DICTIONARY: Health Economics and Finance

10,000 TERMS, DEFINITIONS, ABBREVIATIONS AND RESOURCES

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

SECOND OPINIONS: https://medicalexecutivepost.com/schedule-a-consultation/

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What is a Hospital CHARGE MASTER?

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By Dr. David Edward Marcinko MBA

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According to George Washington University, a hospital chargemaster is a comprehensive list of a hospital’s products, procedures, and services. Everything from prescription drugs to supplies for diagnostic tests has a unique price listing in the chargemaster, making it a go-to document for hospital administrators such as CFOs, clinical documentation improvement specialists, and revenue directors.

Chargemaster usage dates back to the mid-20th century. At that time, fee-for-service (FFS) health insurance plans, which allow patients to direct their medical care by choosing physicians and facilities and paying a portion of the billed total, had just emerged in the U.S. healthcare system. The chargemaster originally served as something akin to an FFS dictionary, with an entry for virtually anything billable under that economic model of healthcare.

CITE: https://www.r2library.com/Resource/Title/082610254

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Over time, FFS itself has evolved and been challenged by alternatives like value-based care (VBC). Chargemasters built for FFS have changed accordingly, and they remain fixtures of the modern hospital revenue cycle. A standard chargemaster is a large electronic file containing multiple elements for each entry. These attributes usually include:

  • The charge for a single unit of the service in question
  • A Current Procedural Terminology (CPT) code; CPT is the official medical code set of the American Medical Association
  • Potentially, a Healthcare Common Practice Coding System (HCPCS) code; HCPCS is based on CPT
  • Alternative CPT and HCPCS codes if needed, e.g. one corresponding only to specific payers
  • A revenue code associated with the charge
  • Flag(s) indicating if the entry is scheduled for deletion, active or inactive
  • An internal reference number within the ledger for accounting purposes

LINK: https://revcycleintelligence.com/features/the-role-of-the-hospital-chargemaster-in-revenue-cycle-management

COURT: https://www.msn.com/en-us/health/medical/colorado-supreme-court-rules-in-favor-of-woman-who-expected-to-pay-dollar1337-for-surgery-but-was-charged-dollar303709/ar-AAXlqNU?li=BBnbfcL

MORE: https://medicalexecutivepost.com/2013/09/26/some-modern-issues-impacting-hospital-revenue-cycles/

RCC: https://medicalexecutivepost.com/2013/03/06/a-better-approach-to-hospital-cost-estimation/

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Did Public Health Fail America During the Pandemic?

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By Dr. David E. Marcinko MBA

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LINK: https://www.msn.com/en-us/news/us/how-public-health-failed-america/ar-AAXid2L?li=BBnb7Kz

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CDC: https://www.cdc.gov/publichealthgateway/publichealthservices/essentialhealthservices.html

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Inflation, CPI and the PPI

By Staff Reporters

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DEFINITION: In finance, inflation is a general increase in prices of goods and services in an economy. When the general price level rises, each unit of currency buys fewer goods and services; consequently, inflation corresponds to a reduction in the purchasing power of money.

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DEFINITION: The Producer Price Index PPI is a group of indexes that measure the change, over time, in the prices received by domestic producers of goods and services. It measures price changes from the perspective of the seller rather than the consumer, as with the CPI. The CPI would include imported goods, while the PPI is relevant to U.S. producers, and therefore would not include imports.

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

The PPI measures over 10,000 products and services. It reports the price changes prior to the retail level. This information is useful to the government in formulating fiscal and monetary policies. The data gathered from the PPI is often used in escalating purchase and sales contracts. That is the dollar amount to be paid at some time in the future.

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Inflation stayed elevated in April but eased off its 40-year high, signaling that a stomach-churning surge in consumer prices since last summer may have peaked.

PPI April 2022: https://medicalexecutivepost.com/2022/05/12/what-is-the-producer-price-index/

The consumer price index increased 8.3% annually, down from 8.5% in March, as a drop in gasoline prices offset a continuing run-up in food, rent and other costs, the Labor Department said Wednesday. March’s yearly advance marked the fastest since December 1981.

READ: https://www.msn.com/en-us/money/markets/inflation-stays-elevated-at-83percent-in-april-but-eases-from-40-year-high/ar-AAX9vp3?li=BBnb7Kz

2nd Opinions: https://medicalexecutivepost.com/schedule-a-consultation/

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OUTCOMES: In-Person and Tele-Health Encounters During COVID-19

By Staff Reporters and MCOL

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Outcomes of In-Person and Tele-Health Encounters During COVID-19

 •  Ambulatory encounters decreased by 1.0% and the number of in-person encounters per enrollee decreased by 17.0% from 2019 to 2020.
 •  For members with an initial telehealth encounter for a new acute condition, the adjusted odds ratio was 1.44 for all follow-ups combined and 1.11 for an emergency department encounter.
 •  For members with an initial telehealth encounter for a new chronic condition, the adjusted odds ratios were 0.94 for all follow-ups combined and 0.94 for in-patient admissions.

Source: JAMA Network, April 26, 2022

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GO FUND ME: Medical Campaigns Reveal a Big Problem with Health Care

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By Jules Lipoff, MD: Senior fellow at the Leonard Davis Institute of Health Economics and an assistant professor of clinical dermatology at Perelman School of Medicine, both of the University of Pennsylvania. Erica Mark, medical student at the University of Virginia, contributed to this article. The opinions expressed in this article do not necessarily represent those of the University of Pennsylvania Health System or the Perelman School of Medicine.

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If you follow the news or your social media feed, you know that crowdsourcing medical expenses is increasingly popular for financing health care costs. In fact, you might have contributed to one; 22 percent of American adults report donating to GoFundMe medical campaigns.

CITE: https://www.r2library.com/Resource/Title/082610254

As of 2021, approximately $650 million, or about one-third of all funds raised by GoFundMe, went to medical campaigns. That staggering amount of money highlights how dysfunctional our health care system is, forcing people to resort to crowdsourcing to afford their medical care — but it’s not surprising. In the United States, 62 percent of bankruptcies are related to medical costs. This should be a wake-up call to address and reform the system further.

Related: https://medicalexecutivepost.com/2021/12/30/does-crowd-sourcing-democratize-the-health-care-insurance-system/

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ESSAY: https://www.msn.com/en-us/news/politics/gofundme-medical-campaigns-reveal-a-big-problem-with-health-care/ar-AAXabGB?li=BBnbfcL

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SURVEY: Employee Financial Healthcare Affordability

By Staff Reporters and MCOL

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WTW: Employee Healthcare Affordability Survey

 •  By the end of 2023, most employers (95%) are expected to offer virtual care for medical and behavioral health issues, and 61% expect to offer lower cost sharing for virtual care.
 •  Over half (55%) think the expansion of virtual care will help decrease costs in the long run, and 50% think it will improve outcomes.
 •  Employer confidence in sponsoring healthcare benefits over the next 10 years is at its highest point in over 10 years (84% in 2022 versus 38% in 2011).
 •  One in 10 employers (9%) currently offer genetic testing as a screening for early-stage cancer with another 5% planning to do so by 2023.

Source: Willis Towers Watson, April 26, 2022

CITE: https://www.r2library.com/Resource/Title/082610254

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The GAP between Medicare and Commercial Hospital Prices

THE GAP INCREASES!

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By Health Capital Consultants, LLC

Gap between Medicare and Commercial Hospital Prices Increases

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A recent study examined the growth in hospital prices paid by commercial health insurance companies compared to Medicare over a seven-year period and found that commercial health plan rates were, on average, 180% higher than Medicare rates as of 2019.

While the national ratio between commercial and Medicare hospital payment growth rates remained relatively stable during the seven-year study period, ratios varied widely on a regional basis. This Health Capital Topics article will discuss this recent study and its implications. (Read more…)

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BITCOIN: A Subjective Theory for Physicians

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By Michel Accad, MD

Michel Accad MD Practices internal medicine and cardiology in San Francisco

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Bitcoin Cash - Wikipedia

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In a recent article on the Mises Institute’s Power and Market blog, Kyle Ward appealed to the subjective theory of value to castigate Peter Schiff for his notorious skepticism of Bitcoin:

READ: http://alertandoriented.com/the-subjective-theory-of-bitcoin/

CITE: https://www.r2library.com/Resource/Title/082610254

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What Really is a STABLECOIN?

Types with Guide

By Staff Reporters

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According to Investopedia, a stablecoin is a class of cryptocurrencies that attempt to offer price stability and are backed by a reserve asset. Stablecoins have gained traction as they attempt to offer the best of both worlds—the instant processing and security or privacy of payments of cryptocurrencies, and the volatility-free stable valuations of fiat currencies.

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Stablecoins are cryptocurrencies where the price is designed to be pegged to a cryptocurrency, fiat money, or to exchange-traded commodities (such as precious metals or industrial metals).

CITE: https://www.r2library.com/Resource/Title/082610254

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Key Points

  • Stablecoins are cryptocurrencies that attempt to peg their market value to some external reference.
  • Stablecoins may be pegged to a currency like the U.S. dollar or to a commodity’s price such as gold.
  • Stablecoins achieve their price stability via collateralization (backing) or through algorithmic mechanisms of buying and selling the reference asset or its derivatives.

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SURVEY on COVID-19’s Impact On Physician Practices and Employment

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By Staff Reporters

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• 108,700 additional physicians became employees of hospitals or other corporate entities – 83,000 of that shift occurred after the onset of COVID-19.
• Hospital and other corporate entities acquired 36,200 additional physician practices over the three-year period, resulting in a 38% increase in the percentage of corporate owned practices.
• 58,200 additional physicians become hospital employees – 51,000 of that shift occurred after the onset of COVID-19.
• 50,500 additional physicians became employees of corporate entities – 32,000 of that shift occurred after the onset of COVID-19.

Source: Physicians Advocacy Institute, April 2022

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Great Resignation: https://medicalexecutivepost.com/2022/03/08/healthcare-industry-hit-with-the-great-resignation-retirement/

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PODCAST: Physician Entrepreneurial Tips on Opening Your Own Medical Practice

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By MEDICAL ECONOMICS

James Underberg, MD, discusses how he left a large health system to open his own practice, and provides tips for physicians considering the same move.

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Private Healthcare Equity: https://www.youtube.com/watch?v=tBwHu1uigoA

ME-P Business Plan: https://medicalexecutivepost.com/2022/04/05/get-your-free-medical-office-start-up-business-plan-from-imba-inc/

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Biden Administration to Overhaul Vertical [Health Systems] Merger Guidelines

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By Health Capital Consultants, LLC

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Biden Administration to Overhaul Vertical Merger Guidelines

The U.S. healthcare industry has seen a rise in vertical integration transactions since the passage of the ACA, especially among physician groups integrating with health systems or insurers, as providers seek to fill gaps in their continuum of care. In response to these trends and resulting market imbalances, the Biden Administration is aggressively pursuing antitrust enforcement by updating and revising U.S. antitrust law guidance.

This Health Capital Topics article will discuss the vertical integration movement and the proposed changes to antitrust laws that may affect the future of healthcare. (Read more…) 

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

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HEALTH TECH: Technology Giants?

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Dr. Bertalan Meskó, MD PhD

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The Medical Futurist

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  • Google in healthcare: The search giant has repeatedly successfully transferred its in-depth knowledge of algorithms in the field of medicine, particularly since it acquired DeepMind.
  • Apple in healthcare: Apple will keep on working on expanding the health features of its devices, Apple Watch and iPhones included.
  • Microsoft in healthcare: Microsoft’s cloud solutions provide integrated capabilities that make it easier to improve the healthcare experience.
  • Amazon in healthcare: Amazon will make further use of its vast knowledge of online shopping trends and behavior and will keep on providing what people need, from medicine to wearables.
  • IBM in healthcare: IBM has a lot to offer in federated learning, blockchain, and quantum computing
  • Nvidia in healthcare: NVIDIA seems incredibly focused on its approach to healthcare. We can expect NVIDIA to be a leader in the use of artificial intelligence in healthcare
  • Facebook in healthcare: The Metaverse developed by Facebook/Meta has incredible potential to revolutionize healthcare.

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Medicare Part C [Advantage Plan] Allegations & Investigations

By Office of Inspector General and the HHS

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READ REPORT: https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp

OIG: https://oig.hhs.gov/oei/reports/OEI-09-18-00260.pdf

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What is STAGFLATION?

By Staff Reporters

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What Is Stagflation?

Stagflation is characterized by slow economic growth and relatively high unemployment—or economic stagnation—which is at the same time accompanied by rising prices (i.e., inflation). Stagflation can be alternatively defined as a period of inflation combined with a decline in the gross domestic product (GDP).

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

The term, a portmanteau of stagnation and inflation, is generally attributed to Iain Macleod, a British Conservative Party politician who became Chancellor of the Exchequer in 1970.

MORE: https://medicalexecutivepost.com/2019/06/25/what-is-a-portmanteau/

Key Takeaways According to Investopedia

  • Stagflation refers to an economy that is experiencing a simultaneous increase in inflation and stagnation of economic output.
  • Stagflation was first recognized during the 1970s when many developed economies experienced rapid inflation and high unemployment as a result of an oil shock.1
  • The prevailing economic theory at the time could not easily explain how stagflation could occur.
  • Since the 1970s, rising price levels during periods of slow or negative economic growth have become somewhat of the norm rather than an exceptional situation.

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How to Achieve Health Equity?

How Flexible Payment Options Are Changing Healthcare

A Guest ME-Post

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Todd Berner MD discusses how you can achieve health equity.

LINK: https://toddberner.com/how-flexible-payment-options-are-changing-healthcare/

RELATED: https://toddberner.com/why-digital-is-the-next-frontier-of-health-equity/

CITE: https://www.r2library.com/Resource/Title/082610254

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Healthcare A.I. and Financial Outcomes Survey

By Staff Reporters

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17% of Healthcare Execs Said AI Would Affect Financial Outcomes

 •  60% of respondents expect AI to impact clinical outcomes.
 •  17% said AI would affect financial outcomes.
 •  13% said AI would impact their operation outcomes.
 •  9% said AI would impact administrative outcomes.
 •  61% of executives hope to bring about a complete digital transformation in their organizations within three to five years.

Source: Morning Consult via HealthIT Analytics, April 14, 2022

CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Why Doctors on Salary is a Bad Idea?

Is Fee-for-Service a Public Health Threat?

This Video Contains Feedback from Doctors Who Are Against Doctors on Salary.

By Eric Bricker MD

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

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PODCASTS: The GREAT ECONOMIC MODERATION / RESIGNATION in Medicine?

A HISTORICAL REVIEW WITH UPDATE

Dr. David Edward Marcinko | The Leading Business Education Network for  Doctors, Financial Advisors and Health Industry Consultants

By Dr. David E. Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

What was the Great Economic Moderation?

The Great Moderation is the name given to the period of decreased macroeconomic volatility experienced in the United States starting in the 1980s.

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

During this period, the standard deviation of quarterly real gross domestic product (GDP) declined by half and the standard deviation of inflation declined by two-thirds, according to figures reported by former U.S. Federal Reserve Chair Ben Bernanke. The Great Moderation can be summed up as a multi-decade period of low inflation and positive economic growth.

But, what about health economics, writ large? And, the actual practice of medicine by physicians in the trenches. Consider this historical review.

GOLDEN AGE OF MEDICINE

The ‘golden age of medicine’ – the first half of the 20th century, reaching its zenith with Jonas Salk’s 1955 polio vaccine – was a time of profound advances in surgical techniques, immunization, drug discovery, and the control of infectious disease; however, when the burden of disease shifted to lifestyle-driven, chronic, non-communicable diseases, the golden era slipped away. Although modifiable lifestyle practices now account for some 80% of premature mortality, medicine remains loathe to embrace lifestyle interventions as medicine Here, we argue that a 21st century golden age of medicine can be realized; the path to this era requires a transformation of medical school recruitment and training in ways that prioritize a broad view of lifestyle medicine. Moving beyond the basic principles of modifiable lifestyle practices as therapeutic interventions, each person/community should be viewed as a biological manifestation of accumulated experiences (and choices) made within the dynamic social, political, economic and cultural ecosystems that comprise their total life history. This requires an understanding that powerful forces operate within these ecosystems; marketing and neoliberal forces push an exclusive ‘personal responsibility’ view of health – blaming the individual, and deflecting from the large-scale influences that maintain health inequalities and threaten planetary health. The latter term denotes the interconnections between the sustainable vitality of person and place at all scales. We emphasize that barriers to planetary health and the clinical application of lifestyle medicine – including authoritarianism and social dominance orientation – are maintaining an unhealthy status quo.

NOTE: https://pubmed.ncbi.nlm.nih.gov/31828026/

GOLDEN AGE OF MEDICAL PRACTICE

To listen to all those desperate to reform health care, you get the impression that physicians are pretty horrible people. We are all sexist, greedy, money grubbing tyrants who will perform unnecessary tests and procedures just to make money. We don’t care about quality or cost. We are killing off 250,000 patients every year with our ignored “errors.”

We purposely keep our patients in pain, or we addict them to narcotics just to shut them up. We are constantly told by lawyers that lawsuits are necessary to protect patients from doctors. We provide unsafe drugs just because the drug reps give us free pens and coffee cups. The government must step in to clean up the mess.

PODCAST: https://www.kevinmd.com/blog/2017/08/9-reasons-golden-age-medicine-golden.html

GOLDEN AGE OF PATIENT TRUST

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THE GREAT PHYSICIAN RETIREMENT AND RESIGNATION: https://medicalexecutivepost.com/2021/11/09/healthcare-industry-hit-with-the-great-resignation-retirement/

YOUR COMMENTS ARE APPRECIATED.

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

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

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Valuation of Home Health Agencies [The Reimbursement Environment]

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By Health Capital Consultants, LLC

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Valuation of Home Health Agencies: Reimbursement Environment

The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and has a strong influence on reimbursement for home healthcare services. In 2020, Medicare and Medicaid accounted for an estimated $829.5 billion and $671.2 billion in healthcare spending, respectively. The outsized prevalence of these public payors in the healthcare marketplace often results in their acting as a price setter, and being used as a benchmark for private reimbursement rates. This effect may be even stronger in the home health industry.

The third installment of this home health valuation series will discuss the reimbursement environment in which these organizations operate. (Read more…) 

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

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INTERVIEW: A Solution for Healthcare Financing?

HEALTHCARE FINANCING

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

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

-Dr. David E. Marcinko MBA CMP®

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Staff & Contributors - CHAMPIONS OF WAYNE

By Richard Helppie

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Survey on Healthcare Financial Affordability

By Staff Reporters

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Gallup: Healthcare Affordability Survey – 3 Takeaways

 •  56% of the U.S. adult population report no recent occurrences of being unable to afford care or prescribed medicine.
 •  36% of the U.S. adult population report recent occurrences of being unable to pay for care or medicine or lack easy access.
 •  8% of the U.S. adult population report recent occurrences of being unable to pay for household care, being unable to pay for prescribed medicine and feeling that they would not have access to affordable quality care if needed today.

Source: Gallup, “Benchmarking Healthcare Affordability and Perceived Value,” March 31, 2022.

CITE: https://www.r2library.com/Resource/Title/082610254

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PROBE: Medicare Advantage [Part C] Plans Deny Needed Care to Tens of Thousands of Patients

By Staff Reporters

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Medicare Advantage Organizations (MAOs) delayed or denied payments and services to patients, even when these requests met Medicare coverage rules, according to a report released by federal investigators on Thursday.

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A verbatim link: https://thehill.com/policy/healthcare/3470005-probe-finds-medicare-advantage-plans-deny-needed-care-to-tens-of-thousands/

Confirmation link: https://www.msn.com/en-us/news/politics/watchdog-private-medicare-plans-denied-nearly-1-in-5-claims-that-should-have-been-paid/ar-AAWHZuT?li=BBnb7Kz

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Health Insurance Plans Confusing and Largely Misunderstood

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By Eric Bricker MD

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According to One Survey, only 4% of People Understand the Basic Insurance Terms of Deductible, Co-Insurance, Copay and Out-of-Pocket Maximum.

In Another Survey by United Healthcare Itself, Only 9% Understood the Terms Premium, Deductible, Co-Insurance and Out-of-Pocket Max.

This Lack of Understanding is Not the Fault of the Employee Benefits Professionals or the Employees… Rather, the Health Insurance Plan Designs Are Just Too Complicated.

CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: https://www.youtube.com/watch?v=Yp6TI7iu-m0

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Comments Appreciated

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On Accounting -VERSUS- Economic Profit

Yes – There is A Difference

[By staff reporters]

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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AMA: Doctors Committed to Tele-Health

By AMA / MCOL

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AMA: Doctors Committed to Tele-Health

 •  More than 80% said patients have better access to care since using telehealth.
 •  62% believe patients have higher satisfaction since offering telehealth.
 •  60% agreed telehealth enabled them to provide high-quality care.
 •  56% are motivated to increase telehealth use in their practices.
 •  44% indicated that telehealth decreased the costs of care.

Source: AMA, April 1, 2022

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INDEX: Fear & Greed

By Staff Reporters

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What a week in the world’s financial markets? It is perfect timing for this ME-P.

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It is useful to look at stock market levels compared to where they’ve been over the past few months. When the S&P 500 is above its moving or rolling average of the prior 125 trading days, that’s a sign of positive momentum. But if the index is below this average, it shows investors are getting skittish.

The Fear & Greed Index uses slowing momentum as a signal for Fear and a growing momentum for Greed.

But, a few big stocks can skew returns for the market. So, it’s important to also know how many stocks are doing well versus those that are struggling.

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PODCAST: The Decline of Employer Sponsored Family Healthcare Insurance Coverage

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Elective Surgery is Seasonal!

By Eric Bricker MD

1) Patients Have Met their Deductible and OOP Max.

2) They Do Not Have To Take Time Off of Work for Recovery.

CITE: https://www.r2library.com/Resource/Title/082610254

However, Is This the Best Time of Year to Have Surgery for Patients?

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PODCAST: Patient Centricity in Value Based Care?

By Eric Bricker MD

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Dr. Sachin MD MBA Jain wrote an outstanding article on Value Based Care in the April 12, 2022 issue of Forbes stating that the Patient Must Come First in Value Based Care.

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RELATED PODCAST: https://medicalexecutivepost.com/2021/12/13/podcasts-the-case-against-value-based-care/
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NUMBER of Physicians in the USA

By Staff Reporters and US Census Bureau

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Physicians in The U.S.A. in 2019

 •  Emergency medicine physicians: 13,741
 •  Radiologists: 19,421
 •  Other Physicians: 698,316
 •  Surgeons: 48,495
 •  Physician assistants: 107,710
 •  Podiatrists: 7,568
 •  Audiologists: 14,517

Source: U.S. Census Bureau, March 2022

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PODCAST: Is Direct Medical Specialty Care Even Possible?

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DEFINITION: Direct Medical Specialty Care (DMSC) is an innovative alternative payment model improving access to high functioning healthcare with a simple, flat, affordable membership fee.  No fee-for-service payments.  No third party billing.  The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider.  Patients have extraordinary access to a physician of their choice, often for as little as $70 per month, and physicians are accountable first and foremost their patients.  DPC is embraced by health policymakers on the left and right and creates happy patients and happy doctors all over the country!

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

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By Doug Geinzer

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Doug Geinzer, Founder and President of High Performance Providers, specializes in high-cost, steerable surgeries. During the episode, Geinzer and host Chris Habig discuss the direct alignment between the specialty care community and the direct primary care community, as well as Geinzer’s job as a consultant to surgeons.

PODCAST: https://healthcareamericana.com/episode/is-specialty-direct-care-possible/

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PODCAST: How To Understand U.S. Healthcare?

Follow The Money!

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By Jonathan Burroughs MD MBA

For those seeking to better understand the US healthcare system, national healthcare consultant Dr. Jonathan Burroughs suggests playing a game of “follow the money.” He asserts that whenever healthcare appears illogical, following the money will make it all rational and clear. The U.S. spends 2x as much money as the rest of the industrialized world, yet its citizens do not live as long as they do in 36 other nations. Dr. Burroughs gives an overview on how to fix the system.

Dr. Burroughs has worked with over 1,100 hospitals across the country to help healthcare leaders navigate the 21st century. He is a popular national speaker, who speaks to the impact of healthcare reform on hospitals, physicians and patients. Jonathan is a healthcare legal expert, who has participated in over 65 cases across the country. He is the winner of the James A Hamilton Award in 2016 awarded by the American College of Healthcare Executives titled “Redesign the Medical Staff Model”. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

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STO LOT Spring Greetings = Life to 100 Hundred Years?

About Centenarians

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By Dr. David Edward Marcinko MBA CMP™

SPONSOR: http://www.CertifiedMedicalPlanner.org

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DEFINITION: A centenarian is a person who has reached the age of 100 years. Because life expectancy worldwide are below 100 years, the term is invariably associated with longevity. In 2012, the United Nations estimated that there were 316,600 living centenarians worldwide.

CITE: https://www.r2library.com/Resource/Title/082610254

Sto Lat (One Hundred Years) is a traditional Polish song that is sung to express good wishes, good health and long life to a person. It is also a common way of wishing someone a happy birthday in Polish. Sto lat is used in the Spring, many birthdays and on international days of language.

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What Percentage of the Population Lives to 100?

According to the Social Security Administration, the overall chances of living to 100 aren’t actually that great. And, according to the World Economic Forum, there are over 500,000 centenarians among the 7.9 billion people worldwide. That means that only a 0.006% of the population is 100 or more.

Here are a few additional facts from the most recently available information from the Society of Actuaries and the Social Security Administration:

  • One out of three males and one out of two females who are in their mid-50s today will live to be 90.
  • For a couple who is 65 today, there is a 50% chance that one person will be alive at 92.
  • If you have lived to be 65, you will likely live another 20 years, on average.
  • If you live to be 75, the average life expectancy is 88.
  • If you live to be 85, the average life expectancy is 92.
  • And, if you live to be 95, the average life expectancy is 98.

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PODCAST: Cash Flow, Revenue & Entrepreneurial Leadership in Healthcare Business

THE ENTREPRENEURIAL M.D.

In this episode we are joined by Dr. Brent Jackson, Chief Medical Officer for Mercy General in Sacramento, CA to discuss the physician life-cycle, burnout, and transitioning into leadership within healthcare.

Play EpisodeDownload (40.4 MB)

Summary: Dr Brent Jackson discusses the flow of revenue throughout the medical industry.

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

SECOND OPINIONS: https://medicalexecutivepost.com/schedule-a-consultation/

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

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SURVEY: 39% of Medical Providers Conduct Covid-19 Screens Via Tele-Health

By staff Reporters

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39% of Providers Conduct Covid-19 Screens Via Telehealth

In a recent survey providers were asked what types of patient care they deliver via telehealth. The survey found:

 •  Conduct primary care visits (75%)
 •  Conduct chronic care visits (72%)
 •  Order prescription refills (64%)
 •  Conduct COVID-19 screenings (39%)
 •  Conduct urgent care visits (38%)
 •  Address mental health concerns (36%)
 •  Conduct follow-up after a procedure or surgery care (28%)

Source: UnitedHealth Group, “Telehealth Use Will Outlive the Pandemic for Health Care Providers, Survey Shows,” March 15, 2022

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The Non-Medical “POISON PILL” Strategy is in the Investing News!

MUSK versus TWITTER

By Staff Reporters

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DEFINITION: A shareholder rights plan, colloquially known as a “poison pill“, is a type of defensive tactic used by a corporation‘s board of directors against a takeover. In the field of mergers and acquisitions, shareholder rights plans were devised in the early 1980s as a way to prevent takeover bids by taking away a shareholder’s right to negotiate a price for the sale of shares directly.

Typically, according to Wikipedia, such a plan gives shareholders the right to buy more shares at a discount if one shareholder buys a certain percentage or more of the company’s shares. The plan could be triggered, for instance, if any one shareholder buys 20% of the company’s shares, at which point every shareholder (except the one who possesses 20%) will have the right to buy a new issue of shares at a discount. If all other shareholders are able to buy more shares at a discount, such purchases would dilute the bidder’s interest, and the cost of the bid would rise substantially. Knowing that such a plan could be activated, the bidder could be disinclined to take over the corporation without the board’s approval, and would first negotiate with the board in order to revoke the plan.

CITE: https://www.r2library.com/Resource/Title/082610254

The plan can be issued by the board of directors as an “option” or a “warrant” attached to existing shares, and only be revoked at the discretion of the board.

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READ: https://www.msn.com/en-us/money/companies/twitter-adopts-poison-pill-plan-to-block-elon-musks-bid/ar-AAWfUaZ?li=BBnb7Kz

MUSK: https://www.cbsnews.com/news/twitter-poison-pill-elon-musk/

TWITTER: https://www.msn.com/en-us/money/companies/twitter-activates-poison-pill-to-thwart-musk-hostile-takeover-attempt/ar-AAWgmwW?li=BBnb7Kz

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PODCAST: Economic Cycles in Healthcare

By Eric Bricker MD

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The TOP 100 Economics Blogs of 2022

INTELLIGENT ECONOMIST

Last Updated: February 3rd, 2022

By Prateek Agarwal

Welcome, and thank you for joining us for the 5th annual Top Economics Blogs list! We are happy, once again, to introduce you to a freshly updated list of economics blogs for 2022. As always, our winners list provides blogs for many different audiences, ranging from the budding economic enthusiast to the seasoned academic. The list also covers a variety of economics topics, whether it be traditional economic theory or the application of economics to current events and issues. In this meticulously curated list, we’ve condensed the most unique elements of each blog into short descriptions, so that you can see which ones catch your eye.

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

For 2022, a few newcomers have emerged, while many mainstays from previous years are present as well. Like previous years, we’ve done our best to capture the blogs which stand out for their quality rather than their popularity. As such, the list is an eclectic group that represents a wide range of tastes and perspectives.

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What is an economist? Definition and examples - Market Business News

Regardless of your school of thought or political affiliation, you can find valuable new content in this list of engaging, high-quality economics blogs.

LINK: https://www.intelligenteconomist.com/economics-blogs/

Product Details

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PODCAST: 50% of Medical Treatments Have Unknown Effectiveness

By Eric Bricker MD

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

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PODCAST: Direct Primary Care Entrepreneurship and Innovation

By Free Market Medical Association

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DEFINITION:
Direct Primary Care (DPC) is an innovative alternative payment model improving access to high functioning healthcare with a simple, flat, affordable membership fee.  No fee-for-service payments.  No third party billing.  The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider.  Patients have extraordinary access to a physician of their choice, often for as little as $70 per month, and physicians are accountable first and foremost their patients.  DPC is embraced by health policymakers on the left and right and creates happy patients and happy doctors all over the country!

CITE: https://www.r2library.com/Resource/Title/082610254

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Q1 2022 – The Entrepreneurial Digital Health Financing Boom Chills

By Phil Taylor

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US digital health company investment financing experienced a dip in Q1 of 2022, dropping to $6 billion from the $6.7 billion invested in Q1 2021. In addition, the average size of each investment deal dropped from $46 million last year to just shy of $33 million. These declines come after a boom in investments in recent years. The Rock Health Digital health securities index also reflected this year’s trend, including special purpose acquisition company (SPAC) listings.

According to Phil Taylor of PharmaPhorum, “SPACs have been a popular route to public listing for digital health as well as many other sectors, but the deals have underperformed, with steep declines in share prices after they closed that has “exerted downwards pressure” on the Rock Health Digital Health Index (RHDHI).”

Read more by clicking here

SPACs: https://medicalexecutivepost.com/2021/11/12/spac-popularity-soaring-in-healthcare/

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