PODCAST: The Blue Cross / Shield Organization[s]

36 Blue Cross Health Insurance Companies Explained

Eric Bricker, MD (@DrEricB) | Twitter

BY ERIC BRICKER MD

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Blue Cross Blue Shield - Health for Life Grand Rapids

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PODCAST: https://www.ahealthcarez.com/blue-cross-explained

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Why are CERTIFIED MEDICAL PLANNER® Textbooks SO DARN Popular?

[By Dr. David Edward Marcinko MBA CMP®]

http://www.CertifiedMedicalPlanner.org

OK – I was a Certified Financial Planner® before my academic team launched the Certified Medical Planner™ online and on-ground chartered education and board certification designation program a few years ago. I am now CFP reformed and in remission.

MORE: Enter CPMs

Enter the Certified Medical PlannerChartered Designation

Today, we are of course, gratified that Certified Medical Planner™ mark notoriety is growing organically in the healthcare, as well as financial services, industry.

Even uber-blogger Mike Kitces MSFS, MTAX, CFP, CLU, ChFC, RHU, REBC, CASL has taken note of us in his musings on the Nerd’s Eye View website. And, the reality is that there are a growing number of CFP educational programs at the post-CFP niche market level.

But, none for healthcare industrial complex: for doctors … by doctors!

Popularity of our Text Books

However, it is our modern, innovative and proprietary Certified Medical Planner™ textbooks and dictionaries that have exploded in the academic marketplace.

In fact, they are now redacted in thousands of medical, graduate, law and B-schools and libraries, as well as colleges and universities throughout the nation. This includes the Library of Congress, National Institute of Health and  the Library of Congress.

What Gives?

We have been told that this textbook popularity and publishing success is because of their balanced and peer-reviewed nature; something not very widespread in the financial services industry that is prone to gross and overstated advertising, salesmanship and marketing hyperbole. And, for this we are very gratified.

But, is there another reason our books are so popular?

A bit of networking and research suggests that interested folks may be eschewing the actual course work in favor of just the high quality textbooks! UGH!

Another reason may be that our books and curricula are kept fresh and updated on our corporate website: http://www.MedicalBusinessAdvisors.com

Assessment

So, what do you think? Matriculation with the professional mark versus self study without the designation mark. Please opine.

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.

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

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

Product DetailsProduct Details

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

Product DetailsProduct Details

Adult Learners and Students:

Product DetailsProduct DetailsProduct Details

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PODCAST: Hospital Price Transparency Regulations

EXPLAINED IN TWO MINUTES

By Eric Bricker MD

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PODCAST: https://www.fshealth.com/hospital-price-transparency-regulations?utm_campaign=Weekly%20Pulse&utm_medium=email&_hsmi=2&_hsenc=p2ANqtz-_ZmuwSwhqaUng6ccvspXNYBrjn8VoHnicgZRLgUpvdYNdXo-YeeDF2nYCu67N5F8dGsrg3Fr5guW-c-rdwZqmR2_XGkg&utm_content=2&utm_source=hs_email&mc_cid=c535b3053b&mc_eid=0192794229

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MORE: https://medicalexecutivepost.com/2021/06/02/hospital-financial-price-transparency/

RELATED: https://medicalexecutivepost.com/2019/09/09/physician-perspectives-on-price-transparency/

MORE: https://medicalexecutivepost.com/2016/08/22/us-state-healthcare-price-transparency-laws/

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PODCAST: How to Sell in Healthcare

How to Read 4 Personality Types

BY ERIC BRICKER MD

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Product Details

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PODCAST: “Signify Health” Start-Up Risk Adjustments [Medicare Advantage Part C]

BY ERIC BRICKER MD

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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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FINANCIAL PLANNING: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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PODCAST: 70% Doctors Owned by Private Equity and Hospitals

THE BUSINESS OF MEDICINE

By Eric Bricker MD

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PODCAST: How Healthcare Policy Sausage is Made

‘America’s Bitter Pill’ by Steven Brill … Contemporary History of Healthcare in America

BY ERIC BRICKER MD

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PODCAST: The ACA “FAMILY GLITCH?

Health Insurance GLITCH-OR-NOT!

BY ERIC BRICKER MD

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

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PODCAST: APPEALS of Medicare Advantage [Part C] Plans

BY CMS

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PODCAST: Medicare Financial Matters

WHAT COUNTS AS INCOME SOURCES?

BY CMS

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

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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™ book cover

RISK MANAGEMENT: 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™

FINANCIAL PLANNING: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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PODCAST: Why AMAZON CARE Will Fail?

BY Eric Bricker MD

Employee AGE AND Demographics

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Healthcare Costs (Per Person Per Year) by Age:
Less than 18: $3,628
19 – 44: $4,422
45-64: $8,370
65+: $18,424

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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™ book cover

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

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ORDER: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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PODCAST: What is the COBRA Law?

By Bernie Portal

The Consolidated Omnibus Budget Reconciliation Act of 1985 is a law passed by the U.S. Congress on a reconciliation basis and signed by President Ronald Reagan that, among other things, mandates an insurance program which gives some employees the ability to continue health insurance coverage after leaving employment.

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

COBRA compliance can be difficult, especially if you’re handling it yourself. Now, it’s even more complicated thanks to recent stimulus bill changes that implemented a 100% free COBRA subsidy for eligible employees and employers.

In this episode, host Ryan McCostlin talks through the ins and outs of this important component of healthcare law that’s designed to help out employees during the pandemic.

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PODCAST: https://www.youtube.com/watch?v=aHLf2pXoZf0https://www.youtube.com/watch?v=aHLf2pXoZf0

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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™ book cover

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The CERTIFIED MEDICAL PLANNER® Program Curriculum

BY DR. DAVID E. MARCINKO MBA CMP®

CMP

THE NEXT GENERATION OF FIDUCIARY FOCUSED FINANCIAL PLANNING AND MEDICAL MANAGEMENT ADVICE FOR DOCTORS

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VISIT: http://www.CERTIFIEDMEDICALPLANNER.org

CURRICULUM: Enter the CMPs

BE AWARE ALL ADVISORS … NEXT GEN FINANCIAL ADVICE IS HERE?

CMP logo

Are you a financial planner, insurance agent or investment advisor seeking to assist your physician clients with medical practice enhancement solutions, along with healthcare targeted financial planning services, but don’t know where to turn for help?

OR, maybe you’ve already had a bad experience with a young physician or astute healthcare professional client that was actually more informed than you in these areas?

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

OR, a doctor/nurse client who demanded a true fiduciary advisor [not fee-based advice, with no dual licenses and no arbitration clauses] documented in writing].

Read this decade old Federal Government report to learn what can happen when your advisor is not an informed Certified Medical Planner© designated medical management practitioner.

Then, become a Certified Medical Planner© and thrive by helping others …. first!

GOV: https://oig.hhs.gov/fraud/docs/alertsandbulletins/consultants.pdf

True yesterday … more true today.

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

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CONTACT: Ann Miller RN MHA CMP®

Phone: 770-448-0769

EMAIL: MarcinkoAdvisors@msn.com

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PODCAST: Healthcare Stocks, Investing & IPOs?

By Eric Bricker MD

Healthcare Stock and IPO Investing Can Be Confusing. The Story of Privia Health is a Good Case Study in Understanding the Underlying Economics in Healthcare Investing:

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

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

ORDER: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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Benefits of Healthcare Participation in Multiple Medical Payment Models

BY HEALTH CAPITAL CONSULTANTS, LLC

New Research Explores Benefits of Participation in Multiple Payment Models


An August 2021 study published in the Journal of the American Medical Association (JAMA) analyzed medical and surgical episodes of care in U.S. hospitals to determine whether outcomes differed in hospitals that participated in Medicare’s Bundled Payments for Care Improvement (BPCI) Initiative depending on whether the patient being treated was attributed to a Medicare Shared Savings Program (MSSP) accountable care organization (ACO).

This Health Capital Topics article will discuss the study’s findings and potential policy implications. (Read more…)

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

ORE: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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PODCAST: Medicare Advantage [PART C] Cost Reduction Strategies

BY ERIC BRICKER MD

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ORDER: https://www.routledge.com/Financial-Management-Strategies-for-Hospitals-and-Healthcare-Organizations/Marcinko-Hertico/p/book/9781466558731

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

MORE: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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PODCASTS: The “Long Fix” for America’s Healthcare Crisis

By Vivian Lee MD PhD MBA

Politics and Prose

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ERIC BRICKER MD PODCAST: https://www.youtube.com/watch?v=fbXM44YSBfs

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Product Details

ORDER: https://www.springerpub.com/the-business-of-medical-practice-9780826105752.html

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PODCAST: MEDICARE: Traveling Abroad Healthcare Care

BY CMS

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International: https://medicalexecutivepost.com/2016/01/30/us-and-international-healthcare-comparison/

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PODCAST: Warren Buffett’s Thoughts on Healthcare

BY ERIC BRICKER MD

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

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In Response to a Question Regarding the Ending of Haven Healthcare–the Joint Venture Among Berkshire Hathaway, JP Morgan Chase and Amazon to Improve Healthcare for their Employee Health Plan Members–Warren Buffett Made the Following Statement:

“Healthcare is the Tapeworm of the US Economy and the TAPEWORM WON.”

Additionally, Warren Buffett Goes on to Say that ‘Prestigious‘ People in the Community Run Hospital Boards and These People Are ‘Fairly Happy‘ with the Healthcare System the Way It Currently Is.

It is Likely that Warren Buffett Formed Some of This Opinion in Speaking About Healthcare with the Vice Chairman of Berkshire Hathaway, Charlie Munger, and Berkshire Board Member and Famous CEO, Tom Murphy.

Charlie Munger Has Served on the Board of a Los Angeles Hospital for 31 Years and Tom Murphy Currently Serves on the NYU Langone Hospital System Board of Directors.

The Support of the Status Quo by ‘Prestigious,’ ‘Fairly Happy’ Hospital Board Members Cannot Be Understated… It Blocks Change and Warren Buffett Appears to Think Similarly.

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PODCAST: Why Kaiser Permanente Health Insurance Has Not Spread?

ACROSS TO MORE OF AMERICA

By Eric Bricker MD

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KAISER VACCINE MANDATE: https://www.msn.com/en-us/news/us/almost-5000-kaiser-permanente-health-care-employees-suspended-for-refusing-vaccine/ar-AAPaVF0?ocid=BingNewsSearch

KP: https://www.msn.com/en-us/news/politics/kaiser-permanente-puts-2000-workers-on-unpaid-leave-over-vaccine-mandate/ar-AAPcwNo?li=BBnb7Kz

Thank You

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PODCAST: “The Hospital” Book Review

By Brian Alexander

If You Like Michael Lewis Books, You’ll Love This

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ANNUAL FINANCIAL STATEMENT REPORTS: Health Insurance Companies

FOR PHYSICIAN INVESTORS

By David Belk MD

Health Insurance Company Financial Index

Below is a listing of the Nine largest for-profit health insurance Companies. The Annual financial statements are linked to the year for each Company and a four page summary report is linked to the name of the health insurance company at the top of the listing.

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

The relevant pages in each financial statement I used to prepare my summaries are listed next to each year’s statement. Aetna and Coventry’s summaries are combined because they merged in 2012. Health Net also Merged with Centene in 2016 leaving only seven major health insurance companies.

A composite summary for the data for all eight companies is here

Composite Data Table

Click on the name of the health insurance company to open the accordion and view the financial statements.

LINK: https://truecostofhealthcare.org/health-insurance-financial-index/

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PODCAST: More on Health Insurance from A Medical Technology CEO

A Professional and Personal look at Health Insurance, with Karl Albrecht
Rich talks with the president of Action Benefits, Karl Albrecht about the state of Health Insurance. 

Albrecht also gives a candid insight to his personal fight with pancreatic cancer and how being a Health Insurance executive as well as a patient, has given him a unique perspective on how things work, and how they could improve.
Image

BY RICHARD HELPPIE

PODCAST: https://richardhelppie.com/karl_albrecht/

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PODCAST: Health Insurance Carrier STOCK EARNINGS CALLS

BY ERIC BRICKER MD

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

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PODCAST: The Economics of Healthcare Will Never be the Same After Covid-19

POST PANDEMIC HEALTH ECONOMICS

BY LAURA GLENN

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As a leader in a community health system, Laura talks about how the COVID 19 pandemic has affected the economics of healthcare. Laura Glenn joined Munson Healthcare as the Vice President of the Physician Network in December, 2017.

In July, 2019 her role expanded and she was appointed the President of Ambulatory Services and Value Based Care. In this role, she remains responsible for integration of the employed and aligned physician practices across the system. In addition, she is responsible for advancing population health strategies including the Munson Clinical Integration Network and other value based payment models as well as providing leadership to the home health division, MHC’s clinical service lines and clinical business intelligence.

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

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PODCAST: Hospital Owned Health Plans

COST-CONTROL THRU MANAGED CARE

BY ERIC BRICKER MD

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PODCAST: On Medicare PAYMENTS to Doctors

TO SPECIFIC PHYSICIANS

BY ERIC BRICKER MD

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MORE: https://medicalexecutivepost.com/2014/04/13/how-much-your-doctor-received-from-medicare/

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

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PODCAST: Medicare and Nursing Home / Long Term Care

By CMS

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

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PODCAST: Healthcare, the Digital Eco-System and the Stock Market?

By Rajeev Ronanki

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Investment guru Jim Cramer says buy stocks along the digitization of everything”.

But – Even Healthcare?

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

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Tele-Health Financial Expansion

BY HEALTH CAPITAL CONSULTANTS, LLC

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Additional $20 Million Directed to Rural Telehealth Expansion

It has been well documented that the COVID-19 pandemic resulted in unprecedented increases in telemedicine utilization across the U.S. However, rural providers and patients, as evidenced by their lower rates of telemedicine usage during this time, have not been able to take advantage of the opportunities provided by telemedicine to the same extent as urban providers.

On August 18, 2021, the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (HHS) announced the latest attempt to ameliorate this issue – the distribution of nearly $20 million to 36 recipients for the purpose of strengthening telehealth services in rural and underserved communities and expanding innovation and quality. (Read more…)

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

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PODCAST: On Covid Pandemic Hospital Costs

FOR EMPLOYERSEMPLOYER SPONSORED HEALTH PLANS

BY ERIC BRICKER MD

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PODCAST: How Health Insurance Became America’s Biggest Hustle

BY ENTREPRENUER MD AND ROBERT PEARL MD

In this episode the Entrepreneur MD is joined by Dr Robert Pearl, MD, to talk about his latest book Uncaring and the need to stand up against the current healthcare model.

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

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Robert Pearl, MD: How Health Insurance Became America’s Biggest Hustle

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Physician Owned Hospitals Myths DeBunked

BY HEALTH CAPITAL CONSULTANTS, LLC

Literature Review Debunks Claims Against Physician-Owned Hospitals


Approximately 250 hospitals across the U.S. are completely or partially physician owned. These physician-owned hospitals (POHs) can offer a variety of services, from general care to specialty services, such as cardiovascular or orthopedic care, known as “focused factories.”

Over the past several decades, healthcare providers and policymakers have claimed that POHs have a negative impact on the healthcare industry, suggesting that: (1) POHs “cherry-pick” the most profitable patients; (2) the quality of care provided at POHs is substandard; and, (3) conflicts of interest exist due to the financial incentive for physician owners to refer patients to their POHs. (Read more…) 

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PODCAST: Why Insurance Carriers Want MEDICARE-FOR-ALL

WHY M-4-A?

BY ERIC BRICKER MD

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

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PODCAST: About Professor Uwe Reinhardt

HEALTHCARE ECONOMIST

By Eric Bricker MD

Uwe Reinhardt PhD was a Princeton Healthcare Economist Who Passed Away in 2017. He Was Possibly the Most Well Known Healthcare Economist in America and Even the World.

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

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RIP: https://medicalexecutivepost.com/2017/11/16/r-i-p-uwe-reinhardt-phd/

Obituary: https://theincidentaleconomist.com/WORDPRESS/UWE-REINHARDT-GIANT-MENSCH-KNIFE-TWISTER/

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PODCAST: Medicare Part D [Rx Drugs]

LATE ENROLLMENT PENALTY CALCULATIONS

Medicare – CMS

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

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PODCAST: Radiology and Healthcare Mis-Communication

BY ERIC BRICKER MD

$128 Billion of Radiology Imaging Studies Are Performed Each Year in America and Unfortunately They Exemplify Healthcare Miscommunication.

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PODCASTS: More Dialysis Center Investigative Reporting

DaVITA and FRESENIUS

By Eric Bricker MD

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Your comments are appreciated.

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

MORE

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PODCAST: APPEALS Traditional [Original] Medicare

BY CMS

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PODCAST: Understanding Your Medicare Choices

ORIGINAL MEDICARE, PART C, MEDIGAP AND YOU

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

BY MEDICARE – CMS

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PODCAST: The Four [4] Parts of Medicare

UNDERSTAND AND KNOW THE DIFFERENCE: A, B C & D

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

BY MEDICARE – CMS

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RISK MANAGEMENT & LIABILITY PROTECTION FOR PHYSICIANS

And … Their Insurance Agents and Financial Advisors

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

DEM avatar

By DR. DAVID EDWARD MARCINKO MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

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https://images.routledge.com/common/jackets/amazon/978149872/9781498725989.jpg

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BOOK REVIEW

It is not uncommon for practicing physicians to have more than a dozen separate insurance policies to protect their medical practice and personal assets. Yet, most doctors understand very little about their policies.BOOK REVIR

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™explains to physicians and insurance professionals the background, theory, and practicalities of medical risk management, asset protection methods, and insurance planning.

The book presents information in a manner that is convenient and highly useful for busy medical practitioners. It discusses the medical records revolution and addresses concerns regarding cloud computing, data security, and technological threats.

The book covers modern health law and policy, including fraud and abuse, workplace-violence, Medicare compliance, HIPAA regulations, AR protection strategies with internal controls, P4P and value based care, insurance and reputation management, and how the ARA legislation is impacting physician practices. It also includes case models and examples that provide you with a real-world understanding of how to recognize and reduce personal and medical practice risks.

With time at a premium for all, and so much information packed into one well-organized resource, this book is a must-read for every physician and financial advisor that serves the health care sector. The book will help physicians make better decisions about the risks they face and will help financial advisors improve the value they provide to their clients who are doctors.

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

THANK YOU

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PODCAST: “New York Times” Article on Hospital Price Transparency

Learn WHY Hospital Prices Are Kept SECRET

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BY ERIC BRICKER MD

The New York Times Posted an Article Explaining Hospital Prices for Patients on Private Insurance Plans Such as Blue Cross, United Healthcare, Cigna and Aetna.

Your comments are appreciated.

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

MORE: https://medicalexecutivepost.com/2021/06/02/hospital-financial-price-transparency/

PODCAST #2: https://medicalexecutivepost.com/2021/05/19/podcast-price-transparency-in-healthcare/

THANK YOU

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PODCAST: Population Health and Patient Economics

HIGH COST MEDICAL CLAIMANTS

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

By Eric Bricker MD

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ESSAY: https://medicalexecutivepost.com/2019/08/31/is-health-economics-heterodoxic-or-not/

ESSAY: https://www.modernhealthcare.com/education/ama-adopts-new-policy-training-physicians-healthcare-economics

MORE: https://medicalexecutivepost.com/2019/11/10/ricardian-derived-demand-economics-in-medicine/

MORE: https://medicalexecutivepost.com/2014/08/27/financial-and-health-economics-benchmarking/

MORE: https://healthcare

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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.

YOUR THOUGHTS ARE APPRECIATED.

Thank You

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PODCAST: On the Corporate Practice of Medicine Laws

IS PRIVATE EQUITY BUYING DOCTORS ILLEGAL?

By Eric Bricker MD

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PODCAST: United States Health Spending by Race & Ethnicity (2021)

CULTURE IN HEALTHCARE

Culture is a factor to consider with healthcare. Depending on the culture they may seek alternative treatment such as homeopathic and treatment they have been raised with in their country Some cultures will get medications from their country because they believe in their medical system more then what is offered.

BY IHME

Creating a culture of health - Sedgwick

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Dr. Joseph L. Dieleman, Associate Professor in the Department of Health Metric Sciences at the University of Washington, is the lead author of the study “US Health Care Spending by Race and Ethnicity, 2002-2016,” published August 17, 2021 in the Journal of the American Medical Association

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PODCAST: https://www.youtube.com/watch?v=xbkSZmB-3f8&t=171s

YOUR THOUGHTS ARE APPRECIATED.

Thank You

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PODCAST: How Medical Prior-Authorization Really Works

Pre-Certification Works OR Doesn’t Work

BY ERIC BRICKER MD

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Thank You

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