BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Posted on July 18, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
THE SHERLOCK COMPANY
This podcast features a brief discussion by colleague Doug B. Sherlock CFA, Senior Health Care Analyst and President, Sherlock Company http://www.sherlockco.com featuring his insights into the quarterly financial reports of health plans, for the first quarter 2021.
1) The 90s HMOs: Lower Premiums, Lower Out-of-Pocket Costs, Many Many Rules Restricting Care.
2) The 2000s PPOs: High and Even Higher Premiums, Lower Out-of-Pocket Costs, Fewer Rules Restricting Care.
3) The 2010s CDHPs: Lower Premiums, HIGH Out-of-Pocket Costs, Fewer Rules Restricting Care.
The Last 30 Years Have Taught Us that Employer-Sponsored Health Plans CANNOT Have All 3–Low Premiums, Low Out-of-Pocket Costs and Few Care Restrictions.
In the 2020s, Employers Are Moving More of Their Employee Healthcare OUTSIDE of the Traditional Healthcare and Health Insurance System with On-Site Clinics, Near-Site Clinics, Virtual Urgent Care, Virtual Primary Care and Bundled-Payment Centers-of-Excellence.
Posted on July 8, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
DEFINITION: CRISPR is a family of DNA sequences found in the genomes of prokaryotic organisms such as bacteria and archaea. These sequences are derived from DNA fragments of bacteriophages that had previously infected the prokaryote. They are used to detect and destroy DNA from similar bacteriophages during subsequent infections
For the first time, CRISPR technology has been used to successfully treat diseasein vivo, or inside the human body.
That big medical news was announced Saturday by the biotech startup Intellia Therapeutics and its partner Regeneron, which said their gene-editing techniques reduced the amount of harmful liver protein associated with a genetic nerve disorder.
What is CRISPR? It stands for “clustered regularly interspaced short palindromic repeats,” and it’s one of those things humans found in nature and then copied. Bacteria use CRISPR to repel viruses, but humans have harnessed it to ctrl+c, ctrl+v DNA sequences, potentially leading to a revolution in treating disease. The two scientists who made that breakthrough in 2012, Jennifer Doudna and Emmanuelle Charpentier, won the Nobel Prize in Chemistry last year (Doudna is also a cofounder of Intellia).
Quote du jour: “There’s a feeling like we’re walking through a door here into all kinds of new possibilities. And there’s not many moments in medicine where you get to experience that,” Intellia CEO John Leonard said. Looking ahead…expect Intellia shares, which have gained 233% since its 2016 IPO, to pop.
Posted on July 5, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
At Least in PartACCORDING TO THESE BOOKS
BY ERIC BRICKER MD
Understandably, Many Doctors Take Issue with This Accusation and Say They Treat Their Patients with Integrity and Accountability. Both Statements May Be TRUE … How is That Possible?
Because of ‘Bad Apples.’
While the Majority of Physicians May Put Their Patients First, There Are a Minority of Physicians that Put Money, Power, Prestige and Promotions Ahead of Patients. It’s These Bad Apples That Ruin Physician Culture.
Problem: Fee-for-Service Rewards Bad Apple Physicians, While Paying the High-Integrity Doctors as Well.
Assessment: If Doctors Want to Keep Fee-for-Service, Then the Bad Apples Must Be Reduced Through 1) Increased Transparency, 2) Greater Doctor Self-Regulation, 3) More Federal Oversight and 4) Increased Employer Investigation.
A “MEME” stock isn’t as easily defined as a growth or value stock, so to give it a definitive categorization would be inappropriate. Nor would actually categorizing it alongside growth and value stocks. They won’t be found in textbooks anytime soon, but to overlook their impact could potentially be an expensive oversight.
Posted on July 2, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
ELECTRIC HEALTH RECORDS
By White Hat Anonymous
Epic Systems, the country’s leading e-health record company, says an algorithm it developed can accurately flag sepsis in patients 76% of the time. The life-threatening disease, which arises from infections, is a major concern for hospitals: One-third of patients who die in hospitals have sepsis, per the CDC.
Generally, the earlier sepsis is diagnosed and treated, the better a patient’s chances of survival—and hundreds of hospitals use Epic Systems’s sepsis prediction model, The Verge reports.
The problem: According to a study published this week in JAMA Internal Medicine, Epic Systems may have gotten the success rate wrong: The model is only correct 63% of the time—“substantially worse than the performance reported by its developer,” the researchers wrote.
Part of the issue can be traced to the algorithm’s development, Stat News reports. It was trained to flag when doctors would submit bills for sepsis treatment—which doesn’t always line up with patients’ first signs of symptoms.
“It’s essentially trying to predict what physicians are already doing,” Dr. Karandeep Singh, study author.
When reached for comment, Epic Systems told us the researchers’ hypothetical scenario lacked “the required validation, analysis, and tuning that organizations need to do before deployment,” adding that the JAMA study’s findings differed from other research.
Many accountable care organizations (ACOs) received disappointing news on May 21, 2021, when the Centers for Medicare & Medicare Services (CMS) announced that it would not be extending the Next Generation ACO (NGACO) model for 2022.
After five years and a dwindling number of participating ACOs, experts were split on whether or not CMS should keep the model in place for another year. On one hand, stakeholders have argued for the NGACO model’s extension until it can be replaced with or integrated into another program; howowever, others asserted that resources could not be properly invested with only one more year left in the program. (Read more…)
Walmart, the world’s largest retailer, opened the first Walmart Health in 2019 with the main goal of helping to meet the healthcare needs of the communities they serve. After opening six locations in almost two years, Walmart is looking to operate a total of 22 standalone clinics by the end of 2021.
This Health Capital Topics article will review Walmart Health’s approach to delivering primary care, the communities into which it is expanding, its partnerships it is developing in the healthcare sector, and the competitive landscape in which it operates. (Read more…)
Nurses on General Medical and Surgical Floors Typically Have a 4:1 Patient to Nurse Ratio During the Day and an 8:1 Patient to Nurse Ratio Overnight.
Nurses in the ICU Typically Have a 2:1 or 1:1 Patient to Nurse Ratio.
Nurses on a Floor or Unit Have a ‘Charge Nurse‘ Who is the Head Nurse for the Floor for That Specific Shift.
Those Charge Nurses Then Collaborate with the Shift Coordinator Who is a Very Senior and Experience Nurse Who Coordinates All the Patient Beds for a Particular Division at a Large Hospital (e.g. All Medicine Patients vs. All Surgical Patients) or for the Entire Hospital If It Is a Smaller Hospital.
Medical Techs Provide Support Roles in Patient Rooms Such as Checking Vitals, Blood Glucose Finger-Sticks, Etc.
The Clerk Sits at the Nurses Station for the Floor and Typically Answers the Call-Button for Each of the Patient Rooms During the Day in Addition To Their Administrative Responsibilities.
There are varying opinions on how much of your total income should go toward savings and retirement goals each month. Moreover, the answer is likely to vary, depending on your full financial profile.
But if you’re looking for some basic KISS guidelines, consider applying the 50-30-20 rule, a budgeting method that allocates 50% of your income to essentials, like rent and bills, 30% to discretionary spending and 20% to savings.
Consequently, When the Supply of a Healthcare Service is Limited, then the Price Goes Up … Way Up, Since the Quantity Demanded Does Not Change.
Examples of Inelastic Demand with Limited Supply in Healthcare Are:
1) Emergencies
2) Patented Medications for Diseases That Have No Other Alternatives
3) Doctor Specialties Where the Patient Has No Choice in the Services Such As Radiologists, Anesthesiologists and Pathologists
The High-Cost Claimants with Inelastic Demand Drive the Majority of Healthcare Costs for a Group. They Generally Fall into 3 Diagnosis Categories: 1) Orthopedics, 2) Cardiovascular and 3) Cancer.
Orthopedics Should Be the 1st Priority for Lowering Healthcare Costs for a Population … While Demand May be Inelastic, Usually There is Choice and Not a Limited Supply of Orthopedic Services.
Efforts in Orthopedics Should Focus on Increasing Choice, Such as Free Travel to Centers-of-Excellence with Bundled Pricing.
Cardiovascular Care and Cancer Care Tend to Have Inelastic Demand AND Limited Supply. Therefore, the Best Way to Lower Healthcare Costs in These Areas is Through Prevention.
Posted on June 15, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
BY ERIC BRICKER MD
[Book Review]
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The Technology Adoption Lifecycle Was Explained in Geoffrey Moore’s Famous Book ‘Crossing the Chasm.‘
If You Are a Healthcare Entrepreneur or Innovator Your MUST Understand and Apply the Technology Adoption Lifecycle.
It States that Disruptive Innovation (i.e. Innovations that Require Behavior Change) Is Not Evenly Adopted Across a Population.
Rather, People Segment Themselves into Sub-Groups That Adopt the New Innovation Differently. To Whit:
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Early AdoptersLove Tinker and Like New Innovations Just Because They Are New. Early Adopters Tend to Not Be Price-Sensitive.
PragmatistsHave a Specific Problem that the New Innovation Will Solve and If They See Other People Using It, They Will Use It Too. Pragmatists Are Somewhat Price-Sensitive.
Conservatives Would Rather Not Adopt the New Innovation, but if it is Already Built-in to Something They Already Buy, Then They Will Be More Likely to Use It. Conservatives are Very Price Sensitive.
Skeptics Will Never Adopt the New Innovation.
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To Spread a New Innovation, One Must Cross the Chasm Between the Early Adopters and Pragmatists With a ‘Niche‘ and ‘Bowling Pin‘ Strategy.
Each generation of doctors and medical professionals is extraordinarily complex, bringing various skills, expertise and expectations to the modern medical work environment. Determining the best method to unite such diverse thinking is one of the many challenges faced by physician executives and healthcare leaders today.
And, as linguistic evolution occurs, the nomenclature of hospitalist was followed by that of intensivist, proceduralist and nocturnalist, etc [www.MedInnovationBlog.com and Personal communication Richard L. Reece MD].
Is it any wonder that many medical leaders and executive in the Baby Boomer generation find themselves at a loss? The days of functional leadership are gone and suddenly, no one cares about the expertise of the Baby Boomers or how they climbed the corporate ladder, in medicine or elsewhere. Leadership in the new era is no longer about command-control or dictating with intense focus on the bottom line; it is about collaboration, empowerment and communication. And, it is not about titles and nomenclature; it is about lifestyle choice.
What else drives these new-wave specialists?
The answer, of course, is the next-generation of physicians and their emerging new medical business and practice models, which include:
“Ambulists” are doctors that travel locally, have no, or only a sparse physical office presence of their own. They sporadically provide services that are additive to traditional practice models [i.e., endocrinologist in a large family medical office with many diabetics].
“In-Situ” physicians regularly provide services that are complimentary to existing traditional practice models [i.e., dentists or podiatrists in a medical practice].
“Laborists” are obstetricians that do not wish to be on-call. First begun in Cape Cod and other Massachusetts hospitals, such obstetricians work regular shifts for the sole purpose of delivering babies.
“Locum Tenens” doctors travel around the country as itinerants [i.e., cruise ships] as temporary substitutes for another the same specialty.
“Officists” remain in their own physical practice, and rarely see patients in the hospital, nursing home, patient home, out-patient facility, etc.
Finally, “dayhawk physicians” mimic the “nighthawk physician” model where radiologists in remote locations read films in the middle of the night as cash-strapped hospitals often find it cheaper to outsource with better services and more timely interpretations in many cases.
Posted on June 11, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
OVER HEARD IN THE DOCTOR’S LOUNGE
I currently have no fewer than 10 separate insurance policies associated with my plastic surgery practice. I understand very little about the policies other than that somebody at some point told me I needed each and every one of them, and each made sense when I bought it. But, I often wonder:
Am I over-insured and thus wasting money?
Am I under-insured and thus at risk for a liability disaster?
I never really had the means of answering these questions …. Until Now!
Posted on June 9, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
AGING AND RETIREMENT
Long-term care (LTC) may not be the first thing individuals or couples think about as they approach retirement, but the costs for those who needs it can disrupt and derail retirement security. A good plan for long-term care requires many decisions over an extended period of time, and well before retirement.
In this article, Milliman consultant Robert Eaton discusses the major considerations and options for financing LTC needs in retirement.
BOOK-VALUE: Cost of capital assets minus accumulated depreciation for a healthcare [corporation], or other organization.
The net asset value of a [healthcare] companies common stock. This is calculated by dividing the net tangible assets of the company (minus the par value of any preferred stock the company has) by the number of common shares outstanding.
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PAR VALUE: For common stock, the value on the books of the corporation. It has little to do with market value or even the original price of shares at first issuance.
The difference between par and the price at first issuance is carried on the books of a corporation as “paid-in capital” or “capital surplus.”
To keep up with the ever-changing healthcare industrial complex, we must learn new definitions and re-learn old terminology in order to correctly apply it to practice. By aggregating the most up-to-date abbreviations, acronyms, definitions and terms, the Health DictionarySeries offers a wealth of information to help understand the ever-changing terms-of-art in healthcare today.
Each 10,000 item handbook is essential for doctors, nurses, benefits managers, financial advisors/planners, and insurance agents, CPAs, and administrators; as well as graduate and under graduate students and professors. Our goal to for each dictionary to be designated as a Doody’s Core Title.
Dictionary of Health Insurance and Managed Care
With more than 10,000 definitions, 4,000 abbreviations and acronyms, and a 3,000 item oeuvre of resources, readings, and nomenclature derivatives, this dictionary covers the Medicare, managed care and Medicaid, private insurance, Veteran’s Administration and PP-ACA language of the entire health and long-term care insurance sector.
Dictionary of Health Economics and Finance
Health economics and finance is an integral component of the health care industrial complex. Its language is a diverse and broad-based concept covering many other industries: accounting, mathematics, the actuarial sciences, stochastics and statistics, salary reimbursements, physician payments, compensation and forecasting are all commingled arenas.
Dictionary of Health Information Technology Security
There is a myth that all healthcare stakeholders understand the meaning of information technology jargon. In truth, the vernacular of contemporary systems is unique, and often misused or misunderstood. Moreover, emerging Heath Information Technology (HIT) thru the HITECG initiatives; in the guise of terms, definitions, acronyms, abbreviations and standards; often puts the non-expert in a position of maximum uncertainty and minimum productivity.
Value-based payment (VBP) structures have the potential to reduce health disparities and, during the pandemic, health care organizations with VBP models have had greater flexibility to effectively pivot their care delivery.
This Health Affairs Blog post outlines three strategies for payers and providers to embrace health equity in VBP design and implementation.
Posted on March 31, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Right Side VERSUS Left Side Cerebral Vascular Accidents
[By staff reporters]
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A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients [occlusive and hemorrhagic]. Within minutes, brain cells begin to die.A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications.The good news is that strokes can be treated and prevented, and many fewer Americans die of stroke now than in the past.
Posted on March 29, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
By staff reporters
Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).
When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.
Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.
Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).
Posted on October 5, 2020 by Dr. David Edward Marcinko MBA MEd CMP™
HOLACRACY versus HEIRARCHY
By staff reporters
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#Holacracy takes powers traditionally reserved for executives and managers and spreads them across all employees.
#Heirarchy is how business has traditionally been done- top down, where the ones who do the most work have the least power (as in the practice of medicine in its current form)
On August 3, 2020, President Donald Trump signed an executive order aimed at expanding access to care through two avenues: telemedicine and eased financial burdens on rural providers. The executive order builds on President Trump’s original expansion of coverage for telemedicine services in early March 2020, an order which was praised by the American Telehealth Association (ATA) and American Medical Association (AMA) for swiftly responding to the growing healthcare crisis. This Health Capital Topics article will discuss the executive rule and the subsequent agency actions on these fronts. (Read more…)
Posted on August 20, 2020 by Dr. David Edward Marcinko MBA MEd CMP™
What is the Difference – Know the Difference
By staff reporters
Both an EMR and EHR are digital records of patient health information. An EMR is best understood as a digital version of a patient’s chart. It contains the patient’s medical and treatment history from one practice. Usually, this digital record stays in the doctor’s office and does not get shared. If a patient switches doctors, his or her EMR is unlikely to follow.
By contrast, an EHR contains the patient’s records from multiple doctors and provides a more holistic, long-term view of a patient’s health. It includes their demographics, test results, medical history, history of present illness (HPI), and medications.
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“Medical Management and Health Economics Education for Financial Advisors”