIMA, david marcinko, doctor investors, emergency funds, financial planning physicians, hope hetico, MBA, physician investors, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.healthdictionaryseries.com, www.medicalbusinessadvisors.com | 11 Comments »

Enter our Writing Contest

Posted on March 3, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

You Must Submit – to Win

By Hope Hetico; RN, MHA, CMP™

Managing Editor

Enter the Medical Executive Post submissions contest and just maybe you can become famous! Simply send in a written post about some aspect of the healthcare industrial complex, finance, administration, policy or health economics space that you are particularly knowledgeable about. Or, visit our topic channels for related ideas. Use you fertile imagination.

Rules

Submission must be original, not submitted elsewhere and under 1,000 words. Rest assured that grammar, spelling, citations and punctuation counts. Originality and thought-leadership is a must. Oh, you must be a subscriber and all copyright ownership will be transferred to us, as well. Your material may even be used in some iMBA, Inc print project or publication, now in-progress or in the future.

Grand Prize

Just think! You could become one of 3 finalists featured as an upcoming Medical Executive Post monthly column, with photographic byline, or even the grand prize winner who’ll receive our free best-selling hardcover textbook, the Business of Medical Practice.

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

Contest Close

Submissions are due December 31, 2009. There are no limits to the number of times you may apply or the number of submissions you may send in. All results are final. The anonymous judges reserve the right of non-selection. And, we reserve the right to reject any content submission; for any reason perceived as reasonable, or unreasonable.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post submissions contest are appreciated.

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Filed under: Career Development, Contest Entrance, iMBA, Inc., Marketing & Advertising, Media Mentions and PR, Nominations Sought | Tagged: david marcinko, health journalism, hope hetico, journalism, publishing, writing, www.healthcarefinancials.com, www.healthdictionaryseries.com, www.medicalbusinessadvisors.com | Leave a comment »

Upcoming Health Economics Interview with Dr. David Marcinko

Posted on March 3, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Coming Soon from Medical Business News, Inc

By Ann Miller; RN, MHA

ME-P Executive-Director

Medical Business News, Inc., the publisher of Medical News of Arkansas, is a leading source for healthcare industry news that is truly useful. With a professional readership comprised of physicians and key industry decision makers, Medical News publications are devoted entirely to healthcare issues that impact both clinical and administrative best practices. Written and edited specifically for healthcare professionals, MBN writers work with experts at the local, regional and national level to keep stakeholders informed about the ever-evolving healthcare system.

Out Reach

It is no wonder then, why local market MNA editor Jennifer Boulden recently contacted us to arrange an interview with Dr. David Edward Marcinko, our Publisher-in-Chief, who is also a former insurance agent, registered investment advisor, health economist and Certified Financial Planner™

Link: www.MedicalBusinessAdvisors.com

Interview Topics

The wide open topic in this environment of medically specific lethargy and macro economic insecurity – personal and business planning for physicians. Of course, since this is a broad field, we will use the rating and ranking system of this blog to help Jennifer and her staff, winnow down categories to top-of-mind concerns of our ME-P subscribers and her MNA readers.

Link: www.HealthcareFinancials.com

Assessment

But, we also ask you to send in any particular issues that you may have in order to make the interview helpful and exciting for all concerned.

Link: www.HealthDictionarySeries.com

Conclusion

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

Link: www.CertifiedMedicalPlanner.com

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Filed under: Accounting, Breaking News, Career Development, Experts Invited, Financial Planning, iMBA, Inc., Insurance Matters, Interviews, Investing, Media Mentions and PR, Op-Editorials, Research & Development | Tagged: BD, Bloomberg magazine, broker-dealer, certified financial planner, certified medical planner, CFA, CFP, CFP Board of Standards, CIMA, david marcinko, Ed Morrow, evan simonoff, FA, financial advisor magazine, Financial Planning, financial planning magazine, insurance agent, investment advisor magazine, Jennifer Boulden, Marion Asnes, MBA, Medical Business News Inc, Medical News of Arkansas, PhD, registered financial consultant, registered representative, registered representative magazine, RFC, Wealth | 1 Comment »

Health HR Webinar Invitation Credibility?

Posted on March 3, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Reaching-Out for ME-P Subscriber Advice?

Dear Dr. David E. Marcinko,

One of my political friends mentioned that you would be a perfect candidate for an informational Webinar we will be hosting. With you being a thought-leader on healthcare, we would be honored if you could be a co-presenter for a complimentary webinar we will be hosting on the stimulus package relating to healthcare, and what it means to companies today. As you know the stimulus package is making its way through congress. Currently the House and the Senate passed their version and currently the conference committee is making one version.

Your Input Requested

Where do you fit in? Many health issues, including health insurance assistance for the unemployed are heavily being discussed. We and other HR professionals would like to hear your thoughts on this tentative new health care policy, before it is too late. What does this mean for businesses today?

Our Mission

The mission of our company is to support, educate and inform companies on how to control and drive down the cost of delivering Human Resources and Employee Benefit Services. Shortly after you speak we will provide administrative tips and ideas for those who are going to have to deal with the administrative burden of covering all those uninsureds dating back a year ago.

The Oportunity

We hope your interest in the problems of, and opportunities for educating, company HR executives will be helpful. We would be happy to provide feedback from our attendees for you if you would like. With your busy schedule we will make this as seamless as possible. We will schedule a short interview with you, ask you questions, write the power point, have you approve it, and provide your transportation to our office; or we will go to yours.

Assessment

I look forward to a favorable reply, and as soon as I receive it, I will reply accordingly.

Yours Sincerely,

Sarah Soss

Marketing & Business Development

5000 Birch Street, East Tower Suite 300

Newport Beach, CA 92660

office – direct: 714-384-0590

internal ext. 4590

secure fax: 714-384-0600

email: sarah.soss@secova.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is this organization credible? How about the invitation; real or sham? Have any ME-P readers or subscribers ever heard-of, or dealt-with, this company? Should the invitation be accepted? Please advise prudently.

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Filed under: "Ask-an-Advisor", Breaking News, iMBA, Inc., Interviews, Sponsors | Tagged: employee benefits, HR, medical HR, obama, Sarah Soss, Secova, webinar | Leave a comment »

Meet Dr. Gary L. Bode CPA MSA CMP™ [Hon]

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

Introducing our Newest Thought-Leader

[By Ann Miller RN MHA]

The Medical Executive-Post is proud to introduce Dr. Gary L. Bode as our newest thought-leader for healthcare financial modernity. Dr. Bode was the Chief Financial Officer [CFO] for a private mental healthcare facility, and previously the Chief Executive Officer [CEO] of Comprehensive Practice Accounting, Inc, in Wilmington, NC. The firm specialized in providing tax solution to medical professionals. Dr. Bode was a board certified practitioner and managing partner of a multi-office medical group practice for a decade before earning his Master’s of Science degree in Accounting [MSA] from the University of North Carolina. He is a nationally known forensic health accountant, financial author, educator and speaker.

A Multi-Faceted Healthcare Financial Expert

Areas of expertise include producing customized managerial accounting reports, practice appraisals and valuations, restructurings and innovative financial accounting, as well as proactive tax positioning and tax return preparation for healthcare facilities. Currently, Dr. Bode is Chief Accounting and Valuation Officer (CAVO) for the Institute of Medical Business Advisors, Inc. He is also a Certified Medical Planner™ http://www.CertifiedMedicalPlanner.org He provides litigation support in his areas of expertise and has been previously accepted as a legal expert witness www.MedicalBusinessAdvisors.com

Assessment

Gary has promised to publish his most exciting ideas and innovative work on our blog. He is also available for private consulting engagements and related professional work on an ad-hoc, or interim basis. So, let’s give a warm ME-P “shout-out” to Dr. Gary L Bode; our newest thought-leader.

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Filed under: Accounting, Breaking News, CMP Program, Research & Development, Sponsors, Taxation | Tagged: Gary Bode, Health Insurance, healthcare, Managed Care, medical accounting, Taxation, Thought-Leaders: | Leave a comment »

Doctors Censoring Patients

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

Another Emerging Ethical Dilemma

[By Hope Rachel Hetico; RN, MHA, CMP™]

Much has been said, and much has been written, about the various healthcare 2.0 initiatives and the new-wave patient collaborative schemes among medical stakeholders. Even our federal government, vis-a-vie, the American Recovery and Reinvestment Act [ARRA], of 2009 [“stimulus”] has increased funding related to health information technology [HIT] for physicians, hospitals and healthcare organizations; hopefully to benefit us all.

Information Technology Money

In fact, according to Steve Lieber, President of the Health Information Management Systems Society [HIMSS], about $20 billion will be investment into health information technology [HIT] at one time. Some money will flow into the current calendar year, some dollars will flow in subsequent years, and some funding will be available until spent.

Consumer-Oriented Websites

And so, it comes with surprise and dismay to me that some doctors may be telling their patients to censor themselves – or find another physician. This, of course, is anathema to consumer oriented websites like RateMDs and Vitals.com, etc. These sites give internet users the chance to recommend and review physicians and hospitals nationwide.

Unethical Behavior

But, some ethicists believe that such self-interested behavior is not professional and when a doctor acts primarily out of self-interest, it is ethically suspect. For example, according to Fox News on February 19, 2009, among groups spearheading the move to censor is a company called Medical Justice® which says it’s only helping protect doctors from online libel as an “emerging threat” within the medical profession. Founder Dr. Jeffrey Segal, a former neurosurgeon robustly supports the consumer rating sites in theory, but in practice they aren’t properly monitored and can do irreparable harm to a doctor’s reputation – especially when people pretending to be former patients write phony reviews.

Assessment

Medical Justice® has been mentioned on this forum before, and according to its website

Medical Justice® creates a practice infrastructure to prevent, deter, and respond to frivolous medical malpractice suits. A membership-based organization, Medical Justice® is relentlessly committed to protecting physicians’ reputations and practices.

Link: http://www.medicaljustice.com

The Center for Peer Review Justice is also a related group of physicians, podiatrists, dentists and osteopaths who have witnessed the perversion of medical peer review by malice and bad faith.

Link: https://healthcarefinancials.wordpress.com/2008/04/17/physician-peer-review

Industry Indignation Index: 65

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Filed under: Ethics, Industry Indignation Index, Information Technology, Managed Care, Op-Editorials, Quality Initiatives, Research & Development | Tagged: AARA, Center for Peer Review Justice, Dr. Jeffrey Segal, HIMSS, HIT, IT, Medical Justice, RateMDs.com, Steve Lieber, Vitals.com | 20 Comments »

ME-P Sponsor of Intellectual Capital

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

www.HealthcareFinancials.com

By Ann Miller; RN, MHA

Executive Director

All hospitals, healthcare systems and organizations use a variety of teaching, educational and didactic techniques to bring value to patients, payers, providers, governments and third-party intermediaries.

Intellectual Capital

This intellectual capital is the sum total of all knowledge and expertise used to serve the healthcare industrial complex and its’ stakeholders. Leaders, CXOs, CEOs, CFO, managers, administrators and employees provide most all of this current cognitive capital.

Print Journal Guide

We believe that Healthcare Organizations: [Financial Management Strategies] adds to this intellectual capital by guiding you, empowering your organization, and creating value for your patients, employees, investors and clients by bridging the intersection of medical mission and profit margin.

Assessment

www.HealthcareFinancials.com seeks to “Bridge the Intersection of Medical Mission and Profit Margin”; using the aggregated free-labor knowledge of those in the industry. There is just no better method available.

Visit and Order Now

Specialty Technical Publishers

8 – 14th Street

Blaine, WA 98230

1-800-251-0381

orders@stpub.com

http://www.stpub.com/pubs/ho.htm

TOC: http://www.stpub.com/pdfs/toc_ho.pdf

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Filed under: "Advisors Only", "Doctors Only", Accounting, Alerts Sign-Up, Career Development, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc., Information Technology, Managed Care, Media Mentions and PR, Recommended Books, Research & Development, Sponsors | Tagged: ASCs, brent metfessell, Calvin Wiese, Carol Miller, CEO, CFO, Charles Fenton, clinics, CXO, Darrell Pruitt, david marcinko, David Nash, David Piasecki, Gary Bode, Groegory O. Ginn, healthcare, Hope Hetcio, hospitals, karen white, Managed Care, medical care, Pati Trites, public health, Richard Helppie, Richard Mata, Robert Cimasi, Todd Zigrang, Wayne Firebaugh, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.medicalbusinessadvisors.com, www.STPub.com | Leave a comment »

Avi Baumstein and HIPAA Compliancy

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

A Ten-Step Process

By Darrell K. Pruitt; DDS

HIPAA inspections are coming. Are you still computerized? If so, are you prepared? The fines are steep if a dentist’s [optometrist, podiatrist, allopath or osteopath’s] computer is hacked and he or she is found to be not in compliance.

About Avi Baumstein

Avi Baumstein is an information security analyst at the University of Florida’s Health Science Center in Gainesville. He posted an article recently; on InformationWeek titled “Time to Get Serious about HIPAA.” Baumstein is one expert who should know.

Link: Ten Step Process

http://www.informationweek.com/news/industry/health-care/showArticle.jhtml?articleID=214600332&pgno=1&queryText=&isPrev=

Mr. Baumstein notes that in October, the HHS inspector general issued a report that was sharply critical of CMS (Medicare and Medicaid) for not enforcing HIPAA security. The embarrassing dope-slap of CMS leadership causes Baumstein and other experts in the security industry to anticipate more “proactive enforcement” (unannounced inspections) in the next year.

From his article, I am led to believe that the last prerequisite for meaningful action to enforce security is a tax-paying and otherwise acceptable nominee for Secretary of Health and Human Services. Whoever Obama finally digs up [Kathy Sibelius] I think providers are in for significant changes.

For example, it will be the Secretary who will ultimately decide if HIPAA inspections will be performed by new federal employees or PriceWaterhouseCoopers personnel – which was the former President’s administration’s “market approach” to helping the GDP by outsourcing policing duties, as well as accountability, to favored big businesses. (For those who are sensitive about political affiliations and become upset with me for saying unflattering things about your heroes, please don’t feel too hurt. I’m a bi-partisan critic for natural reasons).

The ADA’s imaginary playing field and toy soldiers

“The electronic health record may not be the result of changes of our choice. They are going to be mandated. No one is going to ask, ‘Do you want to do this?’ No, it’s going to be, ‘You have to do this.’ That’s why we absolutely need the profession to be represented in the discussions about EHR to make sure our ideas are enacted to the greatest extent possible.”

ADA President-Elect Dr. John S. Findley,

In-house interview ADA News

October 7, 2008

In spite of President Findley’s manicured and traditional cause-I-say-so sound bite, the actual invisibility of ADA leadership in healthcare IT matters clearly hints that whatever happens in Obama’s healthcare reform, dentists’ and patients’ concerns stand little hope of being adequately represented by ADA representatives.

For example, when I recently contacted CCHIT to ask about EHRs in dentistry, I was told that I was one of the first to even mention dentistry to the private and reclusive non-profit EHR certification club. I think that chunk of unexpected news blows a huge hole in President Findley’s boat. Want to see something hilariously scary in a darkly humorous way? The President’s campaign motto this time last year was “Findley for the future.” Get it?

In spite of the silent neglect of dentists’ interests by dental leaders from the top down, I would like to proclaim that there is accidental hope that future HIPAA inspectors will know more about dentistry than the jobless OSHA hired in the late 1980s during the HIV panic. I heard a rumor back then that OSHA sent an inspector to a dental office who didn’t know the difference between a microwave and an autoclave.

Panic and Urgency

Panic, a favored US government bureaucratic response, occurred when OSHA leaders found themselves suddenly under pressure from Congress over a mysterious disease that was raging out of control. Since immediate action was demanded, even if it was irrelevant and wasteful, OSHA leadership was so busy chasing shadows that it was hiring almost anyone just to cover their lower backs. Eventually, the panic subsided and yielded to a low level of common sense, thanks in large part to the intervention of the late Rep. Dr. Charlie Norwood of Georgia – a dentist and a courageous statesman. Nevertheless, because of the momentum of institutional panic, millions of healthcare dollars have been wasted on 99% superstition; incredible? Consider this.

In the last two decades, how many lives have been saved by covering dental chairs with plastic between patients? Now, how much does the effort raise dentists’ fees – thereby lowering accessibility and increasing disease and suffering among Americans? Furthermore, after each dental patient is released, the “contaminated” sheet of petroleum-based polyethylene is thrown away. I ask this: Are the reasons for inevitable environmental problems caused by regularly adding non-biodegradable plastic to the city dump based on evidence-based science?

Of course not! This and other related acts of foolishness are nothing but lingering, costly superstition – now accepted as standard of care without proof of effectiveness. Here is how such absurdity happens: Some of those weekend miracles quickly hired by OSHA in the ‘80s went on to become prosperous and influential consultants with lots of ideas.

Since the US government is prone to panic followed much too quickly by careless and expensive overkill, national responses to adversity often stimulate lots of employment – evidence of need be damned. The OSHA surge of the 80s followed the AIDS scare. More recently, coming on the heels of the banking collapse, auditing has become one of the fastest growing fields in the industry. The feds cannot hire people with accounting skills fast enough. I contend that one should expect that for reasons and attitudes similar to those surrounding the increased funding for OSHA, it follows that news of frightening breaches of EHRs by the hundreds of thousands at a time has created a new nidus of power in a fresh, enthusiastic administration, as well as an enormous employment opportunity for anyone with knowledge of dentistry – like super-hygienists.

A hazy glimpse of the future and a promise to tie all this together soon

This brings us to a fanciful peek over the edge of the event horizon in dentistry. At the same time that HIPAA inspections of dental offices appear unavoidable, there is currently a turf war between fully licensed dentists and expanded duty “super-hygienists” who wish to be able to practice independently – limiting their invasive work to only easy fillings and simple extractions that in their assessment will not turn complicated.

Link: www.HealthcareFinancials.com

Turf Wars

This kind of war has been fought before, and physicians lost. Nurse-practitioners annexed physician turf like Sudetenland, and they are still grabbing lebensraum. CMS loves it.

However, dentistry is different. It is my opinion that because of dental patients’ very personal reasons that include under-rated motivation from primal fear and terror, they will shun almost-dentists almost immediately – leaving graduates with huge student loan payments and lots of unused knowledge about dentistry.

Furthermore, I predict that when super-hygienists consider the expense of finishing out and leasing space at a shopping mall or department store, in addition to monthly loan payments to cover the price of dental equipment, or perhaps even the buy-in price to an insurance-sponsored dental franchise, a few will be discouraged from their initial intention to increase accessibility to dental care by lowering cost and quality.

I think reality will cause a few super-hygienists to be readily lured from their initial goals upon entering two-year junior college programs that taught them nomenclature and the easy parts of doing dentistry. Unless they agreed to work in underserved areas in exchange for paid tuition, some will consider the benefits of working for commission for the US government as HIPAA inspectors. And later, the most successful of these will have the opportunity to continue their careers as HIPAA consultants with lots of ideas.

Are you following me so far? In conclusion, within two years, instead of real-dentists and almost-dentists being faced with uninformed HIPAA inspectors like OSHA’s shock-and-awe weekend miracle crews of the ‘80s, there will accidentally be thousands of nomenclature-savvy super-hygienists graduating across the nation looking for work about the time an acceptable HHS nominee finds his or her stride. What a story!

Did I ever tell you that I once did a short stint as a screenplay writer?

I guess I am being a little bit silly concerning super-hygienists, but do you see how all these pieces of history can conceivably come together at a time when the nation couldn’t be more vulnerable to wasting money on foolishness? Common sense about patients’ security is just not that common in Washington DC, and the absurdity of HIPAA is so great that the stunned silence it evokes actually causes the enforcement of folly to fit in well with the traditional Democratic tendencies of using big government to handle all possible contingencies caused by human frailties – even if that means micromanaging everyone. Who needs that?

Every day, I am increasingly thankful that my office is not computerized. The sheet-metal box that contains my patients’ ledger cards does not have a USB port. Preparation for inspection is tricky by design.

Link: www.MedicalBusinessAdvisors.com

Assessment

Baumstein concedes that preparing for a HIPAA inspection is difficult because the law is intentionally vague:

“One goal of HIPAA was to be a one-size-fits-all, technology-neutral regulation.”

Incredible; when you read the ten obligations Baumstein says a dentist must complete to be compliant with a vague mandate, you too may want to go back to a pegboard system – carbon paper and all.

It seems to me that in 2003 or so, someone in the ADA Department of Dental Informatics should have warned ADA leadership about the obvious fact that as long as there is a dependable supply of cheap carbon paper in the nation, HIPAA enforcement has the potential to drive computers smoothly out of dentistry. Instead, there was silence followed by increased funding for the department’s budget, and the game was on. By 2005, at the urging of the former administration and healthcare IT stakeholder Newt Gingrich, the ADA News was posting articles pushing ADA members to quickly volunteer for irreversible NPI numbers for no good reason. A trusting majority of members dutifully followed the tainted command. I am saddened by the loss few yet comprehend.

Link: www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. In bringing a close to this contiguous, here is something some may find interesting about the University of Florida, where Avi Baumstein works. Do you remember the 330,000 dental patient records that were hacked this fall from the Dental School located in Gainesville, Florida? You guessed it; same college town – same health science center.

And, as of last week that the dental school was still hemorrhaging patient data to who knows where. I bet by now, Baumstein knows more about HIPAA and dentistry than anyone in the nation How about you?

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Filed under: Career Development, Health Law & Policy, iMBA, Inc., Information Technology | Tagged: ADA, ADA News, AMA, AOA, APMA, Avi Baumstein, CCHIT, Darrell Pruitt, EMRs, HHS, HIPAA, InformationWeek, John S. Findley, Kathy Sibelius, Newt Gingrich, NPI Numbers, obama, OSHA, Rep. Dr. Charlie Norwood | 6 Comments »

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