BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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A recent study from Physicians Advocacy Institute (PAI), prepared by Avalere Health, associated the growing number of both physician practice acquisitions and employed physicians between 2019 and 2021 with the COVID-19 pandemic.
To study COVID-19’s impact on physician employment trends, the June 2021 study evaluated the IQVIA OneKey database that contains physician practice and health system ownership information.
To assess these trends at a national and regional level, Avalere researchers studied the two-year period from January 1, 2019 to January 1, 2021. (Read more…)
Posted on August 28, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
ANTI-KICKBACK STATUTEOverview and Impact
Do you want to learn more about the Stark Law and Anti-Kickback Statute Final Rules and how they impact your practice? Join us for a one-hour webinar, presented with Hancock Daniel.
Historically, Medicare has offered value-based payment models to healthcare organizations on both a voluntary and a mandatory participation basis. Because voluntary participants could self-select into programs to reduce spending, it was assumed that they achieved greater savings than mandated participants, but until recently, no data had tested this.
However, a June 2021 study in the Journal of the American Medical Association (JAMA) found no difference in risk-adjusted episodic spending between voluntary and mandatory payment model participants. (Read more…)
Posted on August 17, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
BY NIHCM
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Value-based care has the potential to transform health care, improving quality and access for millions of people, while addressing COVID-19 related disparities. As a result of the pandemic, many rural communities and communities of color face significant reductions in access to health care.
More than 8% of practicing physicians nationwide closed during COVID-19 despite 82 million Americans living in “health professional shortage areas.” The financial strain and burnout experienced by providers has fueled interest in accelerating the adoption of value-based care. As of 2017, only 34% of health care dollars were the result of value-based care payments. This low rate of adoption exists despite evidence tying payments to patient health outcomes and rewarding higher quality care leads to reduced costs.
This webinar brought together experts who are driving innovative initiatives, achieving excellence in health outcomes, and uncovering more effective ways to implement value-based care.
On July 13, 2021, the Centers for Medicare & Medicaid Services (CMS) released its proposed Medicare Physician Fee Schedule (MPFS) for calendar year (CY) 2022.
In addition to numerous payment updates in the MPFS, such as significant updates to the Merit-based Incentive Payment System (MIPS), new policies may preserve expanded telemedicine services through 2023 and clinicians may incur more difficulty earning bonuses under the Quality Payment Program (QPP) eligibility threshold. CMS also includes in the proposed rule a request for information to address COVID-19 vaccine reimbursement proposals. (Read more...)
Posted on August 4, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
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TEXTBOOKREVIEW
Drawing on the expertise of decision-making professionals, leaders, and managers in health care organizations, Hospitals & Health Care Organizations: Management Strategies, Operational Techniques, Tools, Templates, and Case Studies addresses decreasing revenues, increasing costs, and growing consumer expectations in today’s increasingly competitive health care market.
Offering practical experience and applied operating vision, the authors integrate Lean managerial applications, and regulatory perspectives with real-world case studies, models, reports, charts, tables, diagrams, and sample contracts. The result is an integration of post PP-ACA market competition insight with Lean management and operational strategies vital to all health care administrators, comptrollers, and physician executives. The text is divided into three sections:
Managerial Fundamentals
Policy and Procedures
Strategies and Execution
Using an engaging style, the book is filled with authoritative guidance, practical health care–centered discussions, templates, checklists, and clinical examples to provide you with the tools to build a clinically efficient system. Its wide-ranging coverage includes hard-to-find topics such as hospital inventory management, capital formation, and revenue cycle enhancement. Health care leadership, governance, and compliance practices like OSHA, HIPAA, Sarbanes–Oxley, and emerging ACO model policies are included. Health 2.0 information technologies, EMRs, CPOEs, and social media collaboration are also covered, as are 5S, Six Sigma, and other logistical enhancing flow-through principles. The result is a must-have, “how-to” book for all industry participants.
Posted on August 4, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Health Insurance Business Harms Doctors, Patients and Hospitals –Inside Healthcare with Nate Kaufman–
Rich Helppie brings back healthcare expert and consultant, Nathan Kaufman, Managing Director of Kaufman Strategic Advisors.
Rich and Nate talk about the current policy issues surrounding healthcare, and why the United States’ approach to health insurance, care and finance are woefully inadequate in today’s landscape.
In 2020, at the request of the U.S. House Committee on Ways and Means (the Committee), the Medicare Payment Advisory Commission (MedPAC) began investigating the role that private equity (PE) plays in healthcare provided to Medicare beneficiaries.
In its June 2021 “Report to the Congress on Medicare and the Health Care Delivery System,” MedPAC included for the first time a chapter on PE’s effect on Medicare, wherein it discussed the findings and observations from its investigation and answered a number of questions posed by the Committee. This Health Capital Topics article will analyze MedPAC’s answers to those questions, review its investigation of PE’s role in healthcare, and summarize reactions from stakeholders.(Read more…)
On July 19, 2021, CMS released the proposed rule for the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Centers (ASCs) for calendar year (CY) 2022. The proposed rule builds on President Joe Biden’s July 9, 2021 executive order on “Promoting Competition in the American Economy,” as it relates to increasing access and price transparency in the healthcare industry.
In a press release regarding the proposed rule, CMS stated their commitment to addressing the persistent health inequities in the U.S. and finding opportunities to improve data collection that will lead to policy changes to help meet the health needs of patients. (Read more…)
Posted on July 30, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
15 Self-Funded Employers Analyzed Their Pharmacy Claims Data in Conjunction with the Commonwealth Fund and Discovered the Following Regarding their PBM FormularIES
Navigating a course where sound organizational management is intertwined with financial acumen requires a strategy designed by subject-matter experts. Fortunately, Financial Management Strategies for Hospital and Healthcare Organizations: Tools, Techniques, Checklists and Case Studiesprovides that blueprint. ―David B. Nash, MD, MBA,Jefferson Medical College, Thomas Jefferson University
It is fitting that Dr. David Edward Marcinko, MBA, CMP™ and his fellow experts have laid out a plan of action in Financial Management Strategies for Hospital and Healthcare Organizationsthat physicians, nurse-executives, administrators, institutional CEOs, CFOs, MBAs, lawyers, and healthcare accountants can follow to help move healthcare financial fitness forward in these uncharted waters. ―Neil H. Baum, MD, Tulane Medical School
The concept of a self-taught and student motivated, but automated outcomes driven classroom may seem like a nightmare scenario for those who are not comfortable with computers. Now everyone can breathe a sigh of relief, because the Institute of Medical Business Advisors just launched an “automated” final examination review protocol that requires no programming skill whatsoever.
In fact, everything is designed to be very simple and easy to use. Once a student’s examination “blue-book” is received, computerized “robotic reviewers” correct student assignments and quarterly test answers. This automated examination model lets the robots correct tests and exams, while the students concentrate on guided self-learning.
–Just Seeing the Cost of the Lab Test DECREASED the Number of Labs Ordered Per Patient by 9%.
–Doctors Also SUBSTITUTED a Lower Cost Lab Test for a Higher Cost Lab Test 10,000 Times.
The Doctors Were NOT Clinically Directed to Change Their Behavior.
The Doctors’ Pay Was NOT Affected by Their Lab Ordering Either Way.
This Study Illustrates How Giving Doctors Cost Information in a Setting of Clinical and Financial Independence AUTOMATICALLY Decreases Healthcare Waste.
Doctors Can Be Much Better Stewards of Healthcare Dollars … and the Technological Innovation Needed is Minimal.
Disclosure: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health.
Posted on July 21, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
TEXTBOOK RELEASE AND REVIEW
Reviews
Navigating a course where sound organizational management is intertwined with financial acumen requires a strategy designed by subject-matter experts. Fortunately, Financial Management Strategies for Hospital and Healthcare Organizations: Tools, Techniques, Checklists and Case Studiesprovides that blueprint. ―David B. Nash, MD, MBA,Jefferson Medical College, Thomas Jefferson University
It is fitting that Dr. David Edward Marcinko, MBA, CMP™ and his fellow experts have laid out a plan of action in Financial Management Strategies for Hospital and Healthcare Organizationsthat physicians, nurse-executives, administrators, institutional CEOs, CFOs, MBAs, lawyers, and healthcare accountants can follow to help move healthcare financial fitness forward in these uncharted waters. ―Neil H. Baum, MD, Tulane Medical School
Health Insurance Carriers Are Misaligned by Owning PBMs That Make More Money in Rebate Kick-Backs When the Employee Health Plan Spends More Money on Expensive Prescription Drugs.
Doctors Are Misaligned When They *Are Employed by Hospitals That Tie Test and Procedure Ordering Volume to Doctor Compensation.
Hospitals are Misaligned When They Buy Physician Practices and Raise the Prices for In-Office Testing and Procedures by 300%… Even Though NOTHING Has Changed Other Than the Sign on the Door.
Accordingly, True Employee Health Plan Innovation is ALIGNMENT Innovation That Provides Care Outside the of the Status Quo Fee-for-Service System.
Onsite Clinics, Near Site Clinics, Direct Primary Care and Capitated Virtual Care All Provide Real Alignment Innovation for Employee Health Plans.
Posted on July 18, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
THE SHERLOCK COMPANY
This podcast features a brief discussion by colleague Doug B. Sherlock CFA, Senior Health Care Analyst and President, Sherlock Company http://www.sherlockco.com featuring his insights into the quarterly financial reports of health plans, for the first quarter 2021.
Posted on July 16, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
HSA Update 2021
By Michael Thompson
High-deductible health plans have been popular, but it’s becoming clear they are not right for all employees, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.
Specifically, Forrester Research Says That Customer Service is ‘Poor’ at Blue Cross of Texas and Illinois, Blue Shield of California, CareFirst Blue Cross, Anthem, United Healthcare, Cigna and Aetna.
Hospital Billing Customer Services Is Bad Too.
Hospital Billing Complexity is So Troublesome to Patients, that 40% Say They Avoid Preventive Care and Screening Tests Just to Avoid the Billing Headache.
Healthcare Customer Service is Terrible Because Health Insurance Companies and Hospitals Do Not Need Good Billing Customer Service to Be Successful, As Demonstrated by High and Rising Health Insurance Stock Prices and Large and Growing Hospital System Revenue.
For Health Insurance Companies and Hospitals, Not Fixing Their Poor Customer Service May Be a Calculated Business Decision.
Implications:To Help Make Their Employees’ Lives Better, Employers May Need to 1) Hire a Healthcare Navigation Company or 2) Deliver More Care to Their Plan Members Outside of the Traditional Health Insurance and Hospital Systems… and Avoid the Terrible Customer Service All Together.
Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health and is the Former Co-Founder of Compass Professional Health Services.
Posted on July 12, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
MANAGEMENT STRATEGIES, OPERATIONAL TECHNIQUES, TOOLS, TEMPLATES AND CASE STUDIES
TEXTBOOKREVIEWS:
Hospitals and Health Care Organizationsis a must-read for any physician and other health care provider to understand the multiple, and increasingly complex, interlocking components of the U.S. health care delivery system, whether they are employed by a hospital system, or manage their own private practices.
The operational principles, methods, and examples in this book provide a framework applicable on both the large organizational and smaller private practice levels and will result in better patient care. Physicians today know they need to better understand business principles and this book by Dr. David E. Marcinko and Professor Hope Rachel Hetico provides an excellent framework and foundation to learn important principles all doctors need to know. ―Richard Berning, MD, Pediatric Cardiology
… Dr. David Edward Marcinko and Professor Hope Rachel Hetico bring their vast health care experience along with additional national experts to provide a health care model-based framework to allow health care professionals to utilize the checklists and templates to evaluate their own systems, recognize where the weak links in the system are, and, by applying the well-illustrated principles, improve the efficiency of the system without sacrificing quality patient care. … The health care delivery system is not an assembly line, but with persistence and time following the guidelines offered in this book, quality patient care can be delivered efficiently and affordably while maintaining the financial viability of institutions and practices. ―James Winston Phillips, MD, MBA, JD, LLM
Posted on July 10, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Dr. David Edward Marcinko is Speaking Up
Dr. David Edward Marcinko MBA CMP® enjoys personal coaching and public speaking and gives as many talks each year as possible, at a variety of medical society and financial services conferences around the country and world.
These have included lectures and visiting professorships at major academic centers, keynote lectures for hospitals, economic seminars and health systems, keynote lectures at city and statewide financial coalitions, and annual keynote lectures for a variety of internal yearly meetings.
His talks tend to be engaging, iconoclastic, and humorous. His most popular presentations include a diverse variety of topics and typically include those in all iMBA, Inc’s textbooks, handbooks, white-papers and most topics covered on this blog.
1) The 90s HMOs: Lower Premiums, Lower Out-of-Pocket Costs, Many Many Rules Restricting Care.
2) The 2000s PPOs: High and Even Higher Premiums, Lower Out-of-Pocket Costs, Fewer Rules Restricting Care.
3) The 2010s CDHPs: Lower Premiums, HIGH Out-of-Pocket Costs, Fewer Rules Restricting Care.
The Last 30 Years Have Taught Us that Employer-Sponsored Health Plans CANNOT Have All 3–Low Premiums, Low Out-of-Pocket Costs and Few Care Restrictions.
In the 2020s, Employers Are Moving More of Their Employee Healthcare OUTSIDE of the Traditional Healthcare and Health Insurance System with On-Site Clinics, Near-Site Clinics, Virtual Urgent Care, Virtual Primary Care and Bundled-Payment Centers-of-Excellence.
Posted on July 7, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Raises Mortality among Medicare PART D Beneficiaries
QUERY: What are the health consequences when patients reduce their use of prescribed medications in response to higher out-of-pocket costs?
In The Health Costs of Cost-Sharing (NBER Working Paper 28439), researchers Amitabh Chandra, Evan Flack and Ziad Obermeyer use the distinctive out-of-pocket cost-sharing features of Medicare Part D to demonstrate that such reductions can increase mortality.
1) Some Individual Doctors Were Paid Upwards of $5.8 Million Dollars by Medicare in Just a Single Year!
2) The Specialists That Charged Medicare the Most Tended to Be Vascular Surgeons, Ophthalmologists, Oncologists and Cardiologists.
Implications for Employer-Sponsored Health Plans:
1) Medicare Data Can Be Used to Identify High Volume Physicians and Surgeons.
2) The Highest-Costing Doctors Are Concentrated in a Relatively Small Number of Specialties That Can Be Targeted for Detailed Review, Feedback and Possible Exclusion/Steerage Away.
ASSESSMENT: Your thoughts and comments are appreciated.
Many accountable care organizations (ACOs) received disappointing news on May 21, 2021, when the Centers for Medicare & Medicare Services (CMS) announced that it would not be extending the Next Generation ACO (NGACO) model for 2022.
After five years and a dwindling number of participating ACOs, experts were split on whether or not CMS should keep the model in place for another year. On one hand, stakeholders have argued for the NGACO model’s extension until it can be replaced with or integrated into another program; howowever, others asserted that resources could not be properly invested with only one more year left in the program. (Read more…)