PODCASTS: More Dialysis Center Investigative Reporting

DaVITA and FRESENIUS

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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The HISTORY of Messenger RNA

A Tangled History of mRNA

Hundreds of scientists had worked on mRNA vaccines for decades before the coronavirus pandemic brought a breakthrough.

By Elie Dolgin

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Messenger RNA Medicines | Translate Bio | mRNA Therapeutics

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LINK: https://www.nature.com/articles/d41586-021-02483-w?utm_source=pocket-newtabBy

RELATED: https://www.msn.com/en-us/health/medical/pfizer-biontech-say-covid-19-vaccine-is-safe-for-young-children-generates-immune-response/ar-AAODfco?li=BBnb7Kz

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PODCAST: Understanding Your Medicare Choices

ORIGINAL MEDICARE, PART C, MEDIGAP AND YOU

CITE: https://www.r2library.com/Resource/Title/0826102549

BY MEDICARE – CMS

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Why the Stock Markets CRASHED TODAY?

Feel Free to Add to the Our Growing List of Reasons!

BUT REMEMBER THAT CORRELATION IS NOT CAUSATION

CMP logo

BY DR. DAVID E. MARCINKO MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Chart: The Worst Stock Market Crashes of the 21st Century | Statista

THE LIST GOES ON

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China’s Evergrande Project Giant Contagion Jitters

Global and International Market Meltdowns

Crypto-Currency and Gas Price Tumbles

Depressed Automobile Rentals and Used Car Prices

Lowering US Treasury Bond Yields

US Debt Ceiling Risks and Looming Federal Shutdown

Travel Bans with Mask & Vaccine Debates During the Corono-Virus Pandemic

The $3.5 Trillion Dollar Senate Bill

Politics and Potential Federal Tax Law Changes

The National Park, Pacific North-West and California Wild Fires

The Weather, Flooding, Tornadoes, Hurricanes and Tropical Storms

Southern Border Immigration Crisis

A Dearth of Micro-Chips

Quadruple Witching Friday

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CORRECTION? https://www.msn.com/en-us/money/markets/the-odds-of-a-20-correction-in-stocks-are-rising-as-the-market-transitions-to-the-next-stage-of-its-cycle-morgan-stanley-warns/ar-AAODytg

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YOUR COMMENTS ARE APPRECIATED.

Feel free to add to our list.

Is this the start of a cyclical bear market?

MORE: https://medicalexecutivepost.com/2018/12/22/stocks-and-sectors-in-bear-territory/

RELATED: https://medicalexecutivepost.com/2016/03/18/doctors-and-bull-and-bear-markets/

MORE: https://medicalexecutivepost.com/2007/11/25/of-bull-and-bear-markets/

EVERGRANDE: https://www.msn.com/en-us/money/markets/evergrande-s-debt-crisis-has-jolted-the-stock-market-here-s-why-everyone-s-suddenly-worrying-about-china-s-2nd-largest-property-developer/ar-AAODW0q

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INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

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The STEP-UP In Investment Value?

Understanding the TAX loophole of a ‘step up’ in BASIS value

By Dr. David E. Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

The term “step-up” refers to the difference in value and tax liability that an asset has when it is acquired and when it is transferred to an inheritor.

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CITE: https://www.r2library.com/Resource/Title/0826102549

EXAMPLE #2: The proverbial millionaire Doctor Joe, for example, could buy a home for $350,000 and sell it for $1 million, after which he’d pay taxes on the $650,000 gain. But if Dr. Joe passes the home onto his daughter Ella, and she has it appraised at $1 million, its value has taken a “step up” in value to $1 million. If Ella sells the home for $1 million or less, she wouldn’t owe anything in taxes.

ASSESSMENT: For billionaires like Jeff Bezos, Bill Gates and Elon Musk who earn far more through their investments than their salaries, this loophole is a perfect way to shield their wealth. Intergenerational wealth has contributed to surging inequality in America, which grew wider during the pandemic. Since 2019, the wealth of the top 400 richest people in the US increased by $1.4 trillion, per research from Gabriel Zucman and Emmanuel Saez, a pair of left-leaning economists at the University of California, Berkeley.

“Often, for these people, wealth accumulates tax-free their entire lives,” Frank Clemente, executive director at the left-leaning advocacy group Americans for Tax Fairness, opined. President Joe Biden proposed ending this loophole and making billionaires “pay their fair share,” so why does it look like his party won’t touch it?

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INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-

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PODCAST: “New York Times” Article on Hospital Price Transparency

Learn WHY Hospital Prices Are Kept SECRET

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BY ERIC BRICKER MD

The New York Times Posted an Article Explaining Hospital Prices for Patients on Private Insurance Plans Such as Blue Cross, United Healthcare, Cigna and Aetna.

Your comments are appreciated.

CITE: https://www.r2library.com/Resource/Title/0826102549

MORE: https://medicalexecutivepost.com/2021/06/02/hospital-financial-price-transparency/

PODCAST #2: https://medicalexecutivepost.com/2021/05/19/podcast-price-transparency-in-healthcare/

THANK YOU

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PODCAST: Population Health and Patient Economics

HIGH COST MEDICAL CLAIMANTS

CITE: https://www.r2library.com/Resource/Title/0826102549

By Eric Bricker MD

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ESSAY: https://medicalexecutivepost.com/2019/08/31/is-health-economics-heterodoxic-or-not/

ESSAY: https://www.modernhealthcare.com/education/ama-adopts-new-policy-training-physicians-healthcare-economics

MORE: https://medicalexecutivepost.com/2019/11/10/ricardian-derived-demand-economics-in-medicine/

MORE: https://medicalexecutivepost.com/2014/08/27/financial-and-health-economics-benchmarking/

MORE: https://healthcare

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INTERVIEW: A Solution for Healthcare Financing?

HEALTHCARE FINANCING

Former: CEO and Founder
Superior Consultant Company, Inc.
[SUPC-NASD]

EDITOR’S NOTE: I first met Rich in B-school, when I was a student, back in the day. He was the Founder and CEO of Superior Consultant Holdings Corp. Rich graciously wrote the Foreword to one of my first textbooks on financial planning for physicians and healthcare professionals. Today, Rich is a successful entrepreneur in the technology, health and finance space.

-Dr. David E. Marcinko MBA CMP®

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Staff & Contributors - CHAMPIONS OF WAYNE

By Richard Helppie

Today for your consideration – How to fix the healthcare financing methods in the United States?

I use the term “methods” because calling what we do now a “system” is inaccurate. I also focus on healthcare financing, because in terms of healthcare delivery, there is no better place in the world than the USA in terms of supply and innovation for medical diagnosis and treatment. Similarly, I use the term healthcare financing to differentiate from healthcare insurance – because insurance without supply is an empty promise.

This is a straightforward, 4-part plan. It is uniquely American and will at last extend coverage to every US citizen while not hampering the innovation and robust supply that we have today. As this is about a Common Bridge and not about ideology or dogma, there will no doubt be aspects of this proposal that every individual will have difficulty with. However, on balance, I believe it is the most fair and equitable way to resolve the impasse on healthcare funding . . . .

CITE: https://www.r2library.com/Resource/Title/0826102549

Let me start in an area sure to raise the ire of a few. And that is, we have to start with eliminating the methods that are in place today. The first is the outdated notion that healthcare insurance is tied to one’s work, and the second is that there are overlapping and competing tax-supported bureaucracies to administer that area of healthcare finance.

Step 1 is to break the link between employment and health insurance. Fastest way to do that is simply tax the cost of benefits for the compensation that it is. This is how company cars, big life insurance policies and other fringe benefits were trimmed. Eliminating the tax-favored treatment of employer-provided healthcare is the single most important change that should be made.

Yes, you will hear arguments that this is an efficient market with satisfied customers. However, upon examination, it is highly risky, unfair, and frankly out of step with today’s job market.

Employer provided health insurance is an artifact from the 1940’s as an answer to wage freezes – an employer could not give a wage increase, but could offer benefits that weren’t taxed. It makes no sense today for a variety of reasons. Here are a few:

1. Its patently unfair. Two people living in the same apartment building, each making the same income and each have employer provided health insurance. Chris in unit 21 has a generous health plan that would be worth $25,000 each year. Pays zero tax on that compensation. Pat, in unit 42 has a skimpy plan with a narrow network, big deductibles and hefty co-pays. The play is worth $9,000 each year. Pat pays zero tax.

3. The insurance pools kick out the aged. Once one becomes too old to work, they are out of the employer plan and on to the retirement plan or over to the taxpayers (Medicare).

4. The structure is a bad fit. Health insurance and healthy living are longitudinal needs over a long period of time. In a time when people change careers and jobs frequently, or are in the gig economy, they are not any one place long enough for the insurance to work like insurance.

5. Creates perverse incentives. The incentives are weighted to have employers not have their work force meet the standards of employees so they don’t have to pay for the health insurance. Witness latest news in California with Uber and Lyft.

6. Incentives to deny claims abound. There is little incentive to serve the subscriber/patient since the likelihood the employer will shop the plan or the employee will change jobs means that stringing out a claim approval is a profitable exercise.

7. Employers have difficulty as purchasers. An employer large enough to supply health insurance has a diverse set of health insurance needs in their work force. They pay a lot of money and their work force is still not 100% happy.

Net of it, health insurance tied to work has outlived its usefulness. Time to end the tax-favored treatment of employer-based insurance. If an employer wants to provide health insurance, they can do it, but the value of that insurance is reflected in the taxable W-2 wages – now Pat and Chris will be treated equally.

Step 2 is to consolidate the multiple tax-supported bureaus that supply healthcare. Relieve the citizens from having to prove they are old enough, disabled enough, impoverished enough, young enough. Combine Medicare, Medicaid, CHIP, Tricare and even possibly the VA into a single bureaucracy. Every American Citizen gets this broad coverage at some level. Everyone pays something into the system – start at $20 a year, and then perhaps an income-adjusted escalator that would charge the most wealthy up to $75,000. Collect the money with a line on Form 1040.

I have not done the exact math. However, removing the process to prove eligibility and having one versus many bureaucracies has to generate savings. Are you a US Citizen? Yes, then here is your base insurance. Like every other nationalized system, one can expect longer waits, fewer referrals to a specialist, and less innovation. These centralized systems all squeeze supply of healthcare services to keep their spend down. The reports extolling their efficiencies come from the people whose livelihoods depend on the centralized system. However, at least everyone gets something. And, for life threatening health conditions, by and large the centralized systems do a decent job. With everyone covered, the fear of medical bankruptcy evaporates. The fear of being out of work and losing healthcare when one needs it most is gone.

So if you are a free market absolutist, then the reduction of vast bureaucracies should be attractive – no need for eligibility requirements (old enough, etc.) and a single administration which is both more efficient, more equitable (everyone gets the same thing). And there remains a private market (more on this in step 3) For those who detest private insurance companies a portion of that market just went away. There is less incentive to purchase a private plan. And for everyone’s sense of fairness, the national plan is funded on ability to pay. Bearing in mind that everyone has to pay something. Less bureaucracies. Everyone in it together. Funded on ability to pay.

Step 3 is to allow and even encourage a robust market for health insurance above and beyond the national plan – If people want to purchase more health insurance, then they have the ability to do so. Which increases supply, relieves burden on the tax-supported system, aligns the US with other countries, provides an alternative to medical tourism (and the associated health spend in our country) and offers a bit of competition to the otherwise monopolistic government plan.

Its not a new concept, in many respects it is like the widely popular Medigap plans that supplement what Medicare does not cover.

No one is forced to make that purchase. Other counties’ experience shows that those who choose to purchase private coverage over and above a national plan often cite faster access, more choice, innovation, or services outside the universal system, e.g., a woman who chooses to have mammography at an early age or with more frequency than the national plan might allow.  If the insurance provider can offer a good value to the price, then they will sell insurance. If they can deliver that value for more than their costs, then they create a profit. Owners of the company, who risk their capital in creating the business may earn a return.

For those of you who favor a free market, the choices are available. There will be necessary regulation to prevent discrimination on genetics, pre-existing conditions, and the like. Buy the type of plan that makes you feel secure – just as one purchases automobile and life insurance.For those who are supremely confident in the absolute performance of a centralized system to support 300+ million Americans in the way each would want, they should like this plan as well – because if the national plan is meeting all needs and no one wants perhaps faster services, then few will purchase the private insurance and the issuers will not have a business. Free choice. More health insurance for those who want it. Competition keeps both national and private plans seeking to better themselves.

Step 4 would be to Permit Access to Medicare Part D to every US Citizen, Immediately

One of the bright spots in the US Healthcare Financing Method is Medicare Part D, which provides prescription drug coverage to seniors. It is running at 95% subscriber satisfaction and about 40% below cost projections.

Subscribers choose from a wide variety of plans offered by private insurance companies. There are differences in formularies, co-pays, deductibles and premiums.

So there you have it, a four part plan that would maintain or increase the supply of healthcare services, universal insurance coverage, market competition, and lower costs. Its not perfect but I believe a vast improvement over what exists today. To recap:

1. Break the link between employment and healthcare insurance coverage, by taxing the benefits as the compensation they are.

2. Establish a single, universal plan that covers all US citizens paid for via personal income taxes on an ability-to-pay basis.  Eliminate all the other tax-funded plans in favor of this new one.

3. For those who want it, private, supplemental insurance to the national system, ala major industrialized nations.

4. Open Medicare Part D (prescription drugs) to every US citizen. Today.

YOUR THOUGHTS ARE APPRECIATED.

Thank You

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PODCASTS: Surgery Safety Checklists

ATUL GAWANDE MD

Medical Culture

BY ERIC BRICKER MD

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

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PODCAST: Lessons for [physician] Investors: The Trial of Theranos Founder ELIZABETH HOLMES

By Bertalan Meskó, MD PhD

Wofür R&D Jahre benötigt, braucht künstliche Intelligenz wenige Minuten“

Elizabeth Holmes has no idea how much damage she has done with Theranos. As I often wrote, for digital technologies to gain ground and become part of our everyday lives, we need not only technological solutions but a cultural paradigm shift. Holmes rolled a massive rock in front of it.

Similarly, Facebook’s data privacy practices do not increase people’s confidence in the company’s products. All the scandals that have surrounded the social network could backfire when Facebook wants to step into healthcare – and this is exactly what we wrote about in our latest article, Is There A Place For Facebook In Healthcare? In it, we looked at what Facebook currently does in medicine and evaluated whether those are viable ways to follow in the future.

Take care,
Berci
Bertalan Meskó, MD PhD
The Medical Futurist

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MORE: https://www.cnbc.com/2021/09/10/the-lessons-for-investors-from-the-trial-of-theranos-founder-elizabeth-holmes.html?utm_source=The+Medical+Futurist+Newsletter&utm_campaign=f5b0ff1b6b-EMAIL_CAMPAIGN_2021_9_14&utm_medium=email&utm_term=0_efd6a3cd08-f5b0ff1b6b-399696053&mc_cid=f5b0ff1b6b&mc_eid=40fee31c25

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PODCAST: United States Health Spending by Race & Ethnicity (2021)

CULTURE IN HEALTHCARE

Culture is a factor to consider with healthcare. Depending on the culture they may seek alternative treatment such as homeopathic and treatment they have been raised with in their country Some cultures will get medications from their country because they believe in their medical system more then what is offered.

BY IHME

Creating a culture of health - Sedgwick

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Dr. Joseph L. Dieleman, Associate Professor in the Department of Health Metric Sciences at the University of Washington, is the lead author of the study “US Health Care Spending by Race and Ethnicity, 2002-2016,” published August 17, 2021 in the Journal of the American Medical Association

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PODCAST: https://www.youtube.com/watch?v=xbkSZmB-3f8&t=171s

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PODCASTS: FDA Pharmaceutical Industry Ties

CONFLICTS OF INTEREST?

The New York Times Had an Excellent Article on the FDA on September 2, 2021.

The Article Described How the FDA Began Receiving Funding from the Pharmaceutical Industry Itself to Pay for FDA Employee Salaries in 1992–a Potential Conflict-of-Interest. Subsequently, a Study Found that 1/3 of Drugs Approved by the FDA Were Found to Have Safety Problems from 2000 -2010. Another Potential Conflict-of-Interest is Number of FDA Regulators Who Leave Their Positions to Take High-Paying Jobs at Pharmaceutical Companies.

By Eric Bricker MD

FDA rescinds emergency authorization for COVID-19 antibody treatment  bamlanivimab | TheHill

PODCAST:

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PODCAST: INELASTIC Healthcare Demand Explained

BY ERIC BRICKER MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

MORE: https://medicalexecutivepost.com/2019/11/10/ricardian-derived-demand-economics-in-medicine/

Your comments are appreciated.

THANK YOU

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Pass ALL PODIATRY BOARD Certification Examinations!

Electronic Study Guides and A.I.

Advertisement

ALL NEW AND IMPROVED STUDY GUIDE SOFTWARE !

http://www.PodiatryPrep.org

[Versions 2.0]

As we complete our first quarter-century of service to the podiatric community, it is only fitting to update our colleagues of the extreme changes taking place in the individual board exam testing space.

Some of these changes are perfunctory with little practical impact; while others are so profound as to cause extreme consternation in the practitioner community writ-large.

For example:

Nomenclature:

  1. FROM: American Board of Podiatric Surgery -TO- American Board of Foot and Ankle Surgery.
  2. FROM: American Board of Primary Podiatric Medicine and Orthopedics -TO- American Board of Foot and Ankle Medicine and Orthopedics.
  3. FROM: ORAL questions -TO- “oral” computerized Clinical Pathology Conference-like queries
  4. FROM: American Board of Podiatric Medical Specialities -TO- American Board of Medical Specialities, in Podiatry.
  5. FROM: Non-Competitive MOC Exams -TO-Competitive MOC Re-Cert Tests.
  6. FROM: Solely DPM crafted exams to professional psychometric designs by PhDs, computer scientists, and E.Eds.

ABPS Statistics: ABPS Statistics

SURGERY FOR FOOT & ANKLE — Advance Foot & Ankle Care

Testing Dynamics:

  1. The Surgery Certification and Qualification tests now rely less on rote memorization and more on applied cognitive content, and may be very different from any other test you have ever taken, to date [ie., multiple choice or fill-in-the-blank].
  2. The Primary Medicine and Orthopedics Certification and Qualification tests now rely less on rote memorization and more on applied cognitive content, and may be very different from any test you have ever taken, to date [ie., multiple choice or fill-in-the-blank].
  3. Traditional human ORAL questions have been usurped by [non-human] computerized Clinical Pathology Conference [CPC] queries; AKA: Computer Based Testing [CBT] or Clinical Scenario Questions [CSQs].
  4. American Board of Medical Specialities now includes over a dozen general categories; including podiatry.
  5. The Re-Certification tests for Maintenance of Certification [MOC] now rely much less on rote memory, as in the past; and more on deeply experiential content. It is also becoming more competitive, to-date.
  6. So-called “wrong” questions by-design are called psychological “stressor questions” and are used to evoke emotional volatility and waste precious time. So, BEWARE!. Moreover; the so-called “points-to-pass” AND “points-to-fail” philosophy may be re-emerging.

More Here: FARC Promo.Psychometrics

This is the dynamic PODIATRY PREP difference [Unique Competitive Advantage] between our customized Study Guide File Programs with customized board exam preparation content, and the static general “off-shelf” books or Web guides of the past; and/or traditional CEU educational seminars.

SAMPLE QUESTIONS: Traditional Rote ISTITUTIONAL RESIDENCY Questions versus Experiential and Cognitive Styled INDIVIDUAL PRACTITIONER [CBT/CBS] Formats

PRACTITIONERS: Be sure to specify the target exam and customize your own personal study guide, today.

Pilon Fractures: pilon fractures

Hallux Rigidus: HALLUX.LIMITUS.RIGIDUS.SURGERY

AKIN: 3[1][1].AKIN.OSTEOTOMY

CHEVRON: 5[1][1].CHEVRON.MODIFICATIONS

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ORDER NOW: https://podiatryprep.org/order-form/

PHONE: 770-448-0769

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PODCAST: Healthcare Customer Service is Terrible!

WHY?

BY ERIC BRICKER MD

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ORDER TEXT: https://www.amazon.com/dp/B0091ICH30?ref_=k4w_oembed_oQPgAstGiXiIgL&tag=kpembed-20&linkCode=kpd

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PODCAST: On State Health Insurance Commissioners

Not so Hot!

BY ERIC BRICKER MD

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RELATED: https://ocgnews.com/former-georgia-insurance-commissioner-jim-beck-convicted-of-fraud/

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

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PODCAST: Medical Unions in Healthcare

BY ERIC BRICKER MD

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MORE: https://medicalexecutivepost.com/2011/03/05/the-collapse-of-medical-labor-unions/

RELATED: https://medicalexecutivepost.com/2016/12/16/on-doctor-labor-strikes/

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PODCAST: The Case for Physician Entrepreneurship

BY Ismail Sayeed, MD

We are joined by Dr Ismail Sayeed, pediatrician and physician entrepreneur to talk about his cross-border telehealth communications platform Vios, why he transitioned away from clinical practice and how his entrepreneurial journey could not have been possible without that clinical background.

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Doctor Entrepreneur's Podcast | Libsyn Directory

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PODCAST: https://share.transistor.fm/s/f5691aea

RELATED: https://getpocket.com/explore/item/all-companies-should-live-by-the-jeff-bezos-70-percent-rule?utm_source=pocket-newtab

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COMMUNITY MASKING: The Impact on COVID-19

A Cluster-Randomized Trial in Bangladesh

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Freudenberg's surgical masks get FDA clearance

LINK: https://www.poverty-action.org/sites/default/files/publications/Mask_RCT____Symptomatic_Seropositivity_083121.pdf

YOUR COMMENTS ARE APPRECIATED.

MORE: https://www.msn.com/en-us/news/world/us-records-40-million-known-virus-cases/ar-AAOaN08?li=BBnb7Kz

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How We INVEST IN INFLATION?

STRATEGIES AND MITIGATION

Finding investments to weather the storm. Strategies and ways to mitigate inflation risk, including investing in businesses with pricing power, capital intensity, and investing abroad.

By Vitaliy Katsenelson CFA

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PODCAST: The Dartmouth Atlas of Healthcare

Geographic Variation in Spine Surgery

By Dr. Eric Bricker MD

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MORE: https://www.dartmouthatlas.org/

John Wennberg MD: https://tdi.dartmouth.edu/about/our-people/directory/john-e-wennberg-md-mph

CHECKLISTS: https://medicalexecutivepost.com/2009/01/20/a-homer-simpson-moment-of-clarity-on-medical-quality/

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Joint vs. Separate Ownership of Physician Assets

DOCTORS MUST KNOW THE DIFFERENCE

 Dr. David Marcinko MBA CMP®

https://i1.wp.com/images.lawyers.com/LBM_Images/Lawyers/lawyer-j-christopher-miller-photo-1613768.jpg

J. Christopher Miller; JD

HISTORY

Do you remember when Andy DuFresne confronts the chief guard of his prison in The Shawshank Redemption and tells him to divert an inherited sum of money into his wife’s name? Even sixty-five years after the 1949 setting of that conversation, a common means of protecting assets from the reach of creditors is to transfer property into a spouse’s name. Assuming that the spouse is not also at substantial risk of being the target of lawsuits because of the spouse’s profession or lifestyle, it is an effective means of accomplishing that goal. Creditors with valid judgments against an individual may only attach and seize those assets owned by that individual.  Anything worth doing is worth doing right, however, and there are several pointers to structuring asset ownership in a way that maximizes its protective value.

STATES

A small number of states, such as Hawaii, Pennsylvania, and Florida, have statutes that automatically protect property jointly owned by spouses from creditors of either spouse, but often not from creditors of both spouses together. Property that benefits from this characterization is held in as a “tenancy by the entirety,” and prevents only one spouse from transferring away property that the married couple obtained together.  Again, variation in state law determines just how beneficial the formation of a “tenancy by the entirety” can be from an asset protection standpoint.  This protection comes from a public interest in the preservation of marital assets, such that one spouse’s indiscretion may not harm the position of the other spouse. 

The most significant limits to the advantage provided by the tenancies of the entirety are first, that the creditors with claims against both spouses may seize such jointly held property, and second, that upon the first death between the spouses, the property flows directly to the surviving spouse alone, who then no longer has the benefit of the creditor protection.  Moreover, in April of 2002, the U.S. Supreme Court sharply curtailed the benefit provided by tenancies by the entirety by ruling that it does not shield an asset from the federal authorities, even if the tax liability was incurred only by one spouse.[1]

Some states in the South and West are community property states, which is similar to, but not the same as, tenancy by the entirety.  Under the community property theory, all property acquired by either spouse during the residency in that state (or in some states, prior to or during the residency), will be considered jointly owned property even if titled to an individual spouse. Merely by moving to one of these community property states, a person can automatically shift assets, thus reducing the quantity of assets subject to the creditors of the wealthier spouse.

PROPERTY

Community property and land owned as tenants-by-the-entirety is different from a third type of ownership called Joint Tenancy with Rights of Survivorship, sometimes abbreviated as “JTWROS”.  Joint tenancy with rights of survivorship may ease some burdens associated with probating a decedent’s estate, but this form of ownership is not ideal when viewed through the asset protection prism.

An alternative is to hold assets in the name of one spouse or the other, or as “tenants-in-common.”  Tenancy-in-common is best described as a situation in which each spouse owns a one-half undivided share in the property, but does not have the automatic right to full ownership at the death of the other spouse. 

Three advantages flow from this form of ownership:

Asset Protection-Protect Your Assets from Lawsuits ...
  • Neither spouse owns the property exclusively.

A creditor seizing the interest of one spouse would not have a valuable asset because it could not evict the remaining spouse, so creditors will attack these assets only as a last resort to satisfy their claims. However, a lien recorded against either fractional interest would have to be satisfied upon its sale, so that the net proceeds would be reduced by the amount of the lien.  For this reason, tenancy-in-common is only a temporary means of protecting an asset from an adverse judgment, and not quite the same as fully separate ownership.  This flaw is one reason why many estate planners recommend the funding of property into the name of a spouse or family member less vulnerable to adverse judgments.

  • If either spouse were to die, only half of the property would be subject to estate tax.

Ownership of property as tenants-in-common helps in the estate planning arena by facilitating the process of equalizing the assets held by each spouse. Changes made during 2010 and 2013 to the estate tax laws have pushed the federal estate tax exemption above $5 million, so fewer individuals (less than ½ of 1% of the general public by some estimates) will realize an actual tax savings from such planning. Even more appealing is that surviving spouses can now claim the unused exemption left behind by a deceased spouse. Estate tax concerns are now playing a much smaller role in recommending how spouses own their property.

  • A dying spouse has the ability to control how his or her interest is distributed.

In many simple Wills, all property of a spouse is given by bequest to the surviving spouse.  Such a bequest could include partial ownership interests in real estate.  If the surviving spouse is concerned about asset protection, this additional property would not be beneficial because it would easily be sacrificed to the survivor’s creditors.  One way of avoiding this result is to build an estate plan in which each spouse bequests the partial interest owned by that spouse to a trust.  At the first death between two spouses, the trust will hold the partial ownership interest for the benefit of the surviving spouse.  The trust holding the partial residence interest preserves the deterrent faced by creditors of the surviving spouse because seizure of the surviving spouse’s interest would not terminate the spouse’s right to use the land provided for in the trust.

A different set of rules applies to property held jointly by medical professionals who are not married to each other. If property is owned jointly among siblings or business associates instead of a business entity, the owners should make sure that the deed names them as tenants-in-common.  Otherwise, each successive death among the owners will shift the ownership to the survivors, and leave the family of the deceased owner with no lasting value from the owner’s investment into the property and its improvements.

LONG TERM

Assets should be held in a way that protects them from creditors for the long term. The form of asset holdings should thus be a significant part of the discussions held with professional advisors, so that the protection lasts beyond your death or that of your spouse. Structure the protected assets so that they do not flow back to you if your spouse should pass away.  In this manner, integrated asset protection, estate planning, and financial planning unite to protect the family’s interests by extending the benefits of creditor protection for the long term.

ASSESSMENT: Your comments are appreciated.

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[1] See United States v. Craft, 535 U.S. 274 (Apr. 17, 2002).

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

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PODCAST: Health Insurance Claims Adjudication Explained

MEDICAL CLAIMS ADJUDICATION

By Eric Bricker MD

Claims Adjudication Occurs between a Healthcare Provider Submitting a Claim to a Health Insurance Company and the Insurance Company Making a Payment Back to the Provider.

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Does Money REALLY Buy Happiness?

Maybe IT CAN

Psychological Considerations

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Money Can Buy Happiness After All, According to New Study

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R&D 2010: https://www.pnas.org/content/107/38/16489

R&D 2021: https://www.pnas.org/content/118/4/e2016976118

DEM: https://medicalexecutivepost.com/2020/12/11/the-science-of-happiness/

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PODCAST: The State of Mental Health

IN THE USA

By Eric Bricker MD

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MORE: https://medicalexecutivepost.com/2021/07/28/mental-health-entrepreneurial-start-up/

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PODCAST: The Health Economics of Renal Dialysis

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KIDNEY DIALYSIS

CITE: https://www.r2library.com/Resource/Title/0826102549

BY DR. ERIC BRICKER MD

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PODCAST: Six [6] Commission Relationships in Healthcare

The Healthcare Industry is Filled with Commission Relationships Where Money Is Paid, But It Is Not Always Obvious.

BY RIC BRICKER MD

Your comments and thoughts are appreciated.

CITE: https://www.r2library.com/Resource/Title/0826102549

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How vaccine-induced immunity stacks up against natural immunity after an infection?

By Ivan Gazit, Roei Shlezinger, Galit Perez, Roni Lotan, Asaf Peretz, Amir Ben-Tov, Dani Cohen, Khitam Muhsen, Gabriel Chodick, Tal Patalon

***

Experts advise people who’ve had COVID-19 to get vaccinated. Still, natural immunity seems to provide stronger, more lasting protection than vaccines alone.

And, it’s a staggering number: Nearly 39 million Americans have had confirmed coronavirus infections – almost 12% of the population.

A spate of new research suggests that natural infection can offer powerful long-term protection against the coronavirus, but that immunity isn’t guaranteed. So researchers still recommend a full vaccine course to lower the risk of reinfection for people who’ve had COVID-19 before.

Genomic Study Points to Natural Origin of COVID-19 – NIH Director's Blog

Here’s how to understand your immunity if you’ve had COVID-19.

READ: https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1

RELATED: https://www.thelancet.com/action/showPdf?pii=S1473-3099%2821%2900460-6

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PODCAST: The ‘Weaponization’ Of The CV19 Vaccine?

DR. JOHN TRAVIS MD MPH

John W. “Jack” Travis, MD, MPH, completed his medical degree at Tufts University and a residency in preventive medicine at Johns Hopkins, where he received a Masters in Public Health and created one of the first computerized Health Risk Assessments (HRAs).

Dr. Jack joins colleague Pete R. Peter R. Quinones to describe what he refers to as the “weaponization of vaccines” and specifically concentrates on the CV19 “vaccines”.

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COVID-19 Information | Peachtree Corners, GA

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PODCAST: https://freemanbeyondthewall.libsyn.com/episode-586

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Study Finds COVID-19 Accelerated Physician Practice Acquisitions

Study Finds COVID-19 Accelerated Physician Practice Acquisitions

By Health Capital Consultants, LLC


A recent study from Physicians Advocacy Institute (PAI), prepared by Avalere Health, associated the growing number of both physician practice acquisitions and employed physicians between 2019 and 2021 with the COVID-19 pandemic.

To study COVID-19’s impact on physician employment trends, the June 2021 study evaluated the IQVIA OneKey database that contains physician practice and health system ownership information.

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To assess these trends at a national and regional level, Avalere researchers studied the two-year period from January 1, 2019 to January 1, 2021. (Read more…)

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Litigation and Legacy in Education and Medicine

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Distinct Fields Bound by Certain Parallels

[By Jeffrey M. Hartman]  [Dr. David Marcinko MBA]

jhThe fields of education and medicine are distinct, yet bound by certain parallels. In particular, litigation has shaped present practices in each field. Case law has expanded the rights of students and parents while increasing protections for patients. Resulting improvements in the quality of education or health care vary depending on perspective.

Of greater certainty is the comparable increase in procedures, protocols, and overall bureaucracy needed in each field as a result of litigation.

Compensation Culture

Throughout the 1980s and 1990s, a perceived rise in civil cases led some pundits to ascribe a compensation culture to certain segments of America. Sensationalistic stories about plaintiffs seeking outrageous damages generated concern that this compensation culture was real and threatening to business interests across the country.

Media outlets frequently portrayed those behind the questionable suits as poor but entitled people looking to take advantage of tort law for personal gain. Pundits claimed these cases represented a decline in personal responsibility matched by an increase in shameless greed. At the same time, the notion of frivolous litigation creating unnecessary layers of bureaucracy took hold in the American conscious and remained there.

Predatory Litigation

The actual incidence and impact of supposedly predatory litigation remains debatable. Some civil liberties advocates suggest American companies created smear campaigns in the media to make the issue appear more prevalent than it was while attempting to curtail future suits. Without question, some companies have had to pay significant damages, particularly in class action cases.

However, the claims against these companies typically haven’t materialized without cause. Tort law always has existed as a protection. A few plaintiffs and attorneys may have exploited these laws and others may continue to do so. Such exploitative cases haven’t outnumbered cases built around legitimate claims.

Ethics

Questions about the ethics and even the prevalence of civil suits are the stuff of legal philosophy. The more immediate question is whether or not such cases have impacted particular fields and if so, what has been the nature of the impact. Legal precedents often lead to regulation of industries. Some forms of regulation can alter business practices. This can be for the better of all involved. Even if regulation increases costs, it often improves safety or quality.

In fields such as education and medicine, litigation has profoundly influenced practices. Influence on quality is another matter.

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education

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Education

The impact of litigation on education has been most apparent in special education. Class action suits resulted in the foundational special education law in America. Case law continues to establish precedents and corresponding mandates that states and school districts must follow. Many of the cases parents bring against districts stem from these districts struggling to abide by demanding mandates. Large districts retain teams of attorneys who spend a disproportionate amount of their time handling special education cases. Special education bureaucracy requires many schools to employ administrators who deal solely with compliance and protocol. In special education, litigation has led to more litigation.

Special Education

Special education litigation affects school practices in several additional ways. Compensatory education losses in special education pull from overall budgets. Teachers need to compile data on special education students not just for planning, but to protect themselves and their schools in disputes with parents. School members of IEP teams construct programs from the perspective of how readily they can defend themselves should a legal case develop. Decisions about goals for students are often based on the likelihood of students appearing to make progress in a way that prevents potential conflict. When lawsuits do emerge, school districts have demonstrated a historic willingness to settle and give parents what they want rather than getting involved in lengthy and costly legal battles.

Medicine

In medicine, public perception of the effects of litigation are somewhat skewed. Malpractice cases make for attention-getting headlines. However, the number of malpractice suits has decreased in recent years. The average amount for damage claims has leveled off as well. These cases tend to be reserved for incidents involving serious injury and death. Although this might seem counter-intuitive, plaintiffs often lose malpractice cases. Preventable mistakes still account for a massive amount of loss in medicine, but the public perception of malpractice suits driving up insurance costs isn’t exactly accurate.

Malpractice Liability

This isn’t to say litigation has had no effect. Some health care professionals have had their careers upended by ruinous malpractice suits. A few states have enacted damage caps to limit what plaintiffs can claim. Expensive malpractice insurance has become ubiquitous for health care professionals. Many physicians have been suspected of practicing defensive medicine, or over-diagnosing for their own protection from suits. Defensive medicine resembles the tendency of special education teachers to write IEPs that ensure student progress. Layers of bureaucracy weigh on health care systems. Much of this exists as liability protections. Again, this parallels how schools have to handle special education.

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Improvements?

So, has litigation improved either field? In education, programs for students with special needs have expanded opportunities for equitable education. The expansion stems directly from litigation. However, special education has not solved the dearth of opportunities waiting for students with special needs after high school. At the same time, the expense of special education—including the continuing need for defense against further litigation—mires the most vulnerable school districts.

Health care has improved in many ways in recent decades, but most of these improvements are tied to technological advancements rather than litigation. Technological innovations also have contributed to increases in costs. The surge in bureaucracy does more to protect health care systems than patients, but patients have indirectly benefitted somewhat from the precautions litigation has made necessary. Patient behavior continues to drive the incidence of illness, but widespread health education campaigns have made some impact in behaviors such as smoking. Litigation has aided the creation of such public campaigns through pressure on lawmakers.

Imperfect Analogues

Education and medicine aren’t perfectly analogous, so certain comparisons can’t be made fairly. Despite differences, each field has had to respond in similar ways to changes in society. Pressure from litigation is just one of these changes. Other changes have involved how each field interacts with the public it serves. Schools and hospitals have increasingly become de facto social service providers for needy communities. Educators and physicians have had to become wary of their reputations via online ratings sites and their presence in social media in general.

Experts in both fields have their positions challenged by what information parents and patients find online. These similarities might be more analogous than similarities wrought by litigation.

Although the effects of litigation have been different in the two fields, the response in each field has been noteworthy. Litigation more or less created special education. The burgeoning field has improved equitable opportunities while creating logistical quagmires for schools. Outcomes for students have been limited by factors schools can’t control, thus derailing some of the idealistic aims of litigation. Poor outcomes haven’t lessened the burden special education law places on schools.

Meanwhile, public perception of how malpractice has affected medicine differs from the actual effects. Litigation has affected physician practices more than it has affected costs. Patient care has improved through technology more than through legal mandates. Protections have improved vicariously through the threat of litigation, but this might be inadvertently affecting how physicians offer treatment.

Assessment

Overall, litigation has complicated each field by adding layers of protective bureaucracy. Improvements in quality might not be commensurate with the effort expended. Often what the public gains in protection is loses in simplicity and effectiveness. These fields exemplify this maxim.

ABOUT

Jeffrey M. Hartman is a former teacher who blogs at http://jeffreymhartman.com/

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Conclusion

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A Brief History of Managed Medical Care in the USA

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By National Council on Disability

The origins of managed care can be traced back to at least 1929, when Michael Shadid, a physician in Elk City, Oklahoma, established a health cooperative for farmers in a small community without medical specialists or a nearby general hospital. He sold shares to raise money to establish a local hospital and created an annual fee schedule to cover the costs of providing care. By 1934, 600 family memberships were supporting a staff that included Dr. Shadid, four newly recruited specialists, and a dentist. That same year, two Los Angeles physicians, Donald Ross and Clifford Loos, entered into a prepaid contract to provide comprehensive health services to 2,000 employees of a local water company.endnote[i]

Development of Prepaid Health Plans

Other major prepaid group practice plans were initiated between 1930 and 1960, including the Group Health Association in Washington, DC, in 1937, the Kaiser-Permanente Medical Program in 1942, the Health Cooperative of Puget Sound in Seattle in 1947, the Health Insurance Plan of Greater New York in New York City in 1947, and the Group Health Plan of Minneapolis in 1957. These plans encountered strong opposition from the medical establishment, but they also attracted a large number of enrollees.

Today, such prepaid health plans are commonly referred to as health maintenance organizations (HMOs). The term “health maintenance organization,” however, was not coined until 1970, with the aim of highlighting the importance that prepaid health plans assign to health promotion and prevention of illness. HMOs are what most Americans think of when the term “managed care” is used, even though other managed care models have emerged over the past 40 years.

Public Managed Care Plans

The enactment of the Health Maintenance Organization Act of 1973 (P. L. 93-222) provided a major impetus to the expansion of managed health care. The legislation was proposed by the Nixon Administration in an attempt to restrain the growth of health care costs and also to preempt efforts by congressional Democrats to enact a universal health care plan. P. L. 93-222 authorized $375 million to assist in establishing and expanding HMOs, overrode state laws restricting the establishment of prepaid health plans, and required employers with 25 or more employees to offer an HMO option if they furnished health insurance coverage to their workers. The purpose of the legislation was to stimulate greater competition within health care markets by developing outpatient alternatives to expensive hospital-based treatment. Passage of this legislation also marked an important turning point in the U.S. health care industry because it introduced the concept of for-profit health care corporations to an industry long dominated by a not-for-profit business model.endnote[ii]

In the decade following the passage of P. L. 93-222, enrollment in HMOs grew slowly. Stiff opposition from the medical profession led to the imposition of regulatory restrictions on HMO operations. But the continued, rapid growth in health care outlays forced government officials to look for new solutions. National health expenditures grew as a proportion of the overall gross national product (GNP) from 5.3 percent in 1960 to 9.5 percent in 1980.endnote[iii] In response, Congress in 1972 authorized Medicare payments to free-standing ambulatory care clinics providing kidney dialysis to beneficiaries with end-stage renal disease. Over the following decade, the Federal Government authorized payments for more than 2,400 Medicare procedures performed on an outpatient basis.endnote[iv]

Responding to the relaxed regulatory environment, physicians began to form group practices and open outpatient centers specializing in diagnostic imaging, wellness and fitness, rehabilitation, surgery, birthing, and other services previously provided exclusively in hospital settings. As a result, the number of outpatient clinics skyrocketed from 200 in 1983 to more than 1,500 in 1991,endnote[v] and the percentage of surgeries performed in hospitals was halved between 1980 (83.7%) and 1992 (46.1%).endnote[vi]

mind-investing-behavioral-finance

The Influence of Medicare Prospective Payments

Health care costs, however, continued to spiral upward, consuming 10.8 percent of GNP by 1983. In an attempt to slow the growth rate, Congress in 1982 capped hospital reimbursement rates under the Medicare program and directed the secretary of HHS to develop a case mix methodology for reimbursing hospitals based on diagnosis-related groups (DRGs). As an incentive to the hospital industry, the legislation (the Tax Equity and Fiscal Responsibility Act (P. L. 97-248)) included a provision allowing hospitals to avoid a Medicare spending cap by reaching an agreement with HHS on implementing a prospective payment system (PPS) to replace the existing FFS system. Following months of intense negotiations involving federal officials and representatives of the hospital industry, the Reagan Administration unveiled a Medicare PPS. Under the new system, health conditions were divided into 468 DRGs, with a fixed hospital payment rate assigned to each group.

Once the DRG system was fully phased in, Medicare payments to hospitals stabilized.endnote[vii] However, since DRGs applied to inpatient hospital services only, many hospitals, like many group medical practices, began to expand their outpatient services in order to offset revenues lost as a result of shorter hospital stays. Between 1983 and 1991, the percentage of hospitals with outpatient care departments grew from 50 percent to 87 percent. Hospital revenues derived from outpatient services doubled over the period, reaching 25 percent of all revenues by 1992.endnote[viii]

Since DRGs were applied exclusively to Medicare payments, hospitals began to shift unreimbursed costs to private health insurance plans. As a result, average per employee health plan premiums doubled between 1984 and 1991, rising from $1,645 to $3,605.endnote[ix] With health insurance costs eroding profits, many employers took aggressive steps to control health care expenditures. Plan benefits were reduced. Employees were required to pay a larger share of health insurance premiums. More and more employers—especially large corporations—decided to pay employee health costs directly rather than purchase health insurance. And a steadily increasing number of large and small businesses turned to managed health care plans in an attempt to rein in spiraling health care outlays.

Managed Long-Term Services and Supports

Arizona became the first state to apply managed care principles to the delivery and financing of Medicaid-funded LTSS in 1987, when the federal Health Care Financing Administration (later renamed the Centers for Medicare and Medicaid Services) approved the state’s request to expand its existing Medicaid managed care program. Medicaid recipients with physical and developmental disabilities became eligible to participate in the Arizona Long-Term Care System as a result of this program expansion. Over the following two decades, a number of other states joined Arizona in providing managed LTSS, and by the summer of 2012, 16 states were operating Medicaid managed LTSS programs.endnote[x]

Scientists at work

Growth of Commercial Managed Care Plans

During the late 1980s and early 1990s, managed care plans were credited with curtailing the runaway growth in health care costs. They achieved these efficiencies mainly by eliminating unnecessary hospitalizations and forcing participating physicians and other health care providers to offer their services at discounted rates. By 1993, a majority (51%) of Americans receiving health insurance through their employers were enrolled in managed health care plans.endnote[xi] Eventually, however, benefit denials and disallowances of medically necessary services led to a public outcry and the enactment of laws in many states imposing managed care standards. According to one analysis, nearly 900 state laws governing managed health practices were enacted during the 1990s.endnote[xii] Among the measures approved were laws permitting women to visit gynecologists and obstetricians without obtaining permission from their primary care physician, establishing the right of patients to receive emergency care, and establishing the right of patients to appeal decisions made by managed care firms. Congress even got into the act in 1997 when it passed the Newborns’ Mother Health Protection Act, prohibiting so-called “drive-through deliveries” (overly restrictive limits on hospital stays following the birth of a child).endnote[xiii]

Research studies have yielded little evidence that managed health care excesses have undermined the quality of health care services. For example, in a survey of 2,000 physicians, Remler and colleagues found that managed care insurance plans denied only about 1 percent of recommended hospitalizations, slightly more than 1 percent of recommended surgeries, and just over 2.5 percent of referrals to specialists.endnote[xiv] In another study, Franks and colleagues found that medical outcomes were similar for participants in HMOs versus FFS health plans.endnote[xv] Franks also reported that HMO patients were hospitalized 40 percent less frequently than FFS patients, and the rate of inappropriate hospitalizations was lower among HMO patients.

Link: http://www.ncd.gov/publications/2013/20130315/20130513_AppendixB

Recent Developments

Over the past 15 to 20 years, the public outcry against draconian managed care practices has waned, primarily due to the expanded out-of-network options afforded to participants in HMOs, PPOs, and POS health plans. But the perception that managed care represents an overly cost-conscious, mass market approach to delivering medical services lingers among the American public, even though more than 135 million people with health insurance coverage now receive their primary, preventive, and acute health services through a managed care plan.endnote[xvi]People with disabilities, especially high users of medical care and LTSS, share many of the same negative perceptions of managed care as the general public.

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Footnotes

[i]. R. Kane, R. Kane, N. Kaye, R. Mollica, T. Riley, P. Saucier, K. I. Snow, and L. Starr, “Managed Care Basics,” in Managed Care: Handbook for the Aging Network (Minneapolis: Long-Term Care Resource Center, University of Minnesota, 1996).

[ii]. D. Mitchell, Managed Care and Developmental Disabilities: Reconciling the Realities of Managed Care with the Individual Needs of Persons with Disabilities (Homewood, IL: High Tide Press, 1999).

[iii]. M. Freeland and C. Schendler, “Health Spending in the 1980s,” Health Care Financing Review 5 (Spring 1984): 7.

[iv]. D. Drake, Reforming the Health Care Market: An Interpretive Economic History (Washington, DC: Georgetown University Press, 1994).

[v]. Ibid.

[vi]. Mitchell, Managed Care and Developmental Disabilities.

[vii]. Drake, Reforming the Health Care Market.

[viii]. L. Weiss, Private Medicine and Public Health (Boulder, CO: Westview Press, 1997).

[ix]. Employee Benefits Research Institute, EBRI Databook on Employee Benefits (Washington, DC: Employee Benefits Research Institute, 1992).

[x]. P. Saucier, “Managed Long-Term Services and Supports,” a presentation to the National Policy Forum, May 11, 2012.

[xi]. J. Iglehart, “Physicians and the Growth of Managed Care,” The New England Journal of Medicine 331, no. 17 (1994): 1167–71.

[xii]. R. Cauchi, “Where Do We Go From Here?” State Legislatures (March 1999): 15–20.

[xiii]. U.S. Department of Labor, Fact Sheet: Newborns’ and Mothers’ Protection Act, http://www.dol.gov/ebsa/newsroom/fsnmhafs.html.

[xiv]. D. Rembler, K. Donelan, R. Blendon, L. Lundberg, D. Leape, K. Binns, and J. Newhouse, “What Do Managed Care Plans Do to Affect Care: Results of a Survey of Physicians,” Inquiry 34 (1997): 196–204.

[xv]. P. Franks, C. Clancy, and P. Nutting, “Gatekeeping Revisited: Protecting Patients from Overtreatment,” The New England Journal of Medicine 337, no. 6 (1992): 424–9.

[xvi]. Statistics taken from Managed Care Online, http://www.mcol.com/factsheetindex.

Conclusion

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How to READ and UNDERSTAND a Scientific Paper!

A Guide for non-scientists


By Jennifer Raff

Via Bert Mesko MD PhD  

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How to read and understand a scientific paper: a guide for non-scientists

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RELATED: https://getpocket.com/explore/item/3-questions-to-ask-yourself-next-time-you-see-a-graph-chart-or-map?utm_source=pocket-newtab

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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PODCAST: On Electronic Medical Records

EMR OVERVIEW

BY ERIC BRICKER MD

Electronic Medical Records (EMRs) are Used by 80-90% of Hospitals and Physician Practices. One Study Found that EMRs Have Lowered Patient Mortality by 0.09%.

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On Excess IRA and Roth IRA Contributions

BY DAN MOISAND CFP®

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See the source image

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READ HERE: https://www.msn.com/en-us/news/other/i-contributed-too-much-to-my-ira-and-roth-ira-%e2%80%94-what-now/ar-AANP1IP?li=BBnb7Kz

MORE: https://www.irs.gov/retirement-plans/plan-participant-employee/retirement-topics-ira-contribution-limits

EDITOR’S NOTE: Colleague Dan Moisand contributed to our textbook on “Comprehensive Financial Planning Strategies for Doctors and Advisors.”

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PODCAST: Physician Relative Value Units?

HOW DOCTORS GET PAID!

By Eric Bricker MD

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PODCAST: Stark and AKS Final Rules

ANTI-KICKBACK STATUTE Overview and Impact

Do you want to learn more about the Stark Law and Anti-Kickback Statute Final Rules and how they impact your practice? Join us for a one-hour webinar, presented with Hancock Daniel.

Health Capital Topics Newsletter

By Health Capital Consultants, LLC

PODCAST: https://www.healthcapital.com/resources/stark-and-aks-final-rules-overview-and-impact

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Bundled Payment Model Success Unaffected by Type of Participation

BY HEALTH CAPITAL CONSULTANTS, LLC

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Bundled Payment Model Success Unaffected by Type of Participation


Historically, Medicare has offered value-based payment models to healthcare organizations on both a voluntary and a mandatory participation basis. Because voluntary participants could self-select into programs to reduce spending, it was assumed that they achieved greater savings than mandated participants, but until recently, no data had tested this.

However, a June 2021 study in the Journal of the American Medical Association (JAMA) found no difference in risk-adjusted episodic spending between voluntary and mandatory payment model participants. (Read more…) 

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PODCAST: Hospital 340-B Drug Programs

BY ERIC BRICKER MD

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KFF MORE: https://www.kff.org/medicare/issue-brief/whats-the-latest-on-medicare-drug-price-negotiations/

HRSA MORE: https://www.hrsa.gov/opa/index.html

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PODCAST: Tips for the Medical Educator’s “Elevator Pitch”

On Medical Academic – Not Business – Planning

Courtesy: www.CertifiedMedicalPlanner.org

By Dr. David E. Marcinko MBA

We’ve written and opined about medical business entrepreneurs and business start-up plans; before:

MY ESSAY: https://medicalexecutivepost.com/2020/01/20/creating-a-medical-practice-business-plan-in-2020/

MY SCRIPT: https://healthcarefinancials.files.wordpress.com/2017/08/podcast.pdf

QUERY: But, did you ever wonder what to say when you’re standing next to a senior physician colleague who could help further your academic and educational work?

MOOCS: https://medicalexecutivepost.com/2018/09/25/moocs-are-you-an-i-t-educational-futurist/

FLIPPED CLASSROOM: https://medicalexecutivepost.com/2019/05/17/the-flipped-classroom/

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Now, for some granular specificity; let’s cue the elevator pitch with David Acosta MD and Daniel Hashimoto MD MS who demonstrate what to do (and what not to do) to successfully deliver your medical educator’s elevator pitch.

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PODCAST: http://academicmedicineblog.org/tips-for-the-medical-educators-elevator-pitch/

Your thoughts are appreciated.

TEXTS FOR PHYSICIAN EXECUTIVES AND HOSPITAL CXOs

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“Disruptive” DIGITAL BUSINESS MODELS For Health Insurers

The Top 10 [Ten] Disruptive Digital Business Models For Health Insurers

By Zhang Jie

Digital technologies will transform the health insurance business. Early adopters have started to implement new digital business models with initial success. A new report describes ten digital business models for health insurers that will disrupt the industry.

Dear David,

We are excited to announce the release of Research2Guidance’s new “The 10 Disruptive Digital Business Models for Health Insurers” report.

Please find below the special report story.

Advances in higher-quality digital technology—especially apps, sensors, and artificial intelligence (AI)—along with their proliferation among members have spurred the emergence of new business models.

The new report “The 10 Disruptive Digital Business Models for Health Insurers” published by Research2Guidance describes how start-ups, health insurance and general payer organizations have started using these technologies to venture into new forms of health insurance offerings and increasingly step into the healthcare provider role.

New digital models change the way the insurers interact with patients. For example, digital insurers have reworked the trust equation with the patient, outsourced much of their value chain to their members, and now know much more about them. Digital business models tend to also blur the lines between payer and care giver organizations. Some of the first-movers already crossed the line and started to offer services which have previously been provided exclusively by doctors and nurses. The ten digital business models are defined as follows:

  1. Digitally assisted member acquisition is a freemium business model concept.
  2. Mobile health concierge is a business approach designed for members to complete all health insurance tasks using mobile phones with the support from a concierge team.
  3. Peer-to-peer (P2P) insurance refers to a risk-sharing community.
  4. Mobile micro-insurance refers to the health insurance plans that cover short-term small health events or minimal ongoing health insurance.
  5. Health insurers tech platforms license their technology for the management of health plans and members to their customers.
  6. On-demand insurance is a usage-based model that enables members to access desired health plans upon request with the help of a mobile app.
  7. High-risk patient preventive care model concentrates on insuring and managing potentially costly patient groups.
  8. The payer & provider collaboration model stands for a closer, digitally enabled partnership between payers and care providers, especially hospitals.
  9. The API health insurance model uses a list of pre-defined health insurance products accessible to websites and app providers via an application programming interface (API).
  10. Direct primary care model. Within this model, a care provider or a hospital act like a health insurance company using a monthly subscription model.

First implementations of these models indicate the positive impact that they have on the company evaluation, the ability to attract new members, the cost structure, and new revenue streams. Currently, the main impact of digital business models is on company evaluation, which reflects the hype that some companies have created in the investor community. Companies like Oscar, Clover Health, and Bright Health are valued at over $1 billion USD each after only a few years of operation.

Health insurers and start-ups from the USA and China are the most aggressive in adopting new digital business models. Companies from other regions tend to choose a follower approach or implement copycats.

ASSESSMENT

The report also profiles first-mover digital implementations. Profiles include their target groups, operating models, service offerings, and early evidence for success where available.

Conclusion

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