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For Doctors and their Financial Advisors
[By Staff Reporters]
For more on these topics, see the handbooks below:
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A Hybrid Business Entity
By Staff Reporters
A limited liability company (LLC) is a form of business entity some physician use that can provide many advantages to a physician medical practice owner.
Definition
As the name indicates, there is limited liability to the physician. Therefore, the practice owner’s personal assets are protected from claims against the practice and also from practice business debts, unless of course, the owner personally guaranteed any business debts.
No Absolute Immunity
But, limited liability protection is not absolute. There are instances where a doctor owner’s personal assets can be reached.
Assessment
Limited liability protection is similar to that of a corporation. However, unlike a C corporations, an LLC is a “pass-though” entity for taxation purposes. The benefit of being a pass through entity is that there is only one level of tax imposed on the LLC’s earnings. With a C corporation, the earnings are taxed at the corporate level and taxed again at the shareholder level when the earnings are distributed to shareholder.
Thus, the LLC can be considered a hybrid between a corporation and a partnership.
Charitable Business Planning and the LLC
http://www.chslegacy.org/giftlaw/article.jsp?WebID=GL2007-1230&D=201010
Conclusion
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Filed under: Glossary Terms, Practice Management, Risk Management | Tagged: limited liability company, limited liability corporation, LLC | Leave a comment »
ACO Glossary of Terms from CMS, etc
By Staff Reporters
According to Wikipedia, an Accountable Care Organization, or ACO for short, is a health system model with the ability to provide and manage patients, in the continuum of care across different institutional settings, including at least ambulatory (outpatient) and inpatient hospital care and possibly post acute-care in some cases.
Payment is consolidated rather than ala’ carte’, and generally considered cost effective and “bundled”.
Budgetary Accountability
Furthermore, ACOs have the capability of planning budgets and resources and are of sufficient size to support comprehensive, valid, and reliable performance measurements.
Source: http://en.wikipedia.org/wiki/Accountable_care_organization
CMS Definition
Now, aaccording to the CMS Office of Legislation; Section #1899.
ACO Definition: accountable care organization
Medical Provider Market Power and the American Hospital Association
AHA definition: AHA – ACOs
Assessment
The ACO model is one of the latest designs for managing healthcare costs and especially Medicare costs, and is gaining traction among policymakers desperate to control costs and boost quality in healthcare.
Conclusion
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Filed under: Glossary Terms, Practice Management | Tagged: Accountable Care Organization, ACO | 24 Comments »
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By Ann Miller RN MHA
[Executive-Director]
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Filed under: CMP Program, Financial Planning, Glossary Terms, iMBA, Inc., Marketing & Advertising, MAST-HEAD, Practice Management, Recommended Books, Sponsors, Surveys and Voting | Tagged: certified medical planner, david marcinko, financial advisors, medical executive post, Practice Management, www.CertifiedMedicalPlanners.com | Leave a comment »
Understanding the Definition of “Essentiality”
[By Calvin W. Wiese CPA MBA]
An important component of hospital credit analysis is essentiality. Hospitals are unusual businesses that many times possess some form of essentiality to their communities. Healthcare is important to the economic vitality of every community. Many hospitals have served their communities for many years; it is not uncommon to find hospitals that have been continuously operating for more than 100 years in the same community.
Not for Profit Entities
Most hospitals are not-for-profit. In not-for-profit hospitals, no private party actually “owns” the hospital; control is vested in various boards, but no one explicitly “owns” a not-for-profit hospital. In a broad sense, communities own not-for-profit hospitals. They are considered “charities” with a “charitable purpose.” Though a not-for profit hospital may not have owners, it has many” stakeholders,” parties that have vested interests in the continuing success of the hospital.
Stakeholder Webs
Many hospitals have broad and vast webs of stakeholders. Stakeholders are why hospitals rarely close or are shut down. Too many stakeholders have interests in the continuing successful operation of hospitals.
Hospital stakeholder relationships need to be considered in the analysis of essentiality. How strong are these relations? How many are there? How important is the continuing success of this hospital to these stakeholders?
Service Analysis
Another dimension of the essentiality analysis is service analysis. How significant are the hospital’s services? If the hospital shuts down, what population segments would suffer? How significant is the population that would suffer? How much would they suffer?
Assessment
Analysis of hospital’s stakeholders and services should provide a credible view of the degree of essentiality associated with a hospital. Higher degrees of essentiality suggest higher likelihoods that hospitals, one way or another, will meet their commitments, particularly their payment commitments.
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Conclusion
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Filed under: Glossary Terms, Health Economics | Tagged: Calvin W. Wiese CPA MBA, hospital credit analysis, hospital essentiality | 1 Comment »
Guiding Long-Term Investment Decisions
By Staff Reporters
According to Wayne Firebaugh CPA, CFP® CMP™ many successful medical endowment funds will establish a “strategic” allocation policy that is intended to guide long-term (greater than one-year) investment decisions. This strategic allocation reflects the endowment’s thinking regarding the existence of perceived fundamental shifts in the market.
Asset Class Target Ranges
Most endowments will also establish a target range or band for each asset class. The day-to-day managers then have the flexibility to make tactical decisions for a given class so long as they stay within the target range.
Definition
The term “tactical” when used in the context of investment strategy refers to the manager’s ability to take advantage of short-term (under one year) market anomalies such as pricing discrepancies between different sectors or across different styles.
Historically, tactical decisions with respect to asset allocation were derided as “market timing.” However, market timing implies moving outside of the target ranges whereas tactical decision making simply addresses the opportunistic deployment of funds within the asset class target range.
Assessment
www.CertifiedMedicalPlanner.com
Conclusion
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Filed under: Glossary Terms, Investing, Portfolio Management, Retirement and Benefits | Tagged: asset class, Endowment Management, market timing, Portfolio Management, strategic allocation, Tactical Asset allocation | Leave a comment »
The “Father” of Health Economics
By Dr. David Edward Marcinko MBA, CMP™
[Editor-in-Chief]
Professor Kenneth Arrow is a Nobel laureate who explored the characteristics of a perfectly competitive marketplace for an ordinary commodity – and how the healthcare industry deviated from those characteristics – and what aspects of health care might explain these deviations.
But, in as much as he did all this in the 1960’s, he is known today as the “father” of health [not health care] economics.
LINK: https://www.nobelprize.org/prizes/economic-sciences/1972/arrow/facts/
Required ME-P Reading
In fact, his 1963 paper launched health economics as a unique discipline and is as close to required reading as can exist for followers of the ME-P and our related websites and educational consulting firms [sidebar].
Assessment
Arrow Title: “Uncertainty and the Welfare Economics of Medical Care”
Link: Arrow
Commentary
Glossary: Dictionary of Health Economics and Finance
Conclusion
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***
Filed under: Glossary Terms, Health Economics | Tagged: Dictionary of Health Economics and Finance, Health Economics, kenneth arrow | 4 Comments »
Explaining Healthcare Administration Terms, Too!
By Ann MiIler RN, MHA
[Executive-Director]
According to the Wall Street Journal, when it comes to understanding medical information, even the most sophisticated patient may not fully understand. Nearly nine out of 10 adults have difficulty following routine medical advice, largely because it’s often incomprehensible to average people, the CDC says. And that’s bad for health care.
Enter the Medical Jargon
Confused by scientific jargon, doctors’ instructions and complex medical phrases, patients are more likely to skip necessary medical tests or fail to properly take their medications, the agency says. Studies show that poor health literacy drives up costs to the health-care system and worsens patient outcomes.
http://online.wsj.com/article/SB10001424052748703620604575349110536435630.html
Assessment
And so, we too have attempted to explain some of the healthcare administration and practice management jargon in use today
Conclusion
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***
Filed under: Career Development, Glossary Terms, Practice Management | Tagged: Dictionary of Health Economics and Finance, Dictionary of Health Information Technology and Security, dictionary of health insurance and managed care, medical jargon, medical terms | 1 Comment »
And IDTF Prohibitions
[By Staff Reporters]
According to Robert James Cimasi MHA, ASA, AVA, CBA, CMP™ certain physician/hospital relationships referred to as “under arrangements” and “per click” leasing ventures have come under increasing regulatory scrutiny.
Definition
An under arrangement transaction occurs when the hospital contracts with a third party (typically a joint venture owned, at least in part, by physicians who may refer) to provide a hospital service, and the hospital then bills and is reimbursed by Medicare for those services and pays the supplier, or joint venture. As the “entity” to which the physicians refer patients is the hospital, not the joint venture (i.e., the “entity” is deemed to be the entity that submits the reimbursement claim to Medicare) this type of “arrangement” is permitted under Stark.
Stark Revisions
However, buried in the July 2, 2007, 2008 Medicare Physician Fee Schedule proposed rule, CMS has proposed revisions to the Stark regulations that broaden the definition of “entity” to include the person or entity that performs the designated health services and would prohibit space and equipment lease arrangements where per-click payments are made to a physician lessor who refers patients to the lessee. Although the proposed self-referral prohibitions (as well as arrangements where the physician is the lessee and rents space from a hospital) did not appear in the Final Rule, similar provisions are expected in 2008.
CMS has also passed restrictions related to independent diagnostic testing facility [IDTF] arrangements.
Assessment
For example, since January 1, 2008, IDTFs are no longer allowed to share practice locations, operations, and diagnostic testing equipment with other Medicare-enrolled providers, including leasing and subleasing agreements.
Conclusion
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Filed under: Ethics, Glossary Terms, Health Economics, Health Law & Policy | Tagged: "per click” leasing ventures, CMS, IDTF, independent diagnostic testing facilit, Medicare Physician Fee Schedule, per-click payments, Stark laws, under arrangements | Leave a comment »
Delving Deeper into the Historic Origins of Debate
[By Richard J. Mata MD, CIS, CMP™]
According to Wager, Ornstein, and Jenkins, in 2005, the perceived advantages of an EHR system include the following:
Items viewed as an advantage by fewer respondents include the following:
Nothing directly was said about cost savings or increased medical care quality. These topics have become more contentious issues during the past few years.
The Gurley Opinion
According to HIT expert Lori Gurley, in 2006, of the American Academy of Medical Administrators:
“The EHR provides the essential infrastructure required to enable the adoption and effective use of new healthcare modalities and information management tools such as integrated care, evidenced-based medicine, computer-based decision support, care planning and pathways, and outcomes analysis” (Schloefell et al). Although the benefits that support implementation of an EHR are clear, there are still barriers too, therefore the concept is still not accepted. “However, this could also be said of almost every other area of positive change and improvement within healthcare systems […]” (Schloefell et al). There must be more involvement by the government and the private sector “to make changes where possible to instigate, motivate, and provide incentives to accelerate the development of solutions to overcome the barriers” (Young).
THINK: ARRA and HITECH, today. Of course, there are obviously advantages and disadvantages to both the paper medical record and the EHR.
Multi-Factorial Issues
Many factors must be considered before any healthcare organization or medical practice should implement an EHR. The organization must first obtain as much information as possible about this new concept, and then the information must be carefully reviewed and the pros and cons discussed. Only then should the organization make their decision about this very important issue.
“The [EHR] as a part of a Clinical Information System (CIS) is a powerful tool which ties together documentation of the patient visit (clinical information), coding (diagnosis, and treatment procedures), which then translates into more accurate billing processes, reduces reprocessing of medical claims, and that translates into increased customer satisfaction with a provider” (Koeller). Although the technology is available, progress towards an EHR has been slower than expected. “Widespread use of [EHRs] would serve both private-and public-sector objectives to transform healthcare delivery in the United States” […] EHRs would also “enhance the health of citizens and reduce the costs of care” (Dick, Steen, and Detmer).
The MRI Study
According to a 2005-07 survey by the Medical Records Institute, the following factors are driving the push towards EHR systems within medical organizations:
| Motivating Factors | 2005 | Ambulatory |
| The need to improve clinical processes or workflow efficiency. | 89.3% | 91.2% |
| The need to improve quality of care. | 85.0% | 85.3% |
| The need to share patient record information among healthcare practitioners and professionals. | 81.1% | 66.9% |
| The need to reduce medical errors (improve patient safety). | 76.1% | 69.1% |
| The need to provide access to patient records at remote locations. | 67.9% | 65.4% |
| The need to improve clinical documentation to support appropriate billing service levels. | 67.1% | 76.5% |
| The need to improve clinical data capture. | 64.6% | 61.0% |
| The need to facilitate clinical decision support. | 60.7% | 50.7% |
| The requirement to contain or reduce healthcare delivery costs. | 54.6% | 61.8% |
| The need to establish a more efficient and effective information infrastructure as a competitive advantage. | 53.6% | 53.7% |
| The need to meet the requirements of legal, regulatory, or accreditation standards. | 50.0% | 44.1% |
| Other | 5.7% | 5.1% |
| Totals | 280 | 136 |
| Margin of Error | +/- 5.8% | +/- 8.4% |
Now, compare this with the results of the 2007 survey that focused on the factors driving hospitals to expand their use of EHR.
| Driving Factors in a Hospital | 2007 |
| Efficiency and convenience, e.g., better networking to the medical community and patients and remote access | 57.8% |
| Satisfaction of physicians and clinician employees | 42.2% |
| The need to survive and thrive in a much more competitive, interconnected world. | 41.0% |
| Regulatory requirements of JCAHO or NCQA. | 35.6% |
| Savings in the Medical Record Department and elsewhere, including transcription. | 24.0% |
| Value-based purchasing/pay for performance | 17.7% |
| Pressure from payer groups, such as Leapfrog Group | 15.2% |
| Possibility of subsidized purchase of HER, e-prescribing systems, etc. by purchasers/payers/large health systems. | 8.8% |
| Totals | 329 |
| Margin of Error | +/- 5.4% |
Assessment
How have these motivating and driving factors changed today; have they really changed in 2010?
Does this deeper dive reveal any other truths; political, social, business or economic? Is this historical review helpful in understanding the reluctance or eagerness for EMR acceptance, or not?
Conclusion
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Filed under: Glossary Terms, Information Technology, Practice Management | Tagged: American Academy Medical Administrators, ARRA, Clinical Information Systems, EHRs, EMRs, health information technology, HITECH, Lori Gurley, Medical Records Institute, Richard Mata, www.healthcarefinancials.com | 32 Comments »
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[A Three Part CD Primer for the Practicing Physician, CXO or Nurse-Executive]
Are You in Medical Practice or Healthcare Administration? – Buy this CD-ROM!
PART I: Understanding Hospital Information Systems
For the last 30 years, hospital information systems (HISs) have steadily grown in popularity. At present, nearly every acute care hospital in the United States has at least some form of HIS – at a minimum – performing administrative tasks such as patient billing, payor accounting, and employee payroll tracking. Depending on the size of the hospital, an information system may initially cost from several hundred thousand dollars to tens of millions of dollars. In 2005, about $25.8 billion was spent on hospital information technology (IT) in the United States.
By 2010-11 and beyond, it has become critical that such a system produce a positive return on investment (ROI) through patient care quality improvements, increases in organizational efficiency, or enhanced negotiating power with third-party payors and other stakeholders. Some HIS projects, especially more complex undertakings, have been clear failures to the extent that the organization had to abandon the new HIS in favor of the previous manual system. The goal of Part I is to illustrate how hospitals can maximize the chances for successful implementations of HIS while at the same time providing a positive ROI.
PART II: eMRs for the Independent Medical Practice
Many large organizations have a Chief Information Officer (CIO), a Chief Technology Officer (CTO), perhaps a Chief Medical Information Officer (CMIO), or Chief Medical Officer (CMO) that is tasked to do things like figure out the information technology (IT) and computer systems that support clinical and business goals within a healthcare organization. Smaller groups and practices don’t have enough resources to have dedicated staff for such a purpose so the selection, launch and implementation of eMRs will fall onto the physician staff or other senior leadership at a practice … Are you ready?
PART III: Health Information Technology Risks
Your clinical and business data and how it is used is vital to your medical organization. Information technology (IT) and its infrastructure must therefore be protected through careful security policies. These policies are guided in part by the risk inherent in your health organization’s IT infrastructure, its competitive strategy, and its asset and risk management policies. It is important, however, not to over focus on security implementation so that you overlook the clinical operation management and patient-centered care in your healthcare facility.
There are two parts to the security equation: the first involves meticulous inventory of hardware, accessories, and software and the other involves establishing secure IT policies and procedures. Management systems like those developed by the International Standards Organization (ISO) and the National Institute of Standards and Technology (NIST) serve as very functional models that can be applied in the clinical setting.
Part III of this CD-ROM reviews the model codes that offer templates on how to put protections in place and the regulations that have been designed to ensure information security. It also discusses the business continuity and risk management systems you need to keep your organization functioning in case of security and/or privacy breaches. It also offers interpretation and recommendations in making choices as they relate to the IT systems and discusses good healthcare security and privacy practices. For example, the use of role-based access in an electronic health record (EHR) is not mandatory, but that does not mean that it cannot be implemented. In fact, it is usually desirable. Many organizations will used a modified role-based system to limit the amount of protected health information (PHI) that one needs to access.
Special Added Bonus
We also include the following valuable resources for your office staff:
1. Glossary of managed care terms
2. Glossary of health information technology
3. Glossary of medical management abbreviations and practice business acronyms.
Table of Contents: CD-TOC
Now, be among the first-adopters to use this CD for the vital HIT, eMR and IT administration aspects of your medical office, hospital or clinic. You will be glad you did.
Testimonial:
“I am finally beginning to understand HIT and eMRs” [Dr. Sarah Jane Fergson]
And, the handsome, sturdy package makes the checklist CD an ideal gift for the recent graduate, mid-career doctor or mature medical practitioner.
Product Specifications:
Compatible with any PC or Mac computer; Adobe Acrobat Reader® required.
Price: Only $99 USD, includes SPH and tax.
TO ORDER: Please send your check or money order [for CD-ROM] to: iMBA Inc, Suite #5901 Wilbanks Drive, Norcross, GA 30092-1141 [770.448.0769] or MarcinkoAdvisors@msn.com
OR – you may order electronically right here: <a href=”https://www.e-junkie.com/ecom/gb.php?c=cart&i=762864&cl=109140&ejc=2
Filed under: Glossary Terms, Information Technology, Practice Management, Sponsors | 2 Comments »
The RHIO Concept – Defined
[By Richard J. Mata MD, CIS, CMP™]
Regional Health Information Organizations (RHIOs), or data exchanges, are multi-stakeholder organizations. They might include groups of hospitals, medical societies, payers, major employers, and other healthcare organizations.
Generally, these stakeholders are developing RHIOs with the goal of affecting the safety, quality, and efficiency of healthcare as well as improving access to healthcare by expanding the use of health information technology. It is expected that RHIOs will be responsible for motivating and causing integration and information exchange in the nation’s revamped healthcare system
Assessment
Regions in the U.S. continue to use various definitions of “multi-stakeholder organizations.” For instance, in Wichita, Kansas, the Clinics Patient Index is a software architecture as well as support environment that facilitates integration among outpatient clinics and hospital emergency departments.
And, what will be the affect of [HR 3590], or the Patient Protection and Affordable Care Act, on RHIOs?
Conclusion
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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com
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Filed under: Glossary Terms, Information Technology | Tagged: ARRA, Clinics Patient Index, EMRs, HITECH, Regional Health Information Organizations, RHIOs, Richard Mata | 3 Comments »
Does Linguistic Obfuscation Exacerbate our Use Ambivalence?
[By Dr. Richard J. Mata; CIS, CMP™]
[By Dr. David E. Marcinko; MBA, CMP™]
The 2003 Institute of Medicine (IOM) Patient Safety Report [1] described an EHR [2] as encompassing:
The IOM Report
A 1997 IOM report, The Computer-Based Patient Record: An Essential Technology for Health Care, provides a more extensive definition:
A patient record system is a type of clinical information system, which is dedicated to collecting, storing, manipulating, and making available clinical information important to the delivery of patient care. The central focus of such systems is clinical data and not financial or billing information. Such systems may be limited in their scope to a single area of clinical information (e.g., dedicated to laboratory data), or they may be comprehensive and cover virtually every facet of clinical information pertinent to patient care (e.g., computer-based patient record systems).
The HIMSS Model
The EHR definitional model document developed by the Health Information and Management Systems Society (HIMSS, 2003) includes:
“a working definition of an EHR, attributes, key requirements to meet attributes, and measures or ‘evidence’ to assess the degree to which essential requirements have been met once EHR is implemented.”
The IOM Model
Another IOM report, Key Capabilities of an Electronic Health Record System [Tang, 2003], identifies a set of eight core care delivery functions that EHR systems should be capable of performing in order to promote greater safety, quality and efficiency in health care delivery:
8 Core Principles
Today, we realize that the eight core capabilities that Electronic Health [Medical] Records should possess are:
Assessment
With all the confusion surrounding terms like quality improvement and “meaningful use” which can mean major Federal dollars to the coffers of a medical practice, clinic or hospital; are we still confused about basic definitional terms?
And, does eMR linguistic obfuscation exacerbate our use ambivalence and encourage physician/dentist eMR avoidance?
Conclusion
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References:
[1] See http://www.himss.org/content/files/PatientSafetyFinalReport8252003.pdf.
[2] EHR (electronic health record) is often used interchangeably with EMR (electronic medical record). In this discussion, EHR will be used consistently.
[3] See http://www.iom.edu/.
Filed under: Glossary Terms, Information Technology, Practice Management | Tagged: david marcinko, EHRs, electronic health records, electronic medical records, EMRs, health information technology, HIMSS, HIT, IOM, Richard Mata, www.healthcarefinancials.com | Leave a comment »
The NHIN Defined
By Richard J. Mata MD, CIS, CMP™
On November 15, 2004, DHHS called for public comments on its plans for a National Health Information Network (NHIN) within ten years (see Federal Register, vol. 69, no. 219).
This would include establishing “interoperable” (easily exchanged) EHRs for all citizens.
DHHS Template
DHHS outlined four main purposes for the national network:
Assessment
What is the impact of the Patient Protection and Affordable Care Act on the NHIN? How close are the NHIN’s goals and original template to reality?
Your thoughts and commented are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
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Filed under: Glossary Terms, Information Technology | Tagged: National Health Information Network | Leave a comment »
What it Is – How it Works
[By Dr. David Edward Marcinko MBA, CMP™]
[By DeeVee Devarakonda MBA]
The success of a knowledge driven healthcare organization depends on not only how data can be converted to information – and information into marketing insight – but also by acting upon and converting those insights into building meaningful patient acquisition campaigns.
Definition of Patient Recruitment
Patient recruitment or campaign managementis the process of designing, executing, and measuring marketing campaigns through the use of applications that help to:
Key Queries
Some key questions to ask while you build campaigns:
Important Campaign Components
Critical components of campaign management include the following activities:
Learn more: http://www.CertifiedMedicalPlanner.org
The Mindset
Successful patient marketing campaigns begin with the proper mindset and practice culture. There is no technology silver bullet to any P[C]RM campaign. And today, patient privacy is the key element of loyalty with a commitment to build long lasting and profitable campaigns through mutual trust and engaging cross-functional teams that can pick and deploy the elements mentioned above, across the entire enterprise and IT network, as needed.
Assessment
Healthcare organizations should keep privacy and the above components as their laundry list of action items when considering a C(P)RM plan.
Conclusion
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Filed under: Career Development, CMP Program, Glossary Terms, Marketing & Advertising, Practice Management | Tagged: CRM, DeeVee Devarakonda, healthcare marketing campaigns, Medical CRM, medical marketing, www.certifiedmedicalplanner.com, www.HealthDictionaySeries.com, www.medicalbusinessadvisors.com | 2 Comments »
Dictionary of Health Insurance and Managed Care
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The book up for grabs is the Dictionary of Health Insurance and Managed Care by Dr. David E. Marcinko; FACFAS, MBA, CFP™, CMP™ [Editor-in-Chief] and Hope Rachel Hetico; RN, MHA, CPHQ, CMP™ [Managing Editor].
Click here to read the Amazon.com reviews for Dictionary of Health Insurance and Managed Care
Beyond that, all you need to do to win is provide your email below. We will not be using this email for any marketing purposes, nor do we participate with any lists. We just need your email to contact the winner so we know where to send the book.
The only rules are that participants be at least 18 years of age and live in the residential United States. Also, only one entry per person (our software knows how to sniff you out if you cheat, so please don’t bother). We will be announcing a winner on July 1st, 2010 and will be accepting entries until midnight EST on June 30th, 2010.
ENTER TO WIN
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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Healthcare Organizations: www.HealthcareFinancials.com
Health Administration Terms: www.HealthDictionarySeries.com
Physician Advisors: www.CertifiedMedicalPlanner.com
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Filed under: Alerts Sign-Up, Contest Entrance, Glossary Terms, Health Insurance, iMBA, Inc., Managed Care, Sponsors | Tagged: Benefits Group, Health Insurance, Managed Care, www.certifiedmedicalplanner.com, www.HealthDictionaySeries.com, www.medicalbusinessadvisors.com | Leave a comment »
What is it – How does it work?
By Hope Rachel Hetico; RN, MHA
[Managing Editor]
The Internet is a constantly evolving service that continues to grow at an exponential rate, despite late adoption by some physician practices.
History
Since 1995, the primary use of the internet was e-mail communications with peers, hospitals and others.
Next providers linked to hospitals and managed care organizations to obtain more direct connectivity for clinical information and insurance benefits coverage.
More recently, physicians are finding other beneficial avenues to expand their utilization of the Internet:
Health 2.0, Web 2.0 and Patient 2.0
But, ever since the term “web 2.0″ was first used in 2004, there has been an inordinate amount of chatter about what web 2.0 really is and its true impact in medicine. No one’s defined it clearly, but we think the web evolution relative to healthcare essentially falls into 3 generations, as outlined in the new re-source: Dictionary of Health Information Technology www.HealthDictionarySeries.com and our related websites, wikis and professional blogs www.BusinessofMedicalPractice.com
Health 2.0 Journalists
According to healthcare visionary and uber-blogger Matthew Holt, http://www.health2advisors.com and similar other sources, Healthcare 2.0 may be defined as:
“A rapidly developing and powerful new business approach in the health care industry that uses the Web to collect, refine and share information. It is transforming how patients, professionals, and organizations interact with each other and the larger health system. The foundation of healthcare 2.0 is information exchange plus technology. It employs user-generated content, social networks and decision support tools to address the problems of inaccessible, fragmentary or unusable health care information. Healthcare 2.0 connects users to new kinds of information, fundamentally changing the consumer experience (e.g., buying insurance or deciding on/managing treatment), clinical decision-making (e.g., risk identification or use of best practices) and business processes (e.g., supply-chain management or business analytics)”.
And so, if Health 1.0 was a book, Health 2.0 is a live discussion.
Furthermore, Scott Shreeve, MD – http://blog.crossoverhealth.com [personal communication] of Cross-Over Health defines health 2.0 as:
“A New concept of healthcare wherein all the constituents (patients, physicians, providers, and payers) focus on healthcare value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care.”
Assessment
By now, you probably realize that Health 2.0 empowers patients and worries doctors.
Writing for Time magazine recently, journalist Bonnie Rochman explored the ramifications of patients sharing information and tips online, an “empowerment movement” that she calls “Patient 2.0.”
In her piece, she profiled the newly created Society for Participatory Medicine, which “encourages patients to learn as much as they can about their health and also helps doctors support patients on this data-intensive quest,” as well as www.PatientsLikeMe.com, a free service which makes its money by selling anonymized patient information.
Source: http://www.healthjournalism.org/blog/2010/02/patient-20-empowers-patients-worries-doctors
Conclusion
And so, your comments on this ME-P are appreciated. Do doctors really fear Health 2.0? What do Health 2.0 and Patient 2.0 mean to you? How would you define the terms formally, and how do you use Web 2.0 in your medical practice? Or, are you a late-adopter still waiting for governmental or CCHIT definitional clarity?
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Healthcare Organizations: www.HealthcareFinancials.com
Health Administration Terms: www.HealthDictionarySeries.com
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Filed under: Career Development, Glossary Terms, Recommended Books, Research & Development | Tagged: Bonnie Rochman, health 2.0, Matthew Holt, patient 2.0, scott shreeve, Society for Participatory Medicine, web 2.0, www.healthdictionaryseries.com | 2 Comments »
Joint Commission Abbreviations Not Used
By Staff Reporters
In May 2005, The Joint Commission first affirmed its “do not use” list of abbreviations. The list was originally created in 2004 by The Joint Commission as part of the requirements for meeting National Patient Safety Goal Requirement 2B [Standardize a list of abbreviations, acronyms and symbols that are not to be used throughout the organization].
Link: http://www.jointcommission.org/PatientSafety/DoNotUseList/
Official List [Updated 3/5/09]
Link: http://www.jointcommission.org/NR/rdonlyres/2329F8F5-6EC5-4E21-B932-54B2B7D53F00/0/dnu_list.pdf
Assessment
In the era of twitter and other text messaging abbreviations, the list is similar to “never-events” and related conditions frequently discussed on this ME-P.
More info: https://healthcarefinancials.wordpress.com/2008/01/16/never-event-payment-trend-continues/
Conclusion
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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421
Healthcare Organizations: www.HealthcareFinancials.com
Health Administration Terms: www.HealthDictionarySeries.com
Physician Advisors: www.CertifiedMedicalPlanner.com
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Filed under: "Doctors Only", Glossary Terms, Quality Initiatives | Tagged: do not use abbreviations, JCAHO, Joint Commission, National Patient Safety Goal Requirement 2B | Leave a comment »
Where We’ve Been … Where We’re Going!
By John Moore
Channel Surfing
Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register.
Conclusion
Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.
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Filed under: Career Development, Glossary Terms, Health Law & Policy, Information Technology, Research & Development, Videos | Tagged: EHRs, elecronic health records, electronic medical records, EMRs, health information technology, HIT video, PHRs | 3 Comments »
Understanding Fundamental Principles
According to industry inventory management expert Mr. David Piasecki, healthcare inventory is a term that describes medical items used in the delivery of healthcare services or for patient use and resale. Much like Durable Medical Equipment, a certain safety margin of stock should always be available. Inventory ranges from normal administrative office supplies to highly specialized chemicals and reagents used in the clinical laboratory. It should be distinguished from capital supplies, such as major equipment, instruments, and other items that are not used up faster than inventory or related inventory wastes.
Historical Review
Historically, asset utilization ratios provided information on how effectively the enterprise used its inventory assets to produce revenues, or deplete its cash. For example, the inventory turnover ratio (ITR) determines the total volume of inventory turnover (change) during a pre-determined accounting period (month or quarter). It is defined as cost of inventory purchased for the period, divided by average inventory (AI) at cost.
Consulting Firms
Dunn and Bradstreet, the supply chain management – consulting firm and others, do not provide exact comparatives for private healthcare ITR. Nonetheless, ITR is useful as an internal performance indicator of inventory turnover speed and cash flow enhancement. Currently however, for public hospitals, 60 – 75 days is estimated to be the average time for inventory turnover.
The main problem with traditional ITR, similar analyses such as AI and ICP, and the usual inventory costing methods (e.g., last-in first-out, first-in first-out, specific identification, average costs), and even just-in-time inventory costing, is that they do not embrace Supply Chain Inventory Management. This occurs because sources of profit or loss are not recognized in the traditional inventory cost accounting equation:
Assessment
Cost of goods sold = beginning inventory + net purchases – ending inventory
Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.
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Healthcare Organizations: www.HealthcareFinancials.com
Health Administration Terms: www.HealthDictionarySeries.com
Physician Advisors: www.CertifiedMedicalPlanner.com
Filed under: "Doctors Only", Glossary Terms, Practice Management | Tagged: beginning inventory, cost of goods sold, david marcinko, David Piasecki, DME, Dunn and Bradstreet, ending inventory, inventory turnover ratio, ITR, medical inventory management, www.healthcarefinancials.com, www.healthdictionaryseries.com | 3 Comments »
New HHS Regulations
[By Staff Reporters]
Effective September 23, 2009, new regulations issued by the U.S. Department of Health and Human Services (“HHS”) will require covered entities to notify affected individuals and HHS following the discovery of a breach of patient information. These regulations are more expansive than other notification laws that may already exist. Under these new regulations, covered entities must analyze every privacy and/or security incident to determine whether a notification requirement exists and then satisfy detailed notice requirements.
Breach Defined
According to Garfunkel, Wild and Travis PC, a “breach” may be defined as the unauthorized acquisition, access, use or disclosure of unsecured Protected Health Information (“PHI”) which compromises the security or privacy of the PHI. It is important to note that this definition of breach is broader than most state notification laws under which most covered entities have already been operating for a number of years. While state notification laws may only require notification when there is an unauthorized disclosure of social security numbers or other specific kinds of personal information, under these new Federal regulations, unauthorized access, acquisition, use or disclosure of any PHI, not just social security number, is a potential breach. Furthermore; unauthorized uses of PHI, not just access or disclosure, requires notification.
Assessment
For more info: http://www.gwtlaw.com
Conclusion
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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Filed under: Glossary Terms, Health Law & Policy, Information Technology | Tagged: Department of Health and Human Services, EHRs, EMRs, Garfunkel, HHS, HIPAA, PHI, security breach, Wild and Travis, www.healthdictionaryseries.com | 3 Comments »
By Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief]
Dateline: Baltimore Maryland
While in Washington DC on the second portion of our recent ME-P book “signing and opining” tour, I had the good fortune to visit the gravesite of the noted physician Nathaniel Potter, MD. Dr. Potter was born in Carolina county Maryland in 1770 and died in Baltimore on 2 January, 1843. He graduated from the University of Pennsylvania in 1796, and settled in Baltimore, where he practiced medicine until his death. In 1807, he associated with Dr. John B. Davidge in founding the University of Maryland, School of Medicine where he ultimately served as professor and dean. He died penniless.
THINK Potter’s field!
About Green Mount Cemetery
Green Mount Cemetery is located in Baltimore, MD. Established in 1839, it is noted for the large number of historical figures that have been interred in its grounds as well as a large number of prominent Baltimore-area families. It retained the name Green Mount when the land was purchased from the heirs of Baltimore merchant Robert Oliver. Green Mount is also a treasury of precious works of art, including striking works by major sculptors like William Rinehart and Hans Schuler. The cemetery was listed in the National Register of Historic Places in 1980.
Assessment
In as much as Dr. Potter was a well know figure to me, I was most pleased at the impromptu visit to his grave. You see, although I attended Temple University because of my future specialty, my first medical school choice would have been at University of Maryland if post-graduate education opportunities had been different at the time. And, I passed the medical school, and the imposing Greek themed Davidge Hall Dome, daily for four years as I rode the number 8 public transportation bus to my undergraduate studies at nearby Loyola University, in Townson Maryland. Of course, the fact that Potter was educated at the University of Pennsylvania School of Medicine, the first in the nation, did not elude me when I worked in its ER as a young medical student in Philadelphia, back in-the-day. University of Maryland was the fifth such medical school in the country.
About Off Road with Dr. Marcinko
These sporadic off-road segments will continue through-out my summer promotional tour. Attendance at several formal and informal engagements increased since the early summer. The previously noted sales spike for our texts, handbooks and dictionaries; as well as interest in our online www.CertifiedMedicalPlanner.org program.
Part V: https://healthcarefinancials.wordpress.com/2009/08/21/off-road-touring-with-dr-marcinko-part-v/
Conclusion
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***
Filed under: CMP Program, Glossary Terms, iMBA, Inc., Media Mentions and PR, Op-Editorials, Sponsors, Touring with Marcinko | Tagged: david marcinko, Dr. John B. Davidge, ER, Green Mount Cemetery, Hans Schuler, Loyola University, medical school, Nathaniel Potter MD, Robert Oliver, University of Maryland Medical school, University of Pennsylvania Medical School, William Rinehart | Leave a comment »
Review of Automatic Data Collection Equipment
By David J. Piasecki, with
Hope Hetico; RN, MHA
While hardware costs of automatic data collection [ADC] equipment continue to come down for hospital and healthcare organizations, the cost of integration will often prove to be the project buster. Software and integration costs will often be several times the cost of the hardware, especially in smaller health system operations where only a few devices will be used. Integration of ADC technologies is also far from standardized.
Example:
For example, when implementing a system with portable terminals, one integrator may create a program on the terminals that will write directly to the file on the host system, another may create programs on a separate server to do this, another may write or modify a program on your host system and use terminal emulation software, and another may use a screen mapping tool to reformat an existing program to be used on the portable device. So, make sure to speak with several integrators to ensure the best solution. Also, make sure to participate heavily in equipment selection and program/process design (prompts, data input) to ensure a system that provides the highest levels of accuracy and productivity.
Real-Time Locator System
A real-time locator system (RTLS) uses RFID technology that provides the objects they are attached to the ability to transmit their current location. The system requires some type of RFID tag to be attached to each object that needs to be tracked, and RF transmitters/receivers located throughout the facility to determine the location and send information to a computerized tracking system. While it sounds like a great way to eliminate “lost” inventory, the systems are still too costly for most inventory-tracking operations and are more likely to be used to track more valuable assets.
Screen Mapping/Screen Scraping
This software provides the functionality to change the arrangement of data fields on a computer screen that accesses a mainframe computer program. Screen mapping is frequently used in combination with terminal-emulation software to “remap” data fields from a standard mainframe program to be used on the smaller screen of a portable hand-held device.
Speech-Based Technology
Speech-based technology, also known as voice technology is really composed of two technologies: (1) voice directed, which converts computer data into audible commands, and (2) speech recognition, which allows user voice input to be converted into data. Portable voice systems consist of a headset with a microphone and a wearable computer.
Terminal Emulation
Software used on desktop and portable computers is available that allows the computer to act like a terminal connected to a mainframe system. If you have a networked desktop PC and are accessing mainframe programs (green screen programs) you are using terminal emulation. Terminal emulation is also a common method used to connect portable computers (as in pharmacy bar-code ADC systems) to mainframe software.
Warehouse Management System
Computer software designed specifically for managing the movement and storage of materials throughout the healthcare system warehouse or chain of command generally controls the following three operations: (1) put-away, (2) replenishment, and (3) picking. The key to these systems is the logic to direct these operations to specific locations based on user-defined criteria. Warehouse Management Systems (WMSs) are often set up to integrate with ADC systems.
Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated. Can you think of any other data integration technologies? Tell us what you think. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.
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Filed under: Career Development, Experts Invited, Glossary Terms, iMBA, Inc., Information Technology, Practice Management | Tagged: ADC, automatic data collection, CPOE, David Piasecki, HIT, hope hetico, hospital information technology, IT, real-time locator system, RFID, RTLS, screen mapping, Speech-Based Technology, Warehouse management systems, WMS | 1 Comment »
Understanding OSHA Requirements
By Patricia A. Trites; MPA, CHBC, CHCC, CMP™ (Hon)
Dr. Charles F. Fenton, III; JD, FACFAS
Hope Rachel Hetico; RN, MHA, CMP™
The OSHA Standard requires that contaminated needles and other contaminated sharp instruments (sharps) must not be bent, recapped, or removed.
Definition
Contaminated sharps are defined as any contaminated object that can penetrate the skin including, but not limited to: needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires.
Contaminated needles and other contaminated sharps must not be recapped or removed from the syringes unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical procedure. Also, shearing or breaking of contaminated needles is prohibited. This would include those instances, such as during surgery, where recapping was necessary due to the need to give multiple injections from the same syringe. If needles are recapped, it must be through the use of a one-handed technique.
Two-Handed Recapping
Two-handed needle recapping is strictly prohibited by the Standard. Recapping of needles can be a very dangerous procedure. It is during recapping that most skin punctures occur.
Immediately, or as soon as possible after use, contaminated reusable sharps must be discarded and placed in appropriate containers until properly reprocessed. The containers must be:
Assessment
Finally, containers must be at the site as close as feasible to the use of the sharps. This will limit the risk of injury during the time the sharp would otherwise have been transported from the site of use to the site of disposal. During use, the sharps container must be maintained upright, not be allowed to be overfilled, and replaced routinely. When moving containers of contaminated sharps from the area of use, the containers must be closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling. The container must be placed in a secondary container if leakage is possible. Reusable containers must not be opened, emptied, or cleaned manually or in any other manner that would expose employees to the risk of percutaneous injury. Physicians can purchase turn-key sharps containers that, when full, can be shipped back to the distributor for proper disposal.
Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think. How has OSHA affected your practice? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.
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Filed under: "Doctors Only", Glossary Terms, Health Law & Policy, Practice Management, Professional Liability | Tagged: Charles Fenton, contaminated needles, contaminated sharps, hope hetico, OSHA, Patricia Trites, sharps, syringes, Two-handed needle recapping | 6 Comments »
Understanding OSHA Standards
[By Dr. David E. Marcinko; FACFAS, MBA, CPHQ, CMP™]
[By Patricia A. Trites; MPA, CHBC, CHCC, CMP™ (Hon)]
The OSHA Standards for healthcare require that hand washing facilities be readily available to employees.
Definition
Hand washing facilities are defined as a facility providing an adequate supply of:
Location
The hand washing facilities must be located where the employee will have easy access. This will ensure that the employee will be likely to use the hand washing facility and will minimize the time that the contamination will remain in contact with the employee. In those instances where the provision of hand washing facilities is not feasible, either an appropriate antiseptic hand cleaner (e.g., alcohol-based rinse, antiseptic foam, or antiseptic-impregnated paper wipes) in conjunction with clean cloth or paper towels, or antiseptic towelettes, must be provided.
Soap and Running Water
When using antiseptic hand cleansers or towelettes, the hands must be washed with soap and running water as soon as feasible. Not only must the employer provide the hand washing facilities, he or she must also ensure that employees in fact do wash their hands immediately or as soon as feasible following contact with blood or other potentially infectious material [OPIM].
The employee must also wash his or her hands immediately after removal of gloves or other personal protective equipment [PPE]. It is the employer’s responsibility to ensure that hand washing occurs. OSHA states that hand washing must be strictly enforced by the employer.
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Assessment
How has OSHA affected your hospital, medical practice or healthcare facility?
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Conclusion
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Filed under: "Doctors Only", Career Development, Glossary Terms, Health Law & Policy, Practice Management, Quality Initiatives, Recommended Books, Risk Management | Tagged: Charles Fenton, hand washng, OPIM, OSHA, other potentially infectious material, Pati Trites, personal protective equipment, PPE | 8 Comments »
Engineering and Medical Work Practice Controls
By Patricia A. Trites; MPA, CHBC, CHCC, CMP™ (Hon)
Dr. Charles F. Fenton, III; JD, FACFAS
Hope Rachel Hetico; RN, MHA, CMP™
Engineering and medical practice controls are methods used to isolate or remove bloodborne pathogen hazards from the workplace. These practices should be used to eliminate or minimize employee exposure by removing the hazard or isolating the employee from the exposure. However, where occupational exposure remains after institution of these controls, personal protective equipment [PPE] must be employed, as described below.
Engineering Controls
Engineering controls can be described as those an employer purchases and makes available to protect his or her employees. Examples are sharps containers, eye-wash stations, spill-kits, and safer needle systems. It is the employer’s responsibility to implement and maintain a system for ensuring engineering that controls are used. The engineering controls must be examined and maintained or replaced on a regular schedule to ensure their effectiveness. Conducting only an annual review of the engineering controls is inappropriate under the OSHA Standard.
Healthcare Work Practice Controls
Unlike engineering controls, healthcare work practice controls depend upon the behavior of the employee to reduce exposure. Examples are hand washing, utilizing universal precautions, and wearing appropriate PPE. Even with properly implemented work practice controls, exposure can still occur. Some of the engineering and work practice controls that must be addressed (if applicable to the specific healthcare organization) within the employee control plan [ECP] include:
Assessment
These engineering controls must be examined and maintained or replaced on a regular schedule to ensure their effectiveness. Conducting only an annual review of the engineering controls is inappropriate under the OSHA Standard.
Conclusion
How has OSHA affected your practice? Or, is it so 1999?
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Filed under: "Doctors Only", Glossary Terms, Health Law & Policy, Practice Management, Quality Initiatives, Risk Management | Tagged: bloodborne pathogens, Charles Fenton, ECP, eye-wash stations, hand washing, hope hetico, OSHA, Patricia Trites, personal protective equipment, PPE, safe needle, sharps containers, spill-kits | 3 Comments »
A Dedicated Terminology Website
By Staff Reporters
Understanding and defining the new era of healthcare information technology in America.
The ARRA and HITECH concept of “meaningful use” for e-MRs is nebulous and ill defined. This new website is intended to be a collaborative destination site in order to promote the national dialogue and education around the term, “meaningful use”, by providing the HIT community a single-central location to access resources, influence and discuss the definition of “meaningful use” and learn how to take advantage of the HITECH stimulus funds.
Assessment
According to the site, registration for the www.MeaningfulUse.org discussion board is only used for the purpose of posting and will not be used for any marketing purposes. The site is supported by the Association of Medical Directors of Information Systems (AMDIS) and sponsored by Compuware Corporation.
Conclusion
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Filed under: Breaking News, Career Development, Glossary Terms, Health Economics, Information Technology | Tagged: AMDIS, ARRA, Association of Medical Directors of Information Systems, CCHIT, Compuware Corporation., economic stimulus funds, HIT, HITECH, IT, Mark Leavitt, meaningful use, www.healthcarefinancials.com, www.healthdictionaryseries.com, www.MeaningfulUse.org | 13 Comments »
Goodwill Hunting
What’s your Office Really Worth?
[By Dr. David E. Marcinko
; MBA]
There are several measures a physician can take to increase the value of medical practice goodwill, which in turn will make the practice more desirable, and profitable, when selling or taking on a partner.
These are listed below for your consideration:
MORE: AMA News Interviews Dr. Marcinko
Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated. How have you reacted to the recent declines in both medical practice [business] and personal [doctor] goodwill?
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Filed under: Career Development, Glossary Terms, Health Economics, iMBA, Inc., Practice Management, Practice Worth, Research & Development | Tagged: accounting value, book value, business goodwill, david marcinko, goodwill, goodwill valuation, medical practice value, personal goodwill, practice appraisal, Practice Worth | 1 Comment »
Protected Health Information and HIPAA
By Richard J. Mata; MD, MIS, CMP™ [Hon]
One important concept of the Health Insurance Portability and Accountability Act [HIPAA] is the “minimum necessary” rule, which states the minimum use of Protected Health Information [PHI] to identify a person, such as a social security number, home address, or phone number.
Only the essential elements are to be used in transferring information from the patient record to anyone else that needs this information.
Financial Information Included
This is especially important when financial information is being addressed. Only the minimum codes necessary to determine the cost should be provided to the financial department. No other information should be accessed by that department. Many institutions have systems where a registration or accounting clerk can pull up as much information as a doctor or nurse, but this is now against HIPAA policy and subject to penalties. The “minimum necessary” rule is also changing the way software is set up and vendor access is provided.
Human Resources
Another challenging task is keeping up with the number of people who access PHI, because the privacy regulations allow a patient to receive an accounting of anyone who has accessed their information, both internally (within your hospital, Emerging Healthcare Organization, or medical entity) and externally (such as through your business associates). The patient has the right to know who in the lengthy data chain has seen their PHI. This sets up an audit challenge for the medical organization, especially if the accountability is programmed internally. When other business associates use this PHI without documenting access to a specific patient’s PHI, no one would be accountable for a breach in privacy.
http://www.findbookprices.com/author/Hope_Hetico
One way to track access is through a designated record set, which contains medical or mixed billing records, and any other information that a physician and/or medical practice utilizes for making decisions about a patient. It is up to the hospital, EHO, or healthcare organization to define which set of information comprises “protected health information” and which does not, though logically this should not differ from locale to locale.
Assessment
Overlaps from the privacy regulations that are also addressed in the security regulations are access controls, audit trails, policies on e-mail and fax transmissions, contingency planning, configuration management, entity and personal authentication, and network controls. For more information about the Security Standards final rule; reference the Federal Register.
Conclusion
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Filed under: "Doctors Only", Career Development, Glossary Terms, iMBA, Inc., Information Technology, Research & Development, Sponsors | Tagged: designated record set, Dictionary Health Information Technology Security, eHR, eMR, federal register, HIPAA, hope hetico, minimum necessary, PHI, protected health information, Richard Mata, www.healthdictionaryseries.com | 1 Comment »
Basic HIT Nomenclature and HIPAA
[By Richard J. Mata; MD, MIS, CMP™ [Hon]
For the Health Information Technology [HIT] department of a hospital, clinic or medical practice and its coders, the following medical vocabularies are mandated by the Health Insurance Portability and Accountability Act [HIPAA].
Diseases
For diseases: the 9th or 10th International Classification of Diseases (ICD) Clinical Modification should be used. ICD9-CM is maintained by the Centers for Disease Control National Center for Health Statistics, while ICD-10 is maintained by the World Health Organization.
Procedures
For medical procedures: a combination of ICD-9-CM, Current Procedural Terminology maintained by the American Medical Association, the Current Dental Terminology maintained by the American Dental Association, and Healthcare Common Procedure Coding System (HCPCS) maintained by CMS, which is also used for medical devices.
Pharmaceuticals
For drugs: these should be coded according to their National Drug Code classification.
Assessment
“A recent change to Medicare policy made by the Centers for Medicare & Medicaid Services (CMS) helps ensure claims processing isn’t delayed when the only missing information on the CMS-1490S form is the provider or supplier’s National Provider Identifier (NPI).
CMS Transmittal 1747, Change Request 6434, issued May 22, notifies A/B Medicare Administrative Contractors (MAC) and carriers of editorial changes to Medicare policy in Pub. 100-04, Medicare Claims Processing Manual, chapter 1 regarding the monitoring of claims submission violations and the handling of incomplete or invalid claims.
In either case, as stated in the transmittal, “If the beneficiary furnishes all other information but fails to supply the provider or supplier’s NPI, the contractor shall not return the claim but rather look up the provider or supplier’s NPI using the NPI registry.”
http://www.aapc.com/news/index.php/2009/06/missing-npi-no-reason-to-deny-says-cms/
Conclusion
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Filed under: Glossary Terms, Health Insurance, Information Technology, Practice Management, Research & Development | Tagged: ADA, AMA, CDC, CDT, Centers for Disease Control National Center for Health Statistics, CMS, CPT, current dental terminology, current procedural terminology, david marcinko, HCPCS, Healthcare Common Procedure Coding System, HIPAA, hope hetico, ICD-10, ICD-9, international classification of diseases, IT, MAC, medicare, National Drug Code, National Provider Identifier, NPI, Richard Mata, WHO | 2 Comments »
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Filed under: Book Reviews, Glossary Terms, Health Economics, Healthcare Finance, iMBA, Inc., Sponsors | Tagged: AACPD, ABCM, ALOS, atul gawande MD, Brigham Women's Hospital, david marcinko, definitions, dictionary, dictionary health economics finance, DRG, glossary, health dictionary, hope hetico, IBNR, IGARCH, OPHCOO, RBRVS, terms, www.healthdictionaryseries.com | 3 Comments »
More on the NPI, the AAPC, Censorship and Quality Health Care
By Darrell K. Pruitt; DDS
For those who have been following me recently on Twitter (Proots), you know that unlike me, John Hamm has not yet been kicked off of DrBicuspid, and is awaiting a response from Dr. David J. Pettigrew – a dental coding expert with 14 years of experience as Chief Dental Officer for BCBS of New Jersey. I can only shadow the conversation because, as I said, I was kicked off.
Through John Hamm, I sent word to Dr. Pettigrew that he should just shut up and not enter into a discussion about the NPI number. Pettigrew told Johnhamm that I should come onto the DrBicuspid forum and say that in front of everyone. Of course, I am unable to do that because as shameful as it is to my family, I am still banned from posting anything on DrBicuspid.
For real-time developments concerning Dr. Pettigrew’s public defense of the NPI number, it would be better to follow that chunk of drama on Twitter or DrBicuspid. I’ve got other things cooking here. Can you smell it yet?
As you can see, sports fans, I have had Internet contact with a new class of fat, slow-moving healthcare IT stakeholders, and I haven’t been building long-term relationships fortified by good will – if you know what I mean. 14 years of employment at BCBS of New Jersey fails to impress me much.
American Academy of Professional Coders
Those who have studied alphanumeric science have a national organization called the American Academy of Professional Coders [AAPC] which represents business consultants in a growing healthcare niche. Most are employed by providers who are too busy actually performing healthcare to play games with insurance companies for the money owed them. Like SEO professionals who know gimmicks to increase a client’s page rank in relation to competitors, or perhaps a bolus of bad news from a special bastard, professional coders maximize providers’ profits by keeping on top of the ever-changing hoops involved in paying doctors almost all that is owed them following a shorter than average delay.
ICD-10 is Coming
Learning coding is job security these days because in a few years the mandated ICD-10 codes will force even dental offices to hire IT staff, which also cuts down on the nation’s unemployment. I’ve taken a peek at the ICD-10, and it makes the ICD-9 look like simple algebra. I’d stick with well-trained coding professionals. They’ll cost more but you do want to approach making a profit, don’t you?
Of Censorship
I submitted the following stinker to be posted on the AAPC Website. To their credit, it was posted almost immediately. That could be a good sign … OOPS! Several minutes later it went back under moderation. I think someone is having problems with it. You’ll have to read it to understand why. It’s tricky to let go of, yet if it remains posted, it looks like a concession. Some poor slob in the AAPC is in a bad position. I hope you are enjoying this as much as I am.
-Darrell
“A recent change to Medicare policy made by the Centers for Medicare & Medicaid Services (CMS) helps ensure claims processing isn’t delayed when the only missing information on the CMS-1490S form is the provider or supplier’s National Provider Identifier (NPI).
CMS Transmittal 1747, Change Request 6434, issued May 22, notifies A/B Medicare Administrative Contractors (MAC) and carriers of editorial changes to Medicare policy in Pub. 100-04, Medicare Claims Processing Manual, chapter 1 regarding the monitoring of claims submission violations and the handling of incomplete or invalid claims.
In either case, as stated in the transmittal, “If the beneficiary furnishes all other information but fails to supply the provider or supplier’s NPI, the contractor shall not return the claim but rather look up the provider or supplier’s NPI using the NPI registry.”
http://www.aapc.com/news/index.php/2009/06/missing-npi-no-reason-to-deny-says-cms/
“How does an NPI number improve patient care?”
By D. Kellus Pruitt DDS – posted on AAPC Website, 6.4.09
I see that nobody from the American Academy of Professional Coders has yet attempted to answer my question. Some visitors to the AAPC Website who have followed the comments to the article “Missing NPI Won’t Delay Processing – CMS” (no byline) may think the lack of an answer is odd – that is if they happen to notice. The novice professional coder who still does not know much about HIPAA could easily assume that since the article itself is almost a week old, the lack of a response to my question is nothing more than the natural fading of interest. At some point, people logically move on to newer posts and other parts of their lives.
But I know a secret.
Based on nothing more than glaring silence from anonymous officials of AAPC, I know that my question of whether the NPI number improves care did not go unnoticed by a few knowledgeable and sharp individuals. They know enough not to touch a transparently trick question. The answer of course is:
The NPI number does nothing to improve patient care (Gasp!)
There’s more. Five years ago informatics experts (coders), promised that the ten digit identification number for providers will speed payments lightning fast. When is the last time you heard that fib? I cannot fault abundant optimism, AAPC, but by now you are surely aware that physicians have had to wait for a year or more for payment because of foul-ups at NPPES. Some have had to take out loans to pay the salaries of coding professionals and other new IT members of their staffs.
Improving Healthcare?
And as far as “improving” patient care? That would be worse than a fib. That would be called a harmful lie that upsets me in a very personal way. I know where it is documented that dental patients have been forced to leave dentists they preferred simply because one-third of the dentists in Texas do not have NPI numbers. BCBSTX requires that their clients only see dentists who have the numbers. Otherwise, the client has to pay their dental bill in full and BCBSTX isn’t even obligated to refund the employer the insurance premium. Yet BCBSTX sales reps tell these employers that their employees can see any Texas dentist they choose.
I’m sorry. Sometimes I ramble.
To keep it fair, I will ask if there is anyone who would like to point out the benefits of the NPI number. Your AAPC members and many others, including enthusiastic newbie coders, are interested in hearing from leaders of the organization. Many careers are built upon the complexities caused by digitalization and informatics. I don’t blame you for the complications. After all, you don’t make the rules – you just get along with them really well. It’s like our unavoidably complicated tax code and accountants. Accountants call themselves professionals. So why the hell shouldn’t you?
The Medical Executive-Post
Let me say that I am grateful that you believe enough in transparency that this comment remains posted. It wouldn’t surprise me if someone briefly considered deleting it until they discovered that it will be on the PennWell forum and probably on the Medical Executive-Post anyway. And of course, we can all see that you chose the honorable thing to do.
NPI Fallacy
The NPI fallacy reminds me of a scene in the Mike Judge movie “Idiocracy,” when a character 500 years in the future named Frito is asked why fields are fruitlessly irrigated with a politically-correct brand of green colored sports drink instead of water. Frito, who got his law degree from Costco, doesn’t even have to suffer minimal thought before he quickly repeats what he’s heard so many times, “’Cause it’s got ‘lectrolytes.”
Grnerod finds it incredible that I don’t have an NPI number. “How on earth are you billing and getting paid without an NPI?”
I told him (?) that I don’t work if I don’t get paid. Call me an old school radical.
Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated. What are your feelings on the NPI situation? Does it really improve health care, or not? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.
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Filed under: Glossary Terms, Health Economics, Health Insurance, Information Technology, Op-Editorials, Practice Worth | Tagged: A/B Medicare Administrative Contractors (MAC), AAPC, ADA, AMA, American Academy of Professional Coders, BCBS New Jersey, BCBS New York, CMS, CMS Transmittal 1747 Change Request 6434, CMS-1490S, CPT codes, Darrell Pruitt, david marcinko, Dr. David J. Pettigrew, DrBicuspid, ICD-10, ICD-9, John Hamm, medical billers, medical coders, Medicare Claims Processing Manual, National Provider Identifier, NPI, NPI Number, Proots, Pub. 100-04 | Leave a comment »
Special Report for all Medical Professionals
By Dr. David Edward Marcinko; MBA
By Hope Rachel Hetico; RN, MHA
What: A Special Report Prepared upon the Request of “Podiatry Today”
Who: Dr. David E Marcinko and Hope Rachel Hetico; MHA
Topic: Essential Insights on Successful Budgeting
Reporter: Jeffrey Hall [Editor “Podiatry Today” Magazine]
Where: Internet Ether
Although some doctors might view a budget as unnecessarily restrictive, sticking to a spending plan can be a useful tool in enhancing the wealth of a medical practice. These authors emphasize keys to smart budgeting and how to track spending and savings in these tough economic times. The universal applicability to all doctors is obvious.
Read the Report Here
Link: http://www.podiatrytoday.com/essential-insights-on-successful-budgeting
Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated?
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Embracing a New Competitive Practice Culture
By Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief]
There are more than 900,000 physicians in the United States. Yet, the brutal supply/demand/demographic calculus of the matter is that there are just too many aging patients chasing too few doctors. Compensation and reimbursement is plummeting as Uncle Sam becomes the payer-of-choice for more than 52% of us. And, the government as payer will likely increase with the Obama Administration. So, going forward, it is not difficult to imagine the following four rules for a new-wave competitive medical care culture for all physicians.
[A] Rule No. 1
Forget about large office suites, surgery centers, fancy equipment and the bricks and mortar that comprised traditional medical practices. One doctor with a great idea, good bedside manner or competitive advantage, can outfox a slew of CPAs, while still serving the public and making money. It’s a unit-of-one healthcare economy where “ME Inc.”, is the standard and physicians must maneuver for advantages that boost their standing and credibility among patients and payers. Examples include patient satisfaction surveys, the rise of evidence-based medicine; outcomes research analysis, concierge medicine, direct reimbursement payment plans, and economic credentialing; etc.
[B] Rule No. 2
Challenge conventional wisdom, think outside the traditional payer box, recapture your dreams and ambitions, disregard conventional gurus and work harder – and smarter – than you have ever worked before. Remember the old saying, “if everyone is thinking alike, then nobody is thinking”. Do insurance panel members think rationally or react irrationally?
However, you should realize the power of networking, vertical integration and the establishment of virtual medical practices, which come together to treat a patient, and then disband when a successful outcome achieved. Job security in this structure is achieved with successful outcomes, and perhaps not necessarily a degree in the near future. Medical futurists even presume the establishment of virtual medical schools and hospitals, where students and doctors learn and practice their art on cyber-entities that look and feel like real patients, but are generated electronically through the wonders of virtual reality units.
[C] Rule No 3
Differentiate yourself among your medical peers. Do or learn something new and unknown by your competitors. Market your accomplishments and let the world know. Be a non-conformist. The conformity of health insurance plans are an operational standard and a straitjacket on creativity. Doctors should create and innovate, not blindly follow entrenched medical society leaders into oblivion. Seek, and practice, health 2.0 collaboration with all stakeholders.
[D] Rule No 4
Realize that the present situation is not necessarily the future. Attempt to see the future and discern your place in it. Master the art of the quick change and fast but informed decision making. Do what you love, disregard what you don’t, and let the fates have their way with you. Then, decide for yourself if health plans adhere to any of the above rules?
Assessment
Regardless of the future de facto business model of the learned profession of medicine, current practice models are no longer the structure of choice. Rather, a more laissez-faire and highly competitive business model should be pursued. Physicians have been slow to accept this philosophy. Remember, as a physician, if you merely want a static job with promised security, pledged retirement benefits, limited goals and structured regulations; join a health plan panel and become their laborer.
However, if you desire more, such as the possibility of a dynamic career, the unlimited security of your brainpower, non-defined retirement contributions, infinite potential with rules you can create along the way; incorporate the power of ME, Inc., in everything you do. Remain a competitive professional and be a physician ... Get fly!
Conclusion
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Filed under: Career Development, Ethics, Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc., Managed Care, Practice Management | Tagged: Comparative Medical Effectiveness, competition, concierge medicine, CPAs, david marcinko, direct reimbursement, healthcare competition, outcomes research, physician economic credentialing | 3 Comments »
Confusing Nomenclature?
By Dr. David Edward Marcinko; MBA, CMP™
[Publisher-in-Chief]
Recently, John H. Robinson – a Honolulu based independent and dual-registered financial advisor who holds a degree in economics from Williams College and who has written and published numerous professional papers – essentially challenged the credibility of the College for Financial Planning.
“Dr. [Somnath] Basu [PhD] is quite correct in pointing out that the College for Financial Planning is not academically accredited and there are no admissions standards other than a nominal three year industry experience standard (three years as a clerk in a brokerage firm will qualify). Mr. [Kevin] Keller [CEO-CFP BoS] defends the curriculum by stating that, “Topics include economic concepts such as supply and demand, fiscal and monetary policy, time-value of money concepts…” The mere fact that that no prior college level academic experience in finance is required is testament to the fact that the coursework is largely 101 level materials.
To illustrate this point by example, economics represents one small chapter of the Investments section of the CFP curriculum. In contrast, econometrics and statistics alone was a semester long 300 level course in my undergraduate economics studies. This is not to suggest that the CFP program does not provide adequate training and preparation for a career in financial planning, but to assert that the CFP designation trumps a graduate or even undergraduate degree in finance or economics is difficult to defend. This was my counterpoint to Mr. [Dan] Moisand’s bellicose labeling of non-CFP certificants as “faux planners”.
Source: http://www.fa-mag.com/online-extras/4037-revisiting-cfp-credentialing.html
Moreover, he stated that:
”In fairness, some of Dr. Basu’s ideals on the educational standards for financial planning certification seem a bit extreme as well. For instance, I can’t imagine subjecting doctors, attorneys, or even business school professors to periodic recertification exams.”
Source: http://www.fa-mag.com/online-extras/4037-revisiting-cfp-credentialing.html
The Big Question
And so, the big question for financial advisors and Certified Financial Planners®: Is the College for Financial Planning, a college at all? Is it accredited and more importantly, who accredits it? If not; why not? And, was the name “college” purposely selected to obfuscate?
Moreover, and of more importance to our physician readers, FAs and ME-P subscribers: Do doctors, attorneys or business school professors need to periodically recertify themselves by examinations?
IOW: Is Mr. Robinson correct or not – in fact or meaning – on one or both accounts? How about Dan Moisand? Am I, or Mr. Robinson, a “faux” planner?
Assessment
A paper co-authored by Mr. Robinson, entitled, “Reality Check: The implications of sustainable withdrawal analysis on real world portfolios” was awarded the CFP Board of Standards’ 2008 Outstanding Paper Award. He does not hold the CFP® designation.
Disclosure
Among many other “hats”, I am a former licensed insurance agent, certified financial planner, board certified surgeon, visiting B-school professor, and current academic provost for the CMP™ online program in health economics and medical practice management for fiduciary consultants. Our goal is to “raise the bar” for all colleagues in this space.
Update 2013:
Recent:
Conclusion
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Filed under: "Advisors Only", Ethics, Financial Planning, Glossary Terms, Quality Initiatives, Research & Development, Sponsors | Tagged: CFP, CFP BoS, college for financial planning, Dan Moisand, david marcinko, financial advisors, financial planners, financial planning association, FPA, John H. Robinson, Kevin Keller, Somnath Basu | 21 Comments »
Organizing and Analyzing Financial Data
[By Christy Clodwick; MHA]
After all medical practice management data has been gathered, organize it onto a spreadsheet or chart. This analysis report will help to determine the codes and/or health plans that should be targeted for process improvement.
Focus … Focus … Focus
The focus should be on the highest volume and dollar value codes. Does this mean patients with unusual conditions or low dollar value codes are not treated? Hopefully it will not; but it will push this process forward and the practice will see the greatest benefit from these categories. When you review the report and find that a fee is being paid at a much lower rate, this would be indicative of a necessary negotiation with the payer for an increase for that procedure. Most health plans are committed to preventing disease. Maybe, but they are still actually aimed at treating diseases; not preventing them. If this is true of many payers then they should be willing to provide the incentives for those services to be carried out. You will find that some payers’ fee schedules are very much out of line with a percentage of Medicare payments, therefore the practice administrator should focus on those payers and bring evidence of the inadequacies to their attention.
The Specialists
Specialists are, for the most part, paid at a higher rate than primary care physicians not usually for the same service! And, with GPs as gatekeepers, the specialty doc incomes may have actually decreased in some instances, while the GPs may have increased. There was a time when Medicare had two conversion factors, and this was the result. This inequity could also be used as a tool for better reimbursement rates.
Finalizing the Fee and Revenue Analysis
When the final preparations of the fee analysis have been completed, it is time to react to the results of the findings. There are several options to choose from when it has been determined that a health plans fee schedule is not in tune with the practice’s financial growth. The practice should act on these results as soon as they are discovered, to avoid the loss of any more revenue.
No longer Accepting Health Plans
During the analysis phase, you may determine that a health plan’s payment levels are extremely low. You will have to determine whether the plan is worth negotiating or the practice administrator should consider dropping out of the plan altogether at the end of the contract period. It will have to be carefully determined by the local market. If the practice is in a highly competitive market, this process should not be considered as first choice. However, if the market is very slim, the health care purchaser will be responsible for complaining to the health insurance plan provider that there is simply not enough physician coverage for their employees for the area. This could be a very effective way to force a negotiation with the health care company. If this were the case, the area would have less managed care and more MC/MD.
Not Accepting New Patients from Low Paying Health Plans
One option would be to not accept any more patients from the health plan that is reimbursing the practice with low rates. Although this may initially lower your patient count, over time the practice will benefit from new patients with health plans that have a better reimbursement policy. Include snapshot of what the final analysis or report should look like and the details of what it should include. This can be used in any specialty to assist in putting together the individual practice analysis to achieve the same results. But is it noble or ethical? What about any willing provider laws?
The Future for Health Care Reimbursement
The health care purchasers who pay most of the bills, such as employers and the government, will soon be challenging the annual increase and the overall cost of health care. The cost increases of the hospital and pharmacy sectors of healthcare are far higher than that of the physician. However, the pressure for cost containment is being felt across the board. This will eventually depress future reimbursement for all healthcare providers. In the future it will be hard for practices to keep up with the demands of labor, malpractice and supply cost increase. All medical providers need to plan for this future paradigm. To offset this trend, physicians will need to get the most out of the work that they are doing today as well as look to new revenue generating procedures for their practice that will be cheaper and more convenient to the patient.
Process Improvement
The biggest benefits will come from continually improving the process of the daily operations of the practice, as well as ensuring accurate diagnostic coding. This will enable a practice to keep up with charge capturing through the explanation of benefits (EOB) when the charge has been processed and paid by the health insurance provider. When this process identifies that there is room for negotiation, the provider should proceed for a better reimbursement rate. If the provider is in a dominant market, the payers will be more likely to issue sweeping fee increases and so can you give me an example of this ever happening? By completing a Practice Fee Analysis, any practice should be able to use this tool to demonstrate the inequities and negotiate a better reimbursement rate for the practice.
Assessment
The first step in the negotiation process would be to contact a representative of the health insurance company that is in question. If you can produce compelling evidence to the representative, the negotiation process should be the next meeting. These folks may be fired if they do what you suggest, too frequently. Continually updating the practice fee schedule will help the practice stay on top of the contracts that it practices under. Practices that present a well-documented argument may (almost never) be rewarded with positive payer response. Again, proper planning will make for great future performance in any health care practice.
Conclusion
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Filed under: Accounting, Book Reviews, Career Development, Glossary Terms, Health Economics, Health Insurance, Managed Care, Practice Management, Recommended Books, Sponsors | Tagged: CPT, david marcinko, fee analysis, fee schedules, healthcare plans, hope hetico, Medicaid, medical practice management, medical reimbursement, medicare, revenue analysis, RVU, www.healthcarefinancials.com, www.healthdictionaryseries.com | 2 Comments »
Better Data for Improved Fixed Compensation
[By Christy Clodwick; MHA]
[By Dr. David E. Marcinko MBA]
It is known that most health plans operate with fixed fee schedules. While these fee schedules have little or nothing to do with RBRVS, and most are based on a percentage of what Medicare pays, the question is: “are they tied to levels that are more than 3 or 4 years old?” Physicians who have no negotiating tools or a plan in place, and who question the methodology that the payers are using, are (too casual-left) with a ‘take it or leave it’ response from the health insurance provider.
Gathering the Data
A good solid foundation of data is necessary to negotiate better reimbursement rates successfully. The practice administrator or accountant (not 1 in 100 accountants can actually do this) should have this information readily available, especially if the office has an automated billing system.
Steps to Preparing a Fee Analysis
First and foremost, the medical management team in charge of this project will need to determine the most commonly used CPT® codes for the practice. The bulk of primary care or family practice physician fees should be derived from the revenue of the office visit, hospital and preventive medicine codes. This in turn may limit the number of codes for the study. The frequency of each CPT code should be listed over a 12 month period. If applicable, laboratory fees should also be included to see if there are fluctuating reimbursement schemes for these services. The codes on the list should account for at least 75% of the total practice charges.
Determining Top Payers and Reimbursement by Payer
It is known that Medicare and Medicaid use established fee schedules and do not negotiate, therefore the focus should be on the other major payers that make up the bulk of the reimbursement. In this process, make sure that the payers in the report are the practice’s top payers. The practice administrator will also need to determine the reimbursement for each code that is sent to the various payers’ list in the report. The administrator or team leader (the average GP has 3-4 employees, so I don’t think there would be a team leader, here). For this project we can use the Explanation of Benefits EOB that is received from each payer that has been selected for the report. When including this data, make sure the allowed amount, not the paid amount, is referenced. After this information has been gathered, each payer’s reimbursement rate will need to be calculated as a percentage of Medicare’s reimbursement rate. Medicare’s current rates for any geographical area can be found through the “Medicare Physician Fee Schedule Look-up” tool at:
Link: https://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?p_sid=1reSKuxj
This site also provides a reference to Relative Value Unit, (RVU) that Medicare assigns to each code.
RVU Conversion Factors
It is important for the practice administrator or manager to understand the RVU conversion factors and how they work, simply because most payers are in the beginning stages of using this method. To calculate a payment for service you multiply a particular CPT Code by the Medicare conversion factor for that code. For an example we will use the code 99214 – office visit. The Relative Value Unit for that Code is 2.2. The Medicare conversion factor for the same code is $37.34. The calculation would result in a rate of $82.15. Geographical adjustments must be taken into account when performing these calculations. The next step in this process would be to review the fees for each code listed in the report. Calculate each fee as a percentage of Medicare’s rates. You will find different statistics for each payer.
Apply the Rules and Process
Follow these basic rules when applying this new process:
First, if the charges are being reimbursed at 100%, the fee may be too low. At this point, raising the fee for that code would be acceptable (Usually not the case). Next, If several fees are in this category, the practice should just set all its fees to a percentage of Medicare reimbursement across the board, such as 125 percent (many managed care plans pay at less than MC, i.e., 80% MC). Finally, a tiered fee schedule would be applicable if the payers seem to pay more for certain procedures or diagnostic studies. That would set evaluation and management codes at 125 percent of Medicare reimbursement while charging 150 of Medicare reimbursement for other procedures and diagnostic tests.
Assessment
The medical practice administrator should make sure that, no matter which fee schedule is best suited for the practice, it is updated annually to prevent loss of any increases that may occur per payer.
Conclusion
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Filed under: Career Development, Glossary Terms, iMBA, Inc., Managed Care, Practice Management, Recommended Books | Tagged: CPT codes, david marcinko, EOB, hope hetico, Medicaid, medical fee schedules, medicare, physician fee schedules, RBRVS, RVU | 2 Comments »
To combat the climate of barriers and frustrations in medical practice today, physician executives and administrators need to create innovative ways to change and improve medical providers’ outlook in the health care marketplace.
Many Barriers
The barriers—federal anti-trust laws, lack of state or federal regulatory action, marketplace resistance and tremendous cost pressures—are being confronted throughout the healthcare sector and are being felt by medical practices of all sizes, including hospital organizations, medical organizations as well as independent solo practitioners. Although there are tremendous financial pressures in operating a healthcare practice, the demand for healthcare is on the rise. To remain viable in today’s healthcare market place, strategic planning is needed at all levels of every practice’s processes.
Disenchanted Doctors
It is increasingly acknowledged that physicians in today’s health care market are becoming disenchanted with the reimbursement compensation from managed care. This also affects the outlook that they have on the medical profession as a whole. It is important to point out that there are ways to put processes in place to combat or, at the very least, survive all the changes taking place. Strategies can be put in place to offset the high demand for quality care and the discouragement and outrage that physicians are feeling about reimbursement. Physicians did not learn the business side of medicine in medical school, although many physicians today are choosing to diversify their careers by going back to school to get an MBA, or even just further business knowledge, to stay abreast of the changes. Selecting an outside source to assist a practice with the needs of business growth planning can be difficult, if the physician or practice administrator does not know what the needs really are. The best option would be to ask for a recommendation from a colleague who has hired consultants to assist in his or her practice, or to call on the local hospital administrator for assistance in locating an appropriate consultancy firm or management company.
The Planning Process and Process Improvements
The planning process of any business operation should always include management systems that clarify the business strategy and the metrics that most reflect success with that strategy. They should provide the framework to prioritize resources for projects that will improve the metrics, and leverage leaders who will manage the efforts for rapid, sustainable, and improved business results. This plan should also include improvement of processes that are already in place. In essence, this should be a corporate wide approach to process improvements and management of the processes to control the outcome of the progress of these changes.
Driving Success for Plan Development and Implementation
During the plan development stage, all aspects of operations have to be included in the plan in order to ensure a successful outcome. The plan for a healthcare practice should include time management, cost containment, third party reimbursement (to include annual contract(s) review as many practices have 100-200 contracts), insurance coding and compliance, accounting, business management, capitation economics, marketing and business development, medical advertising, and especially important is the health information management system. Plan development, in short, should focus on:
Future Health Economic Policy
With all the changes that have occurred in healthcare, it is safe to assume it will be a struggle to come up with a perfect plan that will sustain all future changes in such a volatile healthcare market. Practice reimbursement would be a good place to start since this is the lifeblood of any healthcare provider. Income from fees has not nominally increased for more than a decade. The introduction of the Resource Based Relative Value Scale (RBRVS), as well as the adoption of a national fee schedule by Medicare, has virtually eliminated a practice’s ability to generate more income from insurance plans by increasing what the practice charges for its services.
www.HealthDictionarySeries.com
Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated? Who can update the above post for modernity? What have we missed? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.
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Asynchronous Data Subscriber Line versus Digital Subscriber Loop
By Carol S. Miller; RN, MBA
Asynchronous Data Subscriber Lines
ADSL is a very fast digital line provided by the telephone company. If available in your area, the ADSL provides fast connections, but generally not as fast as cable. There are various choices, beginning around 256 kbps (about five to six times the speed of a fast modem) going up to 7 Mbps. Prices begin around $60 per month (including Internet service). There is also a set-up charge and a card needs to be inserted in your computer.
Digital Subscriber Lines
DSL is a high-speed direct line that can be 20-100 times faster in communication over the modem, depending on the type selected. Prices for the DSL begin at approximately $30-$40 per month and that includes Internet access. In addition, there is a set-up charge and a network card will need to be installed into the computer. Office workstations can usually share DSL circuits over their existing local area network (LAN).
Internet Connection
To connect with the Internet, as a rule of thumb, the faster the better; therefore, the office should have at least 56 kbps. DSL normally runs over the same line as a basic telephone voice circuit and provides Internet access from speeds of 384 kbps all the way up to 1.54 mbps (megabits per second). The advantage of this configuration is you not only have high-speed access to the Internet, your telephone is still free to make and receive calls at the same time.
Integrated Services Digital Network
A digital telephone line that allows voice and data to be transmitted on the same line in a digital format – instead of analog – and at a relatively high speed, usually around 64 to 128 kbps. When reviewing this service, make sure the ISP has an ISDN connection. If not, you will be charge more by both the telephone company and the ISP. Prices for the ISDN average around $300 plus, with an extra fee to install the telephone line and a monthly service charge of $25 to $100 plus to maintain.
Wireless Network (WiFi – 802.11b)
The biggest change to happen to computers in the last ten years has undoubtedly been the Internet. Close on its heels in importance may just be the adoption of the wireless network access. Wireless Fidelity, or Wi-Fi, is now cost effective and available at the computer store. It is no longer necessary to re-wire buildings with Category 5 wire to provide LAN connectivity and resource sharing to multiple computers. Wi-Fi, or IEE standard 802.11b, enables small offices to connect up to four computers to a single network for less than the cost of a single computer. This means the days of multiple analog lines to offer Internet access to every computer, or a printer on every desktop, are going away. Now a single cable modem or DSL line and a centralized printer can service four users. This can save a small business hundreds of dollars a year.
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Limited Connectivity
For limited connectivity, computer stores are stocked with wireless vendor products that are cost effective, easy to install, and very robust that will push even the most cautious computer user to take the leap to wireless computing. Not only does it make the initial cost to install a network cheaper than it has ever been before, it eliminates the cost to remodel or move computers within a building since instead of requiring data wiring at each proposed desktop all you need now is an electrical outlet to power the PC itself.
Satellite
This is a more modern device. In the past, satellite connections were at 400K bps or fourteen times faster than the average modem. As an example, a 2MB file would be downloaded in 30-40 seconds. Benefits of the satellite connection are: The connection is always on; it is reliable; there is a secure connection; office can have multiple e-mail addresses; the web space is free; and there is tech support coverage nationwide. Costs include around $300 for the equipment, $150 plus to install the equipment, and around $30 to $50 per month for service. Web site reference is satcast.com (DirecWay Satellite Dish).
Conclusion
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Understanding ASPs
By Carol S. Miller; RN, MBA
An Application Service Provider (ASP) enables healthcare organizations to run complex software programs or applications on remote servers that can be accessed from numerous sites and by numerous devices. By installing and maintaining central, instead of on-site services, ASPs reduce the complexity, time, resources, hardware requirements, technical support, cost of installing and distributing upgraded software (done by ASP at its host site), and cost involved in application management. In addition, ASPs provide the physician a means of low cost entry to new applications in a very short timeframe. Upgrades are quickly deployed and healthcare organizations or medical offices can experience affordable and secure business critical applications. Most ASP services are billed on a per use basis or monthly annual fee. An example of an ASP is NextGen, an Internet based enterprise and a real-time practice management system that includes an electronic medical record, appointment scheduling, connectivity with hand-held solutions and patient indexes.
Reverse ASPs in Healthcare
Healthblocks (www.healthblocks.com) coined the term “reverse ASP” to signify that as an ASP, it provides unique solutions through the Healthblocks eSite, tailored to the situations and circumstances that face healthcare organizations and care givers on a daily basis. More formally, a reverse ASP deploys through portals, hosts and manages access to medical applications that offices, in a single, seamless manner, can view a patient’s clinical information. The applications are delivered over networks on a subscription basis and the reverse ASP remotely manages the packaged application over a network. The following benefits are achieved in this model:
Assessment
A reverse ASP model provides physicians, nurses, allied healthcare providers and related personnel with rapid access to confidential clinical patient information. It can also benefit and help extend the reach and usefulness of third-party e-health solutions in a cost-effective manner.
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Conclusion
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Essentials of Risk Management
By Gary A Cook; MSFS, CLU, ChFC, RHU, CFP® CMP™ (Hon)
Medical professionals may not be familiar with the unique differences between the terms – property, casualty and liability. Property insurance is coverage for the loss of, or damage to, real and personal property caused by fire, theft, explosion, riot, vandalism and a host of other risks. Casualty and liability are generally interchangeable terms for the coverage of legal liability due to injury to others or damage to their property.
Personal Liability Coverage
One of the most common of all personal liability coverages is the Homeowner’s policy. This is not one policy, but several policy declarations (what is insured – the location), forms, endorsements, and “floaters,” which protect the structure of the home against loss, as well as the personal property (contents) to various degrees. Risks for homeowners need not be consistent across the country and the rates generally reflect the differences. For example, homes in the Midwest need protection from tornados, while homes along the East, West and Southern coasts need coverage for hurricanes and flood risks.
Policy Form
The Home Owners Policy Form contains five categories of coverage for property:
The Contract
The contract contains three areas of Liability Coverage:
The Endorsements
Endorsements are an important aspect of the Homeowners coverage because they permit the customization of the coverage to the unique requirements of the individual. Two examples:
We noted that the West coast does not have tornados, however, they do have earthquakes and therefore, an endorsement can be added which will transfer the risk for earthquakes – or even volcanic eruptions. If the individual doctor has a home business, the business property can be protected against such perils as loss of business records due to fire or water damage. There is, however, no coverage for liability for providing poor professional services.
The Floaters
Finally, the Homeowners policy may contain “floaters” (named because the articles covered are moveable, thus “float around.”). The use of floaters can be very beneficial for coverage of unique or expensive electronic equipment and most commonly, jewelry. The other common personal coverage is Automobile Insurance. Forty-two states have compulsory insurance laws that require insurance on automobiles before it is registered. Various states have unique laws pertaining to:
Conclusion
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A Review for Doctors and Advisors
By Gary A. Cook; MSFS, CLU, ChFC, LUTC, RHU, CFP®, CMP™ (Hon)
Long-term care (LTC) insurance is considered one of the newest forms of personal coverage insurance. LTC insurance is designed to transfer the financial risk associated with the inability to care for oneself because of a prolonged illness, disability, or the effects of old age. In particular, it is designed to insure against the financial cost of an extended stay in a nursing home, assisted living facility, Adult Day Care Center, hospice or home health care. It has been estimated that two out of every five Americans now over the age of 65 will spend time in a nursing home. As life expectancy increases, so does the potential need for LTC. One unfortunate consequence of being the “new kid on the block” is the lack of actuarial data specifically collected for this style of policy. This results in policy premiums being underpriced to sustain the claims currently being experienced. During the first half of 2003, at least three insurance companies stopped writing these policies because of their losses. Those insurers remaining in this market are expected to increase premiums quickly. Unless these policies can be profitable for the company, their future will be an uncertain one.
Medicare
Any discussion of LTC must begin with an understanding of what Medicare is designed to cover. Currently, the only nursing home care that Medicare covers is skilled nursing care and it must be provided in a Medicare-certified skilled nursing facility. Custodial care is not covered. Most LTC policies have been designed with these types of coverage, or the lack thereof, in mind. To qualify for Medicare Skilled Nursing Care, an individual must meet the following conditions:
Once these requirements are met, Medicare will pay 100 percent of the costs for the first 20 days. Medicare covers days 21 to 100 along with a daily co-payment, which is indexed annually. After the initial 100 days, there is no additional Medicare coverage. Medicare Home Health Services cover part-time or intermittent skilled nursing care, physical therapy, medical supplies and some rehabilitative equipment. These are generally paid for in full and do not require a hospital stay prior to home health service coverage.
Critical LTC Policy Features
According to the U.S. Department of Health and Human Services and the Health Insurance Association of America, there are seven features that should always be included in a good long LTC policy:
In addition, there are another seven features considered to be worthwhile and are included in the better LTC policies:
ADLs
Most LTC policies provide benefits for covered insured’s with a cognitive impairment or the inability to perform a specified number of Activities of Daily Living (ADLs). These ADLs generally include those listed below and the inability to perform two of six is generally sufficient to file a claim:
1. Bathing: Washing oneself in either a tub or shower, or by sponge bath, and includes the task the getting into and out of the tub or shower without hands-on assistance of another person.
2. Dressing: Putting on or taking off all necessary and appropriate items of clothing and/or any necessary braces or artificial limbs without hands-on assistance of another person.
3. Toileting: Getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene without hands-on assistance of another person.
4. Transferring: Moving in and out of a bed, chair or wheelchair without hands-on assistance of another person.
5. Eating: The ability to get nourishment into the body without hands-on assistance of another person once it has been prepared and made available.
6. Continence: The ability to voluntarily maintain control of bowel and/or bladder function, or in the event of incontinence, the ability to maintain a reasonable level of personal hygiene without hands-on assistance of another person.
Other Issues
Another issue concerning ADLs is whether the covered insured requires “hands-on” assistance or merely needs someone to “stand-by” in the event of difficulty. Obviously, LTC policies that read the latter are considered more liberal.
Long-Term Care Taxation
Some LTC policies have been designed to meet the required provisions of the Kassenbaum-Kennedy health reform bill, passed in 1996, and subsequently are “Tax Qualified Policies”. Insured’s who own policies meeting the requirements are permitted to tax deduct some of the policy’s premium, based on age, income and the amount of total itemized medical expenses. The major benefit of the tax-qualified LTC policy is that the benefit, when received, is not considered taxable income. There are several initiatives in Congress, however, which would expand and simplify these deductibility rules.
Assessment
Regardless, the medical professional or financial advisor [FA] should investigate the opportunity afforded them through their current form of business, or client use, for any purchase of a LTC policy. And, small businesses may be permitted to deduct LTC premiums on a discriminatory basis.
Conclusion
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Understanding Basic Access and Connectivity
By Carol S. Miller; RN, MBA
To connect with an Internet service, the medical office will need a computer, modem, telephone line and software. The modem, either external via a connection or internal via a built-in or slot card, takes the digital signals from your computer and converts them to analog signals that your phone line uses. As a rule of thumb, the faster the better; therefore, the office should have at least a 56 bps or use a DSL line.
Accessing the Internet
To access the Internet, the office must obtain an Internet Service Provider (ISP) such as America Online (AOL), Earthlink, ATT Worldnet, Microsoft Network Premiere (MSN), Hot Link, or others. The cost varies on the plan selected but usually averages in the range of $10 to $25 per month. In selecting an ISP, several guidelines need to be considered:
Besides the POTS (plain old telephone service), the physician may wish to have a faster connection to the Internet. Several options are available.
Cable Modems
Cable connection is very fast, providing a lot of bandwidth (the amount of information that can be sent through a particular communication channel). As an example, in the time it takes to transfer a half page across a 56K connection, the cable connection can transfer over 25 pages. As is suggested by the name, the local cable TV provider or community antennae TV (CATV) deliver this service.
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Conclusion
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Defining WANs and LANs
By Carol S. Miller; RN, MBA
Depending on whether the practice is housed in one or multiple-office locations and there is a need to connect multiple computers, either a local area network (LAN) or wide are network (WAN) should be part of the package consideration.
The LAN
The LAN is a computer network that covers only a small area (often a single office or building). The advantage of a LAN (besides connecting several computers to a network system) is the ability to configure one printer for multiple stations. The same may be said for sharing administrative, clinical, financial and operational data in real-time manner to support smooth office function.
The WAN
The WAN provides the ability to link data on one network for multiple office site locations.
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Conclusion
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Checklist for Financial Planners
[By Staff Reporters]
The following will enable the financial planner to assist the client in choosing a nursing home.
The Checklist
1. Review the client’s requirements. An assisted-living facility may suffice instead of a true nursing home, which is required by the frail and elderly needing daily medical care.
2. Pick a location close to home and relatives. Frequent visits are crucial, not only to combat loneliness but also to ensure resident receives proper attention.
3. Read inspection report (state survey). If the financial planner encounters difficulties in obtaining a current report, he or she should assume that the home has something to hide. Don’t expect perfection. Nursing homes provide a difficult service for difficult residents. If a home is unresponsive to inquiry regarding items in a report, assume a similar response to concerns about the quality of care being provided in the future.
4. Tour the facility on an unannounced basis at different times on different days. Stroll through corridors and look and listen. Trust senses and instincts. Items to consider should include:
· Appearance of residents’ rooms. Outward decor of facility can be misleading, so the planner should inspect the residents’ rooms. To what extent can the rooms be personalized? If rooms are shared, how are good roommate matches made?
· Smells. High-quality homes have no lingering stench of urine or air freshener to cover up bad care and unusually high incidences of incontinence due to lack of attention by staff.
· Safety hazards. Be especially aware of items in corridors that can be obstacles to those with unsteady gait and poor eyesight.
· Sufficient staff members who are pleasant and respectful to residents. Are staff members responsive to residents’ needs? Are staff members warm in their interactions with all residents, even those requiring the heaviest supervision? Are aides helping residents with walking or exercise of their arms and legs?
· Residents’ attitudes toward facility’s service. Talk with residents and staff to determine attitudes toward the facility’s service. Does the facility have a family counsel to provide it with input?
· Grooming. A clear sign of neglect is failure to keep residents clean, well dressed, and well groomed.
· Physical restraints. Nursing homes that have eliminated restraints also have improved quality of life and more social contact among residents. Ties, belts, vests, and high bed rails are an easy but unsatisfactory solution to managing residents. Count number of residents that are restrained; ask what percentage are restrained and why.
· Food. Visit at meal time and sample the food to make sure it is palatable. The setting for meals should be attractive and pleasant, and food should be served at the proper temperature. Staff should be available to help residents who are not able to feed themselves. Review menus and determine the amount of concern for nutrition.
· Activities. A wide variety of activities should be provided, and the participation level should be high. Bored residents in front of a television may be a sign of a home’s failure to stimulate its residents.
· Dignity. Residents should be handled in ways that respect their dignity. For example, are residents properly clothed in public?
· Bed sores. Bed sores are a sign of poor care. Review inspection reports and see if they are mentioned, or talk to residents or their families about this topic.
· Special care units. Such units are often used as an expensive marketing device. The special care units may not be designed well and may indicate a lack of outdoor facilities.
5. Review the facility’s policy on medical care. Will residents be seen by their personal doctors or by staff physicians? Does the home have good infection control and immunization plans? What sort of access to dentists and eye doctors is there?
6. Perform financial analysis. The planner should gain a complete understanding of what the client’s and/or his or her family’s financial commitments are and how they will be met.
· Determine the financial strength of the nursing home, particularly if client funds are to be advanced.
· Consider a single lifetime payment in lieu of monthly rental payments.
· Consider exclusions in contract. For example, nursing home insurance coverage should include loss of personal property and personal injury.
· Determine what services the client will require, what is covered under the facility’s general fee, and what services are provided for an extra fee. Determine what the extra fee will be for each additional service that will be required. Family members should not agree to pay these charges because this could delay Medicaid funding.
· Analyze pricing structure in general and what the pattern of increases in fees has been.
· Determine residents’ rights in eviction proceedings for nonpayment of rent, in returning to nursing home after hospital stay, and in having Medicaid make payments on behalf of resident.
· Determine residents’ rights to appeal decisions and what the appeal procedures are.
7. Obtain and check references, including families of current residents, local hospitals, doctors, and government agencies, particularly the ombudsman at state departments for aging.
Assessment
What have we missed?
Conclusion
In any case, early planning is the key to supporting both your kids’ futures and your retirement. Making logical college funding decisions, rather than emotional ones, creates a win/win for everyone.
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Filed under: Estate Planning, Financial Planning, Glossary Terms, Insurance Matters, Recommended Books, Retirement and Benefits | Tagged: david marcinko, extended care facilities, financial planner, hope hetico, insurance, nursing homes, senior care, senior care planner | 12 Comments »
By Dr. David Edward Marcinko MBA
http://www.CertifiedMedicalPlanner.org
According to colleague Robert James Cimasi of Health Capital Consultants LLC in St. Louis MO, concierge or boutique medical practices began in the mid-1970s, and are now in many major metropolitan areas. Concierge medicine is described as a “return to old-fashioned medicine,” where physicians limit their client base and devote more time to each patient. Patients can usually get in to see their physician within a day, and most have 24-hour access to their physician by beeper or cell phone.
The Doctor’s Perspective
Physicians who turn to concierge medicine are typically tired of not having enough time with their patients and dealing with overbooked caseloads, and are looking for a way of balancing their lives while still providing quality care for their patients. Patients who have physicians in this type of practice appreciate the “perks” they get for paying a yearly fee — similar to “annual membership dues.” These fees can range anywhere from $1,000 per year to $10,000 per year depending on the patient’s age, benefits received, area of the country, and practice.
Patient Amenities
Amenities vary by practice, but some include longer physician office visits, increased access to physicians, e-mailed “newsletters” or condition-specific information, physicians accompanying patients on visits to specialists, and house calls. In order to provide more attentive care and amenities to patients, physicians often decrease their patient load to approximately 10-25% of their managed care load. Thus, most of their patients must find other physicians, leading to potential increases in the patient load of managed care physicians.
Elitist Patients
Although concierge medicine may provide many benefits for patients (including more, and in some cases, nearly unlimited access to their physicians), it has been met with some scrutiny. Some say that this type of medicine is elitist, that it is available only to wealthy patients who can pay the annual fees. Medicare beneficiaries who are members of a concierge practice have received political attention, because many politicians have said that the annual fees patients pay is a lot more than the Medicare rate and thus is illegal billing.
Critics
Critics also emphasize that healthcare needs to be first-rate for everyone, something that the current managed care system prevents. The implication that managed care means second-class medicine has also been a fear cited by critics.
Assessment
However, concierge physicians portray their clients as mostly middle-income people who are willing to pay more for this kind of care. Concierge medicine is not a substitute for health insurance. Patients typically keep their traditional insurance to pay for any tests or scans ordered by the physician.
Conclusion
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Filed under: Career Development, Glossary Terms, Health Insurance, Managed Care, Quality Initiatives, Research & Development | Tagged: boutique medicine, concierge medicine, david marcinko, hope hetico, retainer medicine, robert james cimasi, www.healthcarefinancials.com, www.HealthDictionaySeries.com | 7 Comments »
Staff Reporters
www.HealthDictionarySeries.com
FINRA operates Web CRD®, the central licensing and registration system for the U.S. securities industry and its regulators. It contains the registration records of more than 7,500 registered broker-dealers and the qualifications, employment, and disclosure histories of more than 690,000 active registered individuals, making it the worlds’ largest and most sophisticated online registration and reporting system.
More Information
For questions or comments, medical professionals and all others may contact the FINRA Gateway Call Center at (301) 590-6500. Or, see the Dictionary of Health Economics and Finance.
Assessment
Now, to the extent that many believe that FINRA, the FPA, CFP BoS, and the SEC dropped the ball when it comes to financial advisor oversight and compliance, how important is the CRD anyway? Link: http://www.finra.org/Industry/Compliance/Registration/CRD/index.htm
Conclusion
And so, your thoughts and comments on this Medical Executive-Post are appreciated? Is the CRD still needed, or is it a plutocratic dinosaur?
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Filed under: Alerts Sign-Up, Career Development, Ethics, Financial Planning, Glossary Terms, iMBA, Inc., Investing | Tagged: broker-dealers, CFP BoS, CFPs, CRD, david marcinko, dictionary health economics and finance, financia advisors, FINRA, hope hetico, iMBA, Inc., RIAs, SEC, securities industry, Series 63, Series 65, Series 7, stock-brokers, www.healthdictionaryseries.com | Leave a comment »
What it is – How it Works
By Staff Reporters
In the past, according to Robert James Cimasi MHA AVA CMP™ of Health Capital Consultants LLC in St. Louis MO, many employers had defined retirement benefits for employees. Today, most retirement benefits are in the form of 401K plans where companies make defined contributions, effectively shifting the financial risk of paying for retirement to employees.
Defined Health Contributions
Defined health contributions are similar to employer-funded defined retirement contributions like 401K plans. Currently, employers pay for some portion of about half of Americans’ health insurance. Traditional employer-funded plans are those for which the employee simply fills out a form; that is, an employer will offer one or possibly two health insurance plans, and the employee fills out application paperwork. The employer administers the plan and may charge the employee a portion of the monthly premium or pay the entire premium themselves. A defined contribution plan allows companies to shift the financial risk of paying for rising health insurance costs.
Defined Health Benefits
Although part of the “benefit” of a health benefit plan is that the employer also takes care of all the administrative paperwork related to the insurance, companies are increasingly uninvolved in the administration process, opting instead to let the employee decide which plan out of many choices suits them best. For example, if an employer typically spends about $5,000 per employee per year on health benefits, the employer would use that money as a “defined contribution.” The employee then has $5,000 to spend per year on benefits, but instead of using the employer-defined health plan, the employee may choose from a variety of HMOs, preferred provider organizations PPOs, or other health plans. If the insurance premiums rise above this amount, the employee must make up the difference.
Defined Contribution Package
Many employers are currently offering a defined contribution package to their employees. The definition of “defined contributions,” however, can range from one in which employers are completely uninvolved in the administration of benefits and simply give their employees cash or vouchers for the amount contributed that they can use to buy coverage, to a more “defined choice model” where employers offer a variety of health options at differing price levels along with a premium dollar contribution, and a variety of other options in between.
Risk Shifting
Thus, defined contributions shift the financial risk from the employer to the employee. Defined care is not a replacement for managed care, but will probably cause managed care to adapt under these new systems. That is, HMOs, PPOs and other managed care plans still appear to be the main choices in a defined care environment, so they are in fact a part of the system.
Assessment
Another challenge with a defined health benefit program is that the concept of risk-pooling becomes more difficult. In traditional employer-sponsored plans, rates are usually based on the pool of employees; a chronically ill employee who tries to find insurance independently may face rates drastically higher than if they had participated in an employer-sponsored plan.
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Filed under: Book Reviews, Financial Planning, Glossary Terms, Investing, Retirement and Benefits, Sponsors | Tagged: 401-k, 403-b, david marcinko, defined contribution plan, defined denefits plan, employee benefits, employee funding, employer funding, health benefits, Health Capital Consultants, HMO, hope hetico, IRA, legacy plan, PPO, retirement benefits, retirement planning, robert james cimasi, www.healthcarefinancials.com, www.healthdictionaryseries.com | 1 Comment »
An Important and Contemporary Issue – Once Again
[By Patricia Trites; MPA, CHBC, CMP™ (Hon) with Staff Reporters]
The Emergency Medical Treatment and Active Labor Act (EMTALA) is receiving increasing scrutiny from prosecutors during these times of financials stress and credit tightening. The statute is intended to ensure that all patients who come to the emergency department of a hospital receive care, regardless of their insurance or ability to pay. Both hospitals and physicians need to work together to ensure compliance with the provisions of this law.
Triad of Requirements
EMTALA imposes three fundamental requirements upon hospitals that participate in the Medicare program with regard to patients requesting emergency care.
First, the hospital must conduct an appropriate medical screening examination to determine if an emergency medical condition exists.
Second, if the hospital determines that an emergency medical condition exists, it must either provide the treatment necessary to stabilize the emergency medical condition or comply with the statute’s requirements to affect a proper transfer of a patient whose condition has not been stabilized. A hospital is considered to have met this second requirement if an individual refuses the hospital’s offer of additional examination or treatment, or refuses to consent to a transfer, after having been informed of the risks and benefits of treatment.
Third, EMTALA’s requirement is activated if an individual’s emergency medical condition has not been stabilized.
Hospital Transfers
A hospital may not transfer an individual with an unstable emergency medical condition unless:
(1) the individual or his or her representative makes a written request for transfer to another medical facility after being informed of the risk of transfer and the transferring hospital’s obligation under the statute to provide additional examination or treatment;
(2) a physician has signed a certification summarizing the medical risks and benefits of a transfer and certifying that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the transfer outweigh the increased risks; or
(3) a qualified medical person signs the certification after the physician, in consultation with the qualified medical person, has made the determination that the benefits of transfer outweigh the increased risks, if a physician is not physically present when the transfer decision is made. The physician must later countersign the certification.
On-Call Responsibilities
One area of particular concern is physician on-call responsibilities. Physician practices whose members serve as on-call hospital emergency room physicians are advised to familiarize themselves with the hospital’s policies regarding on-call physicians. This can be done by reviewing the medical staff bylaws or policies and procedures of the hospital that must define the responsibility of on-call physicians to respond to, examine, and treat patients with emergency medical conditions. Physicians should also be aware of the requirement that, when medically indicated, on-call physicians must generally come to the hospital to examine the patient. Patients may be sent to see the on-call physician at a hospital-owned contiguous or on-campus facility to conduct or complete the medical screening examination due to the following reasons:
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Conclusion
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Filed under: "Doctors Only", Career Development, Ethics, Glossary Terms, Health Insurance, Health Law & Policy, iMBA, Inc., Managed Care, Practice Management, Recommended Books | Tagged: CMP, david marcinko, emergency care, emergency department, Emergency Medical Treatment and Active Labor Act, emergency room, EMTALA, ER, healthcare, hope hetico, hospital, medicare, Pati Trites, www.healthcarefinancials.com, www.healthdictionaryseries.com | 9 Comments »
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