Dr. David Edward Marcinko MBA MEd CMP™

Such a “Sleazy” Company

Posted on September 19, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

About Delta Dental

[By Darrell K. Pruitt; DDS]

“A contract provision that holds dentists to Delta’s maximum allowed fee for non-covered services will affect all of Delta’s Premier and Preferred Provider Organization participating dentists throughout the country by January 2011″ (my emphasis).

“Delta Caps Rates Nationally for Two Networks”

I copied the line from an American Dental Association News online article by Arlene Furlong’s article is titled “Delta caps rates nationally for two networks.”

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3218

This means that if a Delta preferred provider wishes to make up for the profit lost from providing Delta customers 25% discounts on dentistry, doing more cosmetic dentistry will no longer help keep the doors open. Delta is telling its providers that it will demand discounts on everything for its customers.

Discount Factor Costs

How much does a 25% discount cut into a dentist’s pay? Overhead in dental practices typically run about 65%. Do the math. If the net profit is 35%, and Delta knocks off 25% the dentist’s fee; that means the dentist takes a 70% cut in pay to treat Delta patients. How happy do you think dentists are to see Delta patients who show up for appointments? You guessed it. Delta Dental preferred providers are disagreeable already, according to Doctor Oogle (www.doctoroogle.com), a Patient Driven Referral Site [PDRS].

The Delta Dental Rankings

To see how Delta Dental preferred providers rank in patient satisfaction against all other dentists, pick a few names off of Delta’s list and see where they fall on DR. Oogle’s ranking. I recently saw such a study involving Austin, Texas dentists from almost a year ago. The Delta dentists’ ranks averaged 206 out of 297 Austin dentists listed on the site. That is the bottom 30%. One could say the 70% cut in pay buys Delta Dental clients dental work from the most unpopular 30% of dentists; interesting coincidence.

Cogent Thoughts

Think about this way: In a little more than two years, if a dentist’s practice consists entirely of Delta Dental patients, the doctor cannot raise fees at all. What makes leaders of Delta think they can get away with tyranny in the land of the free?

Furlong further writes: “Tom Dolatowski, Delta’s vice president of marketing and communication, estimates that some 75 percent of dentists nationally are participating in the Delta Dental Premier plan, while some 25-30 percent are participating in the Delta Dental PPO plan.”

That’s how; effective sales techniques

Delta Dental is Simply a Sleazy Company.

This spring, at the Southwest Dental Conference in Dallas, Delta Dental employees encouraged me and other dentists to apply for NPI numbers. NPI application forms were prominently displayed in Delta’s booth. The Delta saleswoman who covers the east side of Fort Worth, my neighborhood, said, “You don’t want to wait until the last minute. May 23rd is the [final] deadline.” (The deadline had been delayed a few times).

Then she and other Delta employees emphatically agreed that the NPI number will soon become a licensure requirement for all Texas dentists anyway. That is an unethical and unlawful lie – condoned, if not encouraged by the leaders of Delta Dental to enhance corporate profits using deception. Everyone knows that the NPI number helps nobody but insurance companies.

Assessment

There is no question that Delta Dental desperately wants dentists to volunteer for NPI numbers. When a dentist applies for the number it gives Delta permission to mine the uninformed dentist’s “Freedom of Information Act-disclosable” data from dental claims. Delta will use its proprietary algorithms to rate the dentist. Then Delta will display the dentist’s value to society on an Internet website. This way Delta can direct its clients to the best neighborhood dentists according to Delta’s preferences – but not necessarily the patients’.

The fact that Delta’s customers generally don’t like Delta’s dentists means that the last thing Delta wants published is patients’ opinions – like those in DR. Ogle.

Conclusion

In my opinion, Delta Dental is such a sleazy company. What is your opinion?

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

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Filed under: "Doctors Only", Health Law & Policy, Managed Care, Practice Management, Research & Development | Tagged: delta dental | 12 Comments »

Healthcare Industry Prognostications

Posted on September 18, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

The PWC Report

By Staff Writers

A recent study by PriceWaterhouseCoopers [PWC] suggests that 2008-09 could be a big period for the healthcare sector with structural changes that could alter the industry. These include alterations to hospital Medicare reimbursement, further IRS pressure on non-profit hospitals, the growth of the retail clinic market and the continued emergence of consumer-directed healthcare, according to the PWC Health Research Institute [HRI].

Predictions

For example, with CMS changing the way it pays hospitals – adding 200 diagnosis codes for severity while refusing to pay for some medical errors and “never-events”, some hospitals will see less income, while others more. The firm also predicts that the retail clinic sector will continue to expand, that the FDA will boost drug and medical device safety standards, and that the IRS will bear down hard on non-profit hospitals to prove that they’re providing adequate community benefits.

Assessment

Health economic Sustainable Growth Rate [SGR] prognostications also suggest that the present path of Medicare reimbursement can not be sustained; with harsh cutbacks like 20% physician payment reductions, threatened.

Conclusion

Since these predictions will be spurred, in part, by the shift in political power triggered by November’s presidential election; your thoughts are appreciated?

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Filed under: Managed Care, Op-Editorials, Practice Management, Research & Development, Surveys and Voting | 1 Comment »

How to Hire a Medical Accountant

Posted on September 18, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Seek Healthcare Specificity

Staff Reporters

Use these 25 questions to educate yourself about accountants. And, use this 25-point checklist on how to pick a good healthcare focused CPA. It can be a powerful list for any medical professional and might help you bring in extra money, immediately.

Other Areas

In the areas of estate planning and financial planning, it is essential that doctors have a good team of financial professionals. This usually involves, at the very least, a CPA, an attorney, and a fiduciary focused financial advisor [maybe].

CPAs

If you are a CPA for docs, use this list as a reference for your doctor-clients. By bringing up the concept of due diligence on your own, it strengthens your position and makes a perfect opportunity to ask for referrals. You may also want to use this list as a newsletter insert or advertisement of some sort. Put a brief notice at the top of the list stating that doctors should ask their CPAs these questions, and if they need someone who fulfills these requirements, you would be glad to meet with them to discuss the questions.

Financial Advisors

As an FA, use this list as a networking tool. Refer your clients to a competent CPA who you already do business with or would like to do business with. When you refer clients to a good CPA, you open the opportunity for him or her to return the favor. Send this list to your existing clients at tax time as a neutral third party to help them find a good CPA (they already have a good financial advisor—you).

Attorneys

As an attorney, use this list the same way a financial advisor or account would—to network with the top CPAs and MDs in town. You can make it a standard piece in your mailings or newsletters once a year. When you start giving leads to other financial professionals, it will open up referrals that will be beneficial to your business.

Certified Medical Planner®

And, if you are a CPA, FA or attorney, be sure to promote your hard-won credentials for healthcare specificity; like the Certified Medical Planner® designation, for example.

25 Questions to Ask Your Future Accountant

What designations or credentials do you have?
Are you in practice full-time?
How many years of experience do you have in tax practice?
Do you do all your returns by computer?
What are your fees, and do you have a schedule that I can see?
Can you provide references from other businesses similar to my own?
Do you use any checklists to maximize my deductions?
How soon do you return calls from clients?
Do you teach any tax courses or have you written for any tax publications?
Are you conservative, aggressive, or somewhere in the middle?
What review process do you use in order to ensure a quality product?
Do you specialize in taxes?
What percentage of your practice relates to taxes?
What other accounting services do you personally perform?
May I look at your tax library?
What do you do after tax season?
How often do you take tax courses?
What is your attitude toward audits?
How do you treat gray areas?
Have you ever been disciplined by the IRS, the SEC, or any accounting society?
How many other clients like myself do you have?
Do you offer pre-year-end tax planning as part of your tax service? If so, is there an extra fee for this?
Are you generally familiar with current health law and managed care policy?
Do you offer any tax planning during the year?
Can you give me a recent tax planning tip or tax change that may benefit me?

Finally, and most importantly of all; how do all of the above synergize into medical and healthcare specificity, for me?

Assessment

As you likely now realize, this list is not for CPAs only; but as a due diligence reminder for most fiduciary financial advisors professionals or attorneys who wish to work with doctor clients; “often the most difficult clients in the business.”

Disclosure

Dr. David E. Marcinko MBA, our Publisher-in-Chief and former CFP®, is founder of the online CMP® program in healthcare economics, management and finance for advisors www.CertifiedMedicalPlanner.com

Conclusion

Your thoughts, opinions and comments are appreciated.

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Filed under: Accounting, Financial Planning, Health Law & Policy, Practice Management | Tagged: CFP, CPA, FA, JD | Leave a comment »

The “Balance-Billing” Conundrum

Posted on September 17, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Doctors versus Patients

Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Recently, it was reported to the public that millions of patients are paying medical bills they don’t actually owe after being confused about the practices of “balanced billing.” .

Formal Definition

According to the Dictionary of Health Insurance and Managed Care – and others – balance billing [BB] may be defined as:

“The practice of a physician, medical clinic, hospital, ASC or medical provider billing a patient for all charges not paid for by an insurance company or healthcare plan. Balance billing is generally prohibited by managed care plans”.

The story in Business Week, on page 40 by Chad Terhune in the September 8, 2008 issue, goes on to discuss how it’s illegal for doctors, hospitals or labs to bill patients for the difference if they deem the insurance payment too low, but that it happens routinely to the tune of $1 billion each year.

And, healthcare journalist Sarah Arnquist similarly noted the practice with more patient BB horror stories in The Health Care Blog [THCB], a policy and political e-periodical not unlike this Executive Post in format; but not content.

Not a New Problem

However, long before the threatening horror-stories first ran about doctors aggressively pursing collections, maybe even as much as a two decades ago, our network of physicians, attorneys, insurance and risk management experts have been writing about this situation in both peer-reviewed and non-peer-reviewed print and traditional publications.

So, the conundrum is not really a new one. In fact, Medicare first prohibited BB, in 1991. But, its ferocity; pitting patient against doctor, might indeed be an emerging issue. And, it is deeply distasteful on many levels.

Managed Care Contracts

Over the years, managed care has replaced usual, customary and reasonable [UCR] fee-for-service [FFS] medicine with a contracted fee-schedule. Essentially under managed care, an MD can “charge” just about anything s/he might want, but the managed care organization (MSO) will only reimburse up to its maximum contractual allowance as determined by a previously set fee schedule; known as a managed care legal-contract.

In other words, medical providers have pre-accepted a fee schedule and have agreed and been contracted to accept “payment-in-full” for services rendered. And, the greater the difference between the MD charge and the allowable reimbursement, the more the MD will eventually write off as artificially inflated accounts receivables [ARs].

Therefore, there is no “balance-bill” to pay [sans fine print specials, out-of-network provider and venue clauses, etc].

Physician Mindset

Yet, the balance billing mindset continuers by some, especially older, doctors and patients! Why mature docs and patients? It’s because the current and next-generation of doctors, and patients, never practiced or worked in a FS environment, and know little of it?

Now, this might occur benignly; but more often than not today – and in my experience as a multiple-hat wearing medical provider, insurance agent, physician-executive and health economist – it occurs maliciously and greedily; pitting the doctor against patient.

Of course, a common physician defense ploy is the cry: “I didn’t know it was wrong” – or – “my staff was doing the balance-billing; not me.”

Staff Education and Training

So, the doctor’s medical staff is an extension of the physician. And, the physician can become vicariously liable for staff transgressions.

Furthermore, several federal regulations, including HIPAA, the False Claims Act, and OSHA have specific staff training requirements. Failure to provide the required training not only subjects the physician to the risk of employee transgression, but also to the risk of administrative discipline for failure to conduct proper training of staff.

Patient Mindset

Now, since most patients receive health insurance their employers, it seems odd that some remain so naive about this conundrum; ethics aside. I mean, managed care has been around for almost 20 years now, and its risks and benefits are well known. Contract-medicine did not begin yesterday.

And so, where have such gullible patients been living? In a hole void of newspapers, magazines, TVs and the internet? What about their neighbors, gossip, HR advisors or benefits departments at work? I know of Corporate America, and have participated in several educational programs where employees are informed of their duties and responsibilities in this managed care contracted world.

And so, at the risk of sounding harsh, I often wonder where have these souls been?

In other worlds; naiveté has a price and if you don’t look out for yourself; who will ultimately look out for you? No one! So, get a clue, already! It’s 2008; not 1988.

The Offensive Plan

As a patient, if this occurs to you, as it did to me when I once visited an out of state optometrist who tried to BB me while on vacation, you might consider the following pre-emptive strike. Forewarned is forearmed and it is far better to play offense, than defense, with these aggressive and greedy docs:

Read and understand your managed care plan contract. Know your duties and responsibilities. Follow the rules.
Privately inform your medial provider that you are aware of the “contract-medicine” concept.
Confidently tell the provider to put the BB invoice in writing, under his personal signature.
Whisper to him/her you will fax it to your employer, third-party payer, attorney, IRS, OIG, DOJ and/or insurance commissioner for a collegial second-opinion check.

Finally, once the problem has been resolved, politely inform the provider that true BB is illegal; and suggest that if your health plan’s compensation is too low, he/she should not re-enlist on the plan.

Outcome

This was all I had to do, as the flustered provider apologized to me, citing personal and staff ignorance. Of course, I then told him of my credentials and my doubt about his “excuse”; but was willing to give him “benefit-of-doubt” this time. No harm-no foul, I reckoned.

Assessment

By personality – maternal side – I tend to employ the passive-aggressive posture of conflict resolution. So, always be knowledgeable but respectful, polite and most of all ‘umble; just like David Copperfield’s fictional character, Uriah Heep.

And, although there will always be miscreant doctors who try to game-the-system, according to David McKalip MD, Chair, Council on Medical Economics [CME] for the Florida Medical Association [FMA], “A free market with price transparency, quality accountability and private contacting between patient and doctor, is the answer” to the unfortunate balance-billing conundrum.

Conclusion

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Dictionary of Health Economics and Finance
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Filed under: Health Insurance, Practice Management, Research & Development | Tagged: balance-billing | 15 Comments »

Seeking Writers and Contributors

Posted on September 16, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Business of Medical Practice [third edition]

Ann Miller; RN, MHA

Project Manager

As readers of the Executive-Post may know, our textbook the Business of Medical Practice is a best seller.

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

Accordingly, we wish to personally invite all subscribers to contribute to our third edition now in progress. New and prior chapters are still available for updating; for a low-effort but high-yield contribution. We have others ideas for this peer-reviewed publication, as well.

Our goal is to help physician colleagues and medical executives benefit from nationally known experts as an essential platform for their success in the healthcare industry. And so, please advise and thanks again for your consideration and possible contributions. Feel free to email me 24/7 for more information MarcinkoAdvisors@msn.com

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Filed under: Book Reviews, Breaking News, Career Development, Health Economics, Marketing & Advertising, Media Mentions and PR, Practice Management, Recommended Books, Retirement and Benefits | Tagged: books, publications, writers | Leave a comment »

Quality Improvement Initiatives

Posted on September 15, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

We Want to Hear from You!

Dr. David Edward Marcinko; MBA CMP™

Publisher-in-Chief

Hope Rachel Hetico; RN, MHA, CMP™

Managing Editor

Our Questions

As new-wave publishers, we value the personal opinions of our complimentary Executive-Post readers.

And, as traditional contributing editors, we also value opinions on our 2 volume, 1,200 pages, premium-print periodical, Healthcare Financials [Journal of Financial Management Strategies] www.HealthcareFinancials.com for institutional subscribers; $535/year.

And so we ask, regardless of venue, do you agree or disagree with what you read in these publications? And, what would you like to read or learn more about?

Your Answers

Have your voice be heard by sending a letter, opinion or comments on topical suggestions to Executive-Director, Ann Miller RN MHA at: MarcinkoAdvisors@msn.com

Assessment

“Our goal is to augment iterative innovation, and see the health economics sector through your eyes. Otherwise, unlike gravity, our goal of a vibrant interactive professional-sticky-network just won’t happen.”

Conclusion

Remember; “What doesn’t get measured – does not get improved.” Help us to improve!

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Filed under: Op-Editorials, Quality Initiatives, Research & Development | Leave a comment »

Paging Doctor Oogle

Posted on September 15, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Patient Driven Referral Sites [PDRSs]

By Dr. Darrell K. Pruitt; DDS

By Staff Writers

It is clear to some practitioners that Internet-based consumerism is the future of medicine; as well as dentistry.

Regardless of the increasing number of complaints about managed care’s malevolent business model, managed care medical and dental plans are already wilting under the heat of transparency as well as the stifling economy. Market share continues to fall because of Adam Smith-like competition.

These days, consumers are talking like a small town. Dentistry is no exception in the healthcare space.

Enter Doctor Oogle

Doctor Oogle is a web 2.0 platform, built on a social architecture of national participation where patients post comments and opine about participating providers; nice or nasty. According to the site, it also offers a public database of dentists with patient feedback about dental practitioners. One can also read reviews, ratings, and recommendations; select a practitioner or schedule an appointment.

Ad-Driven Contrast of PDRSs

In contrast to WebMD, Servicegrades.com or other Patient-Driven Referral Sites (PDRS), which sell dentists ad space, DR. Oogle is completely uninfluenced by paid advertisements because there are none. Participating dentists pay a flat monthly fee.

Defining Dental Quality

If we can agree that in dentistry [perhaps more than medicine] patient satisfaction is an important measurement of quality care, DR. Oogle is a natural measuring tool just begging to be used by patients holding preferred provider lists. In addition, DR. Oogle has the largest database of patient ratings of any other PDRS.

Dollar-Based Dental Benefits

As businesses pull-back from expensive dental and medical insurance, some providers encourage owners to replace it with a fair and simple dollar-based benefit system; like Direct Reimbursement [DR] instead of intentionally confusing procedure-based benefits. This is akin to a concierge medical practice.

And, dentistry may be more susceptible to consumer influences, than whole-body medicine for a variety of reasons; for example:

costs of dental treatment are a small fraction of hospitalization,
emergencies are not generally life threatening, even if painful, and,
patients readily recognize bad dentistry [sometimes even as it is being performed].

Welcomed Transparency

Some dentists – and doctors – opine that managed care dentistry [medicine] is simply dentistry [medicine] provided by the lowest bidder – with little to no quality control – an unethical/specious business foundation that ultimately leads to the abandonment of patients’ interests. Of course, this is not a new hue and cry against managed care precepts.

DIY Studies

And so, in a recently received, and anonymous, do-it-yourself DR. Oogle study; one researcher was shocked at how much the listed dentists were disliked by their customers [patients]. Of course, there are statistical wrinkles:

Maybe these lower rated dentists are not as bad as the reviews describe.
Is it possible that a few vocal people who expect discounts are impossible to satisfy?
How fair is that to a young dentist – just trying to scrape by anyway possible?
What dentist can maintain professionalism indefinitely in the financially thank-less environment of managed care?
What about the future?

Even if a preferred provider goes bankrupt trying to maintain professional standards, he or she remains sadly unappreciated. Discount dentistry [medicine] comes at a tremendous price.

Assessment:

Collaborative healthcare 2.0 is the philosophy where patients, providers, and payers interact collaboratively and competitively in order to enhance quality medical services at value-driven prices in the most appropriate venue and time.

Dr. Oogle is an imperfect tool that in many respects seeks to further this goal.

Nevertheless, although metering tools will undoubtedly improve going forward, caring and competent dental professionals need not fear them. All others beware of patient empowerment and transparency.

Conclusion:

You thoughts and opinions are appreciated. Please comment on Dr. Oogle and/or related doctor evaluation methods. [PDRSs]. Or, discourse on the increasingly transparent healthcare ecosystem in general.

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Filed under: Career Development, Information Technology, Practice Management | Tagged: Add new tag, doctor oogle, PDRS | 6 Comments »

Certificate of Need Legislation

Posted on September 14, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Proposing New CON Barriers-to-Entry

By Staff Reporters

Certificate of Need [CON] laws, regulations, and licensure stipulations are known as Barriers to Entry [B2E] hurdles; and have been removed by many states after decades of utilization. For example Montana, Georgia and others have recently removed them, or currently are critically re-examining their CON laws.

The Mundy Proposal

Pennsylvania State Rep. Phyllis Mundy (D-Luzerne) testified at a recent House Insurance Committee [HIC] hearing on her legislation to re-establish a state Certificate of Need (CON) program for medical equipment as a way to rein in skyrocketing health care costs. Citing the three diagnostic imaging centers near her Kingston home as an example of market saturation, Mundy urged colleagues to require health facilities to justify the need for expensive medical equipment. The Mundy bill also would ban physicians from self-referring patients for procedures at outpatient facilities they have financial interests in, which she said invariably leads to more procedures being done at the facilities.

Purposes and Reasons

According to the September 4^thTimes-Tribune, Mundy believes that the proliferation of specialized clinics, imaging centers and surgical centers in communities is one reason health care costs are escalating. Her legislation would re-establish a state regulatory program that was in effect from the 1970s until 1996, requiring a health care facility to apply to the PA State Health Department for a certificate to start or expand services with costly technology.

Assessment

Allied health professionals are increasingly being accepted and recognized by payers and patients as a legitimate alternative to traditional providers and services [more providers equate to more facilities].

And so, can one really wonder about any new legislation to re-establish CON laws that were first in-acted and then disregarded, more than two decade ago. Moreover, is more legislation and health law policy needed, above and beyond Stark I, II and III?

Conclusion

Your thoughts on this dichotomy are appreciated; is it real or perceived; local, regional or national? And, is the aphorism ”doctors would sell Christmas tress if Medicare reimbursed them” true, or even fair. Please opine and comment.

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

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www.HealthcareFinancials.com

Filed under: Career Development, Health Law & Policy, Managed Care, Practice Management, Quality Initiatives | Tagged: B2E, barriers to entry | 1 Comment »

Growing Your Practice with E-P

Posted on September 13, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Free Marketing Tips in the Executive-Post

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Health Care Complaints versus Compliance

Posted on September 13, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Medical Quality Confusion Reigns

By Dr. David Edward Marcinko; MBA, CMP™

Doctors, medical staff, healthcare administrators and patients can often get confused regarding what issues need reporting through their compliance mechanisms [terminology and definitions].

www.HealthDictionarySeries.com

For example, some staff members may think that every “complaint” should get reported through the system. Since the focus of this program is geared more to concerns of fraud and abuse, the staff needs to be educated about what should be reported and what should not.

Smaller Practices

In small healthcare organizations, education on “compliance-related” issues could be part of regular staff meetings or individual meetings with the compliance coordinator. Staff knowledge of the organization’s expectations can be reinforced on a consistent basis. This will avoid issues that larger organizations have been having, where the compliance hotlines have been used for customer complaints and labor issues.

Assessment

If a healthcare entity notices that inappropriate issues or complaints are being brought up through the compliance program, leadership should respond by evaluating the reasons why this is occurring and look at putting in actions to correct the confusion.

Conclusion

We hope you will opine on our concepts of health administrative definitional-stability concerning complaints versus compliance; please comment.

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post

Filed under: Health Law & Policy, Practice Management, Quality Initiatives, Risk Management | 1 Comment »

How Doctors Get Paid

Posted on September 12, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

It’s all about Flow [Part 1]

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Most patients don’t have a clue about how doctors get paid; it’s not by magic.

Yet, a number of different steps occur during the processing of a medical claim as can be seen in the flow chart below. Each step within the process can be mapped out and each is subject to claim payment-or-claim abortion or rejection.

The steps can also be subjected to a number of variables, depending on a number of different factors including staff competency, time, outside vendors, information management, management decisions in general, or regulatory requirements.

Flow Chart

Of course, any one of these points could lapse, causing the entire process to break down. Like treating patients, when the process has no variables, the end result is very predictable, such as in the flow chart below. When there are variations the end results can be very different.

Treatment is Only the Beginning

Doctor gets the chart

↓

Doctor evaluates patient

↓

Doctor documents visit

↓

Doctor marks billing slip

↓

Doctor gives slip to patient

↓

Patient gives slip to billing clerk

↓

Billing clerk enters information into computer

↓

Office staff submits claim to insurer

↓

Third party payor/Insurance company receives claim

↓

Insurer adjudicates claim

↓

Reimbursement transmitted (electronic or mail) to practice

↓

Reimbursement entered (posted) into practice management system by office staff.

There are two things that you need understand in order to implement an efficient compliance program.

1] The first is the processes needed to run the organization and the desired outcome of those processes.

2] And second, if the process needs improvement, what can be done to make the process function better?

Office Efficiency Checks

Most small medical and dental practices or clinics have a number of checks and balances in place to control variation.

In an example of an inefficient operation, one practice had the physician-executive open every envelope that came into the office. This was done because of a concern that if someone else did it, then something could go missing.

However, the doctor would then turn the mail over to the payment posting person, who would enter claims into the system. Sometimes the person who entered the claims would become busy with other duties and would not be able to enter claims for a couple of days. This proved to be an inefficient method of managing the billing process for the organization.

Assessment

A possible solution is to have one person in the front office to open the mail, organize the contents based on who needs to deal with the information (such as claims, refusals, or requests), and then distribute them accordingly.

More on how physcians get paid.

Part 2: https://medicalexecutivepost.com/wp-content/uploads/2010/02/how-doctors-get-paid-in-2010.pdf

Conclusion

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

***

Invite Dr. Marcinko

Filed under: Health Economics, Health Insurance, Healthcare Finance, Practice Management | Tagged: super bill | 18 Comments »

Emerging Healthcare 2.0 Initiatives

Posted on September 12, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Questions to Consider

Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Hope Rachel Hetico; RN, MHA, CMP™

[Managing-Editor]

Although not always prone to professional introspection, we nevertheless had the recent occasion to ponder the future of the emerging initiative [healthcare business model or philosophy] known as healthcare 2.0.

But, of course, before any discussion begins we must operatively define our terms.

Definitions

Ever since the term “web 2.0” was used in 2004, there has been an inordinate amount of chatter about what web 2.0 really is and its true impact. No one’s really defined it clearly, but we think the web evolution essentially falls into 3 generations:

Web 1.0 – information is communicated from a company [medical practice or hospital] to its customers [individuals or patients]. This is your basic B2C or [business-to consumer] website. The web becomes one big encyclopedia of information by aggregating all these information repositories.

Web 2.0 – information is communicated between company and individuals AND collaboratively between and among individuals. And so, if web 1.0 was a book, web 2.0 is a live discussion.

Healthcare 2.0 – Scott Shreeve MD of Cross Over Health defines healthcare 2.O as:

“A New concept of healthcare wherein all the constituents (patients, physicians, providers, and payers) focus on healthcare value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care.”

Questions to Consider:

And so, we offer these questions to consider about Healthcare 2.0:

How are Web 2.0 technologies like social networks, wikis, podcasts, blogs and micro-blogs, mash-ups and online communities like this Executive-Post changing the face of the healthcare industry?
How are hospital systems, ASCs, medical clinics and physician practices evolving as a result of rapid technological change?
How can health plans evolve in the face of emerging challenges with the help of new technologies and new thinking?
What will come of the recent controversies over genetic testing, the human genome project and 23andMe for example, and the privacy of patient data?
How does transparent financial and reimbursement data impact the competitive scene?
How does transparent physician and hospital quality information affect the competitive scene?
Where does the hype over social networks and user-generated content end and the reality begin?
Does the initiative enhance or detract from traditional medical care delivery models?
Does the initiative enhance or detract from new-wave concierge or retail medical modes?
Is this positive or negative for patients, providers, payers and venues?

Healthcare 3.0

Soon it will not be information anymore; it will be intelligence – artificial or virtual intelligence. You’d interact with it almost like another person. The web won’t just blindly do what we tell it do to, it’ll think for you.

Web 3.0 presents some amazing opportunities in healthcare. For example, imagine being able to be diagnosed by your computer or have your toilet run a SMAC 10 or SMAC 20 on you? Imagine going to Costco®, scanning a barcode with your web-enabled phone, and being instantly notified that your purchase is HSA-eligible.

One day, you’ll type into some (probably Google-like Chrome) search engine or MSFT interface:

“I want to find a podiatric surgeon who’s done at least 100 ankle fusions, who operates on Saturdays near my house, who takes my insurance at XYZ surgery center, who has never been sued, and enjoys playing the flute.”

Voi-la! – Your results would be back with an offer to set up an appointment.

Assessment

Anyway, we digress and don’t have to worry about healthcare 3.0 just yet. Let’s get back to 2008 and see where healthcare is with 2.0.

The primary question really is: where on the web do you go to interact with others about healthcare-related topics? And,is the digital workforce leading, or lagging, in the adoption of social and AI computing for healthcare?

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Filed under: Information Technology, Op-Editorials, Research & Development | Tagged: healthcare 2.0 | 2 Comments »

Determining Medical Fees

Posted on September 11, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Reflecting Worth and Reality

By Dr. David Edward Marcinko; MBA, CMP™

Despite changes in insurance models, a healthcare provider’s fees should reflect what the doctor feels his or her services or procedures are worth. The type of insurance that the patient has should not play an influencing factor in either the fee determination or services rendered.

Additionally, fees should not vary based on the patient’s insurance type, or what the patient’s managed care contract determines is the maximum payable allowance.

Deterring Factors

Determining a professional fee for a given service takes into account many factors including the professional work performed, non-clinical work performed, unusual skills required, time for service, practice expenses (e.g., staff salaries and benefits, disposable items, rent, utilities, etc.), risk, as well as direct (surgical global care) and indirect (communicating with other health professionals, laboratory finding evaluation, review of x-rays, etc.) follow-up care.

Provider Determined

In establishing professional fees, the operative phrase is “provider determined.” While the input from knowledgeable experienced staff is certainly desirous, the ultimate responsibility for determining fees rests on the shoulders of the healthcare professional providing the service. Of course, the medical treatment administered, and for which reimbursement is sought, is assumed to be performed on the basis of medical necessity and effectiveness.

The Import

So why are reasonable fees and reimbursement for services important?

Well, medicine is a business whether physicians like to admit it or not. Businesses that are not profitable do not remain businesses for long. Today, most healthcare professionals will admit they are working harder, more hours, seeing more patients to maintain practice revenues. Even so, in many cases, expense increases are outpacing revenue increases. In an age of managed care, even Marcus Welby, MD would have to work harder.

Getting Started

Actually reviewing the annual Medicare rules and regulations found in the year ending Federal Register is a good place to start. That issue printed between November 1 and December 15 of each year lists all the CPT® codes and their Centers for Medicare and Medicaid Services (CMS) (formally Health Care Financing Administration-HCFA) determined relative value units (RVUs). The RVUs are procedure comparable.

Case Example:

You can assume if, for example, a free muscle flap procedure using microvascular techniques is valued at 68.65 total RVUs, it would be relatively more complicated procedure than a simple repair of a small laceration at a total 4.34 RVUs. You would price your procedure fees accordingly.

Generally, if a managed care allowance exceeds what you have billed; your fee is unreasonably low. The true test of reasonableness is your comfort (emotional as well as economic) level in charging the cash patient the same fee. If you feel it is in the “reasonable” range, and you are not consistently writing off 98% of your charges, it probably is reasonable. Under a managed care fee schedule, the service billed amount generally only has significance when the fee charged is less than the contract allowance.

Assessment

In that case, the MCO allowance is reduced to the lesser amount billed. The physician’s fees should not be lower than the highest contractual reimbursement rate.

Conclusion

Your informed opinions and comments are appreciated. How do you determine professional medical provider fees?

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post

Filed under: Health Economics, Health Insurance, Healthcare Finance, Practice Management, Practice Worth | Tagged: medical fees | 1 Comment »

Medicare Benefits Report

Posted on September 11, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

2007 Payment Services Review

Staff Reporters

In 2007, benefit payments for the four parts of Medicare totaled $426 billion and allocated as follows:

Part A: Hospital Insurance = 41% (includes home health which is partially funded under Part B)

Hospital Inpatient = 30%
Skilled Nursing Facilities = 5%
Home Health = 4%
Hospice = 2%

Part B: Supplemental Medicare Insurance = 28%

Physicians and other suppliers = 20%
Hospital Outpatient = 4%
Other Part B benefits = 4%

Part C: Medicare Advantage (private health plans) = 18%

Part D: Prescription Drug Benefit = 12%

Payments to Drug Plans = 7%
Low-Income Subsidy Payments = 4%
Payments to Union/Employer-Sponsored Plans = 1%

Note: Does not include administrative expenses such as spending for implementation of the Medicare drug benefit and the Medicare Advantage program. Total is net of $8.1 billion in recoveries for 2007.

Data Source: Congressional Budget Office, Medicare Baseline, March 2008.

Publication: Medicare Spending and Financing Fact Sheet; September 2008. The Kaiser Family Foundation.

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post

Filed under: Drugs and Pharma, Health Insurance, Healthcare Finance, Monthly Reports, Research & Development | Tagged: medicare | 1 Comment »

Medical Coding Definitions

Posted on September 10, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding CPT® Methods

By Patricia Trites; PhD

www.HealthcareFinancials.com

The American Medical Association Physicians’ Current Procedural Terminology manual (commonly known as the CPT® manual) is the recognized coding manual used by healthcare providers to bill third party payers.

CPT Codes

No quantitative values are assigned the CPT® codes contained within the CPT® manual. Each third party payers determines a value, whether a direct dollar or unit value, for each CPT® code. Each CPT® code represents a service, procedure, test, or study.

The CPT® manual attempts to define each of the codes specifically by individual descriptive phrases, and generally utilizing guidelines, rules, and definitions related to code groupings: medical, surgical, pathological, and diagnostic services. Third party payers develop for internal use additional protocols, guidelines, rules and definitions.

Assigned Values

The value assigned to each CPT® code is based on a determined amount of work, practice expense and risk inherently bundled into the service or procedure. Each procedure or service is further defined as a body of work made up of multiple lesser components all valued within the main CPT® code.

Case Example:

As an example, if the surgical lengthening of a leg tendon is the main procedure to performed, it would be assigned a unique CPT® code. Within the tendon lengthening code definition and assigned value would be included (bundled or “packaged”) seemingly obvious lesser procedures available to the surgeon in achieving the ultimate goal of the tendon lengthening. These lesser procedures include the incision itself, retraction of vital structures, tying off small vessels, suturing the tendon in a lengthened position, closing the soft tissue in layers, suturing the skin, application of a dressing, and application of a posterior splint.

Modifications

While some surgeons in a particular case may not need to tie off small vessels because no vessels interfered with the surgical exposure, or maybe they had to tie off two more vessels than they usually have to do, or they may elect not to apply a posterior splint, or the procedure takes twenty minutes more because a required instrument falls on the floor and needs to be re-sterilized, the overall code value of the tendon lengthening procedure does not change.

Essentially with the exception of minor modifications, one way or another, the main procedure remains essentially the same. Those minor modifications or variations in technique would be included in what would be called the global surgical description and allowance. Not all potential secondary or minor procedures need to be performed to fully reimburse the primary procedure.

Billing Fragmentation

The fragmentation, breakdown or unbundling of the main or primary procedure through the billing of each secondary procedure is billing abuse at best, intentional double billing at worse. Bundling is also addressed in the Correct Coding Initiative [CCI] issued by the Centers for Medicare and Medicaid Services [CMS]. This is a quarterly publication that lists the procedures and/or services that cannot be billed on the same day for the same patient.

Assessment

Healthcare providers intentionally billing unbundled services may be committing fraud or abuse.

Conclusion

Your thoughts and comments are appreciated.

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post

Filed under: Health Economics, Health Insurance, Health Law & Policy, Managed Care, Practice Management | Tagged: CPT codes | 1 Comment »

Seeking CMO in Iowa

Posted on September 10, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

St. Luke’s Hospital

By Sue LeGrand

St. Luke’s Hospital, a prominent and award-winning 560-bed hospital in Cedar Rapids, Iowa is seeking a Chief Medical Officer due to the retirement of their current CMO. St. Luke’s Hospital is part of the Iowa Health System, one of the top 25 integrated delivery systems in the United States.

St. Luke’s was named a Top 100 Heart Hospital and Press Ganey named St. Luke’s a 2007 Success Story for outstanding patient satisfaction results. Also in 2007, St. Luke’s received the Iowa Recognition for Performance Excellence silver award. This is Iowa’s premier award recognizing high performance management principles.

This CMO opportunity is rich with challenging and attainable priorities. As part of the President’s Council, the CMO be the liaison with the 400-physician medical staff comprised of employed physicians, private practice physicians, members of the Iowa Health Medical Group and contracted physician groups.

Qualifications include board certification, experience as a physician leader in a hospital environment, quality management, medical staff relations, and an excellent clinical background.

If you are interested in learning more, please reply to this message and attach a copy of your current CV / resume, or contact me below:

Sue LeGrand
800/678-7858 ext. 63458
314/863-3631 Fax
slegrand@cejkasearch.com

CEJKA SEARCH
4 CityPlace, Ste 300
Saint Louis, Missouri 63141
http://www.cejkasearch.com

Filed under: Breaking News, Career Development | Tagged: chief medical officer, CMO | Leave a comment »

Advantages of IMAs

Posted on September 9, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

A Doctor’s Case against Mutual Funds

By Dr. David Edward Marcinko; MBA CMP

Publisher-in-Chief

The case against Mutual Funds [MFs], and in favor of Individually Managed Accountants [IMAs]:

No unrealized capital gains
The ability of the physician-investor to dictate or organize a portfolio around current stocks
The manager is not obliged to buy additional securities, no matter how much money pours in
The physician’s portfolio is not subject to a pooled mentality
A physician-investor can own a specified number of securities without over diversifying
Lower fees and Lower commissions as portfolio grows
Ongoing customization in step with world trends
Hands-on or hands-off philosophy, as the investor prefers
Custom diversification blend-in strategies for low-basis stocks
Individual doctor recognition as to tax consequences.

Assessment

How true, false or parsed are the above perspectives?

Conclusion

Your comments are appreciated?

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post

Filed under: Financial Planning, Investing, Op-Editorials, Portfolio Management, Uncategorized | Tagged: IMA, Mutual Funds | Leave a comment »

Dentists, HIPAA, IT and Reform

Posted on September 8, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Healthcare Reform and Presidential Candidates

[Surprising Obama and McCain]

By Darrell K. Pruitt; DDS

Some readers of the Medical Executive-Post may wonder why a dentist’s opinions on healthcare reform should be given space on a website that is about the personal business, management, finance and economics of healthcare.

Like Lab Animals

Even though dentistry is only around 5% of the healthcare market; when it comes to government/insurance regulation using the one-size-fits-all micromanagement model of MBAs and politicians – dentists are your lab animals. So, hear me squeal!

HIPAA Hurts

Our nation’s leaders could learn sobering lessons about how their rules affect healthcare by observing how they affect dentists. As businesses, dental practices are naturally much less complicated than medical practices.

For one thing, dentists maintain only a few thousand active patient charts, whereas family physicians may have three to ten-thousand. This is because physicians see forty or more patients a day. Dentists, whose work involves intricate, but routine hands-on procedures in unpredictable mouths, may see ten patients in a busy day – eighteen if one counts checking hygiene patients.

Sans Bottlenecks

In dentistry, patient bottlenecks have never occurred in the clinical setting, even when burdened by modern, strategically complicated insurance hoops. It takes just as long today to pull a tooth as it did in 1960.

Actually, considering the OSHA mandate of the late ‘80s, defensive medicine and non-productive paperwork such as the meaningless HIPAA privacy release that patients have signed without reading since 2003, dentistry takes a lot more time than it used to.

Thank goodness patients never take the time to read what they sign or dentistry would take even longer.

Pulling teeth will never be faster than it was a hundred years ago when x-rays, as well as surgical-grade alloys became available. Back then dentists were never delayed by the wait for onset of anesthesia. For a closely related reason, experienced patients didn’t want dentists piddling around indecisively using cold steel.

Of Peg-Boards and Ledgers

For decades, the busiest of medical and dental practices ran efficiently using only pegboards, ledger cards and lots of carbon paper, yet the staff still seemed to have time to ask patients about their families. The business of dentistry is so simple that even today some dentists choose to run their practices without the aid of a computer at all – thereby eliminating the unproductive expense of being a covered entity.

Always remember this: there is nothing holding down the cost of being HIPAA compliant, and doctors with small, three-and-a-half employee businesses will be held to the same standards as hospitals with large staffs and a fondness for busywork – busywork that demands department budgets that include overtime pay. HIPAA fits a sole-proprietor dental practice like socks on a rooster.

The Economics of Choice

Here is another important difference. For a considerable amount of dental care, one might delay the purchase of a home entertainment center to chew comfortably. For serious medical care, one might forgo a home to stay alive. Almost all acute, health-threatening dental emergencies can be quickly solved in an outpatient manner with a simple extraction that costs less than $200, and available in almost any neighborhood.

HIPAA

From a dentist’s perspective, the Health Insurance Portability and Accountability Act [HIPAA] was never about portability. Oh, I could tell you stories; couldn’t we all. And, considering how many electronic health records have been fumbled under HIPAA, accountability is a cruel joke as well. That leaves the original 1996 HIPAA Rule stripped down to HIA – the Health Insurance Act; transparency at last.

The Four Cornerstones

A year ago, President George Bush signed an Executive Order that centered on four “cornerstone” goals to help bring about a systematic approach for measuring quality and value in health care, and for making that information publicly available. They are:

Connecting the system through the adoption of interoperable health information technology;
Measuring and making available results and outcomes on the quality of health care delivery;
Measuring-Transparency and making available information on the price of health care items and services; and,
Aligning incentives so payers, providers and patients benefit when all are focused on achieving the best care-value at the lowest unit-cost

The last three cornerstones, Measuring, Measuring-Transparency and Aligning are dependent on providers volunteering for the first – Connecting. Even though dentists were intended to be included in Bush’s plans for healthcare reform, connecting with dentists never happened – especially for dentists who did not volunteer for an NPI number – which gives stakeholders a legal right to Measure, Measure-Transparency and Align.

Or, as my dad, a furniture maker, used to say, “Measure twice, cut once (and for your own sake do not get personally involved in the machinery).”

Assessment

As a dentist who has observed physicians methodically lose control of doctor-patient relationships to stakeholders who hold payments for ransom, I say that if this is interoperability, I hope it never connects to my sheet metal file cabinets full of paper. HIPAA has nothing to offer but expense and liability.

Mark my words. History will show that HIPAA was exposed as a national failure in dentistry first, and that the presidential candidates still don’t know.

Won’t presidential candidates Barack H. Obama and John S. McCain be surprised!

Conclusion

Politicians never consider dentistry. Though it is unfortunate and very expensive, it is nothing new. Stick around. I have other issues, as well, and am not bashful. Of course, your thoughts, opinions and comments are appreciated.

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post

Filed under: Health Law & Policy, Information Technology, Op-Editorials, Quality Initiatives | Tagged: dentist | 5 Comments »

Launching iGuard.org

Posted on September 7, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Institute for Safe Medication Practices

Staff Reporters

A new patient-oriented Web site is scheduled for release this fall to reduce mix-ups over drug names.

The ISMP

The Web site is a partnership of the nonprofit Institute for Safe Medication Practices, and online health service www.iGuard.org, which will send users email alerts about drug-name confusion.

Dug Mix-Ups Not Rare

According to an Associated Press report on September 2^nd, nearly 1,500 commonly used drugs have names so similar to at least one other medication that they’ve already caused mix-ups.

Patient Harm

And, according to a major study by the U.S. Pharmacopeia, at least 1.5 million Americans are estimated to be harmed each year from a variety of medication errors, and name mix-ups are blamed for a quarter of them.

The Food and Drug Administration [FDA] – which currently rejects more than a third of proposed names for new drugs because they’re too similar to old ones – is preparing a pilot program that would shift more responsibility to manufacturers to guard against name confusion.

The Site

According to the website, iGuard.org is a healthcare service initiative that helps monitor the safety of medications (including prescription drugs, over-the-counter drugs, nutritional supplements and herbal extracts).

iGuard.org reportedly will help patients stay safer by:

Checking the safety of medications, and screening for drug-drug and drug-disease interactions.
Alerting members and doctors (optional) as important safety information arises for medications.
Provide accessible medication summaries for healthcare teams.
Help patients learn and share treatment satisfaction and side effect information within its social community.

Assessment

The goal of the site is to spell-out how to better test for potential mix-ups before companies seek approval to sell their products.

Conclusion

Your thoughts and comments are appreciated.

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post

Filed under: Drugs and Pharma, Information Technology, Professional Liability, Quality Initiatives, Research & Development, Risk Management, Uncategorized | Leave a comment »

Report on Hospital Risks

Posted on September 6, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

An IOM Review for Us All

[By Staff Reporters]

Hospitals manufacture miracles by the millions. But, they can also be hazardous to your health.

IOM Report

According to the Institute of Medicine [IOM], a non-profit organization chartered by the US National Academy of Sciences, at least 1.5 million Americans fall prey to hospital error every year.

And, these mistakes aren’t exactly minor either; as between 40,000 and 100,000 people die every year because of shoddy handiwork, including surgical mishaps and drug mix-ups.

Drug Problems

One big problem is that hospital patients may get the wrong drug one time out of five times [20%], according to a study by Auburn University. The death toll from these mistakes is at least as bad as that from car accidents or breast cancer, and may be as bad as that from strokes.

Infections

Another 100,000 people die because of infections from hospital-bred [nosocomial] bacteria that are resistant to one or more of the antibiotics doctors use to kill them off, according to the Center for Disease Control [CDC]. Some of those might be prevented by more hand washing or other precautions.

Assessment

Of course, medical provides, health economists, advisors, administrators and Executive-Post subscribers are familiar with these mistakes; but the public may not be – until now!

And so, this is your chance to learn what the public is reading about this vital issue from Forbes.

Link: http://health.msn.com/health-topics/articlepage.aspx?cp-documentid=100214300&gt1=31036#

You may be surprised, and dismayed!

***

Channel Surfing the ME-P

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

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

* 8

Filed under: Drugs and Pharma, Professional Liability, Quality Initiatives, Risk Management | Tagged: IOM | 2 Comments »

Call for “Executive-Post” Content

Posted on September 6, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Seeking Expert Contributors

The Executive Post at www.HealthcareFinancials.com is currently calling for medical professionals, financial advisors, financial services professionals, accountants, health economists and related CXOs, medical administrators, managers and healthcare business organizations around the world to contribute content to www.HealthcareFinancials.wordpress.com

Call for Editors

The Executive-Post aims to inspire a new generation of doctors, advisors, nurses, accountants, medical and financial professionals, and healthcare administrators and CXOs by allowing unprecedented numbers of individuals the ability to contribute to the well-being of the healthcare industrial complex and humanity. The goal is to create an invaluable clearinghouse for all the best related information that cuts across disciplines, socio-economic status and geography to provide valuable medical business information to anyone, anywhere, at any time.

The Executive-Post website is continually evolving and was officially launch in late 2007. It is maintained by the Institute of Medical Business Advisors, Inc, in Atlanta, Ga. Most content created on the Executive-Post is freely licensable under the GNU Free Documentation License (GFDL). Contact us for advertising details.

Print Edition Healthcare Journalism

If you would like to “step-up-your-game” and be considered as a peer-reviewed print contributor to the third edition of: The Business of Medical Practice [Advanced Profit Maximizing Techniques for Savvy Doctors]; just contact Ann at MarcinkoAdvisors@msn.com There are many chapter topics still available.

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

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post.

Filed under: "Advisors Only", "Doctors Only", Career Development, Op-Editorials, Research & Development | Leave a comment »

Executive Medical Director Opportunity

Posted on September 5, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Suburban Hospital Healthcare System

By Rachel Polhemus

We are conducting a search to recruit an Executive Director, Premier Physician Group [PPG] for Suburban Hospital Healthcare System located in Bethesda, MD.

Attached is a copy of the position specifications along with general information about the community and organization.

Link: suburbanhospexecdir

If you have an interest in the position after your review of the information, please let me know at your earliest convenience. If I do not have an updated resume or curriculum vitae, please email (mailto:rachelp@wittkieffer.com), fax or mail one to me.

I hope to have the opportunity to assist you.

Rachel Polhemus
[Witt/Kieffer]
7201 Wisconsin Ave.
Suite 675N
Bethesda, MD 20814
(301) 654-5070
(301) 654-1318 Fax

http://www.wittkieffer.com

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post

Filed under: "Doctors Only", Career Development, Managed Care | Tagged: medical director | Leave a comment »

The Healthcare Whistleblowers

Posted on September 5, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

A New DOJ Report

[By Staff Reporters]

According to the Deportment of Justice [DOJ], $9.3 billion was recovered from health care providers accused of defrauding the states and federal government the past decade.

The Study

The department ramped up efforts in the 1990s to combat healthcare fraud by using private citizens with insider knowledge of wrongdoing. They now initiate more than 90 percent of the department’s lawsuits focusing on fraud in health care, and receive between15 percent and 25 percent of the amounts recovered.

The Results

According to an Associated Press report on September 2, of the $9.3 billion recovered between 1996 and 2005, whistle blowers got more than $1 billion. And, while the number of claims dropped in recent years, recovery amounts have soared – jumping from about $10 million a case in 2002 to $50 million by 2005.

Assessment

The reason for this up-tick was the late addition of pharmaceutical manufacturers to the list of defendants.

Conclusion

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Filed under: Drugs and Pharma, Health Economics, Health Law & Policy, Healthcare Finance, Practice Management | Tagged: health fraud, whistleblowers | 54 Comments »

Welcome RealDealDocs™

Posted on September 5, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

About RealDealDocs™

Meet a New Executive-Post Sponsor

We’re a group of lawyers and business professionals with a passion for life. Whether it’s heading up to the mountains or down to the beach, or building an innovative company in an important new space, we’re enthusiasts, as one of the recent additions to our team so aptly put it.

We’ve taken this enthusiasm and brought it to RealDealDocs™. As professionals at some of the leading companies in the United States, we all recognized throughout our careers that one of the challenges associated with negotiating and drafting deals is finding language that you know the guy down the hall or across the country has already thought of and would be perfect for what you’re working on, if only you could find it. Everyone from huge professional firms to individual professionals have been trying to solve this problem, but the challenge has been two-fold: 1) finding a huge, centralized library of documents to access (so there’s plenty to choose from); and 2) the fact that this information needs to be profiled, not just full text searchable, because full text search alone just isn’t good enough to find exactly what you’re looking for.

That’s where the innovation behind RealDealDocs™ and its parent product the RealPractice™ Suite of products comes in.

What Makes RealDealDocs™ Unique?

Over the past eight years, we built a proprietary, patented categorization engine which efficiently organizes huge libraries of professional documents, including deal agreements and litigation work product. We combined it with a blazing fast full text search engine and refined it by reviewing the results over millions of professional documents. Importantly, we have also presented this application in an easy to learn search interface so that users can figure out how to get to the information the first time they use it. So whether you’re trying to find an example of an employment agreement for a financial executive at a bank in North Carolina or an obscure pricing clause for a supply agreement out of Asia, you’re going to quickly be able to figure out how to find it.

The RealPractice™ Suite has been adopted at many of the largest professional corporations in the world for their internal document collections, and it is used by tens of thousands of professionals every month. Now we’ve applied this technology to millions of documents that we’ve pulled from public records. These documents have been drafted for companies both large and small by many of the top law firms from around the world. Anyone can access these documents; if only they knew where to find them and they were properly organized. The result is RealDealDocs™, which has been rapidly adopted by lawyers, investment bankers, consultants and professionals at companies of all sizes.

Over the next several months, we’ll be adding new features to RealDealDocs™, including a distinct forms library on top of all of the final agreements pulled from fully negotiated and completed deals and consolidating additional informational resources. We welcome you to contribute any thoughts or suggestions you may have, as that’s the best way for us to continue to incorporate the best thinking of professionals from across the United States and around the world. We hope you enjoy!

Practice Technologies – A History of Excellence

RealDealDocs™ is a division of Practice Technologies, Inc. Established in May, 2000, and based in Venice, California, Practice Technologies, Inc. is a company of lawyers, business professionals and legal technologists who’ve pioneered a task-based approach to information retrieval, whether that information resides inside a firm, in the public domain, or in our own proprietary database.

Practice Technologies’ clients include many of the top law firms and professional corporations in the world. For more information, we encourage you to visit our website at www.PracticeTechnologies.com.

If you are interested in licensing our products for your department or firm, please contact our Sales Department for more information.

310.395.8830 ext 810
866.877.3770 ext 810 Toll Free
sales@RealDealDocs.com

Filed under: Sponsors | Leave a comment »

What is the SIMPD?

Posted on September 4, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Promoting a Direct-Medicine Business Model

By Staff Reporters

The Society for Innovative Medical Practice Design (SIMPD) is an organization of physicians promoting a direct financial relationship with their patients in order to restore the integrity of the patient-physician relationship.

It is their mission to ensure that physicians and patients retain the right to design and implement practices that enhance the effectiveness, efficiency, service, and value of healthcare www.SIMPD.org

Goals and Objectives

Educate individuals, employers, and physicians about why returning to a system where doctors work for patients, not insurance companies nor the government, is the only feasible way to control escalating healthcare costs.
Equip established physicians with the means to convert their practice to a direct pay model and help those who already operate a direct practice to grow.
Convince lawmakers that the only cure to our broken medical payment system is to redefine health insurance and allow doctors to work for our patients, instead of insurance companies and the government.

Assessment

SIMPD Members believe that direct medical practices are possible in most markets. Local demographics will dictate the structure of each individual practice.

Some colleagues call direct medicine the next generation of concierge medical practice. They suggest this is not just healthcare for the rich as portrayed by the media. But, it is a significant component of the cure to our broken healthcare system. What do you think?

http://blog.drmalpani.com/2007/12/society-for-innovative-practice-design.html

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Filed under: iMBA, Inc. | Leave a comment »

SEC Rule 151-A and Insurance Agents

Posted on September 4, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

NAFA Criticizes the SEC

Staff Reporters

Insurance agents without securities licenses won’t be able to sell index annuities under this new proposed rule.

NAFA Opines

The National Association of Fixed Annuities (NAFA) recently took a firm stand against the Security & Exchange Commission’s (SEC) proposed Rule 151A, which would regulate index annuities as securities rather than as insurance products.

Insurance-Securities Hybrid Product

NAFA said in a statement issued in July that it “strongly disagrees with the SEC proposal and will pursue all available avenues of recourse,” including taking legal recourse, if required.

Assessment

NAFA Says Nix SEC Rule 151A.

Conclusion

In other words, if Rule 151A is adopted, insurance agents without securities licenses would not be able to sell Index Annuities [IAs]. IAs are investment products that combine both fixed income investments and equity index options so as to be able to leverage opportunities in both.

Please comment and opine; especially insurance agents, investment advisors and financial planners.

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post

Filed under: "Advisors Only", Financial Planning, Insurance Matters, Investing | Tagged: Add new tag, annuities, annuity, david marcinko, indexed annuity, insurance, insurance agents, NAFA, SC 151A, SEC, securities license | Leave a comment »

Retail Banking Today

Posted on September 3, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Ten Things your Bank and/or Banker Won’t Tell You

Staff Reporters

From: Smart Money

Do you assume that your bank serves your best interests? Do you believe that a big bank’s products are better than a smaller bank? Do you think that that your online bank account information is accurate or secure? If so, think again!

And don’t ever believe everything your bank, or banker, tells you.

Review

As readers of the Executive-Post know; medical, dental, allied healthcare and administration students of all stripes are increasingly in school-debt these days.

Assessment

Therefore, we trust this basic, but important, report will be reviewed by medical practitioners and administrators of all ages. Don’t let the bankers add to your economic misery.

Link: http://articles.moneycentral.msn.com/Banking/BetterBanking/10ThingsYourBankWontTellYou.aspx

Conclusion

Your comments are appreciated.

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post

Filed under: Financial Planning, Funding Basics, Investing, Risk Management | Tagged: bankers, banks, retail banking | 1 Comment »

Medically-Focused Insurance Agents?

Posted on September 3, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Avoiding the “Managed Care Ripple Effect”

[By Dr. David Edward Marcinko; MBA, CMP™]

The healthcare industrial complex represents a large and diverse industry, and the livelihood of other synergistic professionals who advise doctors depend on it as well. These include insurance agents who themselves wish to avoid the collateral ripple effects of the current healthcare debacle.

The Name Game

As a registered health underwriter, insurance counselor, long term care or life insurance agent, it seems that almost every insurance agent is also acquiring a general securities license, or CFP®, in addition to the CLU or ChFC after their name.

The Transition

Currently, about 240,000 life insurance agents, down from more than one million in 1965, are being pressured to move toward financial planning, as distribution of insurance products over the Internet spreads like wildfire.

Meanwhile, the same insurance and investment companies that are knocking on your door are also courting the medical professionals with their practice enhancement programs. Even if you are not interested in going into the financial planning business, you have seen the status of the American College erode of late, even as your own business has declined because of the World Wide Web and various discounted insurance companies.

More Competition

And, in the eyes of your former golden-goose doctor-clients, you may have become a charlatan with the recent mortgage, insurance and banking industry collapse of 2008. Now, it seems as though everyone is clamoring for a piece of your insurance business and cloaking it in the guise of the contemporary topic of the day; medical practice risk-management and financial planning.

If you think this is an exaggerated statement; think again? More than a decade ago, an October 1997 survey conducted by Deloitte & Touche Consulting Group of New York, found insurance agents ranked last in having the trust of a wide selection of the public! The insurance debacle today only exacerbates this opinion.

Regaining Trust

But, how do you regain this lost trust, and what about this new entity known as managed care. How do you learn about it at this stage in your career?

What ever happened to whole-life insurance; or traditional indemnity health insurance, with its deductibles, co-payments and 80/20 patient responsibility? It was so easy to sell, provided good coverage and the agent made a nice profit.

As an insurance agent, all you want to know is, can I still sell insurance and make a living? Like all struggling collateral advisors, you find yourself asking, how do I “talk the talk, and walk the walk”, in this new era of insurance, transparency and liability turmoil?

Assessment

Slowly, as you read about the Certified Medical Planner™ online educational program, you become empowered with knowledge and ideas for new insurance product derivatives that actually provide value to your physician clients www.CertifiedMedicalPlanner.com

After the proscribed course of study, you are no longer just an insurance salesman, but a trusted risk-management advisor and Certified Medical Planner™ for the healthcare industry. You have avoided the “managed care ripple effect.”

Disclaimer: Dr. Marcinko, a former insurance agent and Certified Financial Planner™, is Founder of the Certified Medial Planner™ program for all fiduciary consultants in health economics, finance and medical practice management.

Conclusion

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

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

Filed under: "Advisors Only", Insurance Matters, Quality Initiatives, Research & Development, Risk Management | Tagged: insurance agents | 3 Comments »

Events-Planner: September 2008

Posted on September 2, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

SEPTEMBER 2008

Staff Writers

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

A Look Ahead this Month

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

Sept 4: Medical Provider Network Congress for Health Plans; Financial Research Associates, Atlanta, GA.

Sept 4-7: National Conference on Pain for Frontline Practitioners; www.painweek.org

Sept 7: The Forum 2008: DMAA -The Care Continuum Alliance, Hollywood Fla.

Sept 10-13: American Orthotic and Prosthetic Association National Assembly; Chicago, Ill www.aopanet.org

Sept 9-12: World Medical Tourism and Global Health Congress; San Francisco.

Sept 10-17: AHRQ 2008 Conference; Bethesda, Md.

Sep 11: Delivering Vital Health Information to the Public; Columbia, Mo.

Sept 14: Third Annual World Congress Leadership Summit on Healthcare Revenue Cycle Innovations, World Congress, Las Vegas, NV.

Sept 14-16: 18th Annual HFMA California Fall Conference; Hyatt Regency Newport Beach, Newport Beach, CA.

Sept 17: Modernize Patient Assistance Programs, Institute for International Research, Washington, DC.

Sept: 18-19: JCAHO and JCRs’ Annual Infection Control Conference, Chicago, Ill.

Sept 18-20: 14^th Northwest Podiatric Foundation; Wynn Las Vegas Resort and Casino, NV.

Sept 19: SCF Arizona Medical Provider Seminar-Worker’s Compensation, Radisson Woodlands Hotel; Flagstaff | 602-631-2513 lbrott@scfaz.com

Sept 25-27: Clinical Orthopedic Society Meeting; Annapolis, MD www.cosociety.org

Sept 25-29: Annual Wound Care Congress; Kissimmee, FL www.woundcarecongress.com

Sept 28-Oct 1: ESRI Health GIS Conference; Washington, D.C.

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

MarcinkoAdvisors@msn.com

Related Information Sources:

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

Filed under: Events-Planner | Tagged: Events-Planner, special events | Leave a comment »

Meet a Sponsor

Posted on September 2, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Foot and Ankle Research Consortium, Inc.

Date: September 1, 2008

PRESS RELEASE: FARC, Inc

Atlanta, Georgia USA

The Executive-Post at www.HealthcareFinancials.com is now proudly sponsored, in-part, by the Foot and Ankle Research Consortium, Inc.

FARC is a leading provider of CD-ROMS, books and e-learning tools for orthopedic and podiatric medicine and surgery of the foot, ankle and leg. Since 1992, FARC has been producing the most effective and innovative method of preparing for all Podiatry and Orthopedic Surgery related board examinations; written and oral – qualified and certified. This includes, among others:

The American Board of Podiatric Surgery [ABPS]
The American Board of Podiatric Orthopedics
The American Board of Primary Podiatric Medicine [ABPOPPM]
The American Podiatric Medical Specialties Board [APMSB]
The American Board of Lower Extremity Surgery [ABLES]
The National Board of Podiatric Medical Examiners [Parts II and III of PMLexis].

And, FARC now includes the latest information for all Board Re-certification Examinations, C.Ped and Diabetic Wound Care/Infection and Ulcer Management.

Purchase – Prepare – Pass ™

For more information, please visit: www.PodiatryPrep.com

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post.

“Easy to Use”

www.PodiatryPrep.com

770.448.0769

Filed under: Media Mentions and PR, Sponsors, Uncategorized | Tagged: sponsor | Leave a comment »

HIPAA Rules and Dentistry

Posted on September 1, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

A Survey of Dentists [Pilot Study]

By Darrell Pruitt; DDS

A survey of 18 dentists was performed using the Internet as a platform. The dentists were presented with ten HIPAA compliancy requirements followed by a series of questions concerning their compliancy as well as the importance of the requirements in dental practices.

Frustration with the tenets of the mandate, as well as open defiance is evident by the written responses. In addition, it appears that a dentist’s likelihood of satisfying a requirement is related to the dentist’s perceived importance of the requirement.

Even though this is a limited pilot study, there is convincing evidence that more thorough investigation concerning the cost and benefits of the requirements need to be performed before enforcement of the HIPAA mandate is considered for the nation’s dental practices.

Excerpt:

“Dr. Gerald Daniel seems to have captured many of the dentists’ feelings about the HIPAA Rule when he lamented, “We try to comply, however many times I feel every government agency in the country wants to run my practice without regard to the problems, expense or aggravation it causes the health provider.”

READ IT HERE: hipaa-survey-dentists4

GRAPHS: hipaa-survey-graphs1

Conclusion

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

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Career Development, Health Law & Policy, Information Technology, Op-Editorials, Practice Management, Surveys and Voting | Tagged: DDS, dentists, DMD | 4 Comments »

The NPI Debate Heats Up

Posted on August 31, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Questionable Benefits for Providers

[By Darrell Pruitt; DDS]

I really hate lies!

Even though I have been a member of the American Dental Association [ADA] for 26 years, and intend to remain a member for the rest of my life, I cannot stand by silently any longer while my professional organization uses lies and/or deception to trick trusting members into volunteering for NPI numbers.

Now, to see what I mean, please read what the ADA tells dentists about the benefits of the NPI number http://www.ada.org/prof/resources/topics/npi.asp

1. Once implemented across the entire health care industry, the NPI will be accepted by all dental plans as a valid provider identifier on electronic dental claims and other standard electronic transactions.
2. Dentists will not have to maintain multiple, arbitrary identifiers required by dental plans, nor will they have to remember which number to use with which dental plan.
3. NPIs introduce an important element of standardization to electronic transactions that should improve transaction acceptance rates.

Questionable Benefits Review

See what I mean? Now let’s review:

1. Number one clearly benefits only insurers and number three is unwashed tyranny. The smell of sweet buzzwords counter-balancing the odor of the verb “should” immediately revealed to me traditional PR hucksterism … and I’ve seen better. The NPI number, which is conveniently necessary for electronic transactions, will only make it cheaper for insurers to deny claims. I think anyone can see that denials will increase for natural, bottom line reasons.
2. That leaves benefit number two – reduction of ID numbers – as dentists’ last hope of a return on investment in the voluntary NPI. And, ROI could take a while. In the first place, how much do multiple identification numbers actually slow dentistry production in a computerized dental office? Why don’t we get silly?
3. Of all things, for the ADA to list simplification as a benefit of the NPI is embarrassing, but here is what will make a few ADA leaders avoid each other in the halls of Headquarters next week. Even though the promise of simplification is lame, it is technically the only benefit the NPI number lends dentists and their patients.

Enter the AAFP

Here now, is some fresh bad-news for certain ADA leaders and members who trusted their advice.

In an article that was posted yesterday on the American Academy of Family Physicians (AAFP) website, it looks like CMS reneged on simplification.

http://www.aafp.org/online/en/home/publications/news/news-now/practice-management/20080829keep-ptans.html

PTANS

“Notice to physicians: Hold on to your Medicare Provider Transaction Access Numbers [PTANs], also known as legacy numbers which were to have been retired after the mandatory use of National Provider Identifier [NPI] numbers on May 23.” CMS has found another use for those old PTANs.”

Imagine that. Instead of eliminating all of those identifiers as promised, the NPI is just one more number to add to the hard drive.

Assessment

Regardless, patients don’t suffer harm from all this, right? Wrong.

I’ll describe harm from HIPAA, the biggest blunder in the history of dentistry, and medicine, next time.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Filed under: Career Development, Ethics, Health Law & Policy, Information Technology | Tagged: AAFP, ADA, CMS, Darrell Pruitt, NPI, PTANS | 8 Comments »

Health Insurers Secrets

Posted on August 31, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Seven Things you don’t Know about Health Insurance

By Staff Reporters

“Myth Busters”

Wrapped up in all the noise these days are myths on health insurance that were perhaps once true – or maybe never were.

So, here’s a look at seven things you probably didn’t know about your health insurer.

Link: http://articles.moneycentral.msn.com/Insurance/InsureYourHealth/7SecretsOfHealthInsurers.aspx

Conclusion

Your thoughts are appreciated; especially from insurance agents, industry insiders and medical providers; please opine and comment.

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post

Filed under: Health Insurance, Health Law & Policy, Insurance Matters | Tagged: Health Insurance | Leave a comment »

Healthcare Stock Performance

Posted on August 30, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Doing Well by Doing Good – To Date in 2008

By Staff Reporters

According to Anne Zieger of FierceHealthFinance, healthcare stocks are doing well.

The Standard & Poor’s Benchmark

With healthcare facing some of its biggest financial challenges in years, particularly a growth in bad debt and slides in federal reimbursement, you wouldn’t think that industry stocks would be doing too well.

An Illogical Market

As usual, however, the market has followed its own logic, bringing several healthcare stocks to high points and pushing up the overall value Standard & Poor’s healthcare stocks average by 4.4 percent (compared with a 7.9 percent drop in the overall index).

Meanwhile, mutual funds focused on healthcare are up 6.84 percent over the past three months, according to Morningstar, the only category of stock funds in positive numbers during this period.

Big Pharma and Biotechnology Driven

And, San Francisco Chronicle analysts say that rising healthcare stock performance is driven more by biotechs and big-pharma than provider companies. Their strong performance is partly due to improved performance by the stocks themselves, but also due to investors running away from finance and energy as well.

Healthcare stocks have also been pushed up by foreign investors with strong currencies, who have been on the prowl to take over U.S. companies with below-expected valuations.

The Gainers

Big gainers among the S&P 500 include generic drug-maker Barr, Amgen, Varian Medical Systems and King Pharmaceuticals.

On the other hand, it’s not all good news in this sector, as several managed care companies have lost value, including UnitedHealth Group and Aetna.

Assessment

Of course, hospital companies like HMA and Tenet haven’t done well, lately.

Conclusion

You thoughts and comments are appreciated; especially from wealth managers, financial professionals, insiders or investment advisors.

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Filed under: Financial Planning, Investing, Portfolio Management, Research & Development | Tagged: Standard & Poor's | Leave a comment »

23 and Me

Posted on August 29, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Personal DNA Analysis and Reporting

[By Staff Reporters]

Ever wondered why you were left-handed and your sibling or parent wasn’t?

A not-so-new new company, 23andMe, provides an analysis of DNA, where you can learn more about yourself, your immediate family and even your ancestry.

Target Markets

Those who would be especially interested in this personal genome service include:

Methodology

Customers [sic patients] submit a small saliva sample that is processed using a proprietary custom DNA chip. The resulting data is then presented on a secure website using interactive tools that offer information about ancestry, inherited traits and disease risk.

Board of Directors

This is no lightweight company. It technology founders include:

Linda Avey
Anne Wojcicki
Esther Dyson

While its’ medical advisors are:

Uta Francke; MD [Professor of Genetics and Pediatrics, Stanford University].
Itsik Pe’er; PhD [Assistant Professor of Computer Science, Columbia University].
Peter A. Underhill; PhD [Senior Research Scientist, Stanford University].

Assessment

You can also better understand your genetic tendencies for things like obesity or health issues.

There is even an interactive blog: http://spittoon.23andme.com

Users can find other members with similar genetic makeup and start discussions. And, it is $999 to order a kit for the DNA test.

Conclusion

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Filed under: Drugs and Pharma, Information Technology, Media Mentions and PR, Research & Development | Tagged: DNA, genome | 12 Comments »

Healthcare Focused Tax Attorneys

Posted on August 29, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Avoiding the “Managed Care Ripple Effect”

By Dr. David Edward Marcinko; MBA, CMP™

The healthcare industrial complex represents a large and diverse industry, and the livelihood of other synergistic professionals who advise doctors depend on it as well. These include tax and estate attorneys who themselves wish to avoid the collateral ripple effects of the current healthcare debacle.

Lawyer as Financial Planner

As a tax, estate planning or bankruptcy lawyer, you already know that almost every legal magazine around has articles or advertisements proposing that you become a financial planning professional or business consultant to your physician clients.

Moreover, lawyers of all stripes are being pushed toward interdisciplinary alliances by encroachment on their turf by the Big Four accounting firms. With audits of publicly held companies now a commodity, the giant accounting firms are getting more of their revenues from consulting, and that puts them into direct competition with attorneys, MBAs, actuaries and other management and financial service professionals.

Avoiding a Medical Career

Of all careers, you know how absolutely onerous it is to practice medicine today, and are finally thankful that you did not take that career route many years ago.

So, like your neighbor the accountant, you begin to explore that potential of developing a service line extension to your legal practice, in order to assist your medical colleagues who have been hit on hard economic times. In fact, you soon realize that more than 90,000 trust, probate and estate planning attorneys like yourself are interested in pursuing financial planning in the next decade. Sure, you know it’s difficult to get a CLU or variable annuity license, or become a Certified Financial Planner™ (CFP), but earning your law degree was no cinch either.

And, you reckon, advising physicians has got to be easier than law, or less stressful than the corporate lifestyle of your MBA trained brother-in-law, right?

So, you set out to stretch your legal horizons and explore the basic legal nuances of those topics not available in law school when you were a student. Things like medical fraud and abuse; managed care compliance audits and Medicare recoupments; OSHA, HIPAA and EPA standards; anti-trust issues; and managed care contract dilemmas or de-selection appeals.

Assessment

What a brave new world the legal profession has become! Even the American Bar Association’s commission on multi-disciplinary practice has recommended that lawyers be permitted to share fees and become partners with financial planners, money managers and other similar professionals.

As a real life example, the venerated Baltimore brokerage firm of Legg Mason Inc. teamed-up a few years ago, with the Boston law firm of Bingham Danna, LLC, to create one of the first marriages between a law and securities firm.

And so, if you want in on the challenge, and bucks, you’d better acquire at least a working knowledge of healthcare administration, or perhaps help craft some new case law, or assist your doctor-clients in some fashion; otherwise, you will remain a legal document producer.

Disclaimer: Dr. Marcinko, a court approved expert witness and former Certified Financial Planner™, is also founder of the Certified Medial Planner™ program for all fiduciary consultants in health economics, financial planning and medical practice management www.CertifiedMedicalPlanner.com

Conclusion

Your thoughts are appreciated; please opine? Is this new industry concept a viable one?

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Filed under: "Advisors Only", Accounting, Career Development, Taxation | Tagged: lawyers, tax attorneys | 1 Comment »

Dental Managed Care Survey

Posted on August 28, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Delta Dental Plans Association (DDPA)

By Darrell K. Pruitt; DDS

The common sense truth about managed-care dentistry was recently confirmed by Delta Dental data mining.

Preliminary Oral Care Report

Concerning what one can do to assure the best oral care for oneself or one’s family; allow me to share some significant news about research that has not yet been formally published.

On the morning of August 14 2008, less than two weeks ago, a representative for Delta Dental Plans Association (DDPA) revealed the results of an in-house study that confirms that remaining with the same dentist for the long term prevents fillings.

The 2008 National Dental benefits Conference

It was during the first day of the 2008 National Dental Benefits Conference in ADA Headquarters in Chicago that Maxwell H. Anderson DDS, the dental affairs advisor for DDPA, located in Oak Brook Illinois, announced that by data mining their proprietary dental claims over 11 years, Delta uncovered evidence-based information revealing that clients who change dentists regularly are likely to receive more fillings than those who stay in consistent “dental homes” where they are content.

Dr. Anderson told the audience of about a hundred dentists and dental industry representatives that “The greatest hazard to teeth is changing dentists.”

A Righteous Finding

I find it remarkable, as well as noble, that a managed care insurance company like Delta, based on preferred provider lists that are valid for only 12 months at a time, would voluntarily reveal findings that can only bring harm to their business model.

However, when one thinks about it, Delta’s results clearly make sense. If a patient or family of patients is comfortable with a dental team, they are more likely to keep their check-up appointments as well as take better care of their teeth at home. And, consequently, enjoy better health.

Perhaps Delta came to the righteous conclusion that to hide such landmark findings would be unethical?

Assessment

How do preferred-provider lists cause more fillings?

When dentists can rely on a dental care broker like Delta Dental for new patients, there is an inherent absence of accountability that occurs when guided by the invisible hand of competition in the marketplace, naturally. That is an undeniable fact. Managed care dentistry is dentistry by the lowest bidder with no quality control; also an undeniable fact.

Note: Dr. Pruitt, an attendee of the 2008 National Benefits Conference on August 14 and 15 in ADA Headquarters, is the sole proprietor of a fee-for-service dental practice in Fort Worth, Texas. He represents only himself for the benefit of dental patients. His name cannot be found on any preferred provider list. Report posted with permission.

Conclusion

Your thoughts and suggestions are appreciated. Are this dentist’s “facts” and quality assessment true; please opine and comment?

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Filed under: "Doctors Only", Career Development, Managed Care, Research & Development, Surveys and Voting | Tagged: delta dental | 2 Comments »

Coming Healthcare Worker-Shortage

Posted on August 27, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

It’s All in the Demographics

[A New AAHC Report]

[By Staff Reporters]

Current domestic policies will not avert a US health work-force crisis, according to a new report released by the Association of Academic Health Centers [AAHCs]. Moreover, it recommends developing a national planning body to unite efforts to slow/end work-force shortages.

The Report

The association’s report, “Out of Order, Out of Time: The State of the Nation’s Health Workforce,” points to a long and growing list of challenges. These include projected shortages in primary care and nursing; as the baby-boomer wave of retiring physicians and increasing medical needs of the growing elderly population exacerbate.

Lifestyle Preferences

Also, as reported in the American Medical News, on August 25, other issues fueling shortages of health-care workers include lifestyle preferences (regular work hours and family), economic disparities, rising medical school debt loads, and a dwindling pool of medical school faculty, with fragmented health care work-force policymaking.

Assessment

If this all isn’t enough to discourage new entrants from joining the healthcare industry, the plummeting value of present-day small-to-medium sized private medical practices just might.

In fact, our Publisher-in-Chief, Dr. David Edward Marcinko was recently interviewed by the American Medical News on this very topic. And, the un-edited version of that interview will appear in an upcoming issue of the Medical Executive-Post, shortly after AMNews publication.

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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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 Economics, Research & Development, Surveys and Voting | Tagged: healthcare work force | 3 Comments »

Of Hospital CXOs

Posted on August 27, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Benchmarks versus Hunches

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

By Hope Rachel Hetico; RN, MHA, CMP™

Managing Editor

As administrators and physician-executives, we have often wondered about the managerial thought processes of some former hospital CXOs.

Our History in Georgia

For example, since arriving in Atlanta in the early 1980s, we have seen more than a dozen hospitals and five free-standing outpatient treatment centers shuttered due to fiscal insolvency. Included among the closures were urban and suburban entities, as well as private and public organizations following both profit and not-for-profit business models.

The recent public plight of Grady Memorial Hospital, our only Level III trauma center, is another good illustration. And, there seems to be no commonality among the casualties.

CXO Hunches

We can only surmise that these healthcare organizations were run according to CXO “hunches” regarding cash flow analysis, revenue augmentation and cash conversion cycles, etc.

If true, this reinforces our belief that, although providing high-quality medical care remains the primary concern of all healthcare organizations, profitability does matter … and the maxim “no margin, no mission” still applies.

CXO Benchmarks

Fortunately, we are better informed today as real [entity specific] business benchmarks – not best guesses – can be used to help us make wiser strategic and more profitable financial decisions for almost any healthcare organization.

Assessment

Therefore, we are grateful for the opportunity to edit this blog’s companion print journal guide, Healthcare Organizations [Financial Management Strategies] www.HealthcareFinancials.com

It’s a behemoth at 1,200 pages – in 2 volumes – and produced in arm’s length fashion by iMBA, Inc www.MedicalBusinessAdvisors.com

We trust you, and your healthcare organization, will review, use and profit by it.

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

PS: Don’t forget to review-read-rave and rant online at this communications forum:

www.HealthcareFinancials.wordpress.com

Conclusion

Let benchmarks, this blog, and Healthcare Organizations: [Financial Management Strategies] take precedence over your gut in guiding your decisions.

orders@STPub.com

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Filed under: "Doctors Only", Career Development, Healthcare Finance, Op-Editorials, Practice Management, Research & Development | Tagged: CEOs, CFOs, COOs, CXOs, hospital administrators, physician-executives | Leave a comment »

Practicing Medicine “Bare”

Posted on August 26, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Hold-Harmless Managed Care Contract Clauses

[By Dr. Charles F. Fenton, III; JD]

Most doctors would not think of “practicing medicine bare”; yet perhaps the definition of this term should be re-framed?

Historical Definition

In the past, the term “practicing-bare” meant that a medical provider did not have malpractice insurance.

However, some current managed care contracts require that providers not only have certain limits of malpractice insurance coverage, but also furnish the company with evidence of same. Therefore, some of these providers are under the impression that they are not “practicing-bare.”

Hold Harmless Clauses

Unfortunately, most medical providers have no protection from adverse results arising out of a “Hold-Harmless” clause in a managed care contract or provider-agreement. And, most malpractice insurance companies do not provide such coverage.

So, if your malpractice insurance company does not provide coverage for such events, it is incumbent upon you and your associations to lobby malpractice insurance carriers to provide this coverage.

An additional rider, at an additional premium for Hold-Harmless coverage, would help the doctor sleep better at night.

Contract Considerations

The first question doctors should ask is: Would I consider practicing without malpractice insurance?

If the answer to this question is “no”, then the next question that should be asked is: “Why am I assuming the risk under the Hold Harmless Clause?”

If you cannot provide a lucent answer to this question (stating: “I have no choice,” is not a lucent answer!), then you should consider not signing the managed care contract.

Judgment Proof

Nonetheless, if a medical provider has signed a managed care contract, then they should understand that they are essentially practicing bare, and should take steps to reduce this exposure. In effect, the provider should attempt to become “judgment-proof.”

Such a step does present its own risks. Ultimately, the first step for every physician who signs a managed care contract, with hold harmless agreement, is to read the contract and then consult an attorney or other professional. Of late, plaintiff-attorneys are beginning to make inroads in suing managed care companies. The managed care attorneys foresaw such events and provided protection for the company in the contracts most providers have signed.

As your patients and other plaintiffs become successful in suing and recovering from managed care companies, those companies are going to seek indemnity from you; the provider. Unless you protect yourself, you are likely to become a collateral casualty to some degree or another.

The current practice of medicine presents may perils and risks to doctors and other providers. A doctor may not be able to insure against all these risks, and should take defensive steps to avoid future problems.

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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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: Health Law & Policy, Insurance Matters, Professional Liability, Risk Management | Tagged: Managed Care, practicing bare | 3 Comments »

The NPI and One DDS’s Opinion

Posted on August 25, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

A Dentist Offers his View on the NPI Deadline Issue

By Darrell Pruitt, DDS

I have a unique perspective of the National Provider Identifier [NPI] issue.

As a dentist who has no contracts with any insurance company, I refuse to apply for an NPI number. Legally, I am not compelled to “volunteer” for the number, regardless of whether it is a mandate or not. HHS does not license dentists. States do. Texas says that it is fine by them for me to practice here on the east side of Fort Worth.

Why Volunteer?

Why should I volunteer for the NPI mess?

The NPI does nothing to improve the quality of care I provide. It benefits only payers, and any time anyone fouls up at National Plan & Provider Enumeration System [NPPES], it can only mean one thing – payments will be delayed, earning insurers even more interest on money meant to pay for work already done and long gone out the door.

I should remind you that inflation is due to soar soon as well, making the reimbursement worth even less to the provider the longer it is delayed.

The IRS

And, there is more.

I assume you heard about the IRS sticking their fat fingers into the pie. That happened just recently, completely unexpectedly.

Now the IRS can delay claims as well if one has an NPI number. What a mess. Why would I want to be part of it? If having an NPI forces me to raise my fees, it hurts my patients.

Part of the Hippocratic Oath is to do no harm. It is clearly unethical for a doctor to have an NPI number. Allow me to show you how far ethics will take a Texas dentist these days.

My Situation

Since I am not on any managed care plans, my BCBSTX-covered dental patients who I have treated for years did not pick me off of BCBSTX’s annual preferred provider list. They chose my practice as a consistent dental home, year after year, because they were more than likely referred by a satisfied patient.

When the BCBSTX agents sold my patients’ employers their dental plans, the insured was told to tell employees that they could see any dentist they choose. This is called a traditional indemnity plan, which honors freedom of choice as opposed to the cheaper managed care plans that penalize clients for not going to dentists that the insurance company prefers.

The Managed Care Misnomer

Calling managed care in dentistry “insurance” is a misnomer. It is actually nothing more than a discount dental brokerage service with annual lists of the lowest bidders in the market, and there is no quality control.

Until recently, I have had an unwritten agreement with BCBSTX that I would honor their insurance by allowing their clients to pay only their estimated part of the dental bills, and I would wait for BCBSTX’s share to come later in the mail – however long that takes.

That is called “accepting assignment,” and it is based on trust between dentists and BCBSTX, and is a favor to patients, not a requirement.

I have to say that BCBSTX is so slow at paying their part of their clients’ bills that patients would soon become very impatient if they had to wait as long for their money as I have to wait for mine. My practice, as well as my patience, can tolerate delays … up to a point.

In the end, if a claim is unreasonably delayed by an insurer, I can ultimately call on the state insurance commission to fight for fairness for my patient. Who can I complain to if payment is delayed by the IRS?

Assessment

In the last week, BCBSTX rejected three of my claims because I don’t have an NPI. What am I to do?

Ultimately, I may have to go against my own ethics and apply for an NPI number in order to stay in business.

The NPI does nothing to improve the quality of care I provide to my patients. It only delays payment.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Filed under: Health Insurance, Information Technology, Op-Editorials, Practice Management | Tagged: NPI | 6 Comments »

Physician Owned Hospitals

Posted on August 24, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

New Patient Disclosure Rules

Staff Reporters

According to Bloomberg News, August 19, 2008, doctors with financial stakes in hospitals where they work must tell patients being referred to those facilities about the ownership link, under new rules from Medicare.

Patient Queries

Patients who ask about investors in a physician-owned hospital must be furnished with a list of all doctors, and their immediate family members, who own or have an investment interest and make referrals.

Assessment

Medicare is seeking to make it harder for doctors to boost their payments by referring patients to their own facilities; and it already bars self-referrals for 11 services. The agency said it would end reimbursement agreements with physician-owned hospitals that don’t follow the new disclosure requirements.

Conclusion

What do you think about this, “if they don’t ask – don’t tell” policy; your informed opinions and comments are appreciated. Is it too much disclosure, or not enough?

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Filed under: Career Development, Health Insurance, Health Law & Policy, Healthcare Finance, Insurance Matters, Practice Management, Quality Initiatives, Research & Development, Risk Management | Tagged: physician owned hospitals | Leave a comment »

“E-P” Seeking Tips with E-Mail Update Alerts

Posted on August 24, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Reader Centric Content

Much like collaborative healthcare itself, the Executive-Post depends on input from our informed readers and subscribers. So, if you have a story-line or idea to suggest; or would like a free automated daily E-P subscription delivered right to your mailbox; you can achieve both in two ways.

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ICD-10 Code Set Disagreements

Posted on August 23, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

MGMA Targets Implementation Date

Staff Reporters

The Medical Group Management Association [MGMA], who previously has published commentary and material from our Executive-Post Editor-in-Chief, Dr. David Edward Marcinko, believes that the Centers for Medicare & Medicaid Services’ [CMS] proposed Oct. 1, 2011 compliance date for full implementation of the International Classification of Diseases, Tenth Revision (ICD-10) code sets is not workable.

Numerous Challenges

According to an August 19th edict, the MGMA said the government must overcome numerous challenges before the health care industry can fully implement ICD-10. The proposed rule for the next generation of the Health Insurance Portability and Accountability Act (HIPAA) electronic transactions (ANSI X12 version 5010), released with the ICD-10 proposed rule, must be put in place prior to ICD-10 and MGMA believes this will take several years for full implementation and testing.

Assessment

Because ICD-10 contains 10 times the number of codes as ICD-9, the newer code set will require vast changes for medical groups, hospitals and other health care facilities. MGMA surveys found that 95 percent of medical practices would have to purchase software upgrades for their practice management systems or buy all new software, while 64 percent concluded that they would have to purchase code-selection software, and 84 percent stated that they did not think public and private health plans would be ready to accept claims with ICD-10 codes by October 2011.

Conclusion

Your thoughts are appreciated. Will you be ready for ICD-10; please opine and comment.

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Filed under: Information Technology, Practice Management | Tagged: code sets, ICD-10 | 5 Comments »

Stark Amendments [I-II-III]

Posted on August 22, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

A Review for Physicians, Consultants and Advisors

By Dr. David Edward Marcinko; MBA, CMP™

By Dr. Charles F. Fenton, III; FACFAS, Esq.

The Stark Amendment to the Omnibus Budget Reconciliation Act of 1989 was a step by the federal government to prohibit physicians from referring patients to entities in which they have a financial interest. Originally, the Stark amendment applied only to referral of Medicare patients to clinical laboratories in which the physician had a financial interest.

Stark I Provisions

The Stark Amendment provides that if a physician (including a family member) has a financial interest in a clinical laboratory, then he may not make a referral for clinical laboratory services if payment may be made under Medicare. A financial interest is an ownership interest, an investment interest, or a compensation arrangement.

Exceptions

There are certain exceptions to the Stark Amendment. For example; if a physician personally provides the service or if a physician or employee of a medical group, provides the services.

Safe Harbor Regulations

Like the Safe Harbor Regulations [SHRs], the Stark Amendment permits physician investment in large entities and provides an exception for rural providers. Under the Stark Amendment, large entities are defined as publicly traded entities with assets greater than $100 million.

But, there are certain other exceptions that are similar to the safe-harbor regulations. They include items such as provision for rental of office space, employment and service arrangements with hospitals, and certain service arrangements. These arrangements must be at arms-length and at fair market value.

Stark II

Stark II was passed in 1993 to modify and expand the Stark amendment. In particular, it acts to bring numerous other entities, besides clinical laboratories, within the prohibitions of the Stark amendment.

Stark III

The Federal Register notes that “Stark III” regulations went into effect on March 26, 2008.

Link: http://mamedicallaw.com/blog/2008/06/15/what-do-i-need-to-know-about-the-stark-iii-rules/

Assessment

Self-referral and over utilization may become less of a problem as managed care makes further in roads in medical practice control and quasi-subrogation. Future legislation is likely to address the concerns of the financial incentives towards under utilization of ancillary medical services.

Update

Quote: Self-referrals

Docs and dollars: This one’s a twofer. The first is a hotly-discussed NEJM paper showing that urologists (not radiation oncologists, as we’ve covered earlier) owning a stake in radiation therapy equipment tend to recommend that equipment more often than docs without an ownership stake. The second is a less-publicized government report showing that surgeons with a stake in device distributors also recommend those devices more than other surgeons. This shouldn’t surprise anyone — doctors are human, after all. The Stark laws designed to prevent physician self-referral, for some reason, make an exception for the IMRT conflict-of-interest in the first paper. And I don’t think any legislation foresaw the physician-owned-distributorships in the second article.

-Austin Frakt PhD

Conclusion

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Filed under: Career Development, Health Law & Policy | Tagged: Stark laws | 5 Comments »

Stark III Legislation

Posted on August 22, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Self-Referral Rules Unveiled

[Staff Reporters]

The Centers for Medicare and Medicaid Services [CMS] recently reported changes to the Stark self-referral ban that could have a significant effect on physician-hospital relationships and Physician-Hospital-Organizations [PHOs].

Final IPPS Regulations

The new changes appeared in the final Inpatient Prospective Payment System [IPPS] regulation unveiled on July 31, and due for publication in the August 19th 2008 Federal Register [FR].

“Standing-in-the-Shoes” and other Issues

The healthcare industry will soon have to navigate new Stark rules on issues like percentage-based compensation, per-click arrangements and other “stand-in-the-shoes” legal analysis. And, it’s time to sunset “under-arrangements” with physicians because CMS finalized its revised definition of entities that provide Designated Health Services (DHS) under Stark.

But, CMS also cleared a path for returning to Stark compliance over unsigned physician contracts, and clarified how providers can end the “period of disallowance,” when a Stark violation renders Medicare claims un-payable.

Assessment

According to the Report on Medicare Compliance [8/11/08], the Stark self-referral law bans Medicare payments to entities providing DHS if patients were referred by physicians with an ownership, investment or compensation relationship with the DHS entity.

Conclusion

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Filed under: "Doctors Only", Career Development, Health Law & Policy | Tagged: Stark laws | 7 Comments »

Asset Allocation Portfolio Decisions

Posted on August 21, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

A Historical Perspective for Physicians

[By Jeffery S. Coons; PhD, CFP®]

Managing Principal-Manning & Napier Advisors, Inc

To a large extent, your investment objectives are driven by your investment time horizon and the needs for cash that may arise from now until then. Once these objectives have been set, you must decide how to allocate assets in pursuit of your goals.

Establishing the appropriate asset allocation for a physician’s [any investor] portfolio is widely considered the most important factor in determining whether or not you meet your investment objectives. In fact, academic studies have determined that more than 90% of a portfolio’s return can be attributed to the asset allocation decision.

The following will provide a historical perspective on the risks which need to be balanced when making the asset allocation decision, and the resulting implications regarding the way this important decision is made by investors today.

Growth versus Capital Preservation Balance

The asset allocation decision (i.e., identifying an appropriate mix between different types of investments, such as stocks, bonds and cash) is the primary tool available to manage risk for your portfolio. The goal of any asset allocation should be to provide a level of diversification for the portfolio, while also balancing the goals of growth and preservation of capital required to meet your objectives.

Allocation Decisions

How do investment professionals make asset allocation decisions?

One way is a passive approach, in which a set mix of stocks, bonds and cash is maintained based on a historical risk/return tradeoff. The alternative is an active approach, in which the expected tradeoff between risk and return for the asset classes is based upon the current market and economic environment.

Can any single mix of stocks, bonds and cash achieve your needs in every market environment that may arise over your investment time frame? If such a mix exists, then it is reasonable for you to maintain that particular passive asset allocation.

On the other hand, if no single mix exists that will certainly meet your objectives over your time frame then some judgment must be made regarding the best mix for you on a forward-looking basis. This case implies that some form of active decision making is required when determining your portfolio’s asset allocation. To answer this question, let’s consider the historical tradeoff between the pursuit of growth and the need to preserve capital over various investment time frames.

The Need for Growth

Our first conclusion is that you have to be willing to commit a majority of your assets to stocks to pursue capital growth, but even an equity-oriented portfolio is not guaranteed to meet your growth goals over a long-term time period.

To provide some historical perspective using Ibbotson data, a mix of 50% stocks and 50% bonds provided an 8.9% annualized return from 1926-1998, but failed to surpass what many consider to be a modest return of 8.0% in approximately 49% of the rolling ten and twenty year periods over this time. In fact, a portfolio of 100% stocks provided an 11.2% annualized return, but failed to surpass 8.0% in almost 1 of every 3 ten-year periods and more than 1 of every 4 twenty-year periods.

This data also reflects the difficulty through history of consistently achieving an 8.0% rate even with an aggressive mix of stocks and bonds. In this time of high flying stock markets, it is important to keep in mind that taking more risk is no guarantee of higher returns. However, what is clear from this data is the importance of allowing a manager the flexibility to achieve meaningful exposure to stocks in attractive market environments to pursue the goal of long-term capital growth.

The Need for Capital Preservation

Of course, there is a clear risk of long-term declines in an equity-oriented investment approach, especially for a portfolio dealing with interim cash needs (e.g., a defined benefit plan with ongoing benefit payments, a defined contribution plan with participants having different dates until retirement, or an endowment with ongoing withdrawal needs).

An illustration of the sustained losses that may result from heavy allocations to stocks is the fact that 1 of every 4 one year periods and 1 of every 10 five-year periods resulted in a loss for a portfolio of 100% stocks. Even the 50% stock and 50% bond portfolio has seen losses in almost 1 of every 5 one-year periods and more than 1 of every 25 five-year periods over the past 73 years of available data. Thus, it is clear that no single mix of investments is likely to meet all of the needs for a portfolio in every market environment.

The Need for Active Management of Risk

The analysis to this point has discussed the need to balance long-term growth and preservation of capital, and it has summarized the tradeoff between these conflicting goals. There remains, however, an important issue regarding the appropriate stock exposure for you in the current environment. Even though returns over the long-term may have been strong for an all-stock portfolio, your returns will be very much dependent on the market conditions at the start of the investment period.

To set up this discussion, consider the risk of failing to achieve a target return of 5%, 8% or 10% in the S&P 500 over the last 44 years.

FAILURE RATES OF TARGET RETURNS

IN STOCKS [1955-1998]

1 Year

3 Years

5 Years

10 Years

% Periods with Less Than a 5% Return:

32%

15%

17%

13%

% Periods with Less Than an 8% Return

38%

29%

27%

32%

% Periods with Less Than a 10% Return

41%

44%

Taking the risk of failing to achieve your return goals one step further, does this risk increase with an expensive stock market? Looking at several different stock valuation measures, the U.S. stock market is currently at historically extreme levels. As an example, the S&P Industrials price-to-sales ratio was 2.0 at the end of 1998. High valuation measures are often associated with periods of high volatility in stocks, and a price-to-sales ratio greater than 1.0 (i.e., ½ of current level) has historically been considered high.

FAILURE OF STOCKS TO MEET GOALS WHEN S&P INDUSTRIALS PRICE-TO-SALES RATIO IS GREATER THAN 1.0 [1955-1998]

1 Year

3 Years

5 Years

10 Years

% Periods with Less Than a 5% Return:

42%

26%

24%

45%

% Periods with Less Than an 8% Return

47%

55%

79%

% Periods with Less Than a 10% Return

49%

71%

97%

The data in the table above indicates that high market valuations significantly increase the risk of failing to achieve even moderate return goals. In all, there were 50 quarters from 1955 to 1998 in which the S&P Industrials price-to-sales ratio was over the 1.0. During these periods, strong returns were possible, but less likely to be sustained than when there are less optimistic valuations in the market.

While this does not mean that a major correction or bear market will necessarily occur, the risk of failing to meet your goals is clearly higher than average based upon this data. Because the market is a discounting mechanism, the positive economic environment we see today may become over discounted, resulting in moderate returns until fundamentals catch up with the optimism.

Assessment

Clearly, history tells us that no single mix of assets may provide both long-term capital growth and stability of market values in all market and economic conditions.

Far too often, physician investors and investment professionals take a passive approach to asset allocation, relying on past average returns and correlations to determine asset allocation without a full understanding of the long periods of time in history over which there are significant deviations from long-term averages.

Conclusion

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Filed under: Investing, Portfolio Management, Retirement and Benefits | Tagged: active portfolio management, asset allocation, diversified porfolios, passive portfolio management | 2 Comments »

IT Start-Up QWAQ

Posted on August 20, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Introducing QWAQ Forums

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

QWAQ Forums, yes that name is spelled correctly, is a new start-up company in Palo Alto, California. Founded in 2006 by CEO Gregory Nuyens and CTO David Smith, it just raised $7 million in venture capital funding. Early customers include industry giants Intel and BP.

What It Is?

QWAQ is a [Software-as-a-Service [SaaS] provider that combines enterprise-wide collaboration with a three-dimensional interface environment, akin to Second Life, etc. It provides virtual workspaces for program management, virtual offices and virtual operations centers. Most interestingly, its users create virtual avatars, and meet with co-workers in a 3-D environment to share and edit documents and use other business applications.

For example, QWAQ users upload, share and edits documents like MSFT® WORD files, MSFT-PowerPoint® slides, Open Office® and MSFT-Office® documents. Users can launch FireFox® in a forum to browse the web. There are also VOIP and text chat capabilities

The Healthcare Connection

QWAQ, it seems, is already popular with some doctors like radiologists in different locations who use medical imaging applications inside its forums. And, applications can be co-located and employed behind hospital or health enterprise firewalls, for added security protection.

Assessment

This new-wave application currently lacks granular permissions as all documents can be copied by anyone in the Forums; which are self-invited and self-hosted. Yet, it does seem to possess, next-generational “fly.”

Link: www.QWAQ.com

Conclusion

Current cloud computing competitors include Central Desktop, Basecamp and PBwiki; while MSFT-SharePoint dominates the collaboration space.

But, since no one else offers the 3-D experience of QWAQ, your opinions and comments are appreciated; especially from radiologists and all those HIT experts “out there.”

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post

Filed under: Career Development, Information Technology, Research & Development | Tagged: Add new tag, QWAQ | Leave a comment »

Defined Benefit Plans for Physicians

Posted on August 20, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Making a Comeback in 2008?

[By Staff Reporters]

During the past decade, defined benefit plans have fallen out of favor due to excessive red tape, high administration costs, and IRS scrutiny. However, some experts claim that this trend may be about to reverse.

Suited for Older Doctors

For an older physician-executive who has little in retirement savings, a few young employees (or no employees), but adequate income to start setting a great deal of it aside, the defined benefit plan makes a great deal of sense in that contributions are not limited as they are in defined contribution plans.

Considerations

However, there are other good reasons to reconsider a defined benefit plan.

For instance, a doctor-employer can take into consideration prior years of service and adjust the benefit formula to meet his or her needs. In certain cases, this could result in putting away everything a person makes each year.

The only snag is the interplay between the defined benefit and defined contribution limits that is mandated by Section 415(e) of the Internal Revenue Code. Defined contribution plans have annual contribution limits, while defined benefit plans have annual benefit limits. Under the pension changes signed into law in August 1996 as part of the minimum wage bill, Section 415(e) was eliminated on Jan. 1, 2000, removing this obstacle to the creation of new plans.

Limitations on Qualified Plans

Section 415 limits the amount of benefits that can be provided under qualified pension plans. These limits are indexed for inflation.

For 2007, a defined benefit plan cannot provide for the payment of benefits which exceed the lesser of $180,000 or 100% of the participant’s average compensation for the highest three consecutive years of service, i.e., the three consecutive years during which the participant had the greatest aggregate compensation. The amount of annual additions (i.e., employer contributions, employee contributions and forfeitures) that can be made to a defined contribution plan for 2007 is limited to the lesser of $45,000 or 100% of a participant’s compensation for the limitation year.

Over-Funding Risks

Defined benefit plans still suffer from the risk of over-funding. Excess accumulations can be effectively confiscated up to 50% between penalties, federal, state, and possibly local income tax. The likelihood of over-funding was exacerbated by some pension changes included in the General Agreement on Tariffs and Trade (GATT) passed in December 1994. These changes required use of the 30-year Treasury bond interest rate in calculating funding requirements.

Previously, lump-sum payouts were calculated using the Pension Benefit Guaranty Corporation [PBGC] interest rate, which was lower and more predictable than the T-bond rate. A higher rate results in a lower lump sum withdrawal at retirement.

Assessment

One solution is to keep the pension plan in place when the doctor-business owner retires if interest rates have increased. The doctor should take the maximum annual benefit from the plan and wait for interest rates to drop so that he or she can withdraw the remainder of the balance in a lump sum.

Link: http://www.mondaq.com/article.asp?articleid=51226

Conclusion

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Filed under: Financial Planning, Investing, Retirement and Benefits | Tagged: defined benefit plans, Section 415 plans | 3 Comments »

Next-Gen Health Accountants and Tax Advisors

Posted on August 19, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Avoiding the “Managed Care Ripple Effect”

By Dr. David Edward Marcinko; MBA, CMP™

The healthcare industrial complex represents a large and diverse industry, and the livelihood of other synergistic professionals who advise doctors depend on it as well. These include CPAs, tax specialists and Enrolled Agents [EAs] who themselves wish to avoid the collateral ripple effects of the current healthcare debacle.

Unappreciated CPAs Working Diligently

The nation’s 330,000 or so CPAs know little about the new healthcare dynamics and managerial accounting mechanics. Many often feel as though they are laboring away in obscurity and that their doctor clients do not appreciate what they do or how hard they work.

If you are a CPA, your workweek is ridiculously long, especially January through April; and you often deliver bad news to your clients. You do not earn a generous salary, but you do receive their ire for your efforts.

The Epiphany

So, you begin to scratch your head and ponder, quietly at first, and then out loud. Perhaps managing the medical practice(s) of a physician, or providing consulting services to other medical professional is a business and financial planning opportunity that won’t require a new client base? You can keep your accounting practice during the first four months of the year, and supplement your income with something that may actually earn more than you are making now.

A light then goes off in your head, epiphany! Enter the CPA/PFS designation, exhorting doctor clients to “never underestimate the value”, through an additional 750 hours of financial planning experience and a six-hour comprehensive examination.

New Wave Terms and Definitions

However, new-wave terms such as capitated medicine; per member-per month fixed fees; payment withholds; activity based costing with CPT codes; utilization and acuity rates; and other investment, business and economic nomenclature is likely quite unfamiliar to you.

Furthermore, you may not have the temperament to be a fiduciary, responsible for the financial affairs of others. Then you realize that MBAs and actuaries may actually be the new denizens of the healthcare bean counting and practice management scene. Rather than present numerics of the historic past, they make logical and mathematical inferences about the future. Slowly, you realize that this has occurred because these professionals are proactive, not reactive, as the accounting profession is loosing its premier advisory position within the medical profession.

And, since some doctors are paid a fixed fee amount, regardless of the number of services performed, these futuristic projections are the most important accounting numbers in healthcare today.

Assessment

In fact, your research suggests that as a result, there are now several accountant managers and broker-dealers on the investment scene, as well as an increasing number of accounting-financial planning firms, such as Miller Ray & Houser Business Advisors and CPAs, in Atlanta, who set up a separate investment advisory firm to which they refer clients.

Moreover, the AICPA is providing encouragement to CPAs who wish to provide more professional client services by building a financial planning practice for the new millennium.

Disclaimer: Dr. Marcinko, a member of the Microsoft accounting network, is Founder of the Certified Medial Planner™ program for all fiduciary advisors in health economics, finance and medical practice management www.CertifiedMedicalPlanner.com

Conclusion

Your thoughts are appreciated; please opine?

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

Referrals: Thank you in advance for your electronic referrals to the Executive-Post

Filed under: "Advisors Only", Accounting, Book Reviews, Career Development, Financial Planning, Health Economics, Op-Editorials, Research & Development | Tagged: Certified Medical Planner™ | Leave a comment »

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