BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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When President Joe Biden was elected in 2020, there was much anticipation and speculation regarding what his election would mean for the U.S. healthcare industry in the coming years.
As an ardent supporter of the Patient Protection and Affordable Care Act (ACA) who campaigned on offering a public insurance option similar to Medicare, many in the healthcare industry assumed that the Biden Administration would be a strong proponent of continuing the shift to value-based care, which shift was largely spurred by his predecessor and former boss, Barack Obama, with the passage of the ACA. (Read more…)
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In 2013, a bitcoiner posted “I AM HODLING” on a bitcoin forum, intending to write that he was holding during a large price drop. He was explaining that most people are not successful traders and as a result they will inevitably just lose out in the process of trying to time the bear market, so instead he encouraged that bitcoiners should hold and trust bitcoin.
Since that day, this typo, “hodl,” has worked its way into the everyday vernacular of bitcoiners. It now represents the stance that not only should one not attempt to trade bitcoin through bull and bear runs, but also should not sell bitcoin under any circumstances because whatever asset it is one may purchase with it will one day be outperformed by bitcoin. For some purposes, this may be helpful, but for the adoption of a private money, this is exceedingly dangerous.
Posted on December 7, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
A Curated Report
By Staff Reporters
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The marriage penalty has faded in recent years, particularly after the 2017 Republican tax cuts that targeted high incomes. But the singles penalty remains — the tax code is still written to benefit people in 1950s middle-class marriages who own their homes. That’s not great for the millions of households who are shouldering other cost burdens around single life.
Progressive tax codes are intended, at least theoretically, to ensure equitable distribution of the costs of maintaining civilization. They should (again, theoretically) be readjusted when a certain group begins to shoulder a disproportionate amount of that burden — like, for instance, single or divorced people. That’s not what’s happened, not for couples with two earners and not for the growing number of single or solo households. The reality of how people live and who works has changed. The policy has not kept pace.
The same principle holds true for Social Security, which was created first and foremost as a means of protecting the elderly from living out their final years in the literal poorhouse. The idea was simple: You and your employers pay in part of your salary now, and when you retire, you have enough to survive.
As noted in the first installment of this five-part series, internal medicine is the largest specialty among physicians and an understanding of the various environments in which these physicians operate is crucial in determining their numerous value drivers.
In particular, healthcare reimbursement, the process by which private health insurers and government agencies pay for the services of healthcare providers (including internists), is perhaps one of the most important environments to understand, as it comprises a provider’s expectation of future return on investment.
Posted on November 19, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Hospitals Must Treat All Patients
BY ERIC BRICKER MD
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The Emergency Medical Treatment and Active Labor Act is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act
Posted on November 18, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Harm from Physicians and Health caRE
By Eric Bricker MD
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Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence.
Posted on November 15, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
By THCB
Today on Health in 2 Point 00, Jess DaMassa claims to be blameless for the drama between Jonathan Bush and Glen Tullman. On Episode 198, we talk about Microsoft buying Nuance for $16 billion and $3 billion in debt – is Microsoft taking over healthcare, and is this going to slow Nuance down?
IPOs
Cohere Health raises $36 million in a Series B, working on improving prior authorizations between health plans and providers. We wrap up with a lightning round of IPO rumors regarding Privia Health, VillageMD, and Bright Health.
Health Insurance Companies Paid for Hospital Outpatient Services at an Even Higher Average Rate of 293% of Medicare.
A Detailed Look at the RAND Analysis Reveals that the ‘Basket’ of Services at Each Hospital Had Very Little Data.
For Example, the RAND Study’s Data for the Baylor Scott & White Hospital System in Dallas – Fort Worth Represented Only 0.4% of the Hospital’s Total Revenue.
For the Texas Health Hospital System Also in Dallas – Fort Worth, the RAND Study’s Data Only Represented 0.96% of the Hospital’s Total Revenue.
That Sample Size Is Likely Too Small to Make Accurate Comparisons from One Hospital System to Another Regarding their Commercial Insurance Prices Relative to Medicare.
ASSESSMENT: Your thoughts and comments are appreciated.
Posted on November 5, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
MORE ON EDR SECURITY
By Darrell K. Pruitt, DDS
Dental Care Alliance Data Breach Impacts More Than 1 Million Patients
NEWS FLASH!
“Sarasota, FL-based Dental Care Alliance, LLC, a dental support organization with more than 320 affiliated dental practices across 20 states, has been hacked and the protected health information of more than a million individuals has potentially been compromised. The breach occurred on September 18, 2020, was detected on October 11, and was contained on October 13.”
Currently I am in conversation on LinkedIn with a Chief Information Officer for an IT firm. He assures me that the cloud is more secure than paper dental records stored in heavy and loud metal filing cabinets, but cannot say why.
Meanwhile, I have never heard of a million paper dental records being stolen in one heist. Wouldn’t that require a truck or two? What’s more, once the thieves escape to their hideout, someone will have to enter the data onto computers – while struggling to interpret bad handwriting.
ASSESSMENT: Your thoughts are appreciated …. More later.
Posted on November 4, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
NO LONGER EVEN NOTICED?
BY DARRELL PRUITT DDS
Data breaches are now so common that hardly anyone in healthcare notices them – especially in dentistry. I imagine that more than half of the data breaches from dental offices are never reported, and their patients never warned that their identities might be available on the internet.
Whether you ignore this problem or not, this will not end well, folks.
A June 2021 PricewaterhouseCoopers (PwC) report found that healthcare costs have been on a steady decline for the past decade, but trailing effects from the COVID-19 pandemic could cause increases above anticipated rates over the next several years.
In 2007, the annual cost growth for healthcare spending was 11.9% and declined steadily until 2017, where it floated between 5.5% and 6.0% until 2020. However, projected healthcare cost growth for 2022 is expected to reach 6.5% due to factors such as deferred or forgone care, increased mental health issues, preparation for future pandemics, and investment in digital tools. (Read more...)
Posted on October 27, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
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The right to repair electronics refers to proposed legislation that would provide the practical means for equipment owners to repair their devices, and not a new legal right. The implications for medicine are huge.
Advocates observe that while repair is legal under copyright law and patent law, owners are often prohibited from making their own repairs or hiring technicians they trust to help by manufacturer limitations on access to repair materials such as parts, tools, diagnostics, documentation and firmware.
Posted on October 20, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
OVERHEARD IN THE DOCTOR’S LOUNGE
By Jaan E. Sidorov MD
*** DEFINITION: Prospect theory is a theory of behavioral economics and behavioral finance that was developed by Daniel Kahneman and Amos Tversky in 1979. The theory was cited in the decision to award Kahneman the 2002 Nobel Memorial Prize in Economics.
Amanda, an RN client, was just informed by her financial advisor that she needed to re-launch her 403-b retirement plan. Since she was leery about investing, she quietly wondered why she couldn’t DIY. Little does her FA know that she doesn’t intend to follow his advice, anyway! So, what went wrong?
The answer may be that her advisor didn’t deploy a behavioral economics framework to support her decision-making. One such framework is the “prospect theory” model that boils client decision-making into a “three step heuristic.”
Prospect theory makes the unspoken biases that we all have more explicit. By identifying all the background assumptions and preferences that clients [patients] bring to the office, decision-making can be crafted so that everyone [family, doctor and patient] or [FA, client and spouse] is on the same page.
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*** Briefly, the three steps are:
Simplify choices by focusing on the key differences between investment [treatment] options such as stock, bonds, cash, and index funds.
Understanding that clients [patients] prefer greater certainty when it comes to pursuing financial [health] gains and are willing to accept uncertainty when trying to avoid a loss [illness].
Cognitive processes lead clients and patients to overestimate the value of their choices thanks to survivor bias, cognitive dissonance, appeals to authority and hindsight biases.
ASSESSMENT
Much like in healthcare today, the current mass-customized approaches to the financial services industry fall short of recognizing more personalized advisory approaches like prospect theory and assisted client-centered investment decision-making.
Generally speaking, all income is taxable unless it’s specifically excluded, as is the case with certain gifts and inheritances. In most instances, the income you earn will be reported to both you and the government on an information return, such as a Form 1099 or W-2. If the income you report doesn’t match the IRS’s records, you could face problems down the road—so be sure you include the income from all of the following forms that are applicable to your situation:
1099-B: The form on which financial institutions report capital gains.
1099-DIV: The form on which financial institutions report dividends.
1099-MISC: The form used to report various types of income, such as royalties, rents, payments to independent contractors, and numerous other types of income.
1099-R:The form on which financial institutions report withdrawals from tax-advantaged retirement accounts.
Form 1099-INT: The form on which financial institutions report interest income.
Form SSA-1099:The form on which the Social Security Administration reports Social Security benefits (a portion of which may be taxable, depending on your level of income).
Form W-2:The form on which employers report total annual compensation, payroll taxes, contributions to retirement accounts, and other information.
If you receive an inaccurate statement of income, immediately contact the responsible party to request a corrected form and have them resend the documents to both you and the IRS as soon as possible to avoid delaying your tax return. Also, be aware that you must report income for which there is no form, such as renting out your vacation home.
When you sell an investment, you’ll need to know both the cost basis (what you paid for the investment) and the sale price to determine your net gain or loss. The cost basis of your investment may need to be adjusted to account for commissions, fees, stock splits, or other events, which could help reduce your taxable gain or increase your net loss.
Financial institutions are required to adjust your investments’ cost basis and provide that information on a Form 1099. However, brokerages aren’t required to report the cost basis for investments purchased prior to a certain date, which means you’ll be responsible for supplying that information (see the table below). Be sure to keep records of all investment purchases and sales—even those for which your brokerage is responsible.
Your reporting responsibility
Depending on security type and date of purchase, you—rather than your brokerage—could be responsible for reporting the cost basis of your investment to the IRS.
Posted on October 16, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
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By Darrell K. Pruitt DDS
Compared to hospitals, the business of dentistry is as simple as a lemonade stand. Dental practice management software is an option – not a necessity.
Thank goodness.
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“Cyber Daily: Congress Inches Toward Response to Ransomware Attacks – U.S. legislators in the House and Senate have several bills in play that would put new requirements on companies [including dental offices] to report cyber incidents, including details about ransomware payments.”
As transparency makes it increasingly difficult for dentists to hide ransomware breaches from their patients by quietly paying the ransom (one or more times), paper dental records remain the gold standard of security. Practice management software is not only more expensive than paper records, but it vastly increases patients’ risk of identity theft while offering them NO TANGIBLE BENEFITS… Just ask anyone.
The three Nobel Prize winners in economics show that science is happening all around us—if we’re willing to look.
David Card, Joshua Angrist, and Guido Imbens, US-based economists who shared the prize awarded yesterday, helped pioneer the use of “natural experiments” to conduct studies on real-life situations as if they had happened in a tightly controlled lab.
Here’s one example: Card is most famous for his and Alan Krueger’s 1993 study on the effects of minimum wage on employment. They compared fast food jobs in New Jersey, which had just raised its minimum wage from $4.25 to $5.05, to fast food restaurants in neighboring Pennsylvania. The idea was that NJ and PA are generally pretty similar, so any observed differences in the labor market could lead to important conclusions about raising the minimum wage.
What did they find? That NJ’s higher minimum wage did not hurt job growth…and may have even increased employment. This shocked most experts at the time.
Bottom line: Natural experiments are now ubiquitous in economics research, but only because these Nobel Prize recipients showed what was possible. —NF
Posted on October 12, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
By Bernie Portal
The Consolidated Omnibus Budget Reconciliation Act of 1985 is a law passed by the U.S. Congress on a reconciliation basis and signed by President Ronald Reagan that, among other things, mandates an insurance program which gives some employees the ability to continue health insurance coverage after leaving employment.
COBRA compliance can be difficult, especially if you’re handling it yourself. Now, it’s even more complicated thanks to recent stimulus bill changes that implemented a 100% free COBRA subsidy for eligible employees and employers.
In this episode, host Ryan McCostlin talks through the ins and outs of this important component of healthcare law that’s designed to help out employees during the pandemic.