ReThinking Medical Professional Autonomy in the Era of Obama Care

Eying Contemporary Medical Ethics in Healthcare Reform

By Render S. Davis; MSA, CHE

And, Staff Reportersbiz-book

Not so long ago, a physician’s clinical judgment was virtually unquestioned. Now with the advent of clinical pathways and case management protocols, many aspects of treatment are outlined in algorithm-based plans that allied health professionals may follow with only minimal direct input from a physician. Much about this change has been good. Physicians have been freed from much tedious routine and are better able to watch more closely for unexpected responses to treatments or unusual outcomes and then utilize their knowledge to chart an appropriate response.  

Restrictive Protocols

What is of special concern, though, is the restrictive nature of protocols in some managed care plans that may unduly limit a physician’s clinical prerogatives to address a patient’s specific needs. Such managed care plans may prove to be the ultimate bad examples of “cook book” medicine. While some may find health care and the practice of medicine an increasingly stressful and unrewarding field, others are continuing to search for ways to assure that caring, compassionate, and ethically rewarding medicine remain at the heart of our health care system.

Assessment

Link: For another opinion: http://healthcareorganizationalethics.blogspot.com/2009/09/obamas-speech-good-ethics-and-good.html

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How does the specter of HR 3200-3400 in the healthcare reform debate impact the concept of medical autonomy and professional ethics? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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

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On Increasing Price Transparency in Medicine

About NewChoiceHealth.com

By Staff ReportersCalculator-Scope

NewChoiceHealth, Inc. is an online comparison shopping marketplace built to provide healthcare consumers a way to save money. With NewChoiceHealth.com, consumers can easily locate medical facilities and compare medical procedure costs for services like MRIs, CT scans, mammograms, and more. Patients may shop nationwide, or right in their own local market from over 20,000 medical facilities for over 400 of the most commonly performed medical procedures.

Employer Portal

The site also features an employer portal to combat the rapidly escalating costs of healthcare. A Medical Cost Action Plan (mCAP) is reported to deliver an independent, unbiased, measurable plan which segments employer’s medical cost consumption categories into measurable Consumer Healthcare Efficiency Indices (CHEI) to deliver an actionable plan that reduces healthcare costs.

The Founder

CEO and Founder Brad Myers is a medical cost expert with 24 years of broad experience and extensive knowledge in medical cost informatics, healthcare insurance, managed care, clinical laboratory, and health and life insurance. His website message to ME-P readers, and others, is “shop & save!”

Assessment

Employee passion drives price transparency to healthcare consumers through the web site www.NewChoiceHealth.com Give it a click, for more information, and tell us what you think!

Conclusion

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Product DetailsProduct Details

Ask an Advisor – Must an Insurance Claim CramDown be Accepted?

Calling on Insurance Professionals to Expose the “Wizard” Behind the Curtain

By ME-P Staff ReportersOp-Ed

We received the following request recently. Apparently, this ME-P reader-nurse sustained a covered loss with valid home insurance property-casuality claim. It resulted in disagreement with her insurance adjuster [a common occurrence]. The adjuster cited his/her supervisor’s insistence on claim settlement and closure.  The nurse’s general contractor thinks the monetary amount is significant [$50,000 range after three independent estimates]. The insurance company wants to settle for about half that amount. 

What say you about this scenario?   

INSURED

Dear Big Insurance Company Adjuster

”Many thanks for reaching out to us by phone yesterday. Please be aware that we did not agree to partial payment or supplements and are sorry for any confusion. 

We would however, be pleased to assist by informing your management of our declination of same. Thus, there is no need to issue any payments at this time.

It seems to make far more sense to get all the numbers together with our general contractor and then arrive at a consensus before moving forward. As you know, this was our original plan. We appreciate your deeper understanding of these very complex issues.”

Your Small Client 

INSURANCE ADJUSTER

Dear Client

“This email will serve as a follow up to our telephone call yesterday. I am sorry we were disconnected but I attempted to call you several times and I was unable to leave a message. I am attaching a copy of the updated Big Insurance Company estimate which reflects those changes made due to additional information gathered during my second inspection of your property on September 8th.  Also you will find an updated Replacement Cost Letter.

As discussed, due to the fact we know we owe you the value of the attached estimate, I am processing the actual cash value payment in the amount of $ XYZ. Any additional payments will be handled as supplements. Please feel free to contact me with any questions.

Your Big Insurance Company Adjuster

MANAGEMENT

Dear Client

Also, my management told me I need to proceed with issuing payment based on the amount I know I owe you [insured] as of now, and that I should handle any further negotiations as supplements. I have already discussed this with your husband.

Your Big Insurance Company Adjuster

Assessment

After some internet research, our RN reader discovered that abut 85% of all folks accept inadequate PC insurance payments after being strong-armed by their insurance company in various ways. She is determined to be made whole and indemnified. She also understands that future negotiations and “supplements” after acceptance are typically not favorable to her, and she wishes to maintain her leverage by not accepting them. Can she refuse to cash the check, if sent to her, until satisfied? She is not feeling in good hands, at the moment!

Industry Indignation Index: 85%

Audio Razz: Click to play :

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Must our reader “accept assignment” in the form of this under payment cram-down? How can she expose the Wizard of Oz manager behind the curtain? Will she be the “squeaky wheel” of informed insureds who “get the economic grease” they deserve. Should our Industry Indignation Index percentage be higher, or lower? Is the audio razz deserved, or not. What can she do? Insurance agent and attorney input is appreciated.

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

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Physician Advisors: www.CertifiedMedicalPlanner.com

den window

Introducing Dr. Leila M. Hover

Our Newest ME-P Thought-Leader

By Ann Miller; RN, MHA

[Executive-Director]

Dr. Lee Hover

Leila M. Hover, D. Med. Hum, has a varied background having worked in OB/GYN and as a Clinic Supervisor in a Planned Parenthood Center. She served as Director of a hospital medical library, and then as Director of Scientific Information in several medical communications/advertising organizations.

Interest in Concierge Medicine

Her doctoral dissertation topic was concierge medicine, in which she has a continuing interest.

Assessment

Dr. Hover is a member of the Institutional Review Board of the Atlantic Health System in New Jersey and the Bioethics Committee of Overlook Hospital in Summit, New Jersey. She is also a principal at Information Developers, a medical literature research and document retrieval organization.

ME-P Shout-Out

And so, please give a warn ME-P “shout-out” to Dr. Lee Hover, our newest thought-leader. 

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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About Docs4PatientCare

Politically Involved Physicians

By Staff ReportersUS Senate

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

Mission

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

Board Members

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

Board of Directors

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

Assessment

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

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

Link: http://docs4patientcare.org

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Are these sorts of organizations a form of self-aggrandizement; or not? Can you cite any others? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Take the DME Inventory Switching Challenge!

Join Our Mailing List

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

 [By Staff Reporters]ME-P Logo.2

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

Reducing Taxes

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

CEO – 2 – CFO [Case Model]

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

Key Issues

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

2) What is its justification?

3) How is it notated in financial reports?

4) Is this sort of thing ethical?

Assessment

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

Conclusion

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

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

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

Interview with David B. Lumsden; MD

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

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

About David B. Lumsden MD

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

Our Brief Interview

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

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

Assessment

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

About Off Road with Dr. MarcinkoDavid Lumsden; MD

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

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

Conclusion

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

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

 Please Vote

 

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Let’s Think about Vitality GlowCaps for a Moment

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

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

DEM Thinking

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

What it Is

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

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

Name Droppers

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

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

Overkill

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

A Reasonable Query?

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

Assessment

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

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think. Any early adopters out there, and ready to opine? Or, give em’ a click and tell us what you think! http://rxvitality.com Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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About HealthDataRights.org

Mitigating the Unintended Consequences of HIPAA

By Staff ReportersWaiting for Medical Records

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

Enter a Website and Start a Movement

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

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

Assessment

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

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Visit the site, join the movement by signing their petition, and tell us what you think. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Henry Louis Gehrig, eMRs and Healthcare Reform

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

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]Jacobetti VA

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

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

Panicked Veterans

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

About Henry Louis “Lou” Gehrig

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

Link: http://www.lougehrig.com

Assessment

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

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

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

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

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is it even fair to relate this “isolated incident” to the current healthcare reform debate, the eMR conundrum and/or similar discussions on health Information Technology [IT]? Tell us what you think. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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“Live Long and Prosper”

By Dr. David Edward Marcinko; MBA, CMP™

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

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

The words of Mr. Spock!

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

Just the Facts  

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

Enter the Baby Boomers

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

Aging Boomers

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

Money Preservation Variables

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

Assessment

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

Conclusion

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Kelly Mclendon RHIA censors D. Kellus Pruitt DDS

By Darrell K. Pruitt; DDS

Dateline: 8.15.09

pruitt

Dear Kelly Mclendon, Registered Health Information Administrator

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

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

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

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

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

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

D. Kellus Pruitt; DDS 

Dateline 8.9.09 

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

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

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

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

D. Kellus Pruitt; DDS

Dateline: 8.10.09 

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

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

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

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

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

Conclusion

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

About Atlas Sports Genetics

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Dateline: July 6, 2009people_top

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

About ASG

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

The Kit

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

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

AssessmentESPN

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

 

About Off Road with Dr. Marcinko

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

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

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

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

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think about the performance predictive power of ACTN3? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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ADA President and Broken Promises

The Future President

By Darrell K. Puritt; DDS

pruitt8

The election for a future ADA president occurs the first week in October in Hawaii at the 2009 annual meeting. A couple of days ago, the ADA News Online posted the ADA President-elect candidates’ statements.

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3133

All three sound like they support meaningful dialogue with membership: Candidate Dr. Raymond Gist says one of his goals is: “To protect and preserve ownership of the intellectual property of the ADA while demonstrating transparency and fostering an understanding of how our system works.” Candidate Dr. William Glecos says “My first goal will be to coordinate and improve our communication efforts within the ADA. To make sure we are engaging all our members and imparting a sense of connection and transparency.” Candidate Dr. Marie Schweinebraten says “… communication, internal and external, must be improved to respond in today’s world … barriers must be eliminated to allow member input and volunteer involvement when solving specific issues.” I’ve seen candidates use these same buzzwords before, but not mean them. Dentistry is being severely threatened right now, and I’m too young to retire. So I want to see a future leader confident enough to walk through fire with me on behalf of my patients.

Promises from ADA President-elect candidates have been very disappointing so far. Past President Dr. Mark Feldman, President Dr. John Findley and President-elect Dr. Ron Tankersley each promised “transparency.” Feldman and Findley broke their promises very early, and so far, Tankersley has done no better. Nine months ago I invited Dr. Tankersley to a conversation about the future of electronic dental records and he chose to insult me with silence rather than respond. I took it personally, Ron, and I’ll never forget it. Because all three of these presidents are simply rude people, it wouldn’t bother me to never ask any of them for friendship. 

So do you think our fresh leaders are any more sincere about transparency with membership? Or are they also hoping to be safely elected. This could be an opportunity for one or more of the three to break loose and be counted as a brave leader… or not. Let me show you what Feldman, Findley and Tankersley have gotten us into. Below is a list of duties expected of dentists with NPI numbers that came out today on ANCO Online. If any of you three candidates have the courage to respond to my challenging comments about what I consider to be a perfect example of a renegade department, jump right in. Concerned members need to be warned about the courage we can count on. If you cannot defend the Department of Dental Informatics, just say so. We’ll all be better off. And on truth, we can build. What an opportunity for you! I bet one could easily gain the delegates’ attention by doing the right thing, even if it is unpopular at first to those who may have helped you to power.

Responding to this article in a respectful, professional way could be just what it takes to get a person elected to the highest position in the American Dental Association. That’s what you intensely want, isn’t it? You just have to recognize what I am spelling out for you, Raymond, William and Marie. Just look at the growing discontent with the ADA on the Internet. Whoever is the first to show sincerity and courage, will become a hero to those of us who feel betrayed by those we once trusted. Victory will never be easier. I’ve had a look around. Believe me when I tell you that things are soo bad that even I could be a contender. Don’t make me run for the job.

Here is the first issue for discussion if you are interested: For dentists who were persuaded by the ADA Department of Dental Informatics to quickly volunteer for the 10 digit identifying number, let me ask you this: If you had been told what ADA employees are paid to tell you, which you can read below, would you have applied for an NPI number? And if you were forced to apply for a number by a managed care contract with BCBSTX, Delta Dental or other discount dentistry broker, would that be considered an unfair business practice?

Let’s look at fairness: Who does the NPI number help? Dental patients or BCBSTX? Or perhaps the ADA? We were told again and again in ADA News Online articles written by Arlene Furlong that the best reason for the NPI number was convenience. She said office managers would love it because it would replace numerous identification numbers. When one reads the list of NPI obligations a dentist volunteers their office manager for, all those other numbers don’t seem so bad after all. Why was HIPAA so important that the ADA Department of Dental Informatics forced employees under its supervision to intentionally mislead membership? Does the ADA work for dentists and their patients or for CMS? There you go, Dr. Raymond Gist, Dr. William Glecos and Dr. Marie Schweinebraten. It’s your turn now. If you have the guts to step up to a challenge, it could pay off big. Besides, even if you get elected without first responding to my concerns doesn’t mean you’ll get rid of me. Oh heaven’s no.

D. Kellus Pruitt; DDS

http://anco- .blogspot.com/2009/08/asco-coa-cms-palmettoj1mac-news.html

**** CMS NEWS ****

This message is for health care providers, particularly physicians and other practitioners, who have obtained National Provider Identifiers (NPIs) and have records in the National Plan and Provider Enumeration System (NPPES). The Centers for Medicare & Medicaid Services (CMS) recommends that each health care provider, including individual physicians and non-physician practitioners: · Secure and maintain their own NPPES account information (i.e., User ID, Password, and Secret Question/Answer) for safety and accessibility purposes. Health care providers should maintain the confidentiality of their User ID, password, and Secret Question/Answer in order to protect their NPPES information from unauthorized access. Reset their NPPES passwords at least once a year.

See the NPPES Application Help page at https://nppes.cms.hhs.gov/NPPES/Help.do and select the ‘Reset Password Page’ for applicable rules. Those rules indicate the length, format, content and requirements of NPPES passwords. Review their NPPES records in order to ensure that the information reflects current and correct information. Covered health care providers are required to update their NPPES information within 30 days of the effective date of the change.

Viewing NPPES Information Health care providers, including physicians and non-physician practitioners, can view their NPPES information in one of two ways: (1) By accessing the NPPES record at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created. If the health care provider has forgotten the password, enter the User ID and click the “Reset Forgotten Password” button to navigate to the Reset Password Page. If the health care provider enters an incorrect User ID and Password combination three times, the User ID will be disabled. Please contact the NPI Enumerator at 1-800-465-3203 if the account is disabled or if the health care provider has forgotten the User ID. OR (2) By accessing the NPI Registry at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do.

The NPI Registry gives the health care provider an online view of Freedom of Information Act (FOIA)-disclosable NPPES data. The health care provider can search for its information using the name or NPI as the criterion. Information regarding NPPES data that are FOIA-disclosable can be found at http://www.cms.hhs.gov/NationalProvIdentStand/ by selecting ‘Data Dissemination’. Please note: Business Mailing Address and Business Practice location information (full address and corresponding telephone numbers) are key data elements that are FOIA-disclosable.

Health care providers should not report their residential address unless it is their Business Mailing Address or Business Practice location. The NPPES data appearing on the NPI Registry cannot be deleted; however, it can be updated or changed. Updating NPPES Information Health care providers, including physicians and non-physician practitioners, can correct, add, or delete information in their NPPES records by accessing their NPPES records at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created.

Please note: Required information cannot be deleted from an NPPES record; however, required information can be changed/updated to ensure that NPPES captures the correct information. Certain information is inaccessible via the web, thus requiring the change/update to be made via paper application. The paper NPI Application/Update Form (CMS-10114) can be downloaded and printed at http://www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf.

Deactivating the NPI Health care providers, including physicians and non-physician practitioners, can deactivate their NPIs if the NPIs are no longer required or needed. Reasons for deactivation include retirement, business dissolved, or death of the health care provider. A request for deactivation must be submitted via paper application. The paper NPI Application/Update Form (CMS-10114) can be downloaded and printed at http://www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf.

Health care providers should review the instructions located on the application regarding deactivations in order to properly complete the deactivation request. The Power of Attorney or Executor of the Will may complete the application for deactivation due to death of the health care provider.

Need More Information?

Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Visit CMS’ dedicated NPI web page at www.cms.hhs.gov/NationalProvIdentStand for additional NPI information.

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On the Gates Incident

A Teaching Moment – I Think Not!

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher in Chief]Obama-Hope

ME-P readers are no doubt aware of the Professor Gates incident in Cambridge Massachusetts? So, please indulge me in presenting one doctors’ opinion on the matter; short and sweet. 

The Participants

Professor Henry L. Gates Jr., is an elderly Harvard educated expert on African American studies.

Sergeant James Crowley attempted to resuscitate Boston Celtics star Reggie Lewis in 1993, and is a police department race relations intermediary.

President Obama is a Harvard Law School Professor who knowingly opined without the facts.

Who’s Right?

Now – if these august participants “got it wrong” – how can “they” expect ordinary citizens to “get it right”?

A Teachable Moment?

The only teachable moment here – is that there was no teachable moment. Or, perhaps the real teachable moment demonstrates that we citizens are getting it “right” – faster than the experts.

ME-P Synergy

So, what’s the synergy with the ME-P? Just this; perhaps a psychiatrist or psychologist should attend the next “beer summit.” Or, that Reggie Lewis was from East Baltimore like me; his fan. And, that he attended Dunbar our local public high school. My teachable moment was thus decades ago – taught not by “governmental experts” – but by my parents. Thanks mom and dad!

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think about the Gates incident. Is this even a fertile topic of discussion for the ME-P?

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Journal of the American Dental Association [Letter to the Editor]

ADA Image Tarnished?

[By Darrell K. Pruitt; DDSpruitt]

Dear Editor,  

This is a sincere letter which I am sure you will agree should be published in the October 2009 edition of the JADA. Today is July 19, 2009. I am allowing for the six weeks minimum time it requires for letters to appear in print following their selection for publication. It will be posted on the Internet immediately. In spite of this, I trust you will eventually agree to publish it in spite of your archaic rules. Otherwise, by November, history could show that the editor of the JADA arguably denied representation of dental patients’ interests at a most critical time in the history of the profession. That would be regrettable for your own professional reputation as well as for the JADA’s. As an ADA member, if my concerns are ignored, I will hold you publicly accountable for an explanation for a long time.

Public Laundry

From now on, we will agree to wash our laundry in public because otherwise it doesn’t always come clean. You can call the pressure I bring unprofessional if you want, but following the ADA News’ public exhibition of their shoddy ethics this week, it would be foolish to use my methods as an excuse to deny my access to membership. As I am certain you are aware, there were three revisions of “ADA/idm to phase out service” on ADA News Online (7/10, 7/13 and 7/16). I not only welcome a wide-open public discussion about ethics in journalism with representatives of the JADA, but I encourage it. We both know that the ADA needs clean laundry now more than ever before in its history.

ADA Business Enterprises, Inc.

For members who haven’t heard, the 2 ½ year old joint venture of our ADA Business Enterprises, Inc. (ADABEI) with Intelligent Dental Marketing – a Utah-based private business – fell apart in late spring of this year. Months later, our ADA leaders are still less than transparent with membership about what went wrong. I’ve been in business long enough to know that if mistakes by employees are not revealed and discussed, they are bound to happen again and again. And, it’s not like the leaders of the ADA were not warned. They just didn’t take heed. By late 2007, many knowledgeable people involved in the dental industry easily recognized the faults in the partnership between our non-profit professional organization and a for-profit Utah advertising company. In hindsight, anyone can see that ADA/IDM’s slogan, “Image is everything,” clearly betrays an attitude inconsistent with both the mission of the ADA and the Hippocratic Oath. Nevertheless, even the spirit of the slogan was regretfully adopted by the leaders of the ADA’s Business Enterprises, Inc. Now it is the image of the entire ADA that is suffering the damage.

ADABEI

I personally began questioning the accountability of the tricky ADA/IDM business model over two years ago when the profits from ADABEI had officials excited about avoiding the need to raise membership dues last year. Not unexpectedly, in the atmosphere of euphoria, nobody in Chicago wanted to acknowledge the concerns of a handful of alert members. We were cast aside as troublemakers. So how critical is the risk? With massive, unprecedented health care legislation imminent, this is the worst time imaginable for our stoic, image-conscious officers to lead us to nation-wide embarrassment.

Following the Money

The surrender to such temptations for leaders of non-profit organizations is not unprecedented. Do you know why the dues for the American Association of Retired People (AARP) have been kept so low? Not unlike the ADA, the non-profit AARP reaps profits from insurance policies and other products that its leaders sell to membership – even using misleading ads in AARP dues-supported publications. However, unlike dues money, vendor “kickbacks” don’t depend on accountability to members. A few years ago, the profits derived from agreements with vendors predictably became the lifeblood for AARP’s self-perpetuating bureaucracy – eventually influencing their lobbying efforts. Since non-profits like the AARP and the ADA are traditionally respected by lawmakers who like huge campaign donations, a non-profit entity’s lobbyists can be tempted to quietly represent vendors’ interests at members’ expense. Sometimes they get caught.

Lost Confidence

Almost a year ago, the AARP lost valuable member confidence when the organization was forced to suspend sales of “limited benefit” health plans backed by UnitedHealth Group (of Ingenix fame). Sen. Chuck Grassley said the plans which leave policyholders vulnerable to tens of thousands of dollars in costs were sold by the AARP to naïve and trusting members using misleading marketing tricks – not unlike those used in the ADA’s promotion of ADA/IDM. Sen. Grassley sent a detailed letter to CEO Bill Novelli demanding answers to questions about health insurance plans promoted to over a million dues-paying AARP members. Grassley told USA Today reporter Julie Appleby that “Insurance is supposed to limit your exposure to the potentially high cost of a serious illness and these plans do the opposite.” (Nov 7 2008).

http://www.usatoday.com/news/health/2008-11-07-aarp-insurance_N.htm

Is AARP-level accountability as good as it gets?

I say no. Attention ADA members – It is my opinion that our leaders are losing the control of our professional organization. The recent failure of ADA/IDM isn’t the first glaring sign of trouble in Headquarters. Over a year ago, the executive director, Dr. James Bramson, was suddenly fired with no explanation. In fact, then President Dr. Mark Feldman commanded that the reasons for the firing will not be disclosed. Obediently, ADA leaders have so far maintained firm control of the top secret information which if released could somehow endanger dental patients (?). Because Bramson’s severance pay came from my dues and not out of Dr. Feldman’s pocket, I think I deserve to know more details. Otherwise, this mistake could happen again and again.

The ADA/IDM disaster is also not the only ADABEI embarrassment I see on the horizon. It is my opinion that CareCredit is also showing signs of silent desperation. On July 9, the officials of the wholly-owned ADA subsidiary purchased an ad on dentalblogs.com titled “Press Release: CareCredit Adds 24-Month, No-Interest [sic] Payment Plan” (no byline).

http://www.dentalblogs.com/archives/administrator/press-release-carecredit-adds-24-month-no-interst-payment-plan/

Even though I approve of the benevolence in the idea of extending credit to those with worsening dental problems – especially during these hard financial times for patients – the anonymous CareCredit (ADA) representative who posted the ad failed to respond to my timely and important question: “If the Red Flags Rule is not delayed for the third time in three weeks, how will it affect those who offer Care Credit?”

Assessment

Nor did he or she respond to my follow up response on July 13. “On July 9 at 4:54 pm, I submitted a sincere question concerning how the Red Flags Rules will affect ADA members who sign up for CareCredit. Instead of posting it with the promise of an answer, you regretfully chose to censor an ADA member. Today, July 13, I have a second and third question: Why did you ignore my first one and who is your boss?”

Conclusion

So far, I’m still waiting for responses to all three questions. I trust you will treat my concerns with more respect, Editor.

Conclusion

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Physicians and Money

A Commencement Address on “Positive Deviancy”

Staff Reporters

money1One June 12th, 2009, New Yorker staff writer Atul Gawande MD delivered this commencement address, titled “Money,” to the graduates of the University of Chicago; Pritzker School of Medicine. It expands on the themes he touched on in his recent article about health-care costs in McAllen, Texas, which figures in President Obama’s vision on health care reform. 

 

 

Link: http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html

Related posts at KevinMD.com

  1. “A board-certified, internal-medicine physician makes $7 more an hour than a hairstylist”
  2. Will universal health care lead to a physician shortage?
  3. Does preventive medicine really save money?

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Janis Oshensky Lobbies Congress – Not Dentists

Show Me the Math

By Darrell K. Pruitt; DDSpruitt 

I have noted here far too many times how it disappoints me that Delta Dental Plans Association vice president Janis Oshensky repeatedly chooses to turn to politicians rather than discuss Delta Dental’s arguably egregious and harmful policies with me, a dentist. I intend to put a stop to such disrespect one PR expert at a time if necessary.

Long ago I warned Oshensky that if she didn’t talk to me, she should probably just shut up in order to preserve what’s left of her Internet reputation. Since by posting her Letter to the Editor on POLITICO.com today, she obviously ignored my advice, this highly critical comment will reliably join three others of mine on her first page soon enough. Her employer is sacrificing her like a pawn.

The following comment is the one I posted on POLITICO.com in response to Oshensky’s letter. It might just help the vice president to finally come to a decision on this issue one way or the other. Either way, marketplace conversation like this cannot help but lead to safer air for the community … My pleasure.

http://www.politico.com/news/stories/0709/24873.html

Dear POLITICO.com Editor:

This comment and subsequent invitation to Janis Oshensky is in response to the Delta Dental Plans Association vice president’s July 14, 2009 letter to you. Her letter is the most recent message she successfully sent Congress using a political news Website. Even though Ms. Oshensky holds the position of VP of dental relations as well as public policy, she has avoided answering this dentist’s questions about Delta Dental’s policies for months. If Ms. Oshensky is willing to do so, I would love for her to join me in discussion of Delta Dental’s taxation subsidy right here on POLITICO.com so that our lawmakers can witness a more balanced view of the issues.

Hello – It’s Me

Hello. My name is D. Kellus; Pruitt DDS, and I’m a practicing dentist in Fort Worth, Texas. It is my professional opinion that my patients are harmed by the policies of managed care dental plans like that sold by DDPA because there is no accountability to their clients or dentists. There is barely any accountability to those who select and pay for Delta’s products – dental patients’ naive bosses.

Like virtually every US citizen, your readers probably couldn’t care less about the dental industry. It is precisely because dentistry has been uninteresting for decades that make the microcosm of health care incredibly interesting to me. Let me uncover for your appreciation the event horizon in dental history. You could learn about more than just dentistry.

If left to natural forces of human nature, what happens to value when there is no accountability? For example, what do the 1975 East German Trabant and the 1979 Ford Pinto have in common? By popular vote, those products not only represent the two worst automobiles ever made, but the state shielded both manufacturers from accountability to consumers. Poor quality happens.

Oshensky argues against the taxation of managed care dental benefits like those sold to employers by Delta Dental. Let me offer that if Delta’s product were taxed like income, its value would quickly dive below the market threshold that attracts purchasers’ consideration.

Allow Me to Show-You the Math

Recently, Delta Dental of Michigan lost the accounts of thousands of GM retirees when their group dental benefits were cut in bankruptcy negotiations with UAW. Suddenly, Delta found itself forced to market their product to individuals who for once have the choice to keep their money. Faced with true competition for healthcare dollars, Delta leaders desperately cobbled together individual policies for the retirees who want to continue with their coverage. Even though Delta did everything possible to lower the cost of their coverage, the cheapest of the plans they offered still runs about $30 per person per month, and covers only 50% of everything, including preventive. So for premiums of $360 per year plus half the preferred providers’ 20% to 30% discounted fees, is this a bargain for Michigan retirees?

Free Markets 

In my free-market, fee-for-service practice, if a patient comes in for two cleanings and routine x-rays during a year, 100% of my bill is $208. This is the market price in my neighborhood that is continually challenged by lively competition with other dentists for new patients who may not even have dental benefits. Those customers pay in full at the time of visit, just like most people whose bosses purchased Delta Dental Plans.

Value Comparisons

So let’s compare value of Delta Dental’s product with cash. If I were a Delta Dental preferred provider, my fee of $208, less Delta’s 25% discount would be $156. Never mind that my wife has problems with my 70% cut in pay, let’s move on. 

The patient’s half of the $156 I earned is $78. $360 + $78 = $438. So for one uneventful year of discounted dental services with a dentist chosen from a list of names, a patient can expect to spend more than twice as much than if they paid the free-market price at the point of service.

Assessment

Not only is that hardly a bargain, but it is my opinion that managed care dentistry is dentistry by the lowest bidder with no quality control. That should be enough meat to get this conversation rolling. Now it’s your turn Ms. Oshensky. I think you have to admit that you’ve got holes to mend in the dental relations part of your job.

Conclusion

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ADA / IDM Breakup – You Heard it Here First

Will CareCredit be the Next ADA Subsidiary to Fail?

I saw a warning sign last week.

By Darrell K. Pruitt; DDS pruitt

My aggressive writing hobby has understandably brought me in hard contact with public relations people whose job is to insulate good ol’ boys from accountability – even if it means taking hits for the team and staining their reputations. Let’s face the fact we all of us involved in public relations know but don’t dare discuss: Depending on the ethics of one’s employer, PR professionals are sometimes used up like expendable pawns. And avoiding bylines for press releases no longer shields anyone from accountability.

I often silently stalk PR employees (Gasp!) on the Internet who work for sleazy companies just to better understand them. I’ve discovered that it is not hard to find and exploit the weaknesses of those whose heart isn’t behind selling their employer’s product. Sometimes all it takes is a fistful of transparency to cause defenseless representatives to completely shut up, and that alone makes our neighborhood safer. Committee-approved methods of evasion are as simple-minded as committees, so it doesn’t take long to figure them out – exposing the shameful ethics of those who sign off on the use of lame, institutional trickery.

For example, here’s a very popular, traditional PR trick: If a huge business entity such as the ADA has bad news they can no longer keep secret from customers, professional PR-types will advise their bosses to post bad news on a Friday to soften the blow. When traditional leaders find that they can no longer sidestep accountability, delaying accountability until a busy news day is the next best thing one can purchase. Even though the tricks seem simple, there are people who study evasion science as part of obtaining a degree in marketing.

So how good is the ADA’s PR team? How much time did ADA members’ employees buy for leaders before they had to quietly acknowledge an expensive failure?

On July 10, a Friday, “ADA/idm to phase out service” was posted on ADA News Online without a byline. (Another PR trick: When the ADA posts an orphan without a name, it means someone is ashamed of the bastard.)

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3655

ADA Business Enterprises, Inc. (ADABEI), a wholly owned ADA subsidiary, announced today that ADA Intelligent Dental Marketing (ADAidm) of Salt Lake City, one of its joint venture companies, is no longer able to provide marketing services to its customers due to significant production and operational difficulties.”

Now the ADA must refund money to members in a depressed market. Could this embarrassment for our professional organization have been quietly avoided instead of delayed and magnified? I personally started seeing clues of CEO Trajan King’s reticence long ago, and warned ADA leaders in Chicago about my concerns. Nobody ever responded to my numerous, sincere warnings.

These are highly critical times on Capitol Hill and our patients trust us to represent their welfare. Dentists are their last hope, because there is nobody else who cares. Practicing dentists are solely responsible for assuring the benevolence of our niche market, and we are losing control publicly. Disasters like the ADA/IDM make the ADA look foolish to Congress, and word gets around fast on the Internet.

This morning, I read an article posted on The NY Times titled “Study Measures the Chatter of the News Cycle, “ written by Steve Lohr.

http://www.nytimes.com/2009/07/13/technology/internet/13influence.html?_r=1

Researchers at Cornell used powerful computers and sophisticated algorithms to accomplish an unprecedented analysis of news articles and comments on the Web during the 2008 presidential campaign. They studied the characteristics of the news cycle by scanning 1.6 million mainstream media sites and blogs for repeated phrases and tracking the history of their appearances.

Lohr writes: “The researchers’ data points to an evolving model of news media. While most news flowed from the traditional media to the blogs, the study found that 3.5 percent of story lines originated in the blogs and later made their way to traditional media.”

The study also shows that traditional news outlets are still quicker than blogs by 2.5 hours. I should now point out that the Cornell study was performed using data from very popular, huge news items collected during a presidential election – not hidden, niche news like dentistry’s.

If you are involved in the dental industry, where are you more likely to read time-sensitive news about our profession first? In an ADA publication, or from D. Kellus Pruitt; DDS?

Whereas traditional media is 2.5 hours quicker with popular topics, I scooped traditional ADA News Online by three weeks when I posted “ADA/idm – A bad union after all?” on the PennWell forum.

http://community.pennwelldentalgroup.com/forum/topics/adaidm-a-bad-union-after-all

So what about the warning sign I saw concerning CareCredit – a wholly-owned subsidiary of the ADA?

When Trajan King, former CEO of the defunct ADA/IDM partnership refused to acknowledge my questions, I immediately suspected something was terribly wrong with the union of my non-profit professional organization and his for-profit Utah advertisement company. Six months later, my fears were confirmed. Now then, I hope it grabs someone’s attention that I see the same warning signs coming from the ADA’s CareCredit business. Note this date: July 13, 2009.

On Thursday, July 9, CareCredit purchased a press release on dentalblogs.com: “CareCredit Adds 24-Month, No-Interst [sic] Payment Plan” (no byline).

http://www.dentalblogs.com

Since dental problems only get worse, I consider the idea of extending credit to dental patients is a benevolent thought during these hard financial times. I also say that the offer appears to have been put together out of generosity and not greed like the ADA/IDM disaster. However, at 4:54 pm on the same day that CareCredit’s press release was posted, I submitted a difficult question for the anonymous author of the piece who works PR for CareCredit – and is an ADA employee.

“If the Red Flags Rule is not delayed for the third time in three weeks, how will it affect those who offer Care Credit?”

I was given the hopeful response “Your comment is awaiting moderation,” but days later there is no sign that my question is being considered at all. Please, oh please ask yourself: What could CareCredit leaders be hiding and how much will it end up costing ADA membership?

I will not be ignored by anyone. Today, I submitted two follow-up questions on dentalblogs.com. I considered warning the anonymous moderator that this is being simulposted on other blogs, as well as described on Twitter, but then I thought, why spoil the fun? Let the leaders of the ADA Business Enterprises, Inc. (ADABEI) get word of my e-Attack from their colleagues. Won’t they be surprised!

Oh, and for those who are wondering what happened to ADA/IDM CEO Trajan King – he quit.

Dear Dentalblogs.com moderator:

On July 9 at 4:54 pm, I submitted a sincere question concerning how the Red Flags Rule will affect ADA members who sign up for CareCredit. Instead of posting it with the promise of an answer, you regretfully chose to censor an ADA member. Today, July 13, I have a second and third question: Why did you ignore my first one and who is your boss?

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Concierge Medicine and the “Zombie” Medical Practices

Continued Growth of Boutique Medical Practices Today

[By Dr. David Edward Marcinko; MBA CMP™]dem2

The boutique, or direct reimbursement, or cash based medicine, or concierge medical practice business model requires an annual fee for personalized treatment that includes amenities far beyond those offered in the typical practice, or suggested by physician medical unions. Patients pay annual out-of-pocket fees for top tier service, but also use traditional health insurance to cover allowable expenses, such as inpatient hospital stays, outpatient diagnostics and care, and basic tests and physician exams. Typical annual fees can range from $1,500 to $ 5,000 per patient, to family fees that top $25,000 a year, or more. The concept, initially developed for busy corporate executives, has now made its way to others desiring such service.

A Higher Level of Care

Medical providers get to provide a much higher level of care and get to know their patients as they enjoy the incentive to spend appropriate time with them, and over time, get to know them within their unique social/cultural context as well (hence the house calls become important). Patients enjoy the access, the attentiveness, and are willing to spend cash to have the type of unhurried, contemplative time with physicians that is required to develop a trusted relationship and deliver high quality care. The financial remuneration potential is compelling as well.

Now, let us compare and contrast various parameters of traditional medical practice [third party reimbursement] with the same parameters of  so-called “new-wave” concierge medicine. Then, let the next-generation of doctors decide.

Current Traditional Model

  • patients seen at 15-20 min increments
  • 2,000 – 3,000 patients
  • Paperwork, administrative burdens, frustrations, and lack coordinated care
  • Impersonal experience (long waits, un-intelligible interactions with health care system)
  • Average Salary = $150,000-250,000

Concierge Practice Model Potential

  • direct relationship with patients
  • 300-500 patients
  • $1,500 – $3,000 access/retainer fee
  • Reduced overhead, positive interactions, care coordination and increased quality
  • Personalized experience (reduced headaches and paperwork with transparent pricing)
  • 24/7 access, same day appointments with multiple other amenities
  • Average Salary = $100,000 – $500,000

Enter the Franchisors

Concierge medical practices can be developed organically, or use a franchise business model [personal communication, Suzanne R. Dewey, Forté Partners, LLC, Williamstown, MA]. Examples of franchisors include:

Opponents and Pessimists

There have been plenty of opponents, within medicine and outside, to the idea of concierge practices almost from the first day.  For example,

The state of Washington’s insurance commissioner attacked the concept of practices offering all the primary care patients needed for a prepaid fee or retainer, arguing that such practices amounted to the business of underwriting health insurance. He said that the practices would have to meet all the regulatory requirements for such an insurance business, including establishing capital reserves and maintaining loss reserves for the payment of claims. It didn’t work, and besides, few concierge practices offer free traditional medical care once retainers are paid–most concierge physician’s bill insurance plans for all the services covered under their patients’ coverage.  The Medicare folks chimed in and managed to drive one physician out of business, arguing that he had tried to charge Medicare patients an extra $600 a year for services already covered by Medicare, hence he was guilty of illegal “balance billing.” Rather than fight Medicare over the issue, the doctor gave up and closed his practice. [C. Davis, “Big Problems for Medicare and Concierge Medicine,” Sierra Sacramento Valley Medicine, 55:3, May/June, 2004 (www.ssvms.org)]” 

Attacking ME?

Objections to concierge medicine focus on both its causes and its effects, and some critics have even attack me, personally. For example, just look what “they” said in the online journal: “Health Care Strategic Management.”

Many critics argue that concierge medicine merely reflects physician greed and unconcern over the needs of the community. Indeed, a recent book by David Marcinko, Business of Medical Practice [Advanced Profit Maximization Techniques for Savvy Doctors], includes a chapter on “The Case for Concierge Medicine” (Ch. 24) as one of the ways ‘savvy’ physicians can maximize their profit, as if that is what medicine is all about. While the image of physicians may retain some Marcus Welby elements of their rushing to the hospital or a patient’s home in the middle of the night, most physicians would rather stay home and leave the job to someone else, it is argued”.

Nicht Schadenfreude

Just think! My mother always feared I’d be a no-body. Good publicity – bad publicity – just spell the name correctly. Schadenfreude may be defined as a “largely unanticipated delight in the suffering of another which is cognized as trivial “ and I take no delight in the slow collapse of traditional medical practice models; or the economic, professional or personal pain of colleagues. But, I also often tell my critics – and clients – that although it’s awfully nice to be altruistic; I am always mindful of the competitive business adage: “no margin-no mission.” And, in as much as this attack was written in July 2005, I can only wonder if I was prescient, or just lucky? With all due respect, I believe it was the former, rather than the later. Why so? Well, just consider how fast www.ChoiceMed.com is growing. This stuff is not rocket-science.

www.MedicalBusinessAdvisors.combiz-book1

About Concierge Choice Physicians

Concierge Choice Physicians: http://choice.md  is a national organization offering a hybrid business model. Physicians divide their practice between a traditional practice and a retainer practice. The retainer practice is limited to approximately 150 patients. A typical concierge practitioner may have 300-500 patients, while the norm for a traditionalist is about 2,000-3,000 patients.

Assessment – Whither the “Zombies”

I, also ruefully wonder how many “zombie” medical practices [practitioners] are out there? You know the kind – a medical practice with neither a good/bad balance sheet. One with only subsistence level operating performance; a practice that is not growing organically or thru merger activity. It is just barely existing as the doctor-in-charge slowly, agonizingly, milks it to death; or retires, whichever comes first.

Conclusion

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Government-Enabled Patient “Bounty Hunters”

Spider Webbing Technology May Trip-Up Miscreant Doctors

By Dr. David Edward Marcinko; MBA CMP™

HO-JFMS-CD-ROMUnder the Health Insurance Portability Accountability Act (HIPAA), the U. S. Department of Health and Human Service (HHS) have operated an “Incentive Program for Fraud and Abuse Information.”

In this program, HHS pays $100 – $1,000 to Medicare recipients who report abuse in the program.

To assist patients in spotting fraud, HHS has published examples of potential fraud, which include:

  • medical services not provided;
  • duplicated services or procedures;
  • more expenses, services, or procedures claimed for than provided (upcoding/billing);
  • misused Medicare cards and numbers;
  • medical telemarketing scams; and
  • no-medical necessity.

Real Health Fraud Exists

There is no question that real fraud exists. The Office of Inspector General of HHS saved American taxpayers a record $32 billion in 2006, according to Inspector General Glenn A. Fine.  Savings were achieved through an intensive and continuing crackdown on waste, fraud, and abuse in Medicare and over 300 other HHS programs. To discourage flagrant allegations, regulations require that reported information directly contribute to monetary recovery for activities not already under investigation.  For the DRA in 2009, this includes the following:

  • promoting state False Claims Acts (section 6032);
  • enhancing the Fair and Accurate Credit Transaction Act, with “red flags” (PL 108-159); see http://www.gpo.gov/fdsys/pkg/PLAW-108publ159/content-detail.html
  • employee education about false claims recovery (section 6033);
  • augmenting the Medicaid Integrity Program (section 6034);
  • enhancing third party recovery (section 6035); and
  • “mining” medical claims for potential fraud with the help of sophisticated computer technology algorithms – called “spider-webbing” – which locate a common insurance claim denominator and then follow the thread throughout claims review. Indicators of  possible fraud include doctors charging more than peers; providers who administer more tests or procedures per patient; providers who conduct medically “unlikely” procedures; providers who bill for more expensive procedures and equipment when there are cheaper options; and patients who travel long distances for treatment.

Assessment

CMS and private companies are able to save far more money by detecting fraud before claims are paid than recovering the money after the factAnd so, a further erosion of patient confidence can be expected as CMS, and private insurers, assume the “bounty hunter” view of healthcare providers.

Conclusion

Of course, your thoughts and comments on this Medical Executive-Post are appreciated. Do you feel like the hunter; or the hunted? Tell us what you think? Do you ever – or never –  fear the spider? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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For details about how to report an abuse, see www.usdoj.gov/oig/FOIA/hotline.htm.

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IRS Warning on Hospital Charity Care

On Hospital Community Benefit Laws 

By Staff ReportersOslo Port

According to an Internal Revenue Service survey of nearly 500 not-for-profit hospitals in May 2006, only nine percent of total revenues were dedicated to community charity care. The report warned charity [Samaritan] and not-for-profit healthcare entities that attempts to set a percentage threshold for determining tax-exempt compliance may have a:

disproportionate impact on hospitals, depending upon their size, where they are located their community benefit mix, and other hospital and community demographics.”

In a follow-up, February 12, 2009, the IRS reported on executive compensation of the same tax-exempt hospitals”.

Link: http://greisguide.com/wp-content/uploads/2009/02/eo_interim_hospital_report_072007.pdf

Existence Justification

HO-JFMS-CD-ROMWhile the question whether  tax-exempt hospitals are providing enough charity care to justify their tax exemption remains, the report failed to reach specific conclusions on whether existing community benefit standards are appropriate and if tax-exempt hospital executives are being compensated too richly. The findings also serve as a caution to long term acute care hospital [LTACH] governance and compensation committees.  The CEOs and CFOs of these entities should note that a similar survey may be performed on for-profit hospitals in the near future.

Defining “Community Benefits”

According to Jason Greis, of the Gries Guide on LTACHs, on February 12, 2009:

“The current ‘community benefit’ standard was established by the IRS in 1969 in Revenue Ruling 69-545.  The standard sets out factors to be considered in measuring community benefit, including: (i) a board made up of a broad base of community members; (ii) an open medical staff; (iii) participation in Medicare and Medicaid; (iv) application of surplus funds toward improving facilities, equipment, patient care, medical training, research, and education; and (v) a full-time emergency room open to all regardless of ability to pay (the emergency room standard applies differently to tax-exempt Long Term and Acute Care Hospitals [LTACH] that do not maintain a full array of emergency department services).  Under the current community benefit standard, individual hospitals are given flexibility to determine what services will-best serve their communities.”

Today, some pundits suggest that if Congress doesn’t establish new charity care requirements imminently, the IRS should revert to its community benefit standard above, and revise down or eliminate the tax exemption.

Link: http://greisguide.com/wp-content/uploads/2009/02/eo_interim_hospital_report_072007.pdf

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Should non-profit hospitals be evaluated more carefully by the IRS for their community benefit? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Medical Negligence and the “Burden of Proof”

Understanding the Malpractice Trial Process

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

In all civil trials, the plaintiff, as the accuser, has the burden of proving his case.  Much like a criminal defendant, a civil defendant has no burden and is presumed “innocent” of any claim by the plaintiff.  As a result, if the plaintiff presents no evidence, or insufficient evidence to support his claim, the defendant wins without having to present his case.  The burden the plaintiff carries is that he must prove his case by what is called a preponderance of the evidence.  In other words, the plaintiff must prove it is more likely than not that he should win.  The best way to visualize this burden is to imagine a set of scales.  If the scales are even, or tipped in favor of the defendant, then the plaintiff has not carried his burden, and loses.  In order to prevail, the plaintiff must tip the scales in his favor.

Proving Medical Malpractice

To prove a case of medical malpractice, a plaintiff-patient must present evidence that the defendant-doctor was negligent, and the plaintiff does this by proving the treatment provided was below the applicable standard of care.  The “standard of care” is the care and skill that a reasonably prudent practitioner would provide in treating a patient.  It is established by the medical community at large, and is constantly evolving.  Care that violates the standard of care today may not necessarily violate the standard of care several years ago.  This distinction is an important one, since most cases take several years to get to trial.  The standard of care is never based on the outcome of the case; a bad result does not necessarily mean a violation of the standard of care.

The Medical Expert Witnesses

Expert medical testimony is required to establish a violation of the standard of care in virtually all medical malpractice cases.  A plaintiff who fails to present the required expert medical testimony in a medical malpractice case will lose.  The plaintiff must also produce expert medical testimony that the alleged negligence caused the injury.

For example, suppose that a patient’s widow brings a medical malpractice case against a surgeon who admitted the patient for removal of an AO plate embedded in bone.  The plaintiff-widow alleges that the surgeon should have done something to prevent a pulmonary embolism, which occurred three days after the patient was dismissed from the hospital, killing him.  The patient might have an expert who would testify that she would not have removed the AO plate, but left it in place.  Such testimony does not carry the burden of proving care below the standard required of the surgeon.  Indeed, in most cases, the standard of care allows a practitioner to choose from a variety of treatment options within an acceptable range.  Mere testimony by an expert witness that “I would have treated this patient differently” is insufficient to establish a breach of the standard of care.  The bad result also is not itself proof of any negligence.  Nor is there any evidence that the doctor caused the patient’s death (i.e., that the embolism would not have occurred without the alleged negligence of the surgeon). Therefore, doctor wins on all elements.

Assessment

Have you ever been involved in a medical malpractice trial; or other healthcare litigation process? The Medical Executive-Post readers are interested in hearing your story.

Conclusion

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The Power of “ME Inc” for Physicians

Embracing a New Competitive Practice Culture

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dem21

There are more than 900,000 physicians in the United States. Yet, the brutal supply/demand/demographic calculus of the matter is that there are just too many aging patients chasing too few doctors. Compensation and reimbursement is plummeting as Uncle Sam becomes the payer-of-choice for more than 52% of us. And, the government as payer will likely increase with the Obama Administration. So, going forward, it is not difficult to imagine the following four rules for a new-wave competitive medical care culture for all physicians.

[A] Rule No. 1

Forget about large office suites, surgery centers, fancy equipment and the bricks and mortar that comprised traditional medical practices. One doctor with a great idea, good bedside manner or competitive advantage, can outfox a slew of CPAs, while still serving the public and making money. It’s a unit-of-one healthcare economy where “ME Inc.”, is the standard and physicians must maneuver for advantages that boost their standing and credibility among patients and payers. Examples include patient satisfaction surveys, the rise of evidence-based medicine; outcomes research analysis, concierge medicine, direct reimbursement payment plans, and economic credentialing; etc.

 [B] Rule No. 2

Challenge conventional wisdom, think outside the traditional payer box, recapture your dreams and ambitions, disregard conventional gurus and work harder – and smarter – than you have ever worked before. Remember the old saying, “if everyone is thinking alike, then nobody is thinking”. Do insurance panel members think rationally or react irrationally?

However, you should realize the power of networking, vertical integration and the establishment of virtual medical practices, which come together to treat a patient, and then disband when a successful outcome achieved. Job security in this structure is achieved with successful outcomes, and perhaps not necessarily a degree in the near future. Medical futurists even presume the establishment of virtual medical schools and hospitals, where students and doctors learn and practice their art on cyber-entities that look and feel like real patients, but are generated electronically through the wonders of virtual reality units.

www.HealthcareFinancials.com

HOFMS

[C] Rule No 3

Differentiate yourself among your medical peers. Do or learn something new and unknown by your competitors. Market your accomplishments and let the world know. Be a non-conformist. The conformity of health insurance plans are an operational standard and a straitjacket on creativity. Doctors should create and innovate, not blindly follow entrenched medical society leaders into oblivion. Seek, and practice, health 2.0 collaboration with all stakeholders.

[D] Rule No 4

Realize that the present situation is not necessarily the future. Attempt to see the future and discern your place in it. Master the art of the quick change and fast but informed decision making. Do what you love, disregard what you don’t, and let the fates have their way with you. Then, decide for yourself if health plans adhere to any of the above rules?

AssessmentKung Fu

Regardless of the future de facto business model of the learned profession of medicine, current practice models are no longer the structure of choice. Rather, a more laissez-faire and highly competitive business model should be pursuedPhysicians have been slow to accept this philosophy.  Remember, as a physician, if you merely want a static job with promised security, pledged retirement benefits, limited goals and structured regulations; join a health plan panel and become their laborer.

However, if you desire more, such as the possibility of a dynamic career, the unlimited security of your brainpower, non-defined retirement contributions, infinite potential with rules you can create along the way; incorporate the power of ME, Inc., in everything you do. Remain a competitive professional and be a physician ... Get fly! 

Conclusion

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About Timely Medical Alternatives; Inc

Understanding Canadian Health System Alternatives

By Staff Reporters

ObamaIn 2003, Timely Medical Alternatives Inc. was formed to help Canadians, on long medical waiting lists, to take personal responsibility for their own medical care and “Leave the queue” [the national healthcare system waiting-list].

Urgent Need

According to their website, the need for private medical services is thriving in Canada. The mission of Timely Medical Alternatives [TMA] is to accommodate Canadian’s needs for private medical services by providing them with options, referrals to hospitals, clinics and diagnostic imaging facilities.

Link: http://www.timelymedical.ca

Assessment

Timely Medical Alternatives, a PPO, says it is able to expedite most types of private medical services from diagnostics to virtually all types of surgery, including procedures not available within the Canadian healthcare system. Wait times for clients are measured in days rather than in months or years.

Link: www.HealthDictionarySeries.com

Sicko Alternative

The movie documentary Sicko was directed by Michael Moore in 2007. It compared the highly profitable American health care industry to other nations, and HMO horror stories

Link: www.michaelmoore.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Please compare and contrast TMA to “Sicko”, our current domestic health system, and the Obama administration’s vision of national healthcare for the US; and opine .Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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On the Patient Friendly Google Health Initiative

Join Our Mailing List

Data Integrity and Health 2.0 Accuracy Concerns Linger

google3

[By Staff Reporters]

According to its’ website, and mission statement, Google Health aims to put patients in charge of their digital health information. It’s safe, secure, and free.

Triple Play of Benefits

Google Health purports to:

  • Organize health information all in one place.
  • Gather medical records from doctors, hospitals, and pharmacies.
  • Share information securely with family members doctors and caregivers, etc.

Google says members are always in control of how data is used. It will not sell information. Members decide what to share, and what to keep private.

Link: privacy policy

Blogsite

Google health was launched in the spring of 2008. Since then, it even maintains its own blog-site, which stated on 3/4/09.

 “We continue to learn a tremendous amount since launching Google Health in the spring of 2008. We’re listening to feedback from users every day about their needs, and one issue we hear regularly is that people want help coordinating their care and the care of loved ones. They want the ability to share their medical records and personal health information with trusted family members, friends, and doctors in their care network”

Link: http://googleblog.blogspot.com/2009/03/google-health-helping-you-better.html

Good thing too!

A Cautionary Tale

However, privacy advocates worry about the vast amount of data that Google is redacting. Growing consumer market clout means the early-adopter patient who cares about digital records, and eHRs, may have fewer choices in the future. And, for medical professionals, what does this say about CCHIT, Allscripts and the Military, etc; or, the emerging Wal-Mart eMR initiative for doctors?

Assessment

For example, when one now [in]famous patient named Dave deBronkart – a tech-savvy kidney cancer survivor – tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, he was stunned at what he found.

Read this Link: http://www.boston.com/news/nation/washington/articles/2009/04/13/electronic_health_records_raise_doubt

Is MSN’s Health Vault any better?

Channel Surfing the ME-P

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Conclusion

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About Fiduciary Benchmarks, Inc

Independent Custom Benchmark Groups

By Staff Reportersfp-book1

Department of Labor [DOL] regulations under ERISA, and specifically pending section 408(b)(2), requires that retirement plan sponsors obtain fee disclosures for their plans and that all fees be “reasonable” for services provided.

Fiduciary Benchmarks, Inc. [FBi] was launched to support plan sponsors, advisors, consultants, record-keepers and other plan service providers in addressing this obligation. Fiduciary Benchmarks helps document a thorough and objective process and well-informed decisions. This is an increasingly important topic for hospitals, healthcare systems, CXOs, CFOs, sponsoring medical entities and many modern physician-executives.

Background

Fiduciary Benchmarks, Inc was founded in October 2007 with the express purpose of providing pension and retirement plan benchmarking services. The genesis of the firm was recognition by FBi principals that the marketplace did not have an efficient and affordable way to help plan sponsors meet their fiduciary obligation to determine if plan fees are reasonable.

Progressing Past Current Approaches

Existing marketplace approaches to assessing fee reasonableness (including the use of simple averages books, issuing RFIs, participating in a mock RFPs or actually taking a plan to market) were falling short in terms of validity and/or the time, effort and disruption involved. These gaps continue today.

FBi Modern Approaches

FBi spent more than a year sharing their methodology and reports with the marketplace. They solicited and considered feedback from record-keepers and TPAs, advisors, consultants, independent auditors and ERISA attorneys. As a result, products are claimed to be well vetted and improved.

Link: http://www.fiduciarybenchmarks.com

Fiduciary Report [The Duty to Use Outside Sources]

“Fiduciaries are not expected to be experts. They may reasonably rely on the assistance of others in performing required investigation of and data gathering process. One of the key issues in determining whether reliance on the expert is reasonable is whether the expert is independent and unbiased.”

-Fred Reish

Assessment

In order to remain independent and conflict free, FBi does not perform any traditional investment consulting, plan monitoring and/or record-keeper search work. FBi offers benchmarking services, where desired, by plan sponsors, directly. Fiduciary Benchmarks, Inc. is a completely independent company.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated; especially from FAs, wealth managers, CPAs, CFAs and CMPs™? Experienced customer opinions are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Beware the Faux Medical Journals

When is a “Journal” … not a Journal?

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chiefdem23

Allow me to begin this post by making the unusual disclosure that I was the Editor-in-Chief of a print guide in healthcare finance and economics [aka periodical or journal].

Formally, the title was: Healthcare Organizations [Financial Management Strategies]. At 2 volumes, and more than 1,200 pages, it was quite a job to update it quarterly. And, with more than two dozen contributing authors, it was a labor of love indeed. Alas … no more!

ho-journal9

Varying Levels of Credibility

Now, we doctors know that medical journals are not all alike. There are different levels of “credibility.” Some are peer-reviewed, others not. Some are trade magazines. Frankly, some “real” journals are better, and more respected than others. Some entrenched journals are in decline, while other emerging journals are leading-edge in the health 2.0 space. Still others, like the formerly esteemed Journal of the American Medical Association [JAMA], have been accused of outright censorship.

Link: https://healthcarefinancials.wordpress.com/2009/04/02/is-jama-censoring-physician-dissent/

Adventures

Of course, doctors also know that pharmaceutical companies routinely offer us reprints of articles from medical journals that are favorable to their products. But, news of a Merck-sponsored publication for doctors in Australia has come to light in a personal injury lawsuit over Vioxx. It raised more than a few eyebrows in international medical publishing circles. It may have even crossed the line of journalistic, not to mention medical, ethics.

Read: Merck Paid for Medical ‘Journal’ Without Disclosure; by Natasha Singer, May 13, 2009.

Link: http://www.nytimes.com/2009/05/14/business/14vioxxside.html?_r=1&adxnnl=1&adxnnlx=1242313549-xaAEwW4MCd7pJh9OdgWdUQ

Mis-Adverntures

Tracy Staton wrote more about these mis-adventures in a story, dated May 14, 2009, in FiercePharma.

Analysis and Apology

Analysis in the Pipeline: http://seekingalpha.com/article/136942-merck-and-elsevier-cross-the-line-in-joint-medical-journal?source=yahoo

Libology Mea Culpa: http://www.libology.com/blog/tag/excerpta-medica

Assessment

Perhaps; Merck ought to read our Medical-Executive Post on health journalists?

Link: https://healthcarefinancials.wordpress.com/2009/03/17/battered-health-journalists

Or, our Medical-Executive Post on medical experts, reporters and journalists?

Link: https://healthcarefinancials.wordpress.com/2009/03/09/healthcare-experts-versus-health-journalists

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Economic Facts your Dentist Doesn’t Want You to Know

Some Office Visit Schedules Linked to Insurance Payment

By D. Kellus Pruitt; DDS

 http://thebulletin.us/articles/2009/05/21/herb_denenberg/doc4a15404e56e5f308210565.txt

pruitt

Here is the link to an article written by Herb Denenberg titled: “Some Facts Your Dentist Doesn’t Want You to Know”.  In it, he shared with his readers some information about dentistry that is hard to find. I submitted the following comment.

Dear Herb Denenberg,

Yours was a great article, and as a dentist with 27 years in a comfortable practice and 32 years in an expensive marriage, I find your cost-saving points oh so painfully accurate. Nevertheless, I must honestly agree that not only can some patients safely go a year or more between check-ups (ouch!), but many don’t need bitewing x-rays every year either (Good thing neither my patients nor my wife read the stuff I write).

Of BiteWing X-Rays

Readers who are hopefully from places other than the east side of Fort Worth can easily understand that the more treatment and x-rays I recommend, the more money I make. I must honestly add that my devoted and trusting dental patients, like most Fort Worth dentists’ patients, are reliably willing to accept my recommendations for these kinds of procedures without questioning the need. Let me put it this way: Annual bitewings are an easy $56 sale, mostly because fee-for-service insurance pays for them at 100% anyway. (If an angry dentist should ask who told you that, it wasn’t me). That is why it should not be taken lightly my approval of the advice about dentistry published in the book “1,001 Things They Won’t Tell You.” And; they won’t, sometimes.

Ethics and EBD

True to ethics I learned at the University of Texas dental school, in San Antonio (UTHSC), in the last six months, my hygienists and I have been determining which patients are safe to go a year and a half without routine bitewing x-rays. They are commonly taken every year simply because it has always been that way, and that interval was adopted as the minimum time most insurers allow. As readers can see, not a hint of Evidence-Based Dentistry [EBD] was involved in that determination. It was just a 1950’s guess.

Extended Prophylactic Schedules 

This week we found four candidates in our practice for extended schedules. Our honesty will save these patients (their insurance companies) money by eliminating unnecessary care. And I really, really hate saving insurance companies money, on principle alone.

In My DefenseGnome

In my defense of continuing to maintain a large number of my patients on 6 month prophys and 12 month x-rays – and with the hope of restraining local dentists from throwing rocks through my windows – let me say up front that most people still need the old-school schedule in order to prevent disease. And, a few of the more fragile cases need x-rays and cleanings even more often than insurance allows.

Assessment 

My patients and I are fortunate that I can freely charge the prices I deem necessary in order to put my patients’ interests above my wife’s. Let’s face it. Ethics are invisible to dental patients and they are not free. Ethics are a precious courtesy that dentists who accept managed care insurance find themselves forced to eliminate because contracts prevent them from raising fees as the market demands. Managed care dentistry is dentistry by the lowest bidder with no quality control. I only wish that someone would have pointed out that chunk of information in the book. Now, I’d better have my wife go ahead and start my car in the morning when she grabs the paper.

Conclusion

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College for Financial Planning Credibility

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Confusing Nomenclature? 

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

dem2Recently, John H. Robinson – a Honolulu based independent and dual-registered financial advisor who holds a degree in economics from Williams College and who has written and published numerous professional papers – essentially challenged the credibility of the College for Financial Planning.

“Dr. [Somnath] Basu [PhD] is quite correct in pointing out that the College for Financial Planning is not academically accredited and there are no admissions standards other than a nominal three year industry experience standard (three years as a clerk in a brokerage firm will qualify). Mr. [Kevin] Keller [CEO-CFP BoS] defends the curriculum by stating that, “Topics include economic concepts such as supply and demand, fiscal and monetary policy, time-value of money concepts…” The mere fact that that no prior college level academic experience in finance is required is testament to the fact that the coursework is largely 101 level materials.

To illustrate this point by example, economics represents one small chapter of the Investments section of the CFP curriculum. In contrast, econometrics and statistics alone was a semester long 300 level course in my undergraduate economics studies. This is not to suggest that the CFP program does not provide adequate training and preparation for a career in financial planning, but to assert that the CFP designation trumps a graduate or even undergraduate degree in finance or economics is difficult to defend. This was my counterpoint to Mr. [Dan] Moisand’s bellicose labeling of non-CFP certificants as “faux planners”.

Source: http://www.fa-mag.com/online-extras/4037-revisiting-cfp-credentialing.html

Moreover, he stated that:

In fairness, some of Dr. Basu’s ideals on the educational standards for financial planning certification seem a bit extreme as well. For instance, I can’t imagine subjecting doctors, attorneys, or even business school professors to periodic recertification exams.”

Source: http://www.fa-mag.com/online-extras/4037-revisiting-cfp-credentialing.html

The Big Question

And so, the big question for financial advisors and Certified Financial Planners®: Is the College for Financial Planning, a college at all? Is it accredited and more importantly, who accredits it? If not; why not? And, was the name “college” purposely selected to obfuscate?

Moreover, and of more importance to our physician readers, FAs and ME-P subscribers: Do doctors, attorneys or business school professors need to periodically recertify themselves by examinations?

IOW: Is Mr. Robinson correct or not – in fact or meaning – on one or both accounts? How about Dan Moisand? Am I, or Mr. Robinson, a “faux” planner?

Assessment

A paper co-authored by Mr. Robinson, entitled, “Reality Check: The implications of sustainable withdrawal analysis on real world portfolios” was awarded the CFP Board of Standards’ 2008 Outstanding Paper Award. He does not hold the CFP® designation.

Disclosure

Among many other “hats”, I am a former licensed insurance agent, certified financial planner, board certified surgeon, visiting B-school professor, and current academic provost for the CMP™ online program in health economics and medical practice management for fiduciary consultants. Our goal is to “raise the bar” for all colleagues in this space.

Update 2013:

Recent:

Conclusion

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Understanding Periodic or New Employee Practice Compliance Audits

Perform and Improve as Needed

By Patricia Trites MPA, CHBC; with Staff Reporters 

www.HealthcareFinancials.comho-journal12

There are several types of compliance audits that a medical practice, clinic or healthcare organization might need to perform. The starting point, discussed elsewhere on this ME-P, is to obtain a baseline audit. The next step is periodic audits or reviews that are performed after information is obtained from the baseline audit.

Periodic Audits

Periodic audits are performed on an on-going basis. Depending on the volume of billing, these may occur weekly for a large multi-specialty ambulatory clinic to quarterly for a small medical practice. These periodic audits can be random or scheduled. Sometimes in the process of seeing how things run, a surprise review can be informative to staff and practitioners.

New Employee Audits

New employees require regular training and reviews until there is confidence in their capabilities. Background checks are often helpful to find out whether there are any potential conflicts. In hospitals, health plan offices, surgery centers, and other regulated facilities, background checks are a normal part of the credentialing process. This process typically includes Medicare violations, which would show up on the National Practitioner Data Bank report. However, independent medical practices do not have access to this type of information and may have to rely on other organizations to obtain the information. The OIG and the General Services Administration both maintain a database of excluded persons and entities that can be accessed through the Internet. As part of the organization’s initial and periodic audits, queries of these two databases should be performed for all employees and independent contractors (like locum tenens physicians). Failure to do so can put the practice at risk of large civil money penalties ($10,000 for each occurrence) and liability for refunds of all claims the excluded individual had part in providing or billing.

Assessment

Additional audits can be performed whenever new employees are added, or if there are complaints or issues that arise in the course of business; prn.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? What interesting, informative or strange tidbits have you uncovered in your auditing processes?

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More On Attempted ME-Post Censorship

Return to Ethridge’s Hill

By Darrell K. Pruitt; DDSpruitt

For those who have stayed up late, here is a sneak preview of some upcoming action – hopefully attracting the best PR people BCBS of New Mexico can field – Becky Kenny and Ross Blackstone. 

ModernHealthcare.com – The Strong Arm? – NOT

You may or may not recall that about two months ago, Martin Ethridgehill, who once worked for BCBSNM, posted a comment on ModernHealthcare.com that was later removed as ordered by Becky Kenny – a PR specialist who represents the interests of BCBSNM. So what did Becky’s recently laid-off colleague say that justified field censorship? The title says it all:  “Don’t Rush eHRs Without Addressing Medical ID Theft.”  It attracted my attention before it attracted BCBSNM’s. They move slower than I do.

Blue Cross – Blue Shield 

Apparently, even though leaders of BCBS think caution might be prudent in paying Texas physicians for health care, the organization is not necessarily in favor of delaying the adoption of eHRs … or something like that. Maybe Jon Stewart will explain it some day for us on Comedy Central.

ME-P … Marcinko Does Not Fold 

And who is this Ross Blackstone? He’s a manly piece of PR. He tried to persuade Dr. David E. Marcinko, publisher of the ME-P, to remove my comment which is not a copy of Ethridgehill’s statement, but is a report on his statement. Blackstone learned that Marcinko doesn’t fold as easily as the publisher of ModernHealthcare.com folded to Becky Kenny’s demand. I bet she got nasty with them.

The Blackstone Video 

So who is Ross Blackstone? I’m trying to get away from posting links because they are so tedious. But you just have to watch “Ross Blackstone Reporter Resume” video on YouTube. 

http://www.youtube.com/watch?v=IuHBnNiYvcU

Assessment

“First they ignore you, then they attack you, and then you win”

-Mohandas Karamchand Gandhi

Conclusion

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

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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Healthcare Organizations: www.HealthcareFinancials.com

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Selecting an Assisted-Living Facility

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Checklist for Financial Planners

[By Staff Reporters]

Thousands of boarding homes cater to the elderly. Their operators promise to provide at least a place to sleep and food to eat. Beyond that, the services and assistance offered will vary from facility to facility. This checklist will help the financial planner or his or her client find a facility that is appropriate in all respects to the client’s resources and needs. Unlike nursing homes, assisted-living facilities often operate without any scrutiny from public agencies. Furthermore, Medicaid often will not be a source of funds.

The Checklist

The items the financial planner and client should consider when selecting a facility are listed below.

      1.   Determine the client’s willingness to live in a group environment.

      2.   Avoid unlicensed facilities, particularly if Medicaid-provided services may be needed in the future.

      3.   Review the facility’s inspection report.

      4.   Review the facility’s service contract and house rules. Look for answers to the following questions:

            a.         Where will the resident live?

                        Are there any types of ownership rights?

                        What flexibility is there with respect to furnishings?

                        Will the same unit be available after a hospital stay?

            b.         What meals are included?

                        Will the facility provide appropriate meals and a special diet?

            c.         What form of transportation does the resident currently use?

                        What transportation is provided by the facility?

                        Can residents shop, dine, attend services or visit doctors?

            d.         What help does the facility provide during a medical emergency?

                        What type of staff training is provided or required? Is there 24-                        hour-a-day staffing?

            e.         What provisions are there for privacy? When are rooms cleaned and when can staff access the rooms?

            f.          What is the basic cost and what are the costs for extras?

                        What is included in each?

                        What provisions for fee increases are there?

            g.         Can a resident see his or her own doctor?

                        Does the facility offer transportation for appointments?

            h.         Who’s in charge of administering and scheduling medication?

                        Can medication and other supplies be purchased at the facility?

            i.          What happens if the resident’s health begins to fail?

                        Does the facility provide additional services to help with ADLs?

            j.          What is the procedure for transfers from one unit to another?

                        Does the resident have any opportunity to express an opinion?

            k.         What’s required if a contract is terminated by facility or resident?

                        What is the provision with respect to refunded fees?

                        Is there a required minimum stay?

Assessment

What have we missed?

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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Understanding the Emergency Medical Treatment and Active Labor Act

An Important and Contemporary Issue – Once Again

[By Patricia Trites; MPA, CHBC, CMP™ (Hon) with Staff Reporters]

tritesThe Emergency Medical Treatment and Active Labor Act (EMTALA) is receiving increasing scrutiny from prosecutors during these times of financials stress and credit tightening. The statute is intended to ensure that all patients who come to the emergency department of a hospital receive care, regardless of their insurance or ability to pay. Both hospitals and physicians need to work together to ensure compliance with the provisions of this law.

Triad of Requirements

EMTALA imposes three fundamental requirements upon hospitals that participate in the Medicare program with regard to patients requesting emergency care.

First, the hospital must conduct an appropriate medical screening examination to determine if an emergency medical condition exists.

Second, if the hospital determines that an emergency medical condition exists, it must either provide the treatment necessary to stabilize the emergency medical condition or comply with the statute’s requirements to affect a proper transfer of a patient whose condition has not been stabilized. A hospital is considered to have met this second requirement if an individual refuses the hospital’s offer of additional examination or treatment, or refuses to consent to a transfer, after having been informed of the risks and benefits of treatment.

Third, EMTALA’s requirement is activated if an individual’s emergency medical condition has not been stabilized.

Hospital Transfers

A hospital may not transfer an individual with an unstable emergency medical condition unless:

(1) the individual or his or her representative makes a written request for transfer to another medical facility after being informed of the risk of transfer and the transferring hospital’s obligation under the statute to provide additional examination or treatment;

(2) a physician has signed a certification summarizing the medical risks and benefits of a transfer and certifying that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the transfer outweigh the increased risks; or

(3) a qualified medical person signs the certification after the physician, in consultation with the qualified medical person, has made the determination that the benefits of transfer outweigh the increased risks, if a physician is not physically present when the transfer decision is made. The physician must later countersign the certification.dhimc-book21

On-Call Responsibilities

One area of particular concern is physician on-call responsibilities. Physician practices whose members serve as on-call hospital emergency room physicians are advised to familiarize themselves with the hospital’s policies regarding on-call physicians. This can be done by reviewing the medical staff bylaws or policies and procedures of the hospital that must define the responsibility of on-call physicians to respond to, examine, and treat patients with emergency medical conditions. Physicians should also be aware of the requirement that, when medically indicated, on-call physicians must generally come to the hospital to examine the patient. Patients may be sent to see the on-call physician at a hospital-owned contiguous or on-campus facility to conduct or complete the medical screening examination due to the following reasons:

  • all persons with the same medical condition are moved to this location;
  • there is a bona fide medical reason to move the patient;
  • qualified medical personnel accompany the patient; and
  • teaching physicians may participate.

Channel Surfing the ME-P

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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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Become a Published Print Author with Us

The Business of Medical Practice [3rd Edition]

By Hope Rachel Hetico RN, MHA, CMP™

[Managing Editor]biz-book7

Dear Colleagues,

As you may know, we are commencing work on the third edition of our best selling book: The Business of Medical Practice

TOC 1st: http://www.amazon.com/Business-Medical-Practice-Maximizing-Doctors/dp/0826113117/ref=sr_1_8?ie=UTF8&s=books&qid=1231111232&sr=1-8

TOC 2nd: http://www.springerpub.com/prod.aspx?prod_id=23759

Invitation to Contribute

Accordingly, we would be honored for you to consider contributing a new or revised chapter, in your area of expertise, for a low-effort but high-yield contribution. Our goal is to help physician colleagues and management executives benefit from nationally known experts, as an essential platform for their success in the healthcare 2.0 business industry. Many topics are still available: [health accounting and costing; law, policy and administration; Medicare fraud and abuse; coding and insurance; HIT, grid and cloud computing; finance and economics, competitive models, collaboration and leadership, etc].

Support Always Available

Editorial support is available, and you would enjoy increasing subject-matter notoriety, exposure and public relations in an erudite and credible fashion. As a reader, or preferably a subscriber to the ME-P, your synergy in this space may be ideal. Time line for submission of a 5,000-7,500 word chapter is ample, and in a prose writing style that is “wide, not deep.” 

A Health 2.0 Initiative

And, be sure to address health 2.0 modernity. Update chapters from the second edition are also available. 

Definition: https://healthcarefinancials.wordpress.com/2008/09/12/emerging-healthcare-20-initiatives

Assessment

Please contact me for more details, if interested. A best selling-book is rare; while a third-edition volume even more so. Join us in this project. Regardless, we trust you will remain apostles of our core ME-P vision, “uniting medical mission and financial profit margin”, promoting it whenever possible.

Front Matter Link: frontmatter1advancedbusinessmedicine4 

Contact Info:

MarcinkoAdvisors@msn.com

770.448.0769

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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About Certified Medical Planner™

 

 

 

SPONSOR NOTICE

 

Top 10 Reasons to Become a

Certified Medical Planner™

 

1. Expertise: Provide health economics, business and financial advice to physicians.

2. Credibility: Gain health industry recognition and fiduciary clout.

3. Opportunity: Focus on the lucrative and expanding physician advisory niche.

4. Recognition: Join a select group of advisory experts.

5. Distinction: Become quality; rather than product driven.

6. Achievement: 500 hours of financial, health economics and management education.

7. Evidence: Validate deep healthcare industry knowledge.

8. Resource: CMP™ text and hand books, dictionaries, and institutional print journal.

9. Distinction: Set yourself apart with our chartered logo and trade-mark identity.

10. Commitment: Become the “go-to” financial advisor for all medical professionals.

 

www.CertifiedMedicalPlanner.com

 

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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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On Continuity of Medical Care and HIMSS

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Considering Pay-for-Retention [P-4-R]

By Darrell K Pruitt; DDSpruitt5

Here is the question on lots of minds these days; how can we change the way medical providers are paid so they are both incentivized and adequately compensated to provide consistent, high-quality, patient-centered medical homes?

My Novel Idea

Here is a solid, common sense idea; increase providers’ pay gradually according to how long the doctors retain patients – who are free to choose any doctor they wish.  Consistency is the mortar of a medical home [i.e., pay-4-retention]. 

An Ounce of Prevention 

If prevention, which predates eHRs by thousands of years, is more than just a modern buzzword, the nation can still shave much more expense from health care by promoting continual, personalized care for consumers than from digital health records alone – void of prevention incentives. Who in the audience still cannot understand that concept? Think of it this way. How do business leaders in the land of the free retain the best employees? They pay bonuses. Even waiters get tips to encourage interest in providing service consumers will return for. What do US physicians get?  Guaranteed cuts in their Medicaid payments over the next decade. Physicians no longer encourage their children to become doctors. Surprised? Scared? 

Consumers Should Rule 

In place of consumers ruling their healthcare in the US, well-positioned, giant stakeholders have persuaded lawmakers to offer physicians bonus money (that will later be taken away), not for curing patients, but for using digital records “in a meaningful manner.” It’s called “Mark and Michael Leavitts’ Clicking for Cash.”  Since the rules are made up along the way, they change like the weather. That is why the larger and more progressive medical facilities pay bonuses to retain their best “Coders” and other informatics specialists who keep up with the current Ingenix-styled games in order to maximize profits. It is my opinion that health care IT’s complexity works well with the economic stimulus plan to improve employment in the nation. Entrepreneurial stakeholders will continue to be movie-star popular right up until the complete collapse of Medicare.  Then they’ll be impossible to find www.HealthDictionarySeries.com

HIMSS 

Have you ever heard of HIMSS?

“The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry’s membership organization exclusively focused on providing leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare.”

– From the HIMSS Web site.

HIMSS Annual Meeting 

A week ago, HIMSS convened its annual convention in Chicago. The keynote speakers for the four day event were actor Dennis Quaid; followed by the Chairman and CEO of Kaiser Foundation Health Plan, George C. Halvorson; then the economist and former Chairman, Board of Governors of the Federal Reserve, Alan Greenspan, and finally; Jerry M. Linenger, MD, MSSM, MPH, PhD, Captain, Medical Corps, USN (Ret.), NASA Astronaut, and Space Analyst, NBC News. As one can tell, healthcare IT has lots of momentum. In fact, Dave Roberts, the HIMSS vice president for government relations confidently told Bob Brewin on NextGov.com

“The e-records initiative is an entitlement program like Social Security.” 

http://www.nextgov.com/nextgov/ng_20090406_1509.phpdhimc-book9

Another Entitlement Program – Entitlement for Whom

In Regina Herzlinger’s 2007 book “Who Killed Health Care?” the Harvard School of Business professor argues that entitled stakeholders, including a few ambitious members of HIMSS, are destroying health care in the name of reform. In the first half of her 260 page book, she spells out entrepreneurial malfeasance in simple well-annotated terms. In the last half, she describes why Consumer-Driven Health Care [CDHC] makes sense to her. Professor Herzlinger does not specifically mention the words “medical home” in her book, yet she emphasizes the importance of continuity of care. To promote continuity, she suggests that managed care insurance policies be extended to three years duration and longer.  Although she also does not mention dentistry, it is obvious to me that since chronic illnesses like diabetes are exacerbated by poor oral health, continuity of care in dentistry is of special importance.  It occasionally takes years to improve some patients’ oral health care. And sometimes we fail.

Assessment 

If these assumptions about continuity of care are accurate, it follows that the physical and economic health of the nation depends on long-term medical insurance contracts with employers and freedom-of-choice in providers. So is prevention worth holding ourselves accountable to consumers for once? Maybe it is just me, but I think unprecedented truth in healthcare will soon emerge regardless of stakeholders’ needs for confusion and obscurity.  It is called consumerism.  And it goes hand-in-hand with the Hippocratic Oath, the free-market and common sense.

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.

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

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

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More about Healthcare Organizations [Financial Management Strategies]

Our Print-Journal Preface

By Hope Rachel Hetico; RN, MHA, CMP™hetico1

As Managing Editor of a two volume – 1,200 pages – premium quarterly print journal, I am often asked about our Preface.

A Two-Volume Guide

As so, our hope is that Healthcare Organizations: [Financial Management Strategies] will shape the hospital management landscape by following three important principles.

What it is – How it works

1. First, we have assembled a world-class editorial advisory board and independent team of contributors and asked them to draw on their experience in economic thought leadership and managerial decision making in the healthcare industrial complex. Like many readers, each struggles mightily with the decreasing revenues, increasing costs, and high consumer expectations in today’s competitive healthcare marketplace. Yet, their practical experience and applied operating vision is a source of objective information, informed opinion, and crucial information for this manual and its quarterly updates.

2. Second, our writing style allows us to condense a great deal of information into each quarterly issue.  We integrate prose, applications and regulatory perspectives with real-world case models, as well as charts, tables, diagrams, sample contracts, and checklists.  The result is a comprehensive oeuvre of financial management and operation strategies, vital to all healthcare facility administrators, comptrollers, physician-executives, and consulting business advisors.

3. Third, as editors, we prefer engaged readers who demand compelling content. According to conventional wisdom, printed manuals like this one should be a relic of the past, from an era before instant messaging and high-speed connectivity. Our experience shows just the opposite.  Applied healthcare economics and management literature has grown exponentially in the past decade and the plethora of Internet information makes updates that sort through the clutter and provide strategic analysis all the more valuable. Oh, it should provide some personality and wit, too! Don’t forget, beneath the spreadsheets, profit and loss statements, and financial models are patients, colleagues and investors who depend on you.ho-journal9

www.HealthcareFinancials.com

Assessment

Rest assured, Healthcare Organizations: [Financial Management Strategies] will become an important peer-reviewed vehicle for the advancement of working knowledge and the dissemination of research information and best practices in our field. In the years ahead, we trust these principles will enhance utility and add value to your subscription. Most importantly, we hope to increase your return on investment [ROI] in some small increment.

Visit and Order Now

Specialty Technical Publishers

8 – 14th Street

Blaine, WA 98230

1-800-251-0381

orders@stpub.com

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

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

Conclusion

And so, your thoughts and comments on this Medical Executive-Post, complimentary e-companion are appreciated. If you would like to contribute material or suggest topics for a future update, please contact me. Subscribers, have we attained our goals and objectives, as a work-in-progress in this preface statement?

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About: Healthcare Organizations [Financial Management Strategies]

Our Print Mission Statement

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

Publisher-in-Chief

dem25As Editor-in-Chief of a two volume – 1,200 pages – premium quarterly print journal, I am often asked about our mission statement; or the journal’s raison d’etra.

A Two-Volume Guide

As so, Healthcare Organizations: [Financial Management Strategies], with its quarterly updates, will promote and integrate academic and applied research, and serve as a multi-disciplined communications forum for the dissemination of financial, managerial, business and related economic information to decision makers in hospitals, outpatient centers, clinics, medical practices and all mature and emerging healthcare organizations. 

Target Market and Ideal Reader

Healthcare Organizations [Financial Management Strategies] and its quarterly updates should be in the hands of all:

* CFOs, CEOs, COOs, CTOs, VPs and CIOs from every type of hospital and healthcare organization including: public, federal, state, Veteran’s Administration and Indian Health Services hospitals; district, rural, long-term care and community hospitals; specialty, children’s and rehabilitation hospitals; diagnostic imaging centers and laboratories; private, religious-sponsored, and psychiatric institutions.

*  Physician Hospital Organizations, Management Services Organizations (MSOs), Independent Practice Associations (IPAs), Group Practices Without Walls (GPWWs), Integrated Delivery Systems (IDSs) and their administrators, comptrollers, cost accountants, budget directors, cash managers, auditors, healthcare attorneys and consultants,  and actuaries, and all endowment fund directors, executives, consultants and strategic financial managers.

*  Ambulatory care centers, hospices, and outpatient clinics; skilled nursing facilities, integrated networks and group practices; academic medical centers, nurses and physician executives; business school and health administration students, and all economic decision-makers and directors of allopathic, dental, podiatric and osteopathic healthcare organizations.

Assessment

After publication, my suggestion is to read, study and act upon the guide in this way:

1. First, browse through the entire text.

2. Next, slowly read those chapters and sections that are of specific interest to your professional efforts.

3. Then, extrapolate portions that can be implemented in specific strategies helpful to your healthcare setting.

4. Finally, use its’ ME-P updates as a reference manual to return to time and time again; and enjoy!

Conclusion

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

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

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