BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
[Click on Image to Enlarge]
ME-P Free Advertising Consultation
The “Medical Executive-Post” is about connecting doctors, health care executives and modern consulting advisors. It’s about free-enterprise, business, practice, policy, personal financial planning and wealth building capitalism. We have an attitude that’s independent, outspoken, intelligent and so Next-Gen; often edgy, usually controversial. And, our consultants “got fly”, just like U. Read it! Write it! Post it! “Medical Executive-Post”. Call or email us for your FREE advertising and sales consultation TODAY [770.448.0769]
Medical & Surgical e-Consent Forms
ePodiatryConsentForms.com
iMBA Inc., OFFICES
Suite #5901 Wilbanks Drive, Norcross, Georgia, 30092 USA [1.770.448.0769]. Our location is real and we are now virtually enabled to assist new long distance clients and out-of-town colleagues.
ME-P Publishing
SEEKING INDUSTRY INFO PARTNERS?
If you want the opportunity to work with leading health care industry insiders, innovators and watchers, the “ME-P” may be right for you? We are unbiased and operate at the nexus of theoretical and applied R&D. Collaborate with us and you’ll put your brand in front of a smart & tightly focused demographic; one at the forefront of our emerging healthcare free marketplace of informed and professional “movers and shakers.” Our Ad Rate Card is available upon request [770-448-0769].
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.
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
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.
The IRS destroyed data for an estimated 30 million filers in March 2021, according to the Treasury Inspector General for Tax Administration. The decision, prompted by a backlog of paper filings, has sparked anger in the tax community. “It just further damages the IRS’ reputation in the business community and in the public,” said Larry Harris, director of tax services at Parsec Financial.
More than $200 billion has been wiped off the cryptocurrency market today alone, as investors are sent into a panic. Ethereum, the world’s second largest digital currency plummeted by 20% in the space of 24 hours. Bitcoin, the original cryptocurrency started in 2009, dropped by 9%, but overall it is down 50% since its all time high in November. Chaos on the market has seen other currencies such as Shiba Inu and Dogecoin losing 30% and 25%, respectively. Meanwhile Terra Luna, which was among the top 10 most valuable cryptocurrencies had 98% of its value wiped out overnight, falling to below one dollar per coin.
Immediately after becoming the interim CEO of Starbucks (NASDAQ: SBUX), Howard Schultz suspended the company’s share-repurchase program. “This decision will allow us to invest more into our people and our stores — the only way to create long-term value for all stakeholders,” he said in a press release.
Snowflake, Meta, Microsoft and Uber — are all down from 20% to as much as 60% year to date. The technology stock sector, especially unprofitable firms and richly valued software names, have been hit the hardest as of late. The NASDAQ Composite slid more than 13% in April, dropping almost 30% from its all-time high.
President Biden, anticipating the milestone of one million American lives lost to Covid-19, said in a formal statement on Thursday that the United States must stay committed to fighting a virus that has “forever changed” the country.
Finally, Microsoft founder Bill Gatessaid on Tuesday that he tested positive for COVID-19 and is experiencing mild symptoms. In a series of tweets, the billionaire shared that he was “lucky to be vaccinated” and will be isolating until he’s healthy again.
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.
***
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.
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.
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.
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.
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
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
• 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.
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…)
As of 1998, May 8th was designated as National Student Nurses Day, to be celebrated annually. And as of 2003, National School Nurse Day is celebrated on the Wednesday within National Nurses Week (May 6-12) each year.
***
***
The nursing profession has been supported and promoted by the American Nurses Association (ANA) since 1896. Each of ANA’s state and territorial nurses associations promotes the nursing profession at the state and regional levels. Each conducts celebrations on these dates to recognize the contributions that nurses and nursing make to the community.
The ANA supports and encourages National Nurses Week recognition programs through the state and district nurses associations, other specialty nursing organizations, educational facilities, and independent health care companies and institutions.
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…)
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.
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.
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.
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…)
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®
***
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 . . . .
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.
• 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.
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.
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.
• 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.
Q: What is the plan for a future with COVID? A: A new 136-page report written by dozens of experts provides a comprehensive roadmap to the next normal both to address the pandemic and protect against future biosecurity threats. The group identified 12 key areas of focus, including long COVID, equity, and vaccines. The report also addressed concerns about how the end of the pandemic will disrupt the U.S. health care system when policies introduced during the public health emergency come to an end.
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!
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.
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 Studies provides 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 Organizations that 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
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
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%)
DEFINITION: Physical and psychological reliance on opioids, a substance found in certain prescription pain medications and illegal drugs like heroin.
Opioids are prescribed to treat pain. With prolonged use, pain-relieving effects may lessen and pain can become worse. In addition, the body can develop dependence. Opioid dependence causes withdrawal symptoms, which makes it difficult to stop taking them. Addiction occurs when dependence interferes with daily life. Taking more than the prescribed amount or using illegal opioids like heroin may result in death.
Symptoms of addiction include uncontrollable cravings and inability to control opioid use even though it’s having negative effects on personal relationships or finances.
Treatment varies but may include discontinuing the drug. Medications such as methadone can help alleviate the symptoms of withdrawal and cravings. Pairing medication with inpatient or support programs generally has the most success.
A recent survey of nearly 1,000 patients with opioid use disorder (OUD) about recovery, telehealth, and stigma found in regards to recovery:
• 95% Describe their overall outlook on recovery as positive; just 1% describe as negative. • 76% Report having a strong support system to help navigate treatment. • 43% Returned to treatment immediately after relapse, 34% took over 3 months to start over. • 30% Blame individuals for the opioid crisis (over drug companies, doctors, and the government.)
*** 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!
WASHINGTON (Reuters) – The United States on Wednesday renewed the COVID-19 public health emergency, allowing millions of Americans to keep getting free tests, vaccines and treatments for at least three more months.
The public health emergency was initially declared in January 2020, when the coronavirus pandemic began. It has been renewed each quarter since and was due to expire on April 16.
The Department of Health and Human Services (HHS) in a statement said it was extending the public health emergency and that it will give states 60 days notice prior to termination or expiration.
This could be the last time HHS Secretary Xavier Becerra extends it, policy experts have said.
Today’s consumer price index [CPI] reading is expected to show that March prices surged 8.4% over last year.
Treasury yields rose and stocks dropped in anticipation of higher interest rates and a cooling economy. The tech-heavy NASDAQ lost more than $1 trillion in market value in just the past five trading sessions.
US average gas prices sank to their lowest level in more than a month, at $4.11 a gallon. The easing is likely a reaction to the White House’s big release of crude reserves and lock-downs in China reducing overall demand for fuel.
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.
Additional Disability Insurance for Practice Owners and Physician Executives
By Perry D’Alessio CPA
Some medical clinics, hospitals, health care employers and other business entities may offer disability insurance to their employees on a group basis as part of an employee benefit program. This is a good thing.
The expense for this coverage is typically deducted as an ordinary and necessary expense by the employer entity.
Additional DI
However, many entities also purchase additional disability insurance for the owners and executives; etc. This additional disability insurance expense should not be deducted on the entity’s tax return for two reasons.
First, it would probably be considered a discriminatory benefit to the owners and, therefore, not be allowed as a deduction anyway.
Second, and more importantly, when a person becomes disabled and qualifies for disability benefits whose premiums have been deducted as a business expense by the entity, the disability insurance proceeds are considered taxable income to the person receiving them.
A Catastrophe
This can be personally catastrophic since disability insurance covers only a portion (approximately 60 percent) of regular earnings. The coverage was designed to be paid on an after tax basis. The benefits would be tax free to the beneficiary and would be close to the disabled person’s net take home pay before being disabled.
***
***
Assessment
Here is one of those instances where the traditional tax planning thought process is overridden by a long term (potential) tax cost / benefit decision.
Channel Surfing the ME-P
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. It is fast, free and secure.
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.
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
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
The Dallas Morning News Reported that Healthcare Costs Per Capita in the Dallas-Fort Worth Metro Area are Higher than New York City, Houston, Miami, Chicago, Atlanta and Washington, D.C.
MANAGEMENT STRATEGIES, TOOLS TEMPLATES AND CASE STUDIES
***
Reviews:
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
National Public Health Week is observed during the first week of April every year. That’s seven days to champion the health of all Americans. It’s a week to recognize that everyone should lead healthier lives, irrespective of where they live, work, or come from. Since its founding in 1955, the initiative has become an important movement to highlight issues that can improve the health and happiness of a nation. You could choose to crush a workout or any workout challenge today. It’s a great week to start eating healthy and stick to it. Whatever you do, remember to involve your friends, family, and the larger community. It’s also a week when we campaign for health policies that are fair, inclusive, and accessible to all communities in the United States.
The first National Public Health Week took place in April 1955 and was organized by the American Public Health Association (A.P.H.A.). Since then, the initiative has received tremendous support from civil societies and administrations across the United States. The day recognizes the long history and achievements in public health. It also serves to highlight critical issues to help people lead healthier and happier lives.
In attempting to reach these goals, National Public Health Week seeks to address the root causes of poor health, disease, and lifestyles. It starts with recognizing that healthcare is still a privilege many cannot afford. Where people are born, their neighborhoods, places of work, different lives, and backgrounds determine the quality of healthcare access.
For example, a child who goes to school hungry will not be an engaged student. People working for minimum wages sacrifice health for the sake of an income. It’s thousands of families who have no access to nutritious food in their communities. Or those without the means to travel to access quality healthcare, often located far away.
National Public Health Week is committed to making health inclusive and equitable. It hopes to foster decision-making that considers the health of all communities — irrespective of income, race, or gender. Each year, the first full week in April celebrates the power of the community in realizing this vision. The A.P.H.A. usually announces different themes for each day of the week. From fitness challenges and discussions to sharing healthy recipes — it’s seven days of committing to health as a country.
So, no matter where you are, APHA invites you to join us as we celebrate National Public Health Week! This year’s theme, Public Health Is Where You Are, celebrates what we know is true: The places where we are, physically, mentally and societally, affect our health and our lives.
Celebrate and promote health in your community by hosting your own NPHW event!
***
… Here are a few ideas:
Host virtual health panels and discussions. …
Team up to reach new audiences and build community. …
Public health is now part of the political conversation but everyone doesn’t understand it in the same way. Hence the idea of interviewing Governor John Kasich, former governor of Ohio, who has been promoting a greater attention to public health, about what is public health for him.
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.
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
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
A survey was recently conducted by Centivo of 805 US adults ages 18-64 with employer-sponsored private health insurance. The survey found that respondents were willing to accept the following conditions in exchange for significant cost savings:
• 50% would accept referrals for specialists as a requirement. • 47% would select a primary care physician (PCP) from a defined list. • 30% would give up their current PCP. • 28% would stop seeing a current specialist.
1) Traditional Medicare: Health Insurance for Seniors 65 and older. Medicare Part A is coverage for hospital services. Medicare Part B is coverage for doctor, physical therapist and other provider services and for outpatient services such as labs and imaging.
2) Medicare Advantage: Health Insurance for Seniors 65 and older administered through a private health insurance company. It is sometimes referred to as Medicare Part C. It can be chosen instead of Traditional Medicare and often includes Dental Insurance, Vision Insurance, Hearing Aid Insurance and Prescription Drug Coverage.
3) Medicare Part D Prescription Coverage: Additional insurance for people on Traditional Medicare to cover their prescription medications as well. Medicare Part D is administered by private insurance companies.
4) Medicare Supplement Plans: Insurance that can be purchased in addition to Traditional Medicare to cover the expenses that Traditional Medicare does not cover, such as hospitalization deductibles and Medicare Part B co-insurance.
5) Medicaid: The health insurance program administered by each state for it’s economically disadvantaged residents. It is funded in part by the Federal Government and in part by each state. It is administered by private health insurance companies.
6) Affordable Care Act (ACA) Exchange Plans: Health insurance for people under 65 who make too much money to qualify for Medicaid, but do not received health insurance through their employer. ACA Exchange Plans are subsidized by the Federal Government and administered by private insurance companies.
Written by doctors and healthcare professionals, this textbook should be mandatory reading for all medical school students—highly recommended for both young and veteran physicians—and an eliminating factor for any financial advisor who has not read it. The book uses jargon like ‘innovative,’ ‘transformational,’ and ‘disruptive’—all rightly so! It is the type of definitive financial lifestyle planning book we often seek, but seldom find. —LeRoy Howard MA CMPTM,Candidate and Financial Advisor, Fayetteville, North Carolina I taught diagnostic radiology for over a decade. The physician-focused niche information, balanced perspectives, and insider industry transparency in this book may help save your financial life. —Dr. William P. Scherer MS, Barry University, Ft. Lauderdale, Florida This book was crafted in response to the frustration felt by doctors who dealt with top financial, brokerage, and accounting firms. These non-fiduciary behemoths often prescribed costly wholesale solutions that were applicable to all, but customized for few, despite ever-changing needs. It is a must-read to learn why brokerage sales pitches or Internet resources will never replace the knowledge and deep advice of a physician-focused financial advisor, medical consultant, or collegial Certified Medical Planner™ financial professional. —Parin Khotari MBA,Whitman School of Management, Syracuse University, New York In today’s healthcare environment, in order for providers to survive, they need to understand their current and future market trends, finances, operations, and impact of federal and state regulations. As a healthcare consulting professional for over 30 years supporting both the private and public sector, I recommend that providers understand and utilize the wealth of knowledge that is being conveyed in these chapters. Without this guidance providers will have a hard time navigating the supporting system which may impact their future revenue stream. I strongly endorse the contents of this book.—Carol S. Miller BSN MBA PMP,President, Miller Consulting Group, ACT IAC Executive Committee Vice-Chair at-Large, HIMSS NCA Board Member This is an excellent book on financial planning for physicians and health professionals. It is all inclusive yet very easy to read with much valuable information. And, I have been expanding my business knowledge with all of Dr. Marcinko’s prior books. I highly recommend this one, too. It is a fine educational tool for all doctors.—Dr. David B. Lumsden MD MS MA,Orthopedic Surgeon, Baltimore, Maryland There is no other comprehensive book like it to help doctors, nurses, and other medical providers accumulate and preserve the wealth that their years of education and hard work have earned them. —Dr. Jason Dyken MD MBA,Dyken Wealth Strategies, Gulf Shores, Alabama I plan to give a copy of this book written ‘by doctors and for doctors’ to all my prospects, physician, and nurse clients. It may be the definitive text on this important topic. —Alexander Naruska CPA,Orlando, Florida
Health professionals are small business owners who need to apply their self-discipline tactics in establishing and operating successful practices. Talented trainees are leaving the medical profession because they fail to balance the cost of attendance against a realistic business and financial plan. Principles like budgeting, saving, and living below one’s means, in order to make future investments for future growth, asset protection, and retirement possible are often lacking. This textbook guides the medical professional in his/her financial planning life journey from start to finish. It ranks a place in all medical school libraries and on each of our bookshelves. —Dr. Thomas M. DeLauro DPM,Professor and Chairman – Division of Medical Sciences, New York College of Podiatric Medicine
Physicians are notoriously excellent at diagnosing and treating medical conditions. However, they are also notoriously deficient in managing the business aspects of their medical practices. Most will earn $20-30 million in their medical lifetime, but few know how to create wealth for themselves and their families. This book will help fill the void in physicians’ financial education. I have two recommendations: 1) every physician, young and old, should read this book; and 2) read it a second time! —Dr. Neil Baum MD,Clinical Associate Professor of Urology, Tulane Medical School, New Orleans, Louisiana
I worked with a Certified Medical Planner™ on several occasions in the past, and will do so again in the future. This book codified the vast body of knowledge that helped in all facets of my financial life and professional medical practice. —Dr. James E. Williams DABPS, Foot and Ankle Surgeon, Conyers, Georgia
This is a constantly changing field for rules, regulations, taxes, insurance, compliance, and investments. This book assists readers, and their financial advisors, in keeping up with what’s going on in the healthcare field that all doctors need to know. —Patricia Raskob CFP® EA ATA, Raskob Kambourian Financial Advisors, Tucson, Arizona I particularly enjoyed reading the specific examples in this book which pointed out the perils of risk … something with which I am too familiar and have learned (the hard way) to avoid like the Black Death. It is a pleasure to come across this kind of wisdom, in print, that other colleagues may learn before it’s too late— many, many years down the road. —Dr. Robert S. Park MD, Robert Park and Associates Insurance, Seattle, Washington
Although this book targets physicians, I was pleased to see that it also addressed the financial planning and employment benefit needs of nurses; physical, respiratory, and occupational therapists; CRNAs, hospitalists, and other members of the health care team….highly readable, practical, and understandable. —Nurse Cecelia T. Perez RN, Hospital Operating Room Manager, Ellicott City, Maryland
Personal financial success in the PP-ACA era will be more difficult to achieve than ever before. It requires the next generation of doctors to rethink frugality, delay gratification, and redefine the very definition of success and work–life balance. And, they will surely need the subject matter medical specificity and new-wave professional guidance offered in this book. This book is a ‘must-read’ for all health care professionals, and their financial advisors, who wish to take an active role in creating a new subset of informed and pioneering professionals known as Certified Medical Planners™. —Dr. Mark D. Dollard FACFAS, Private Practice, Tyson Corner, Virginia As healthcare professionals, it is our Hippocratic duty to avoid preventable harm by paying attention. On the other hand, some of us are guilty of being reckless with our own financial health—delaying serious consideration of investments, taxation, retirement income, estate planning, and inheritances until the worry keeps one awake at night. So, if you have avoided planning for the future for far too long, perhaps it is time to take that first step toward preparedness. This in-depth textbook is an excellent starting point—not only because of its readability, but because of his team’s expertise and thoroughness in addressing the intricacies of modern investments—and from the point of view of not only gifted financial experts, but as healthcare providers, as well … a rare combination. —Dr. Darrell K. Pruitt DDS, Private Practice Dentist, Fort Worth, Texas This text should be on the bookshelf of all contemporary physicians. The book is physician-focused with unique topics applicable to all medical professionals. But, it also offers helpful insights into the new tax and estate laws, fiduciary accountability for advisors and insurance agents, with investing, asset protection and risk management, and retirement planning strategies with updates for the brave new world of global payments of the Patient Protection and Affordable Care Act. Starting out by encouraging readers to examine their personal ‘money blueprint’ beliefs and habits, the book is divided into four sections offering holistic life cycle financial information and economic education directed to new, mid-career, and mature physicians.
This structure permits one to dip into the book based on personal need to find relief, rather than to overwhelm. Given the complexity of modern domestic healthcare, and the daunting challenges faced by physicians who try to stay abreast of clinical medicine and the ever-evolving laws of personal finance, this textbook could not have come at a better time. —Dr. Philippa Kennealy MD MPH, The Entrepreneurial MD, Los Angeles, California Physicians have economic concerns unmatched by any other profession, arriving ten years late to the start of their earning years. This textbook goes to the core of how to level the playing field quickly, and efficaciously, by a new breed of dedicated Certified Medical Planners™. With physician-focused financial advice, each chapter is a building block to your financial fortress. —Thomas McKeon, MBA, Pharmaceutical Representative, Philadelphia, Pennsylvania An excellent resource … this textbook is written in a manner that provides physician practice owners with a comprehensive guide to financial planning and related topics for their professional practice in a way that is easily comprehended. The style in which it breaks down the intricacies of the current physician practice landscape makes it a ‘must-read’ for those physicians (and their advisors) practicing in the volatile era of healthcare reform. —Robert James Cimasi, MHA ASA FRICS MCBA CVA CM&AA CMP™, CEO-Health Capital Consultants, LLC, St. Louis, Missouri Rarely can one find a full compendium of information within a single source or text, but this book communicates the new financial realities we are forced to confront; it is full of opportunities for minimizing tax liability and maximizing income potential. We’re recommending it to all our medical practice management clients across the entire healthcare spectrum. —Alan Guinn, The Guinn Consultancy Group, Inc., Cookeville, Tennessee Dr. David Edward Marcinko MBA CMP™ and his team take a seemingly endless stream of disparate concepts and integrate them into a simple, straightforward, and understandable path to success. And, he codifies them all into a step-by-step algorithm to more efficient investing, risk management, taxation, and enhanced retirement planning for doctors and nurses. His text is a vital read—and must execute—book for all healthcare professionals and physician-focused financial advisors. —Dr. O. Kent Mercado, JD, Private Practitioner and Attorney, Naperville, Illinois
Kudos. The editors and contributing authors have compiled the most comprehensive reference book for the medical community that has ever been attempted. As you review the chapters of interest and hone in on the most important concerns you may have, realize that the best minds have been harvested for you to plan well… Live well. —Martha J. Schilling; AAMS® CRPC® ETSC CSA, Shilling Group Advisors, LLC, Philadelphia, Pennsylvania I recommend this book to any physician or medical professional that desires an honest no-sales approach to understanding the financial planning and investing world. It is worthwhile to any financial advisor interested in this space, as well. —David K. Luke, MIM MS-PFP CMP™, Net Worth Advisory Group, Sandy, Utah Although not a substitute for a formal business education, this book will help physicians navigate effectively through the hurdles of day-to-day financial decisions with the help of an accountant, financial and legal advisor. I highly recommend it and commend Dr. Marcinko and the Institute of Medical Business Advisors, Inc. on a job well done. —Ken Yeung MBA CMP™, Tseung Kwan O Hospital, Hong Kong I’ve seen many ghost-written handbooks, paperbacks, and vanity-published manuals on this topic throughout my career in mental healthcare. Most were poorly written, opinionated, and cheaply produced self-aggrandizing marketing drivel for those agents selling commission-based financial products and expensive advisory services. So, I was pleasantly surprised with this comprehensive peer-reviewed academic textbook, complete with citations, case examples, and real-life integrated strategies by and for medical professionals. Although a bit late for my career, I recommend it highly to all my younger colleagues … It’s credibility and specificity stand alone. —Dr. Clarice Montgomery PhD MA,Retired Clinical Psychologist In an industry known for one-size-fits-all templates and massively customized books, products, advice, and services, the extreme healthcare specificity of this text is both refreshing and comprehensive. —Dr. James Joseph Bartley, Columbus, Georgia
My brother was my office administrator and accountant. We both feel this is the most comprehensive textbook available on financial planning for healthcare providers. —Dr. Anthony Robert Naruska DC,Winter Park, Florida
Why Hospitals, Clinics and Medical Offices are Not Hotels, or Manufacturing Plants or Production Assembly Lines, etc.
By Dr. David E. Marcinko FACFAS, MBA, CMP™
[Editor-in-Chief]
The rising cost of health insurance remains a major concern for business; despite the Affordable Care Act [ACA] of March 2010. Local and national news publications have trumpeted that healthcare costs are not just rising but are growing in proportion to the cost of other goods and services.
Many of these publications have expressed the widely held view that because of the “inflation gap,” the cost of medical expenses needs curbing. Proponents of this viewpoint attribute the growth in the gross domestic product (GDP) devoted to personal medical services (from 5% in 1965 to approximately 14% in 2005 and 17% in 2012) to increases in both total national medical expenditures as well as prices for specific services, and then conclude that there is a need to rein in the growing costs of healthcare services for the average American, even if it be through a legislative mandate.
Healthcare Is the Economy
According to colleague Robert James Cimasi MHA, AVA, CMP™ of Health Capital Consultants LLC in St. Louis, MO, healthcare cannot be separated from the economy at large. Although economists have cited the aging population as the reason for the increase in healthcare’s share of the GDP, other voices assert that financial greed among HMOs, pharmaceutical companies, hospitals, and medical providers like doctors and nurses is responsible. In reality, the rise in healthcare expenditures is, at least in large part, the result of a much deeper economic force.
As economist William J. Baumol of New York University explained in a November 1993 New Republic article: “the relative increase in healthcare costs compared with the rest of the economy is inevitable and an ineradicable part of a developed economy. The attempt [to control relative costs] may be as foolhardy as it is impossible”.
Baumol’s observation is based on documented and significant differences in productivity growth between the healthcare sector of the economy and the economy as a whole.
Low Productivity Growth
Healthcare services have experienced significantly lower productivity growth rates than other industry sectors for three reasons, according to Cimasi:
1) Healthcare services are inherently resistant to automation. Innovation in the form of technological advancement has not made the same impact on healthcare productivity as it has in other industry sectors of the economy. The manufacturing process can be carried out on an assembly line where thousands of identical (or very similar) items can be produced under the supervision of a few humans utilizing robots and statistical sampling techniques (e.g., defects per 1,000 units). The robot increases assembly line productivity by accelerating the process and reducing labor input. In medicine, most technology is still applied in a patient-by-patient manner — a labor-intensive process. Patients are cared for one at a time. Hospitals and physician offices cannot (and, most would agree, should not) try to operate as factories because patients are each unique and disease is widely variable.
2) Healthcare is local. Unlike other labor-intensive industries (e.g., shoe making), healthcare services are essentially local in nature. They cannot regularly be delivered from Mexico, India or Malaysia. They must be provided locally by local labor. Healthcare organizations must compete within a local community with low or no unemployment among skilled workers for high quality and higher cost labor.
3) Healthcare quality is — or is believed to be — correlated with the amount of labor expended. For example, a 30-minute office visit with a physician is perceived to be of higher quality than a 10-minute office visit. In mass production, the number of work-hours per unit is not as important a predictor of product quality as the skills and talents of a small engineering team, which may quickly produce a single design element for thousands of products (e.g., a common car chassis).
Assessment
Healthcare suffers a number of serious consequences when its productivity grows at a slower rate than other industries, the most serious being higher relative costs for healthcare services. The situation is an inevitable and ineradicable part of a developed economy.
For example, as technological advancements increase productivity in the computer, and eHR, manufacturing industry, wages for computer industry labor likewise increase. However, the total cost per computer produced actually declines. But in healthcare (where technological advancements do not currently have the same impact on productivity), wage increases that would be consistent with other sectors of the economy yield a problem: the cost per unit of healthcare produced increases.
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.
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
OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
Support our online development, and advance our onground research initiatives in free market economics, as we seek to showcase the brightest Next-Gen minds.
THE ME-P DISCLAIMER: Posts, comments and opinions do not necessarily represent iMBA, Inc., but become our property after submission. Copyright © 2006 to-date. iMBA, Inc allows colleges, universities, medical and financial professionals and related clinics, hospitals and non-profit healthcare organizations to distribute our proprietary essays, photos, videos, audios and other documents; etc. However, please review copyright and usage information for each individual asset before submission to us, and/or placement on your publication or web site. Attestation references, citations and/or back-links are required. All other assets are property of the individual copyright holder.
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 