RESOURCES: Financial and Economic Essays for Doctors and Healthcare Professionals

https://marcinkoassociates.com

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Informational essays of most current interest to healthcare professionals. Check back periodically for practical updates. Our catalogue library of major books, texts, case models and dictionaries is suggested for additional financial, economic, business and medical practice management information and education.

READ HERE: https://marcinkoassociates.com/articles-essays/

UPDATE: Prior ME-P Topics:

1-The number of balance billing disputes reaching arbitration is far higher than federal projections suggested.


2-Experts worry ACOs could face lasting financial difficulties due to an alleged $2 billion Medicare urinary catheter fraud scheme. 

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Some Cool New Health Care Administration Abbreviations and Terms

By Ann Miller RN MHA

[Executive-Director]

Abbreviations for 2024

  • AALL American Association for Labor Legislation
  • ACA Accountable Care Organizations (see PPACA)
  • AAMC Association of American Medical Colleges
  • AHA American Hospital Association
  • ALOS Average Length of Stay
  • AMA American Medical Association
  • ANA American Nurses Association
  • ASTHO Association of State and Territorial Health Offi cials
  • CAT Computerized Axial Tomography
  • CCMC Committee on the Costs of Medical Care
  • CDC Centers for Disease Control and Prevention
  • CHC Community Health Center
  • CHSS Cooperative Health Statistics System
  • CME Continuing Medical Education
  • CMS Centers for Medicare and Medicaid Services
  • CPO Combined Provider Organization
  • DHHS Department of Health and Human Services
  • DO Doctor of Osteopathy
  • DOD Department of Defense
  • DRG Diagnosis-Related Group
  • DVA Department of Veterans Affairs
  • EAP Employee Assistance Program
  • ED Emergency Department
  • EMS Emergency Medical Service (or System)
  • EMT Emergency Medical Technician
  • EPA Environmental Protection Agency
  • EPO Exclusive Provider Organization
  • FDA Food and Drug Administration
  • GAO General Accounting Offi ce
  • GPO Government Printing Offi ce
  • GDP Gross Domestic Product
  • GMENAC Graduate Medical Education National Advisory Committee
  • GNP Gross National Product
  • GPEP General Professional Education of the Physician Panel
  • HCFA Health Care Financing Administration
  • HIV Human Immunodeficiency Virus
  • HMO Health Maintenance Organization
  • HRSA Health Resources and Services Administration
  • IDS Integrated Delivery System
  • IPA Individual or Independent Practice Association
  • IPO Independent Practice Organization
  • JCAHO Joint Commission on Accreditation of Healthcare Organizations
  • LCME Liaison Committee on Medical Education
  • LPN Licensed Practical Nurse
  • MC Managed Care
  • MCH Maternal and Child Health
  • MCO Managed Care Organization
  • MEPS Medical Expenditure Panel Survey
  • MHS Marine Hospital Service
  • MMWR Morbidity and Mortality Weekly Report
  • MRI Magnetic Resonance Imaging
  • MVSR Monthly Vital Statistics Report
  • NCHS National Center for Health Statistics
  • NHANES National Health and Nutrition Examination Survey
  • NHIS National Health Interview Survey
  • NIH National Institutes of Health
  • NIMH National Institute of Mental Health
  • NIOSH National Institute of Occupational Safety and Health
  • NLN National League for Nursing
  • NP Nurse Practitioner
  • OMB Offi ce of Management and Budget
  • OPD Outpatient Department
  • OSHA Occupational Safety and Health Administration
  • PA Physician Assistant (or Associate)
  • PPACA Patient Protection and Affordable Care Act of 2010
  • PHO Physician–Hospital Organization
  • PHS Public Health Service
  • POS Point of Service
  • PPGP Prepaid Group Practice
  • PPO Preferred Provider Organization
  • RBRVS Resource-Based Relative Value System
  • RN Registered Nurse
  • SAMSHA Substance Abuse and Mental Health Services Administration
  • UR Utilization Review
  • USDA United States Department of Agriculture
  • USPHS United States Public Health Service
  • VA United States Department of Veterans Affairs
  • WHO World Health Organization
  • WIC Women, Infants, and Children Supplemental Nutrition Program

Assessment

Feel free to send us your own new-wave abbreviations and terms.

MORE: Glossary Terms Ap 3

SOURCE: Jonas’ US Health Care System

http://www.springerpub.com/product/9780826109309?utm_medium=email&utm_campaign=718+Public+Health+Single&utm_content=718+Public+Health+Single+Version+A+CID_ba75230692a1f4f7e4e896da56f9dff2&utm_source=MyemailFX&utm_term=Jonas+Introduction+to+the+US+Health+Care+System+7th+Edition

Product DetailsProduct DetailsProduct Details

Medical Malpractice Trial Types

Understanding the Litigation Process

By Dr. Jay S. Grife; Esq, MAinsurance-book

There are two types of trials, trial by jury and trial by judge. It is the task of the judge to determine the law, while the jury determines the facts.  In a trial by judge—called a “bench” trial—the judge determines both the law and the facts.  The U.S. Constitution guarantees a trial by jury.  If a party does not request a jury trial, however, the right to a jury trial can be waived.

The Statistics

Most civil cases in the United States are tried by jury.  Of the 3 percent of all cases that go to trial, the Department of Justice reports about two-thirds are jury trials, and one-third are bench trials. Whether to try a case to the judge or to a jury is strictly a matter of choice by the litigants.  If either party timely requests a jury trial, however, the case must be tried to a jury.  Because of the constitutional implications, in most cases both parties must waive their right to a jury trial in order for the case to be tried to a judge.  In a few instances, such as trials for injunctions and family law matters, a jury trial is not an option and a judge must hear the case.  However, the majority of civil issues offer the litigants a choice between bench or jury trials.

Notions and Perceptions

So why would anyone choose to have a case heard by a judge as opposed to a jury, or vice versa?  The reasons are mainly based on preconceived notions about judge and juror biases.  Generally, most litigants favor a jury over a judge because the decision is put into the hands of many rather than in the hands of one.  Plaintiffs usually like juries because lay individuals are believed to be more sympathetic, and a plaintiff can appeal to the emotions of a jury.  Conversely, defendants usually prefer bench trials because a judge is thought to be more objective in deciding a case.  Requesting a bench trial can also result in a much quicker trial date.  Since court dockets in most large cities are becoming increasingly congested, the time difference between a jury trial date and a bench trial date can be literally years.

Assessment

None of the perceptions about the benefits of a jury trial or a bench trial apply to all situations—every case is different.  There is at least some empirical evidence that some of the commonly held conceptions about bench and jury trials are actually misconceptions.  For example, while it is almost universally believed that juries tend to favor plaintiffs and award much higher monetary amounts, a recent study by the Department of Justice suggests that judges favor plaintiffs and return higher verdicts.  Still, jury trials outnumber bench trials by about two to one [1].

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PHYSICIANS: www.MedicalBusinessAdvisors.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


[1] See Civil Jury Cases and Verdicts in Large Counties, Civil Justice Survey of State Courts at: http://www.usdoj.gov/bjs/abstract/cjcavilc.htm.

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Malpractice Trial Jury Selection

Understanding the Trial Process

[By Dr. Jay S. Grife; Esq, MA]insurance-book

The selection process for a jury begins with what is called the jury pool.  A number of citizens are selected as potential jurors, usually several times the number of jurors needed for a trial.  From this pool of potential jurors, the jury panel is selected.

Jury Size and Constituency

The size of the jury panel varies by state and locale.  Most juries consist of about six to twelve individuals on a panel.  In addition, one or more alternate jurors may also be selected.  Alternate jurors sit with the jury and hear evidence just as all the other jurors.  In some states, they also sit in on jury deliberations, though they are not allowed to participate.  If for some reason a member of the panel is unable to continue with the trial or other deliberations, the alternate juror fills in.  The number of alternate jurors varies, and determining the number is usually left to the discretion of the judge.  Generally; longer trials require more alternate jurors.

Pre-Trial Questionnaires

Before any potential juror appears at the courthouse for a trial, usually a questionnaire form is mailed for the individual to complete and return to the court.  Such forms request information such as name, age, occupation, educational background, participation as a party or witness in previous litigation, previous jury service, etc.  Attorneys for the parties are able to obtain and review these questionnaires in advance of the trial date.

More Questions

On the day of trial, when the potential jurors arrive at the courthouse, the judge typically asks some generic questions about their ability to serve.  The judge may ask whether any potential juror has a problem staying for the duration of the trial, or whether the potential jurors know any of the parties or their attorneys.  The purpose of these questions is for the judge to determine which, if any, of the potential jurors will be excused immediately from service.

Assessment

Many juries tend to be comprised of citizens with little or no college education.  One of the possible reasons for this result is that many professionals, especially medical professionals, request to be excused from jury service, citing their professional commitments as justification.  Ironically, professionals are usually the first to complain when juries who lack any representatives with advanced education hear their own cases.  Once the judge is finished with the preliminary screening of the jury pool; attorney questioning of the jurors and voir dire begins.

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Onsite Visits for Medical Office Appraisals

The Medical Practice Walk-through – A Necessity?

Dr. David E. Marcinko MBA

The most effective means for any professional appraiser to confirm his or her understanding of business value, and how internal controls over financial and managerial reporting is designed and operated in a medical practice, is to evaluate and test its effectiveness.

This includes making inquiries about and observing the personnel who actually perform the managerial duties and controls; reviewing documents that are used in – and that result from – the application of the controls; and comparing supporting documentation to the accounting records.

In performing an onsite office walkthrough, professional valuators examine and review transactions in a medical practices information system to the point where it is reflected in the company’s financial reports.

Practice onsite walkthroughs provide the valuator with evidence to:

·Confirm the medical process flow of transactions

·Understand the management design components of a medical practice valuation related to the prevention or detection of fraud, over utilization, excessive expenses, etc

 · Learn about office workforce processes by determining whether points at which misstatements related to each relevant financial statement assertion that could occur have been identified

·Document whether office controls have been placed in operation.

Of course, an onsite walk-through is the premier component of any comprehensive medical practice valuation engagement.

CONCLUSION: What are your thoughts on onsite valuation visits; pro or con?

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

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DAILY UPDATE: MACRA Update, Crypto Restitution as the Markets Fade

HAPPY MARDI GRAS

By Staff Reporters

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In welcome news for physicians, a bipartisan group of senators will get to work on Medicare payment reform. The lawmakers plan to propose changes to the physician fee schedule and updates to the 2015 MACRA law.

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Stat: $3+ billion. That’s how much restitution New York State Attorney General Letitia James is now seeking from Digital Currency Group, Genesis Global Capital, and Gemini, the crypto exchange run by the Winklevoss twins, for allegedly defrauding more than 230,000 investors, after initially suing in October (CNBC).

CITE: https://www.r2library.com/Resource

Here’s where the major benchmarks ended:

  • The S&P 500 index fell 4.77 points (0.1%) to 5,021.84; the Dow Jones Industrial Average gained 125.69 points (0.3%) to 38,797.38; the NASDAQ Composite lost 48.12 points (0.3%) to 15,942.55.
  • The 10-year Treasury note yield (TNX) dropped more than 1 basis point to 4.173%.
  • The CBOE Volatility Index® (VIX) rose 1.00 to 13.93.

Despite the mixed performance of large-cap stock indexes, several other market sectors got off to a strong start this week. Banking and retail were among the strongest performers, and the small-cap Russell 2000® Index (RUT) surged 1.8% to end at its highest level since late December.

Tech shares erased early gains, with the Philadelphia Semiconductor Index (SOX) fading to a 0.2% loss after earlier rising to a record intra-day high.

Peterson noted shares of many semiconductor companies are well into technically overbought territory, which often can lead to sharp pullbacks, though the timing of such a move is difficult to pinpoint. He cited unusually elevated Relative Strength Index (RSI) readings, at 90-plus, for two AI darlings: Arm Holdings (ARM) and Super Micro Computer (SMCI).

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PODCAST: Employee Healthcare Ecosystem Power Structure Explained

By Eric Bricker MD

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VIAMEDIS: French Company Health Data Breach

By Staff Reporters

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Viamedis did not state how many people were affected by the breach, but it did confirm that it manages third-party payments for 84 complementary health insurance companies which when combined, service 20 million people.  As soon as the data breach was spotted, Viamedis disconnected its third-party payment management platform.

“Beneficiaries will be able to continue to use their carte vitale and their third-party payment card, the temporary disconnection from the Viamedis platform will only have an impact on certain health professionals, in particular opticians and audio-prosthetists,” it said.

Speaking to Agence France-Presse (AFP), Viamedis General Director, Christophe Cande, said the attack wasn’t ransomware, but rather a successful phishing attack against one of the company’s employees. 

“To date, we do not have the number of insured individuals impacted; we are still in the process of investigation,” Cande said. 

Viamedis filed a complaint with the public prosecutor, and notified other relevant authorities. For healthcare professionals, it said it would notify them on the details of exposed data later.

Via BleepingComputer

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VALUE BASED CARE: Guidelines and Best Practices?

http://www.MarcinkoAssociates.com

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Three healthcare industry groups—America’s Health Insurance Plans (AHIP), the American Medical Association (AMA), and the National Association of Accountable Care Organizations (NAACOS)—released the 36-page playbook on July 25th, 2023. Adoption of the best practices in the playbook is voluntary; the playbook is intended to encourage the adoption of value-based care arrangements in the private sector, according to a news release from the three groups.

CITE: https://www.r2library.com/Resource

Under a value-based care model, providers are reimbursed based on patient outcomes rather than the quantity of services provided like in the traditional fee-for-service model. The value-based care model has been around since the late 1960s. But, widespread adoption has been slow—less than half of the primary care physicians said in a 2022 survey from the Commonwealth Fund that they had received any value-based payments.

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Healthcare Corporate Business Updates

By Staff Reporters

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Walgreens tapped Mary Langowski, a former CVS Health executive, to lead its U.S. healthcare segment. The move comes as the retail pharmacy giant looks to boost profitability in its healthcare business.


CVS Health cut its outlook for 2024 on the back of higher medical costs in the fourth quarter. The drugstore chain, which owns Aetna, joins other healthcare companies to see a spike in utilization.


And … following up on a federal law passed in September to increase competition among organ transplant contractors, HRSA is issuing requests for proposals for several different contracts.

CITE: https://www.r2library.com/Resource


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AMERICAN DREAM: Now Costs $3.4 Million?

By Staff Reporters

SPONSOR: http://www.MARCINKOASSOCIATES.com

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The classic “American Dream” including two kids, a house, and car now costs more than most folks make in a lifetime. According to Investopedia.

READ HERE: https://www.investopedia.com/the-american-dream-now-costs-over-usd3-million-8409951

PHYSICIAN SPECIFIC ASSISTANCE AND RESOURCES: https://marcinkoassociates.com/financial-planning/

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PODCAST: Healthcare Advertising & Spending in the USA

By Eric Bricker MD

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HOSPITAL OPERATING MARGINS: Non-Profits Still Down

By Staff Reporters

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Operating margins at not-for-profit hospitals are expected to “gradually improve” in 2024 but will still lag far behind pre-pandemic levels, according to a January report from credit rating agency Fitch Ratings.

Median operating margins for not-for-profit hospitals dipped to record lows during the pandemic, falling to 0.2% in 2022, according to the agency, which has yet to report numbers for 2023. In 2019, the median not-for-profit hospital operating margin was 2.4%, according to Moody’s.

Despite signs that margins are improving, they’re still “nowhere near” where they were pre-2020, and a “larger expense base will keep huge gains unlikely,” according to Fitch.

CITE: https://www.r2library.com/Resource

“2024 will not be markedly better and certainly not the V-shaped recovery we’re hoping for,” Kevin Holloran, senior director and sector head at Fitch, said in a statement.

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PODCAST: Healthcare Quality is Due Diligence

By Eric Bricker MD

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BUSINESS SCHOOL: Case Studies for Physicians and Healthcare CXOs

MARCINKO ASSOCIATES, Inc.

http://www.MarcinkoAssociates.com

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READ – STUDY – LEARN – PROSPER

The Marcinko & Associates case study and white-paper compendium is a teaching vehicle that presents potential clients with a critical management issue that serves as a spring board to lively debate in which participants present and defend their analysis and prescriptions. The average case is 2 to 100 pages long (prose, tables, graphs, charts, spread sheets and figures, etc).

CASE MODEL Sample Privatization: https://tinyurl.com/3af5nf7s

Our two main types of cases are actual “field cases” based on onsite research, and “library cases”, written from public reference sources. We also write “Marcinko & Associates “armchair cases” based entirely on our general knowledge and subject matter experience.

PURCHASE: $99 PURCHASE “CASE MODELS IN HEALTHCARE: https://tinyurl.com/26ke3n9w

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

READ MORE: https://marcinkoassociates.com/case-studies/

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DENTISTRY: Ransomware e-Dental Records

By Darrell Pruitt DDS

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The ransom one pays to extortionists is only part of the costs. Now there are also legal liabilities to paying.

We will be hearing much more about ransomware in dentistry soon.

Guaranteed.

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JANUARY: Doctors Beware Divorce Month

OVERHEARD IN THE ADVISOR’S LOUNGE
[January is Divorce Month]

SPONSOR: http://www.MARCINKOASSOCIATES.com

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January is nick-named the “divorce month” because of an uptick in activity for divorce lawyers after the New Year. Yet, January to April 15th is also a very low period in terms of people inquiring about divorce mediation. The reason is that couples generally want to know where they stand financially before pursuing divorce.

CITE: https://www.r2library.com/Resource

And, with the economy improving in 2024, people may be less inclined to wait. While anecdotal evidence abounds, hard figures are more elusive. An analysis of national divorce filings between 2008 and 2011 by legal information website FindLaw.com found a spike in January and a gradual rise until a peak in late March.

Mediation: https://medicalexecutivepost.com/2023/08/12/a-step-wise-approach-to-the-divorce-mediation-process-for-doctors/

UPDATE 2024: The exclusivity of marriage in the contemporary era has dire, compounding consequences across generations. As researchers Shelly Lundberg, Robert A. Pollak and Jenna Stearns document, in 1960, people with and without college degrees married and formed families in a similar manner, but today, just 11% of childbirths for those with college degrees are non-marital, while 58% of childbirths for those without are. This cleavage makes possible what the Brookings Institution’s Melissa Kearney describes as “two-parent privilege,” an emerging phenomenon through which well-off couples transmit educational and economic advantages to their children. Viewed from this angle, it should not surprise us that many Americans think the rich are galloping ever further ahead.

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2024: Healthcare Industry Future Outlook

By Health Capital Consultants, LLC

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2024 Healthcare Industry Outlook

Nearly one year removed from the end of the COVID-19 public health emergency, the healthcare industry expects a number of new opportunities in 2024, despite lingering challenges exposed by the pandemic. For example, healthcare organizations anticipate issues related to workforce shortages and legislative challenges; however, the industry also expects that opportunities emanating from technological advancements will allow them to grow and transform.

This Health Capital Topics article reviews anticipated U.S. healthcare industry activity for 2024 as well as trends that may drive change in the industry. (Read more…)

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ENTREPRENEURS: Physicians and Medical Professionals

By Dr. David Edward Marcinko MBA

SPONSOR: http://www.MARCINKOASSOCIATES.com

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SERVING ALL PHYSICIANS AND HEALTHCARE PROVIDERS

At D.E. Marcinko & Associates our clients traditionally are medical entrepreneurs that include physicians [MD, MBBS, DPM and DO], dentists [DDS and DMD], Registered Nurses [RNs], Certified Registered Nurse Anesthetists [CRNA], Physician Assistants [PA] and Nurse Practitioners [NP]. A growing cohort of clients include medical technologists, physical, speech and occupational therapists, etc.

The above healthcare providers are naturally segregated into three career tranches: 1. New practitioners, 2] Mid-Career practitioners and 3] Mature practitioners. We serve them all and are fully prepared for any special needs situation that may arise in any tranche [death, divorce, adverse risk event and/or bankruptcy, reorganization, etc].

At D. E. Marcinko & Associates, our colleagues are located throughout the United States. They are considering the sale, purchase, strategic or operational improvement, merger, acquisition and/or other business or personal financial planning transaction. Our guidance helps doctors, nurses, practices, clinics, ambulatory surgery centers, outpatient wound care facilities realize their ultimate goals.

We can do it all for you, or educate and guide do it yourself colleagues to reach the best possible outcomes.

READ MORE: https://marcinkoassociates.com/welcome-medical-colleagues/

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PODCAST: Hospital Medicare Break-Even Plans

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By Eric Bricker MD

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What is MEDICAL AID [Assistance] in DYING?

MAiD

By Staff Reporters

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Medical Assistance in Dying (MAiD) by Pam Dominguez

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Medical Aid in Dying [MAiD] is an end-of-life option for people who are terminally ill. Terminally ill means you have an illness, disease, or health condition that, according to doctors, you will likely die from within 6 months. If you’re eligible for MAiD, you can ask a doctor who participates in MAiD to prescribe life-ending medications. You can take these medications at a time of your choosing.

Medical Aid in Dying (MAID) is legal in eleven jurisdictions in the United States: California, Colorado, District of Columbia, Hawaii, Maine, Montana, New Jersey, New Mexico, Oregon, Vermont, and Washington.

But, only patients can make a request for MAiD. Family members, caregivers, and health care agents cannot request MAiD for a patient.

READ: http://tinyurl.com/yes7wbzm

NOTE: If you are struggling with thoughts of suicide or worried about a friend or loved one, call or text the Suicide & Crisis Lifeline at 988 for free, confidential emotional support 24 hours a day, seven days a week.

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Physician Payments in 2025

By Staff Reporters

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American Medical Association (AMA) leaders lauded the Medicare Payment Advisory Commission (MedPAC) this month for backing increased physician payment rates for 2025.

CITE: https://www.r2library.com/Resource

AMA President Jesse Ehrenfeld praised MedPAC, a nonpartisan independent legislative agency that advises Congress on the Medicare program, for endorsing a draft recommendation that urges lawmakers to increase physician payment rates to reflect inflation. He cast the move as “a critical first step toward the necessary work of reforming the broken Medicare payment system.”

“Long-term reforms from Congress are overdue to close the unsustainable gap between what Medicare pays physicians and the actual costs of delivering high-quality care. When adjusted for inflation in practice costs, Medicare physician pay declined 26% from 2001 to 2023,” he said in a statement.

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PODCAST: Doctors Subconsciously Influenced By Pharmaceutical Companies?

Dr. Eric Bricker MD

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PODCAST: Patient-Doctor Mismatch in Population Health

By Eric Bricker MD

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DOCTORS Getting OUT of Medical Practice!

By Staff Reporters

SPONSOR: http://www.MARCINKOASSOCIATES.com

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Why are doctors leaving practice?

For many physicians it’s about demographics. Just like the rest of us, doctors are aging too. Already the average physician age is about 53 years old. The Association of American Medical Colleges reports that about half of doctors are over the age of 55. Over the next decade, an estimated 40% of physicians will be over 65 years old. This means more than two of every five active physicians will reach age 65 within the next 10 years.

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Moreover, compared with their boomer colleagues who were more likely to work past retirement, a robust 60% of younger Generation X doctors are reporting that they plan to retire by age 60.

Doctors cite poor quality of life and stress as reasons for their early departure. The pandemic certainly crushed many providers and has led to burnout. Generation X physicians in their 40s and early 50s were more likely than boomers to report that their current work life was not making the grade. In short, 43% of middle-aged doctors, compared with 31% of doctors over age 55, were reporting lower levels of professional fulfillment. Moreover, 47% of mostly Gen X doctors indicated dissatisfaction with their level of personal fulfillment compared with 36% of practicing boomer physicians.

COACHING: https://marcinkoassociates.com/process-what-we-do/

That dissatisfaction is translating into action and the pandemic is not the only reason for discontent. One survey of physicians in Massachusetts indicated that one in four doctors plans to leave medicine in the next two years and that staffing shortages and related administrative demands, e.g., hospital system metrics, paperwork, eMRs and meeting insurance requirements, were the most cited source of workplace stress. 

RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PHYSICIAN: Executive Leadership Thoughts

By Dr. David Edward Marcinko MBA

SPONSOR: http://www.MARCINKOASSOCIATES.com

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[Human Nature, Medical and Financial Ethics and Modern Principles]

In any medical blog or investing treatise of gravitas, thoughts on human nature are usually placed at the end of the work, or an afterthought if included at all. However, we elected to prominently place this material as a stand alone feature. Why?

In the end, the success of any financial advisor or physician endeavor ultimately comes down to changing human behavior – helping a doctor/nurse/technician alter whatever s/he was doing toward something that will better allow them to avoid errors and pursue quality care and investing or practice management goals.

Yet, there is still remarkably little education or training for financial planners or medical professionals focused directly on motivation or change theory, in any related area except psychiatry/psychology or perhaps professional liability. Instead, doctors and advisors/planners are increasingly turning to professional consultants to learn best practices on how to help them actually make the behavioral changes necessary to achieve their medical quality improvement and client acquisition goals; as we attempt to answer these questions:

  • Are you and your medical practice, or financial advisory practice, ready for change?
  • How to transition from [traditional] solo practitioner B-models to modern forms?
  • What are leadership, management and governance?
  • In group practices, how is leadership shared?
  • What issues need be considered when hiring a financial planner or practice administrator or clinic CEO?
  • What is medical ethics and financial munificence? Why is it needed? How does it work?
  • What are the types of risk?
  • How are risks managed in the medical practice space or financial advisory eco-system?

In addition, medical and financial planning practitioners need to strive to avoid what Zenger and Folkman describe as the 10 most common leadership shortcomings based on a survey of 11,000 leaders. They include:

  1. Lacks energy and enthusiasm
  2. Accepts mediocre self performance
  3. Lacks clear vision and direction
  4. Poor judgment
  5. Not collaboration
  6. Not following standards
  7. Resistant to new ideas
  8. Doesn’t learn from mistakes
  9. Lacks interpersonal skills
  10. Fails to develop others.
  •  Source: Zenger and Folkman: The Daily Stat: The 10 Most Common Failures of Business Leaders, Harvard Business Publishing, June 4, 2009.

Leadership V. Management: https://medicalexecutivepost.com/2023/04/14/healthcare-leadership-vs-management/

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Can this Doctor RETIRE?

AFFORDABILITY IN 2024

By Staff Reporters

SPONSOR: http://www.MARCINKOASSOCIATES.com

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CAN THIS DOCTOR RETIRE – HE ASKS?

I’m a late career entry and 55 year old burned out doctor who wants out. Can I retire in 2 years with a pension of $6,100 a month (net). I have $825,000 in my 401(k) and 457 plan and a mortgage of $95,000 at 5.30%. I am not planning to move and will retire in place.

SOME THOUGHTS AND ANSWERS?

Congratulations on you solid retirement fund on top of a pending pension. 

The first step you should take is to create a detailed budget for your retirement years. Consider expected living costs, healthcare expenses, travel and any other major expenses. Many folks make the mistake of setting up a monthly budget, but keep out significant milestones that are often costly, such as paying for a child’s college education or wedding.

Next, you should figure out your plan for housing. Mortgage payments, upkeep and taxes are important considerations. There was no mention of mortgage equity. 

Another factor to take into account is state and Federal tax projections. If the 401(k) funds are all pre-tax dollars, any distributions will be taxable and there may be penalties if funds are withdrawn prior to 59 ½ years old. That will impact your retirement plan if you’re preparing to retire at 57-58.

It also sounds like you haven’t taken into account your Social Security allowance. It’s possible that your pension is one that comes with a government pension offset which would explain why you didn’t include it. On the other hand, maybe you’re thinking it’s far out enough that it doesn’t factor into your calculations?

Finally, you may want to look for a fee-only financial advisor that is paid directly by the client and doesn’t receive commissions for recommending financial products. So, advice is less biased. And get a fiduciary advisor which means they are required to put your best interests ahead of their own. 

Also, someone with medical niche specificity. Good Luck!

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NOTE: This is not an offer to buy or sell any security or interest. All investing involves risk, including loss of principal. Working with an adviser may come with potential downsides such as payment of fees (which will reduce returns). There are no guarantees that working with an adviser will yield positive returns. The existence of a fiduciary duty does not prevent the rise of potential conflicts of interest.

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ADVERSE: Medical Events

By Dr. David Edward Marcinko MBA

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Aggregated experience from the Doctors Company and other malpractice insurers has shown that adverse medical events tend to fall into three categories:

A. Medical and/or System Error 
Error is defined by the National Quality Forum Consensus report titled Standardizing a Patient Safety Taxonomy as “the failure to perform a task satisfactorily against customary standards and the failure cannot be attributed to causes beyond the patient or provider.” When the investigation (including a sentinel event root cause analysis) is complete and the cause is determined to be medical and/or system error, a disclosure meeting should take place with the patient or family.

B. Known Risk/Complication or Unforeseeable Event 
The key factor in this category is pre-ventability. Disclosure communications following unpreventable complications or unforeseeable events need to be forthright, open, and compassionate, though they differ qualitatively from apologies after preventable errors.

  1. Review the known facts surrounding the adverse outcome.
  2. Determine if the event was preventable.
  3. Review your process of informed consent to determine if the known risk or complication was discussed.
  4. Proceed to the disclosure meeting with the patient or family. Focus on discussing the cause(s) of the known risk or complication. Review the informed consent if appropriate.

C. Unexplained Change in Patient Status or New Diagnosis of Late-Stage Disease 

  1. The main challenge in communicating after a Category C event is the avoidance of a premature conclusion that a severe and surprising outcome must be due to a negligent error. It is especially important in these circumstances to limit the information conveyed to the confirmed details and to provide ongoing updates as new information becomes available. These cases are particularly vulnerable to retraction and correction cycles that render all subsequent communications with the patient and family questionable.
  2. Conduct an internal review of the medical records to determine exactly what happened and to determine if the status change was preventable or if the new diagnosis could have or should have been made earlier.
  3. If appropriate, initiate an external expert review. Peer reviews of the medical care with the outcome blinded can lend unique insight into these events.
  4. If a sentinel event occurred, a root cause analysis is appropriate.
  5. Proceed to the disclosure meeting. Review the findings of your medical record review and investigation. Explain the implications of the change in the patient’s health status and how this will affect his or her subsequent disease management. Discuss the prognosis and management of the newly diagnosed late-stage disease.

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Disruptive Behavior and Bullies in Medicine

“Micro-Aggressors” in Healthcare

[By staff reporters] http://www.CertifiedMedicalPlanner.org

Every workplace has “micro-aggressors” or/or bullies that exhibit disruptive behavior.

But, when the workplace is a hospital, it’s not just an employee problem.

Definition

Microaggression is a term coined by psychiatrist and Harvard University  professor Chester M. Pierce in 1970 to describe insults and dismissals he said he had regularly witnessed non-black Americans inflict on African Americans.

In 1973, MIT economist Mary Rowe extended the term to include similar aggression directed at women; eventually, the term came to encompass the casual degradation of any socially marginalized group, such as the poor and the disabled.

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Case Report

In one reported case, the worker, felt threatened: His superior came at him “with clenched fists, piercing eyes, beet-red face, popping veins, and screaming and swearing.” He thought he was about to be hit. Instead, his angry co-worker stormed out of the room.

But, it wasn’t just any room: It was in a hospital, adjacent to a surgical area. The screamer was a cardiac surgeon, and the threatened employee was a perfusionist, a person who operates a heart/lung machine during open heart surgery. In 2008, the Indiana Supreme Court ruling in Raess v. Doescherupheld a $325,000 settlement for the perfusionist, who said he was traumatized.

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Conclusion

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

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PODCAST: The United Health Group Financial Giant

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Crafting a Medical Practice Strategic Marketing Plan

Necessary Today – Not So In the Past

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

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Marketing plays a vital role in successful practice ventures. How well you market your practice, along with a few other considerations, will ultimately determine your degree of success or failure. 

The key element of a successful marketing plan is to know your patients – their likes, dislikes and expectations. By identifying these factors, you can develop a strategy that will allow you to arouse and fulfill their wants and needs. 

The Beginning

Identify your patients by their age, sex, income/educational level and residence. At first, target only those patients who are more likely to want or need your medical services. As your patient base expands, you may need to consider modifying the marketing plan to include other patient types or medical services. 

Your marketing plan should be included in your medical business plan and contain answers to the questions asked below:

·Who are your patients; define your target market(s)?

·Are your markets growing; steady; or declining?

·How is the practice unique?

·What is its market position?

·Where will we implement the marketing strategy?

·How much revenue, expense and profit will the practice achieve?

·Are your markets large enough to expand?

·How will you attract, hold, increase your market share?

·If a franchise, how is your market segmented?

·How will you promote your practice and services?

Practice Competition

Competition is a way of life. We compete for jobs, promotions, scholarships to institutions of higher learning, medical school, residency and fellowship programs, and in almost every aspect of our lives. 

When considering these and other factors, we can conclude that medical practice is a highly competitive, volatile arena. Because of this volatility and competitiveness, it is important to know your medical competitors. Questions like these can help you determine:

·Who are your five nearest direct physician competitors?

·Who are your indirect physician competitors?

·How are their practices: steady; increasing; or decreasing?

·What have you learned from their operations or advertising?

·What are their strengths and weaknesses?

·How do their services differ from yours?

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Chief-Marketing-Officer

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Patient Targeting

Patient targeting generally describes the strategic competitive advantage and/or professional synergy that is specific and unique to the practice. Intuitively, it answers such questions as:

·Who is the target market?

·How is the practice unique?

·What is its market position?

·Where will we implement the marketing strategy?

· How much revenue, expense and profit will the practice achieve?  

The science of modern marketing however, is based on intense competition largely derived from the interplay of five forces, codified in the early 1980s, by Professor Michael F. Porter of Harvard Business School. They are placed in this section of the business plan and include the following:

Power of suppliers: The bargaining power of physicians has weakened markedly in the last managed care decade.  Reasons include demographics, technology, over/under supply and a lack of business acumen. 

Power of buyers: Corporate buyers of employee healthcare are demanding increased quality and decreased premium costs within the entire healthcare industry. The extents to which these conduits succeed in their bargaining efforts depend on several factors:

·Switching Costs: Notable emotional switching costs include the turmoil caused by uprooting a trusted medical provider relationship.

·Integration Level: The practitioner must decide early on whether or not he will horizontally integrate as a solo practitioner, or vertically integrate into a bigger medical healthcare complex.

·Product Importance: Increasingly, HMOs do not often strive to delight their clients and may be responsible for the beginning backlash these entities are starting to experience. Additionally, some medical specialties have more perceived value than others (i.e., neurosurgery v. dermatology)

· Concentration:  Insurance companies, not patients, represent buyers that can account for a large portion of practice revenue, thereby bringing about certain concessions.  A danger sign is noted when any particular entity encompasses more than 15-25% of a practice’s revenues.

Threat of new entrants: Some authorities argue that medical schools produce more graduates than needed, inducing a supply side shock. Others suggest that there too many patients? Regardless, this often can be mitigated by practicing in rural or remote locations, away from managed care entities, or in areas with under-served populations.

Current or existing competition: Heightened inter-professional competition has increased the intensity and volume of certain medical services and referrals may be correspondingly with-held.  Rivalry occurs because a competitor acts to improve his standing within the marketplace or to protect its position by reacting to moves made by other specialists.

Substitutions: Examples include: PAs for DOs, nurse practitioners for MDs, technicians for physical therapists, hygienists for dentists, cast technicians for orthopedists, nurse midwives for obstetricians, foot care extenders for podiatrists and even, hospital sanitation workers for medical and surgical care technicians.  Any strategy to ameliorate these conditions will augment the successful business practice plan. 

MORE: Healthcare Market.Tensions 2,0 MARCINKO

MORE: Strategic Management Improvement

Enter the Chief Marketing Officer [CMO]

A Chief Marketing Officer or marketing director is a corporate executive responsible for marketing activities in an organization.  The CMO leads brand management, marketing communications, market research, product management, distribution channel management, pricing, often times sales, and customer service, etc.

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DEM at Drexel

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Academic Metaphor?

Now, with all the competition today at the college and university level; notwithstanding the recent Hollywood Elite University acceptance debacle, can you see how these basic ideas might also be helpful in the academic and educational strategic marketing ecosystem?



The Emerging Role of University CHIEF STRATEGY OFFICER

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 The changing role of a college / university Chief Marketing Office [narrow focus] –versus–  Chief Strategy Officer [broader entity focus].

Assessment

A good way to accomplish and codify the above marketing plan concept is through a SWOT analysis. Mention the Strengths, Weaknesses, Opportunities and Threats of your specialty specific practice and what you plan do to maximize the positive, and minimize the negative aspects of the analysis.

Conclusion

Only after the above forces have been considered, should you begin the process that many physicians mistake for crafting their marketing efforts; executing the actual marketing plan. 

If you are not going to the right audience, making the correct statements or delivering your message through the proper advertising channels, you might as well put your medical practice marketing plan into the trash can because it will not secure you funds, or benefit your practice. 

Do you have a marketing plan, and more importantly, how well do you execute it? 

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

Speaker: If you need a moderator or a speaker for an upcoming event, Dr. David Edward Marcinko; MBA is available for speaking engagements. Contact him at: MarcinkoAdvisors@msn.com

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DAILY UPDATE: Canadian Drugs, ACA and the Mixed Stock Markets

By Staff Reporters

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States that have long pushed the FDA to allow drug importation from Canada touted the move as a major step forward in their efforts to lower prescription drug spending and rein in healthcare costs. But while the idea of importing drugs from Canada is new for states, some businesses have been using existing drug import pathways to help consumers save money on certain high-cost medications.

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More than 20 million US residents—a record number, according to the Biden administration—have signed up for health insurance through the Affordable Care Act’s marketplaces. (the New York Times)

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Here’s where the major benchmarks ended:

Stocks were a mixed bag yesterday as investors pored over the first big earnings reports and new data showing that wholesale prices surprisingly went down in December. Airlines took a hit after Delta beat earning expectations but lowered its profit forecast.

  • The S&P 500 index rose 3.59 points (0.1%) to 4,783.83, up 1.8% for the week; the Dow Jones Industrial Average® (DJI) fell 118.04 points (0.3%) to 37,592.98, up 0.3% for the week; the NASDAQ Composite rose 2.57 points to 14,972.76, up 3.1% for the week.
  • The 10-year Treasury note yield (TNX) fell about 3 basis points to 3.943%.
  • The CBOE® Volatility Index (VIX) rose 0.26 to 12.70.

Retailers and consumer discretionary shares were among the market’s weakest performers Friday, and regional banks were also under pressure. The KBW Regional Banking Index (KRX) fell 2% for the week and ended at a one-month low. Energy shares led gainers behind strength in crude oil futures. The small-cap-focused Russell 2000® Index (RUT) ended little-changed for the week but is still down 3.8% so far this year.

CITE: https://www.r2library.com/Resource

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SAMPLE: New Physician Letter of Employment Contract

BY DR. DAVID E. MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

SAMPLE NEW PHYSICIAN LETTER OF EMPLOYMENT INTENT

Dear Dr. [Name of Physician]

On behalf of [Name of medical practice or clinic] (hereinafter called the “practice”), this letter sets out a proposed agreement for your initial employment in Dr. [Name of physician]’s medical practice. After both you and Dr. [Name of physician] have agreed upon all issues related to your employment, a formal physician employment agreement will be prepared for your review and signature.

1.   Term: You will be an employee of the practice for an initial [Duration]-month period starting [Month, Date, Year]. Should you and the practice want to proceed past this initial employment period, an offer of co-ownership may be made to you as described in item nine below.

      Your employment with the practice will essentially be “at will,” since you or the practice may voluntarily terminate it at any time upon 30 days’ written notice to the other. However, the following are conditions under which the practice may terminate your em­ployment immediately: (a) upon your death or disability for three (3) consecutive months; (b) upon the suspension, revocation, or cancellation of your right to practice medicine in the State of [State]; (c) if you should lose privileges at any hospital at which the practice regularly maintains admission privileges; (d) should you fail or refuse to follow reasonable policies and directives es­tablished by the practice; (e) should you commit an act amounting to gross negligence or willful misconduct to the detriment of the practice or its patients; (f) if you are convicted of a crime involving moral turpitude, including fraud, theft, or embezzlement; and (g) if you breach any of the terms of your employment contract.

2.   Compensation: Your salary for the initial 12-month period will be $[dollar value] and $[dollar value] in the second 12-month period, each year payable in monthly installments. You will also be enti­tled to an incentive bonus calculated as follows: [Percentage] % of your collected production when such collections exceeds $[dollar value] in the first year and $[dollar value] in the second year. The bonus each year will be calculated and paid on a semiannual basis. You will also be entitled to receive a one-time signing bonus of $[dollar value] if you sign your employment contract before [Month, Date, Year].

      A portion of your compensation may be paid for by proceeds received from [Name of hospital] under the terms and conditions of a hospital recruitment agreement. The parties to this agreement will be the hospital and the practice only. However, forgiveness of any advances made by the hospital will be directly contingent upon the length of time you remain with the practice. Therefore, should your employment terminate for any reason, the practice will re­quire you to repay to it any amounts the practice repays the hospi­tal, in no matter what form, per the terms and conditions in the hospital recruitment agreement. [Note: Use this if the practice signs a hospital recruitment agreement with the hospital.]

3.   Benefits: In addition to your base compensation and incentive bo­nus, the practice will pay for the following: (a) health insurance, (b) malpractice insurance, (c) continuing medical education (CME) costs, (d) medical license fee, (e) board certification exam fee, (f) reasonable cellular phone costs, and (g) a pager. You will also be entitled to a moving cost allowance for relocating to [Location.] You will be entitled to two weeks of paid vacation, 10 working days as paid sick leave, and four days paid time off for CME or the board certification exam.

4.   Disability Leave: In case of absence because of your illness or injury, your base salary will continue for a period not exceeding 30 days per calendar year, plus any unused vacation time and sick leave. You will be entitled to any incentive bonus payments that may be due to you as collections are received on your prior production. Absence in excess of 30 days would be without pay. Unused sick leave cannot be carried over to succeeding years, nor will it be paid for at any time.

5.   Exclusive Employment: As an employee, you will be involved full-time in the practice and you may not take any outside employ­ment during the term of your employment agreement without the practice’s written approval. However, you will be entitled to keep compensation from honorariums, royalties, and copyrights if ap­proved by the practice in writing. If the practice does not give approval, then the income from such activities shall remain the property of the practice.

6.   Termination Compensation:  Should your employment terminate for any reason, you will be entitled to accrued but unpaid base compensation, earned but unpaid incentive bonus, and unused va­cation leave.

7.   Non-Solicitation: During the course of your employment, the prac­tice will introduce and make available to you its contacts and refer­ring physician relationships, ongoing patient flow, general hospital sources, business and professional relationships, and the like. Since you have not been in private practice in the area previously, you acknowledge that you currently have no established patients following you. If there should be a termination, the practice will not restrict your ability to practice medicine in the area; however, it will require you to enter into a nonsolicitation agreement in which you agree not to solicit the employees of the practice nor its patients to follow you into your new medical practice. [Note: Insert Covenant Not to Compete here, if applicable.]

8.   Employee-Only Status: During the term of your employment, you will not be required to contribute any money toward the practice’s equipment or operations, but likewise your work will give you no financial interest in the assets of the practice. However, the prac­tice intends to offer you the opportunity to buy into the ownership of the practice as set forth in item 9 below.

9.   Ownership Opportunity: At the end of your employment period, the practice will evaluate your relationship and may offer you the opportunity to become a co-owner in the practice (or enter into an office-sharing relationship). This offer is not mandatory and is at the total discretion of the practice. Should an offer not be tendered for some reason, the practice will wait until the end of your next 12-month employment period to decide whether to tender an offer of co-ownership.        If an offer of co-ownership is made, Dr. [Name of physician] will discuss with you the following: (a) what percentage of the practice you will be allowed to acquire, (b) how best to value such interest, and (c) how you will pay for the acquisition of such interest. The practice hopes to achieve mutually agreeable solutions to these ownership issues.

We hope this offer meets with your approval. If so, please contact Dr. [Name of physician] as soon as possible. This letter is not intended to be a legally binding agreement; it is, rather, a tool to be used to prepare your formal physician employment agreement. If you should have any questions, please do not hesitate to contact myself or Dr. [Name of physician] at your convenience.

Sincerely,

Atlantic Physicians Group

MEDICAL GROUP PRACTICE, LLC

Lantana FLA

ASSESSMENT: Your thoughts are appreciated.

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

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DOWN: Digital Health Care Funding

By Dr. David Edward Marciniko MBA CMP

SPONSOR: http://www.MarcinkoAssociates.com

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DEFINITION: According to the Food and Drug Administration [FDA], the broad scope of digital health includes categories such as mobile health (mHealth), health information technology (IT), wearable devices, tele-health and tele-medicine, and personalized medicine. From mobile medical apps and software that support the clinical decisions doctors make every day to artificial intelligence and machine learning, digital technology has been driving a revolution in health care. Digital health tools have the vast potential to improve our ability to accurately diagnose and treat disease and to enhance the delivery of health care for the individual. Digital health technologies use computing platforms, connectivity, software, and sensors for health care and related uses. These technologies span a wide range of uses, from applications in general wellness to applications as a medical device. They include technologies intended for use as a medical product, in a medical product, as companion diagnostics, or as an adjunct to other medical products (devices, drugs, and biologics). They may also be used to develop or study medical products.

Cite: http://tinyurl.com/2jbafuc7

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As many investors predicted, digital health funding took a dive in 2023, according to Rock Health’s year-end funding report. Startups got creative to stay afloat but many digital health founders will have to “face the music” in 2024, the VC firm’s analysts say.

CITE: https://www.r2library.com/Resource

Editor’s Note: I am on the Advisory Board of Medblob™a start-up based in Boston, MA. The digital mission of Medblob™ is to improve community and national health by allowing patients to better manage their health, providers to better treat their patients, and researchers to have the best information to discover cures to the most prevalent and pernicious diseases.

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PRIVATE HOSPITAL EQUITY: Adverse Events Rise?

By Staff Reporters

DEFINITION: Adverse events are medical errors that healthcare facilities could and should have avoided. The National Quality Forum (NQF) defines these errors, which are also called serious reportable events. There are 29 adverse events listed as reportable errors. The events may result in patient death or serious disability. The department manages aggregate data on adverse events and posts quarterly reports on this website.

Cite: https://www.r2library.com/Resource

NEVER EVENTS: https://medicalexecutivepost.com/2007/12/20/new-never-events-policy/

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A hospital’s acquisition by a private equity firm is linked to a rise in adverse events despite the pool of lower-risk patients they tend to admit, according to a Medicare Part A claims analysis just published in the Journal of the American Medical Association [JAMA], and according to Dave Muoio of Fierce Healthcare.

JAMA: https://jamanetwork.com/journals/jama/article-abstract/2813379

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PODCAST: Impact of Education on Employee Health Care

HEALTH INSURANCE DEMOGRAPHICS

By Eric Bricker MD

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PODCAST: Hospital Cost to Charge Ratios Explained

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

Medical Cost Accounting: https://medicalexecutivepost.com/2022/08/30/understanding-medical-cost-accounting/

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PODCAST: Why Hospitals Cry “Poor”

By Eric Bricker MD

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HELPING DOCTORS ACHIEVE: New Year Resolutions

COACHING AND MENTORING

Physician Goal Setting [Business V. Personal Approach] in 2024

By Marcinko Associates, Inc.

SPONSOR: http://www.MarcinkoAssociates.com
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CORPORATE APPROACH

The year-end physician, nurse and/or medical employee reviews in general aren’t very effective at motivating employees in ACOs, and VBC organizations, etc.

And, according to a Gallup [non-medical worker] poll, only 14% of employees “strongly agreed” that a performance review inspired them to improve. But in recent years, some workplaces have changed how they conduct performance reviews—or abandoned them altogether especially in technology.

  • A decade ago, Microsoft disbanded its version of stack ranking, the practice pioneered by General Electric CEO Jack Welch in the 1980s in which the company would rank every employee. Experts say it hurts morale and can create a toxic work culture.
  • Netflix has around 10,000 employees but has eschewed the year-end review for informal conversations during the year.
  • Google revamped its system last May by reducing performance reviews from twice to once a year.
  • Apple dropped performance reviews completely.

Healthcare business and corporate employees want feedback, even physicians, but it has to be useful.

PERSONAL APPROACH

Now that you’ve set your personal goals on your landmark date (New Year 2024), how you pursue it will go a long way toward whether you achieve it. There are generally two ways to tackle the goals you’ve set for yourself—and one yields more success than the other.

  • Avoidance goals: While this works well when it comes to your ex-medical partner or spouse, it’s not how you want to attack resolutions. Avoidance goals include “stop eating sweets” or “watch less TV.”
  • Approach goals: Instead of avoiding a behavior, you create a new one. Your goals would be “eating more vegetables” or “reading more books” to replace the habits you want to shake.

And, a recent study found that approach goals are more likely to be accomplished (59%) than avoidance goals (47%) across a wide range of potential resolutions. Good luck with that!

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HAPPY NEW YEAR: From All of Us at the ME-P

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 From us all to you and yours.
Here’s to making a difference and paying it forward today, in 2024, and beyond. 

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PODCAST: State Health Insurance Commissioners

By Eric Bricker MD

MORE ON OUT-OF-NETWORK SURPRISE MEDICAL BILLS

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DAILY UPDATE: Happy “Festivus” with Drug Delays as the Stock Market Win Streak Continues

By Staff Reporters

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Festivus is a secular holiday on December 23rd as an alternative to the pressures and commercialism of the Christmas Season. Originally created by author Daniel O’Keefe, Festivus entered popular culture after it was made the focus of the 1997 Seinfeld episode which O’Keefe’s son, Dan,co-wrote.

The non-commercial holiday’s celebration includes a Festivus dinner, an unadorned aluminum Festivus pole, practices such as the “airing of grievances” and “feats of strength”, and the labeling of easily explainable events as “Festivus miracles”. The TV episode refers to it as “a Festivus for the rest of us”.

It has been described both as a parody holiday festival and as a form of playful consumer resistance. Journalist Allen Salkin describes it as “the perfect secular theme for an all-inclusive December gathering”.

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(Bloomberg) — Drug-makers are slow-walking products to market to get around President Joe Biden’s plan to lower medication prices.

Companies from Roche Holding AG to biotech Alnylam Pharmaceuticals Inc. are among those delaying or evaluating therapies in light of the government’s new ability to negotiate for lower prices. Firms that normally try to sell drugs as soon as possible are suspending clinical trials and shifting timelines, while patient groups are demanding change. 

Here is where the major benchmarks ended:

Here’s where the major benchmarks ended:

  • The S&P 500 index was up 7.88 points (0.2%) at 4,754.63, up 0.8% for the week; the Dow Jones Industrial Average was down 18.38 points at 37,385.97, up 0.2% for the week; the NASDAQ Composite® (COMP) was up 29.11 points (0.2%) at 14,992.97, up 1.2% for the week.
  • The 10-year Treasury note yield (TNX) was up about 1 basis point at 3.901%.
  • The CBOEe® Volatility Index (VIX) was down 0.62 at 13.03.

Small-cap stocks continued a strong finish to the year. The Russell 2000® Index (RUT) rose 0.8% Friday to end at its highest level since April 2022 and rose 2.5% for the week, the small-cap benchmark’s sixth consecutive weekly gain. Regional banks and utilities were also among the strongest performers. In other markets, the U.S. Dollar Index (DXY) extended its recent slide and dropped to its weakest level since late July, reflecting ideas an outlook for lower interest rates may prompt investors to seek higher returns elsewhere.

Finally, with just four trading days left in 2023, the S&P 500 and other major equity benchmarks are poised to turn in a strong year that may more than make up for 2022’s losses. Through Friday, the S&P 500 was up nearly 24% for the year, after tumbling 19.4% in 2022. The Dow Jones Industrial Average and the NASDAQ Composite were up 13% and 43%, respectively, after losing 8.8% and 33% in 2022.

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HAPPY HOLIDAYS: A New Covid Virus Variant!

By Staff Reporters

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READ HERE: N.1 is the Covid variant that’s spiking just in time to disrupt the holidays.

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EtG – The Rosie Ruiz of Bent Science and Bad Medicine

BAD Medicine … and that is NOT “Good”

Langan MD[By Michael Lawrence Langan MD]

The original pitch to the medical boards for Etg  was done by ex-felon Greg Skipper who is one of the Federation of State Physician Health Program (FSPHP) “impaired physician” architect…

EtG: https://www.verywellmind.com/widely-used-etg-test-for-alcohol-unreliable-80212

Conclusion

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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PODCAST: FFS MedicalPayment As a Public Health Threat?

FEE FOR SERVICE

By Eric Bricker MD

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PODCAST: US Primary Medical Care V. Other Industrialized Nations

By Eric Bricker MD

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SECTION 179 DEDUCTIONS: Physicians Avoiding IRS Tax Mistakes

By Staff Reporters

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DEFINITION: Section 179 of the U.S. IRS code is an immediate expense deduction that business owners can take for purchases of depreciating business equipment instead of capitalizing and depreciating the asset over a period of time. The Section 179 deduction can be taken if the piece of equipment is purchased or financed and the full amount of the purchase price is eligible for the deduction.

CITE: https://www.r2library.com/Resource/Title/082610254

Not understanding parameters – Eligible property and annual limits

Medical practices may make mistakes by not fully understanding which types of property qualify for a Section 179 deduction. Section 179 is applicable only to assets used for business purposes. Failing to allocate assets properly can lead to improper deductions.

Eligible property for Section 179 may include:

  • Equipment, X-Ray, computers, fax machines, telephones, and other business property
  • Furniture and fixtures
  • Off-the-shelf-software that is used for business operations
  • Improvements to real-estate such as roofs, heating, ventilation, and air-conditioning.

Section 179 limits are updated annually, so it is important for doctors and practice owners to be aware of these limits and to plan accordingly.

Source: Natalie Westfall, Physicians Practice [12/4/23]

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“23andMe” Hacked & “Neuralink” Device Defective?

By Staff Reporters

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In a significant breach of privacy, hackers gained access to the DNA relatives data of 6.9 million users on 23andMe, posing serious questions about the security measures in place for our most personal data.

Meanwhile, Neuralink, the brain-computer interface company, faced disturbing reports about its clinical trials. Allegedly, up to a dozen monkeys suffered severe adverse effects, including brain swelling and partial paralysis, after being implanted with the Neuralink device.

Neuralink Corp. is an American company that is developing brain computer interfaces (BCIs) as of 2022. Founded by Elon Musk and a team of seven scientists and engineers, Neuralink was launched in 2016 and was first publicly reported in March 2017.

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DEAR COLLEAGUES: Are You a Financial Advisor’s “Customer” or “Client”?

By Dr. David Edward Marcinko MBA CMP

SPONSOR: http://www.MarcinkoAssociates.com

First – a little “insider expert” background on the confusion. It exists largely because of the influence that large financial institutions (who earn revenue through the sale of financial products) have on legislators.

The Investment Advisors Act of 1940 requires that anyone giving investment advice must be acting in a fiduciary capacity. The intent was to separate the financial salespeople, who had significant conflicts of interest, from the investment advisors, who had few to none. If you know very little about financial products, would you rather be educated as the customer of a commissioned salesperson or the client of a fee-for-service advisor? Hands down, you’d want the fee-for-service advisor.

Of course, the financial institutions selling products understood this. They were able to influence the drafting of the 1940 Investment Advisors Act, to exclude “any broker or dealer whose performance of such [advisory] services is solely incidental to the conduct of his business as a broker or dealer.” So if salespeople just happen to give some financial advice that is “incidental” to the sale of a product, they and their companies are not held to the fiduciary standard. Our U.S. Congress allows financial companies to advertise as if they are fiduciaries while their sales forces are not held to a fiduciary standard.

Now, according to Rick Kahler CFP®, the same conflict arises in some professional designations, like the Certified Financial Planner® designation conferred by the CFP® Board. The designation initially certified the completion of training in financial planning. In 2008 the Board added a fiduciary requirement to the designation.

However, CFP®’s are only held to a fiduciary requirement when they are doing what the CFP® Board defines as financial planning. If a CFP® professional is giving advice to a client, the fiduciary standard applies. Yet the same professional can sell the same client an annuity with high fees and high commissions, even if the product may not be in the client’s best interest, as long as no “financial planning” is part of the transaction. The result is significant confusion for consumers.

The bottom line is this: when you look for financial advice or financial products, don’t assume the advisor is looking out for you. It’s your responsibility to find out whether any financial professional owes you a fiduciary duty.

So, I suggest you ask directly, “Am I a customer or a client?” The answer is almost always “a client,” as most financial services salespeople honestly don’t know the difference. After you explain that difference, ask them to verify their fiduciary duty in writing. That five-minute solution may have a lasting impact on your financial well-being.

Better yet, consider speaking to your fiduciary focused and fee-only Certified Medical Planner® professional colleagues at D.E. Marcinko & Associates.

“By Doctors – For Doctors”

CMP: http://www.CertifiedMedicalPlanner.org***

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PODCAST: Health Insurance is Sold; NOT Bought

BUILD A HEALTHCARE SALES MACHINE

By Eric Bricker MD

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