On Health Insurance Premiums and Deductibles RISING!

 

2020 Employer Health Benefits Survey – Summary of Findings

CMS Reimbursement Reductions

CMS Reimbursement Reductions 2021

By staff reporters

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 MORE:

Anesthesiology, -21 percent
Physician assistant, -21 percent
General surgery, -20 percent
Cardiology, -19 percent

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FMV of the Medical Practice?

FINANCIAL OPINIONS OF MEDICAL PRACTICE FAIR MARKET VALUE [FMV]
Courtesy: https://lnkd.in/eBf-4vY
Plastic Surgery-Medical Practice Worth, Valuation, Sales & Succession Planning

For doctor-colleagues, buying or selling a practice may be the biggest financial transaction of their lives. Reasons for appraising practice worth include: sales, merger, succession, retirement and estate planning; partnership disputes and divorce; or as an important tool for organic growth and strategic planning.

DHEF: https://lnkd.in/dqdbWM9
FOREWORD: https://lnkd.in/ecwZWxu

However, the transaction is fraught with many pitfalls to avoid and no medical specialty seems immune; especially when it comes to contentious fair market value [FMV] appraisals.

ESSAY: https://lnkd.in/eujJySP
MAXIMIZATION: https://lnkd.in/dG8UYaa
BLUNDERS: https://lnkd.in/etgDpqr
Your comments are appreciate.

BUSINESS, FINANCE, INVESTING & INSURANCE TEXTS:
1 – https://lnkd.in/ebWtzGg
2 – https://lnkd.in/ezkQMfR
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***

Doctors and Nurses FIRED During the US Pandemic

If They Speak Out About Lack of Gear

By Staff Reporters

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LINK:

https://www.bloomberg.com/news/articles/2020-03-31/hospitals-tell-doctors-they-ll-be-fired-if-they-talk-to-press

Your thoughts are appreciated

THANK YOU

On “SIGNIFY HEALTH”

The SEC Filing 

SIGNIFY HEALTH Goes Public

https://www.dallasnews.com/business/health-care/2021/02/11/signify-health-goes-public-with-7-billion-valuation-as-ceo-says-company-is-long-on-dallas/

By Signify Health

https://lnkd.in/ePKNEak

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Medicare Buy-In Policies for Older Adults on Health Insurance Coverage and Health Care Spending

RESEARCH REPORT

The Effects of Medicare Buy-In Policies for Older Adults on Health Insurance Coverage and Health Care Spending

  • Bowen Garrett
  • Jessica Banthin
  • Anuj Gangopadhyaya
  • Matthew Buettgens
  • Adele Shartzer
  • John Holahan
  • Diane Arnos

December2020 (corrected February 2021)

LINK:

https://www.urban.org/sites/default/files/publication/103348/the-effects-of-medicare-buy-in-policies-for-older-adults-on-health-insurance-coverage-and-health-care-spending.pdf#:~:text=The%20Effects%20of%20Medicare%20Buy-In%20Policies%20for%20Older,Medicare%20to%20purchase%20a%20Medicare-like%20health%20insurance%20plan.

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The Real Cost of Health Care “Cost Sharing”

NBER WORKING PAPER SERIES

THE HEALTH COSTS OF COST-SHARING

  • Amitabh Chandra
  • Evan Flack
  • Ziad Obermeyer

Working Paper: 28439

http://www.nber.org/papers/w28439

DHEF

DHEF: https://lnkd.in/dqdbWM9

NATIONAL BUREAU OF ECONOMIC RESEARCH

1050 Massachusetts Avenue

Cambridge, MA 02138

February 2021

BUSINESS & MANAGEMENT TEXTBOOKS OF INTEREST TO SAVVY PHYSICIANS

BUSINESS & MANAGEMENT TEXTBOOKS OF INTEREST TO SAVVY PHYSICIANS
Courtesy: https://lnkd.in/eBf-4vY

Health Economics, Finance, Accounting, Investing, HR and Insurance; etc.
BOOKS: https://lnkd.in/dys_xQz

 


INVITATION: https://lnkd.in/d2SefCY
SPEAKING TOPIC LIST: https://lnkd.in/e7WrDj9
MY “AVATAR”: https://lnkd.in/d6BU-TQ
Thank You
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Hedge Fund Titans

Top 15 Earning Managers for 2020

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EMR Data Insecurity?

What Else is New?

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EHR Vendor Pays $18M to Settle Kickback Allegations | MedPage Today

UNDERSTANDING MEDICAL PRACTICE CYBER SECURITY RISKS | The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants (medicalexecutivepost.com)

https://www.womblebonddickinson.com/us/insights/blogs/states-gear-limit-use-biometrics-and-biological-data

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Malpractice Insurance “Policy Limits”

WHAT ARE “LIMITS” OF MALPRACTICE INSURANCE LIABILITY?

Courtesy: https://lnkd.in/eBf-4vY

HEALTH ECONOMICS DICTIONARY:

https://lnkd.in/dqdbWM9

DEFINITION: What the insurance company will pay on a doctor’s behalf in the event of a claim. If your limits of liability are “$1,000,000 / $3,000,000” it would mean that the insurance company would pay a maximum of $1 million per occurrence and $3 million per year for claims.

For further clarification, refer to the examples below and assume limits of liability of 1,000,000 / $3,000,000:

· In one year you have 4 lawsuits each for $800,000:
The insurance company pays $3,000,000 and you are responsible for $200,000.
· In one year you have 2 lawsuits each for $2,000,000:
The insurance company pays $2,000,000 ($1 million each) and you are responsible for $2,000,000 ($1 million each).
· In one year you have 9 lawsuits each for $20,000:
The insurance company would pay everything.

However, most states have minimum requirements for limits of liability should you have hospital privileges. And so your thoughts are appreciated.

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:
1 – https://lnkd.in/ebWtzGg
2 – https://lnkd.in/ezkQMfR
3 – https://lnkd.in/ewJPTJs
Thank You
***

Hospitals and Price Transparency

DISCLOSURE OF CASH PRICE

SECTION 1.

(a) In this section, “hospital” means a hospital: (1) licensed under Chapter 241; or (2) owned or operated by this state or an agency of this state. (b) A hospital shall disclose the hospital’s cash price for each health care service regularly provided by the hospital. The required disclosure must be made: (1) by posting the prices on the Internet website of the hospital; or (2) if the hospital does not have an Internet website, by providing the prices in writing on request to any person.

SECTION 2. This Act takes effect September 1, 2021.

A New Corona Virus Variant?

A Rapid Rise in COVID-19 Cases?

By CDC.gov

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Medicare and the Growing Federal Budget

A Growing Share

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US Health Insurers’ Profits Amid the Pandemic

BOOM!

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An Op-Ed by a Healthcare Industry Thought Leader & Giant

New Years Resolutions 2021 [Repost]

By Nathan Kaufman • 1st Managing Director at Kaufman Strategic Advisors 

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1. I will continue to verify any statements I make about the healthcare system by talking to physicians and operators with REAL-WORLD EXPERIENCE and not rely solely on statistical comparisons.

2. I will promote that there is a correlation between cost, quality, and access in today’s healthcare system. Those who believe health systems should approach anything close to Medicare breakeven advocate for low quality and significant service reductions.3. I will continue to promote the fact that whoever affiliates with the best doctors will win in the long run.

4. I will encourage my clients to avoid the attempt by payers and many industry desk jockeys (e.g., Rand Corp.) to commoditize healthcare delivery. The best doctors, services, and ultimately the best outcomes are not commodities; they come at a price.

5. I will not stand by and watch the payers, government, and the aforementioned academic knuckleheads destroy the hospital industry using the ‘value con’– they already destroyed the rural hospital sector.

6. I will only consider a health system to be under quality leadership if market share grows and profits meet or exceed the industry benchmark. I won’t accept ‘mission’ as an excuse.

Happy New Year – Just Sayin’ n8

What is BIDEN CARE?

Bidencare: The President-Elect’s Healthcare Plan

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By Health Capital Consultants, LLC
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The Biden Administration has put forth their healthcare plan, which seeks to expand access to affordable healthcare with the following:
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(1) upholding and expanding the Patient Protection and Affordable Care Act (ACA), to reduce the amount that consumers pay for health insurance on the individual marketplace; (2) offering a new, public insurance option similar to Medicare; (3) prohibiting the practice of “surprise billing”; (4) leveraging the Department of Justice’s (DOJ’s) and Federal Trade Commission’s (FTC’s) antitrust authority to target market concentration within the healthcare system; and, (5) driving down prescription drug prices by increasing competition for, and regulation, of pharmaceutical companies.
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The Pandemic and Long Term Care Facilities

COVID-19 and Long Term Care Facilities

By http://www.MCOL.com

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Historic Physician Reimbursement Trends

Not Inflation Protected

By Federal Register

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Health Economics and Finance

THE BUSINESS OF MEDICAL PRACTICE AND HOSPITAL MANAGEMENT

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:
1 – https://lnkd.in/ebWtzGg
2 – https://lnkd.in/ezkQMfR
3 – https://lnkd.in/ewJPTJs

HOSPITAL MANAGEMENT & BUSINESS TEXTS FOR PHYSICIANS AND CXOs:

1 – https://lnkd.in/eEf-xEH 2 – https://lnkd.in/e2ZmewQ

“DICTIONARY OF TERMS FOR THE BUSINESS OF MEDICINE”
DHEF: https://lnkd.in/dqdbWM9
DHIMC: https://lnkd.in/e9AmEhd
DHITS: https://lnkd.in/eWx3WjZ
MORE: https://lnkd.in/eVGcji5

THANK YOU
******

Systemic Racism & Health Care, COVID & Treatment

COVID-19 [NIHCM]

By staff reporters

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https://nihcm.org/publications/systemic-racism-health-care-covid-treatment?utm_source=NIHCM+Foundation&utm_campaign=c7ef174251-EMAIL_CAMPAIGN_2020_12_02_02_53&utm_medium=email&utm_term=0_6f88de9846-c7ef174251-167744768

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Value Based Insurance Design?

VBID – Epic Fail

By Staff reporters***

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CMS Final Rule Brings Transparency to Healthcare Industry

Healthcare Transparency

By Health Capital Consultants, LLC

On October 29, 2020, the Centers for Medicare & Medicaid Services (CMS) released the Transparency in Coverage final rule. This long-anticipated final rule stems from President Donald Trump’s June 2019 executive order on “Improving Price and Quality Transparency” and builds upon the hospital Outpatient Prospective Payment System (OPPS) price transparency requirements released in November 2019.

 

These requirements came under fire in a lawsuit filed by the American Hospital Association (AHA), Association of American Medical Colleges (AAMC), Children’s Hospital Association (CHA), and Federation of American Hospitals (FAH), against the Department of Health and Human Services (HHS); the requirements were upheld by the courts in June 2020 and the lawsuit is being appealed by the plaintiffs. (Read more…) 

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Covid-19 Economic Impact in the USA

Estimated Impacts

By http://www.MCOL.com

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A Real [FREE-MARKET] Hospital Bill

CIRCA 1969 = Morristown Memorial Hospital, NJ, USA

By Anonymous

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“DICTIONARY OF TERMS FOR THE BUSINESS OF MEDICINE”
DHEF: https://lnkd.in/dqdbWM9
DHIMC: https://lnkd.in/e9AmEhd
DHITS: https://lnkd.in/eWx3WjZ
MORE: https://lnkd.in/eVGcji5

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I rotated thru this facility back when I was at Temple University

Dr. David Edward Marcinko MBA

ME-P Editor-in-Chief

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Corona Virus [Pictorial] Update?

An Info-Graphic?

By Staff Reporters

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A Veteran’s Suicide in Front of VA Clinic

Self Immolation

[By staff reporters]

A veteran committed suicide by setting himself on fire in front of a New Jersey VA clinic after staff at the clinic repeatedly failed to ensure he received adequate mental health care, an investigation of the death found.

Department of Veterans Affairs staff canceled an appointment Charles Ingram had in fall 2015 because a provider was unavailable, didn’t follow up to reschedule, and when he walked into the clinic to ask for an appointment, they didn’t schedule it until three months later, the VA inspector general found.

Ingram, a 51-year-old Gulf War veteran, had been approved to receive treatment at a non-VA facility, but no one at VA contacted him or scheduled the appointment.

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https://www.usatoday.com/story/news/politics/2017/11/15/vet-set-himself-fire-after-long-va-waits-appointment-cancellation-investigation-finds/866834001/#:~:text=WASHINGTON%20%E2%80%94%20A%20veteran%20committed%20suicide%20by%20setting,to%20ensure%20he%20received%20adequate%20mental%20health%20

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Continue reading

McCarran–Ferguson Act and Domestic Health Insurance

The McCarran–Ferguson Act

By Howard Green MD

***

The McCarran–Ferguson Act, 15 U.S.C. §§ 1011-1015, is a United States federal law that exempts the business of insurance from most federal regulation, including federal antitrust laws to a limited extent.
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The McCarran–Ferguson Act was passed by the 79th Congress in 1945 after the Supreme Court ruled in United States v. South-Eastern Underwriters Association that the federal government could regulate insurance companies under the authority of the Commerce Clause in the U.S. Constitution and that the federal antitrust laws applied to the insurance industry.
-United States Federal Law
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Health Insurance industry redistributing unlimited cash from patient premiums into the Georgia US Senate run off election to prevent a Democrat Senate Majority from removing the health insurance exemption to Federal antitrust, monopoly, price fixing and collusion McCarran Ferguson laws.

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Product DetailsProduct DetailsProduct Details

Free Market Health Care = NOT!

Free Market Health Care = NOT!

By Nate Kaufman

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“Trump-Care” Ads on Facebook and Google?

ProPublica

The thousands of “Trumpcare” ads Facebook and Google have published show that the shadowy “lead generation” economy has a happy home on the platforms — and even big names like UnitedHealthcare take part.

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State with Lowest Un-Insured Rates

The Top Five States with the Lowest Adult Un-Insurance Rates

CIRCA 2019

By http://www.MCOL.com

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Major Health Insurance Plans

Employer Rankings

[By staff reporters]

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“Medical Management and Health Economics Education for Financial Advisors”

CMP® CURRICULUM: https://lnkd.in/eDTRHex
CMP® WEB SITE: https://lnkd.in/guWSApq

Your thoughts and comments are appreciated.

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

***

Gap Between Private Insurance and Medicare Hospital Payments Increased in 2018

Click to access PAYMENT.pdf

 

 

“America First Healthcare Plan”

“America First Healthcare Plan”

By Robert Gergely MD

Yesterday, The President @POTUS outlined his plans for “America First Healthcare Plan”.

In 45 min. in front of Medical Professionals he brilliantly outlined a free market, competitive and PATIENTS centered philosophy for Medical Care in America. For those who care please view the video. you can find it here:https://lnkd.in/e9pxR-U

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THANK YOU

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Healthcare Fraud and Abuse Costs and Cases Rose in 2019

Click to access FRAUD.pdf

 

On Medicare Advantage Plans (Private Medicare)

PART C

By John Kelly

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Medicare Advantage Plans (Private Medicare) are sold on a county-by-county basis. Attached is the market penetration of MA (compared to traditional FFS Medicare) for every county in the USA.

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Wonder why Medicare Advantage Premiums are going down (on average)? Because premiums are one of the measures by which the elderly decide what to purchase. Even though premiums are declining, not all MA plans are ‘cheaper’ than traditional FFS Medicare. Caveat Emptor.

It is also interesting to note that 3 carriers – Humana, UHC and BCBS Affiliates — cover 60% of all MA plan subscribers and use national networks of providers to offer broad service availability (compared to smaller plans, PSP’s and other narrow network options).

Medicare premiums per beneficiary typically exceed $10,000 per year. With effective ingenious use of benefit design, prior authorization, incentives, PBM contract rebates, etc., — there is a lot of money to be made in Medicare Advantage plans — accounting for the rapid growth in these plans over the last decade.

Physician Practices Weathering the Storm of COVID-10?

Physician Practices Weathering the Storm of COVID-10?

By staff reporters

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Update on Medical “Prior Authorization”

Survey Highlights on Pre-Certification

By wedi

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Product Details

“DICTIONARY OF TERMS FOR THE BUSINESS OF MEDICINE”
DHEF: https://lnkd.in/dqdbWM9
DHIMC: https://lnkd.in/e9AmEhd
DHITS: https://lnkd.in/eWx3WjZ
MORE: https://lnkd.in/eVGcji5

***

 

 

Employee Health Cost Projections

Per Employee

By: http://www.MCOL.com

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The Economic Impact of Lung Diseases

Among US Workers

By: http://www.MCOL.com

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The COVOD-19 Vaccine Race?

Get Ready – Get Set – Go!

By staff reporters

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The Economic Impact of Lung Disease

Among U.S. Workers

By http://www.MCOL.com

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2021 Physician Fee Schedule

2021 Physician Fee Schedule & Quality Payment Program Proposed Rules Released

[By Health Capital Consultants]

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On August 3, 2020, the Centers for Medicare & Medicaid Services (CMS) released two proposed payment rules for calendar year (CY) 2021: the Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP). CMS included in the MPFS proposed rule adjustments to physician payment rates and an expansion of telemedicine services.

The proposed QPP rule, meanwhile, takes into account adjustments made for the COVID-19 public health emergency (PHE) and seeks to reduce unnecessary regulatory burden on providers by eliminating some requirements. These rules, which have garnered mixed reactions from stakeholders, are both open for comment until October 5, 2020. (Read more…)

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A-Symptomatic Novel Corona Virtus Cases

By staff reporters

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US Health Insurer’s Profits Boom!

Amid Corona Virus Pandemic

By staff reporters

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ON PATIENTS WITH TWO OR MORE CHRONIC DISEASES

Medicare FFS Spending = 93%

By staff reporters

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RACIAL DISPARIETIES AMONGT MEDICARE BENEFICIARIES

AT HIGH-PERFORMANCE HOSPITALS

By http://www.MCOL.com

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Take the “FACE MASK PLEDGE”

Pledge to Protect – One Another

By Dr. David E .Marcinko MBA

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Your thoughts and comments are appreciated.

BNG AND INSURANCE TEXTS FOR DOCTORS:USINESS, FINANCE, INVESTI

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

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How to Discuss Public Health?

Three Ways to Discuss

By staff reporters

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THANK YOU

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ANOSMIA, HYPERSOMIA, AGEUSIA, HYPOGEUSIA, DYSGEUSIA and the CORONA VIRUS?

WHAT IS “ANOSMIA”

By Darrell Pruitt DDS and David E. Marcinko MBBS, MBA

Anosmia, also known as smell blindness, is the loss of the ability to detect one or more smells. Anosmia may be temporary or permanent. It differs from Hyposmia which is a decreased sensitivity to some or all smells.

According to Wikipedia, Anosmia can be due to a number of factors, including an inflammation of the nasal mucosa, blockage of nasal passages or a destruction of one temporal lobe. Inflammation is due to chronic mucosa changes in the lining of the paranasal sinus and in the middle and superior turbinates. When anosmia is caused by inflammatory changes in the nasal passageways, it is treated simply by reducing inflammation. It can be caused by chronic meningitis and neurosyphilis that would increase intracranial pressure over a long period of time, and in some cases by ciliopathy, including ciliopathy due to primary ciliary dyskinesia. The term derives from the New Latin anosmia, based on Ancient Greek ἀν- (an-) + ὀσμή (osmḗ, “smell”; another related term, hyperosmia, refers to an increased ability to smell). Some people may be anosmic for one particular odor, a condition known as “specific anosmia”. The absence of the sense of smell from birth is known as congenital anosmia.

Ageusia is the loss of taste functions of the tongue, particularly the inability to detect sweetness, sourness, bitterness, saltiness, and umami. It is sometimes confused with anosmia – a loss of the sense of smell. Because the tongue can only indicate texture and differentiate between sweet, sour, bitter, salty, and umami, most of what is perceived as the sense of taste is actually derived from smell. True Ageusia is relatively rare compared to Hypogeusia – a partial loss of taste – and Dysgeusia – a distortion or alteration of taste.

ASSESSMENT:

If you should suddenly lose your sense of smell (anosmia), you might want to get tested for COVID-19 – even without the presence of other symptoms.

“A majority of COVID-19 patients experience some level of anosmia, most often temporary. Analyses of electronic health records indicate that COVID-19 patients are 27 times more likely to have smell loss but are only around 2.2 to 2.6 times more likely to have fever, cough or respiratory difficulty, compared to patients without COVID-19.”

See: “How COVID-19 Causes Loss of Smell – Olfactory support cells, not neurons, are vulnerable to novel coronavirus infection.” By Kevin Jiang for Harvard Medical School, July 24, 2020.

https://hms.harvard.edu/news/how-covid-19-causes-loss-smell

Your thoughts and comments are appreciated.

BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:

1 – https://lnkd.in/ebWtzGg

2 – https://lnkd.in/ezkQMfR

3 – https://lnkd.in/ewJPTJs

THANK YOU

***