Understanding the Impact of Regulations, Laws, and Healthcare Reform

Posted on June 17, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Consequences of the Accountable Care Act [PP-ACA]

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

There is a fair amount of activity that will take place in the next 24 months in response to ICD-10 transition, healthcare reform, Accountable Care Act (ACA), meaningful use compliance and its financial incentives, and other regulatory issues that will require system or software upgrades to support the new efforts.

Some ACA Examples

As an example, The Affordable Care Act is sure to significantly alter reimbursement structures and delivery of care.

Below are several areas that will be affected:

With the projected increase in patient volumes, the associated cost of about 62% will emanate from Medicare cuts: $162 Billion through reducing fee-for-service Medicare payments; $136 Billion from setting Medicare Advantage rates based on Fee-for-Service payments; and $36 Billion from cutting hospital Medicare/Medicaid disproportionate share.
Compliance reviews will be increased through the Recovery Audit Contractors (RACs) where Centers for Medicare and Medicaid Services (CMS) expect to obtain $2.9 Billion in additional savings. With the RAC in place, hospitals and providers need to increase their focus and attention in improving documentation quality and validating medical necessity to substantiate their reviews.
Reduced payments for readmissions and Medicare penalties for poor outcomes can and will affect the bottom line for both hospitals and providers in the future.
By 2015, more than 19 million uninsured will receive coverage and in 2016, another 11 Million uninsured will be insured. This will create more patients per hospital/provider and will require more full-time equivalents to support the revenue cycle process of registration, documentation, billing and collection.
With the ICD-10 conversion will create a more complex requirement for documenting diagnoses and will require software modifications for hospitals and providers as well as significant training.

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[Our Forthcoming Book]

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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:

PRACTICES: www.BusinessofMedicalPractice.com
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CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Book Reviews, Health Insurance, Health Law & Policy | 2 Comments »

Doubting the Accountable Care Organization B-Model

Posted on May 24, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

New Healthcare Business Model or Edsel Model?

By David Edward Marcinko MBA http://www.CertifiedMedicalPlanner.org

[Publisher-in-Chief]

Defined by Professor Michael Porter at Harvard Business School, value is defined as a function of outcomes and costs. Therefore to achieve high value we must deliver the best possible outcomes in the most efficient way, outcomes which matter from the perspective of the individual receiving healthcare and not provider process measures or targets.

Sir Muir Gray expanded on the idea of technical value (outcomes/costs) to specifically describe ‘personal value’ and ‘allocative value’, encouraging us to focus also on shared decision making, individual preferences for care and ensuring that resources are allocated for maximum value.

Healthcare Value and ACOs

According to our Medical Executive-Post Health Dictionary Series of administrative terms http://www.HealthDictionarySeries.org and health economist and colleague Robert James Cimasi MHA, ASA, AVA CMP™ of www.HealthCapital.com; an ACO is a healthcare organization in which a set of providers, usually large physician groups and hospitals, are held accountable for the cost and quality of care delivered to a specific local population.

ACOs aim to affect provider’s patient expenditures and outcomes by integrating clinical and administrative departments to coordinate care and share financial risk.

ACO Launch

Since their four-page introduction in the PP-ACA of 2010, ACOs have been implemented in both the Federal and commercial healthcare markets, with 32 Pioneer ACOs selected (on December 19, 2011), 116 Federal applications accepted (on April 10, 2012 and July 9, 2012), and at least 160 or more Commercial ACOs in existence today.

Federal Contracts

Federal ACO contracts are established between an ACO and CMS, and are regulated under the CMS Medicare Shared Savings Program (MSSP) Final Rule, published November 2, 2011. ACOs participating in the MSSP are accountable for the health outcomes, represented by 33 quality metrics, and Medicare beneficiary expenditures of a prospectively assigned population of Medicare beneficiaries.

If a Federal ACO achieves Medicare beneficiary expenditures below a CMS established benchmark (and meets quality targets), they are eligible to receive a portion of the achieved Medicare beneficiary expenditure savings, in the form of a shared savings payment.

Commercial Contracts

Commercial ACO contracts are not limited by any specific legislation, only by the contract between the ACO and a commercial payor.

In addition to shared savings models, Commercial ACOs may incentivize lower costs and improved patient outcomes through reimbursement models that share risk between the payor and the providers, i.e., pay for performance compensation arrangements and/or partial to full capitation.

Although commercial ACOs experience a greater degree of flexibility in their structure and reimbursement, the principals for success for both Federal ACOs and Commercial ACOs are similar.

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Dr. David E. Marcinko with 1960 Ford Edsel

[The Edsel was an automobile marque that was planned, developed, and manufactured by the Ford Motor Company during the 1958, 1959, and 1960 model years. With the Edsel, Ford had expected to make significant inroads into the market share of both General Motors and Chrysler and close the gap between itself and GM in the domestic American automotive market. But, contrary to Ford’s internal plans and projections, the Edsel never gained popularity with contemporary American car buyers and sold poorly. The Ford Motor Company lost millions of dollars on the Edsel’s development, manufacturing and marketing].

More:

Update

Junking the Merit-Based Incentive Payment System (MIPS) would undoubtedly let the proverbial air out of the MACRA balloon, dealing a significant blow to the value-based reimbursement shift; right?

Assessment

Although nearly any healthcare enterprise can integrate and become an ACO, larger enterprises, may be best suited for ACO status.

Larger organizations are more able to accommodate the significant capital requirements of ACO development, implementation, and operation (e.g., healthcare information technology), and sustain the sufficient number of beneficiaries to have a significant impact on quality and cost metrics.

Conclusion

But, will this new B-Model work? Isn’t leading doctors in a shared collaborative effort a bit like herding cats? And, what about patients, HIEs, outcomes management, data analytics and … Population Health via our colleague David B. Nash MD MBA of Thomas Jefferson University, often considered the “father” of Pop Health?

OR, what about the developing IRS scandal and full PP-ACA launch in 2014? Will it affect federal funding, full roll-out, or even repeal of the entire Act?

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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PHYSICIANS: www.MedicalBusinessAdvisors.com
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HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Research & Development | Tagged: ACA, Accountable Care Organization, CMS, David Nash, edsel, HealthCapital.com, HIE's, Medicaid, medicare, Medicare Shared Savings program, Population Health, robert james cimasi | 16 Comments »

Purchase ME-P Textbooks, Handbooks and Dictionaries to Thrive

Posted on May 23, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Our Library is Growing … thanks to you

By Ann Miller RN MHA

[ME-P Executive-Director]

We have been publishing the Medical Executive-Post for more than eight years now. And, with almost 3,000 formal posts, by the nation’s brightest experts, we have a treasure trove of information available to you.

So now, for the first time, all this information – and more – has been codified, updated, copy-righted and copy-protected in print form for your purchase and use. All have been edited by our Publisher – Dr. David Edward Marcinko and Professor Hope Rachel Hetico.

Just click on an image below to order.

Assessment

Purchase our white papers, too: https://medicalexecutivepost.com/white-papers/

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Book Reviews, Financial Planning, Health Economics, Health Insurance, Healthcare Finance, Information Technology, Practice Management, Professional Liability, Risk Management | Tagged: david marcinko, Financial Planning, Health Economics, Health Insurance, Healthcare Finance, HIT, Hope Heticl, medical executive post, medical risk management, Practice Management | 3 Comments »

Healthcare Promises [aka ACA]

Posted on May 15, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

On the Affordable Care Act

By Rick Kahler MS CFP® ChFC CCIM www.KahlerFinancial.com

“I’m not sure what’s wrong or what kind of surgery you need, but we have to operate right now.”

If you heard this from your doctor, you’d jump off the examination table and run for the door. Yet that’s essentially the approach the President and Congress used three years ago to pass a bill, optimistically called the Affordable Care Act, which was the largest transformation of the U.S. health care system in our lifetime.

The Debate

During the frenzied debate our elected leaders made many promises as to the amazing benefits this legislation would bestow on Americans. After listening to speeches from President Obama, Speaker of the House Nancy Pelosi, and President of the Senate Harry Reid, I recounted those promises in this blog on March 21, 2010.

The Promises

Let’s revisit those promises.

All Americans will now receive affordable, or free, quality health care.
No one will ever be denied coverage.
No one will ever go into bankruptcy because of the costs of health care.
There will be increased access to health care for 95% of Americans.
There will be no decline in the quality of health care.
Health care costs will go down.
Health insurance coverage will be affordable to the middle class.
There will be no decline in Medicare benefits.
Insurance premiums will decline for the middle class.
It will unleash unprecedented entrepreneurial opportunity for the economy.
The deficit will decline, saving taxpayers $1.3 trillion.
It will cut $500 billion of waste, fraud, and abuse out of Medicare.
No government funds will be used to fund abortion.

Are these promises coming true? Many of them are pending full implementation of the act in 2014. Others have fallen flat or encountered the law of unintended consequences.

Business Owner’s

I’ve heard recently from several owners of small businesses about their increased health insurance costs. In addition to premium increases of nearly 50% over the past two years, they are seeing increased administrative costs from what one person called the “insanity and complexity” of the new regulations.

Businesses with fewer than 50 employees aren’t required to provide health insurance. The incentive for owners of businesses close to that threshold is to keep employee numbers below 50, which means curtailing growth or even laying people off.

Those without employer-provided insurance are supposed to be able to shop for coverage in new health care exchanges, beginning this October. However, half the states have chosen to rely on the federal government instead of setting up their own exchanges.

This has brought criticism even from former supporters like Democratic Senator Max Baucus of Montana, who helped write the health care bill. He is concerned that the exchanges will not open on time and consumers won’t have the information they need to use them. He told the Huffington Post that Obamacare is headed for a “train wreck.”

ACA Cost Estimates

The proponents said the ACA would cost $938 billion over 10 years. In addition to the promised Medicare savings, this was to be covered by a total tax increase of $562 billion over 10 years. This included a Medicare tax of 3.8% on dividends, rents, interest, and investment income on individuals and small business earning over $250,000.

The Office of Management and Budget, however, places the cost at $1.8 trillion over 10 years, resulting in a shortfall of around $900 billion.

Assessment

Whether Obamacare becomes the wild success the proponents guaranteed is yet to be seen. However, what we’ve seen so far isn’t promising. We as consumers would be well advised to pay close attention and ask tough questions before we accept this drastic surgery.

More

Conclusion

Are these promises coming true? 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.

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Filed under: Health Insurance, Health Law & Policy | Tagged: ACA, Affordable Care Act., Harry Reid, Max Baucus, Obama care | 15 Comments »

The status of African American insurance coverage

Posted on April 8, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

A Struggling PP-ACA Sector

The Affordable Care Act has developed into one of the critical pivots on which the success of President Obama’s second term is expected to turn. Yet, one sector that’s already struggling is African Americans.

In 2012, 17.4 percent of non-Hispanic African Americans were uninsured. More critically, only 55.9 percent of African Americans are expected to continue to live in good health, while a more or less healthy life is expected in 69.4 percen of white Americans.

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Assessment

These and other alarming facts were revealed by the National Health Interview Survey of the Center for Disease Control and Prevention, and corroborated by data from the U.S. Census Bureau. Both these agencies were data sources for this infographic, which takes a closer look at the health insurance situation of African Americans.

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Health Economics, Health Insurance, Healthcare Finance, iMBA, Inc. | Tagged: African Americans, CDC, National Health Interview Survey, Obama care, PP-ACA, U.S. Census Bureau | 1 Comment »

A Visual on Health Entitlement Spending

Posted on April 4, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

A Story in Six Charts

By Nancy Chockley PhD www.NIHCM.org

Between the fiscal cliff, sequestration, a potential government shut down and the debt ceiling, Washington is experiencing a seemingly endless succession of budgetary crises.

Although health entitlement programs are often on the table in negotiations, there has been little agreement on the scope and direction of meaningful reform. The recent slowdown in health spending growth may strengthen the impulse on some fronts to delay action, but long-term projections leave little doubt that federal health spending will continue to be a major contributor to our fiscal woes.

Assessment

This chart story pulls together essential facts on how much the federal government is spending on mandatory health care programs, how that spending affects the budget, and the hard spending and revenue trade-offs necessary to improve our fiscal outlook.

chart story

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Health Economics, Health Insurance, Healthcare Finance | Tagged: Health Entitlement Spending, Nancy Chockley PhD, www.MIHCM.org | 2 Comments »

How to Handle Incurred But Not Reported Health Insurance Claims [Webinar]

Posted on April 2, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

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Event Information

[Live Audio Conference – Webinar]

Presenter: Dr. David Edward Marcinko; MBA CMP™

http://www.audioeducator.com/speakers/index/speaker/600

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Conference Date: Tue, Apr 02, 2013

Aired Time: 1 pm ET | 12 pm CT | 11 am MT | 10 am PT

Length: 60 Minutes

Product Description

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Here’s How to Augment Bottom-Line Revenues by Understanding IBNR Healthcare Claims

One of most relevant financial issues of the PP-ACA and contemporary healthcare and medical reimbursement is known as Incurred But Not Reported (IBNR) healthcare claims. IBNR claims are an indirect result of prospective payments systems, the insurance industry and commercial risk contracts, and to some extent fee-for-service medicine. IBNR claims represent a risk and an opportunity for managed care companies, healthcare organizations, clinics, physicians and related medical providers alike.

Join this enlightening event presented by expert speaker Dr. David Edward Marcinko MBA CMP™ who will provide you detailed insights on IBNR claims so that you do not face any compliance risk and optimize your organization’s bottom line.

Here is a brief sample of some details you may learn:

Historical Review
What Is an IBNR Claim?
IBNR Problems for Healthcare Organizations
IBNR Claims — Management Volume and Consequences
Inadequate Cash Flows
Reserve Shortfalls and Fiscal Instability
Inaccurate Pricing
Administrative Cost Increases
Regulatory Sanctions
Managed Care Organization Exacerbation of IBNR Claims
IBNR from a Net Present Value Perspective
Tax Strategies for IBNRs

IRS Rules and Regulations
IBNR Tax Qualifications for Managed Care Organizations
How Managed Care Organizations Intensify IBNRs
How Does IBNR Affect Net Present Value?

IBNR Challenges and Solutions

1. Tax and Court Penalties

IRC Section 4958
Excess Benefit Definition
Taxes under Section 4958

2. Tax Deductibility

Potential Solutions to the IBNR Challenge
IBNR Calculations and Methodology

Actuarial Data Analysis
Open Referral Analysis
Historic Cost Analysis

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Who should attend? All charge-master coordinators, coding personnel, billing and claims transaction personnel, internal auditing personnel; and financial and compliance personnel! And, all administrators, accountants, comptrollers, office managers, billing clerks and physician-executives, CFOs, CXOs and other interested parties.

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http://www.audioeducator.com/medical-coding-billing/ibnr_problems-040213.html

ORDER HERE FOR WEBINAR

Filed under: Accounting, Health Insurance, Practice Management, Videos | Tagged: capitation, commercial risk contracts, Dr. Marcinko, fee-for-service medicine, Health Insurance, healthcare claims, IBNR, Incurred But Not Reported, PPSs, prospective payments systems | 1 Comment »

Medicare Inpatient Profitability in US Hospitals

Posted on March 14, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

The Impending Need for Cost-Efficiency

[By Objective Health]

Medicare patients often account for the largest proportion of inpatient volume for an average US hospital. With the exception of outlier cases, Medicare inpatient services are adjusted for wage rates and reimbursed as a single predetermined payment across the country.

Over the next few years, Medicare is expected to substantially reduce growth in payment rates, thereby pressuring hospitals to become more cost-efficient.

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Assessment

This infographic highlights the need for hospitals to manage costs, showing that there is a wide variation in Medicare inpatient profit across US hospitals, which is primarily driven by differences in Medicare cost per case.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Filed under: Health Economics, Health Insurance | Tagged: Hospitals and Healthcare Organizations, medicare, Objective Health, Profitability of US Hospitals | 3 Comments »

Understanding the Pre-Reform Impact of Self-Pay Patients

Posted on March 12, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

On Us Hospitals

Source: Objective Health

Pre-reform, many hospitals experience significant uncompensated care costs from self-pay patients.

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This infographic illustrates the variation in self-pay uncompensated care costs across US hospitals and regions.

Assessment

Despite the uncompensated care risk, 1/6th of self-pay inpatients are scheduled admissions, though their procedures are much less elective than the procedures of the insured.

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Health Economics, Health Insurance, Healthcare Finance | Tagged: admissions, direct pay medicine, hospitals, Objective Health, self-pay patients, uncompensated care | Leave a comment »

Why are Medical Bills so High [video]

Posted on March 10, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

______________________________

TIME’s Best Cover Story … Ever?

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TIME magazine just dedicated its current issue to just one article: “Bitter Pill: Why Medical Bills Are Killing Us.”

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The article, written by Time contributor Steven Brill, is required reading for all healthcare providers, administrators, legislators, patients — basically, everyone; especially readers of this ME-P.

The article is too comprehensive to summarize in one blurb, but Mr. Brill did a good job of describing its origins to Jon Stewart on The Daily Show.

Throughout all of the discussions during the Obamacare debate, the focus was usually on who should pay the medical bills. Brill said, “We never asked the first question: Why are the bills so high?”

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Assessment

We wish we could say we thought of this, but it was Matt Yglesias who did.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

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Filed under: Health Economics, Health Insurance, Healthcare Finance, Videos | Tagged: Bitter Pill: Why Medical Bills Are Killing Us.”, healthcare costs, Jon Stewart, Matt Yglesias, The Daily Show., TIME magazine, Why are the medical bills so high | 3 Comments »

“The Doctor’s Dilemma”

Posted on March 2, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

On Hospital Monopolistic Powers

By Ann Miller RN MHA

As George Bernard Shaw, whose works include “The Doctor’s Dilemma” might have put it, that any lawmaker would grant hospitals monopolistic powers plus the freedom to price as they see fit is enough to make one despair of political humanity.

C.O.N.

And, here is a post on Certificates of Need, too.

http://www.ncsl.org/issues-research/health/con-certificate-of-need-state-laws.aspx

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc. | Tagged: Certificate of Need, CON, George Bernard Shaw, Hospital Monopolistic Powers, The Doctor’s Dilemma | Leave a comment »

Books for Savvy Doctors and their Financial Advisors and Management Consultants

Posted on February 17, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Learn and Prosper from the ME-P

By Ann Miller RN MHA

Assessment

Click on each image for more information.

Feel free to write a review and tell us what you think?

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Book Reviews, Career Development, Financial Planning, Glossary Terms, Health Economics, Health Insurance, Healthcare Finance, Insurance Matters, Practice Management, Risk Management, Touring with Marcinko | Tagged: Dr. David Marcinko, Financial Planning, Health Economics, Health Insurance, Healthcare Finance, Investing, malpractice, medical practice management, Risk Management | 1 Comment »

Dr. Benjamin Solomon Carson, Sr for President?

Posted on February 11, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

Forget …. Being like Mike – Instead … Be like Ben

By Dr. David Edward Marcinko MBA CMP™

A unique speech was delivered by neuro-surgeon Benjamin Carson MD on February 7, 2013 at the National Prayer Breakfast in President Barack Obama’s presence.

Who is Ben Carson MD?

Benjamin Solomon “Ben” Carson, Sr. (born September 18, 1951) is an American neurosurgeon and the Director of Pediatric Neurosurgery at Johns Hopkins Hospital. He was awarded the Presidential Medal of Freedom, the highest civilian award in the United States, by President George W. Bush, in 2008.

The Breakfast

During the breakfast, Carson suggested that political correctness is a “dangerous” threat to free speech and encouraged Americans to share their views without hesitation. Carson also included his ideas on the national debt, deficits, taxation and health care; he explains his personal position on each matter.

Here is a teaser quote:

I don’t like to bring up problems without coming up with solutions… What about our taxation system? It is so complex, there is no one who can possibly comply with every jot and tittle. That doesn’t make any sense.

What we need to do is come up with something that’s simple. The inherently fair principle is proportionality: you make 10 billion dollars, you put in a billion. You make 10 dollars, you put in one. Of course, you have to get rid of the loopholes.

Some people say, ‘That’s not fair! It’s doesn’t hurt the guy who made 10 billion dollars.’ Where does it say you have to hurt that guy? He just put a billion dollars into the pot!

My Connectinon to Ben Carson

Ok, I really don’t have any connection to Dr. Carson despite the seven degrees of separation philosophy. But, I did grow up in Baltimore Maryland and played stickball in the parking lot of the famed Johns Hopkins University Hospital. I was even seen in the ER for a minor injury as a kid.

But, I was not accepted into medical school there, and could not attend Johns Hopkins University up on North Charles Street for my undergraduate career, because of the expense.

The Video

Nevertheless, this video is worth watching. It is 26 minutes in length and it is interesting to watch the president grimace as he gives a complete opposite solution to every problem the country faces.

Link: http://www.youtube.com/watch?v=vyyHegP255g

Ben’s Proposals

I especially liked Ben’s thoughts on the following topics:

Replacing the IRS with tithing for all income levels. No need to hurt the successful among us with a graduated tax system.
Giving all Americans a Health Savings Account [HSA] at birth. This will not only give them some financial skin-in-the game, but makes them educated stewards of their healthcare needs, treatments and expenses. And, the savings portion would be transferrable to a next generation beneficiary for estate-like continuity.
Giving everyone a personal electronic health record [pEHR] at birth.
Reforming the welfare state so it does not become a way of life
Morality and the PC mania.

Assessment

Ben is one smart pediatric brain surgeon. I would consider voting for him in a heart-beat. But, as a surgeon, I am like him, a doer who wants to solve a problem.

Unfortunately, Washington politicians are often talkers who place self-interest above all. Problem solving often takes a back-seat to pleasing constituents.

Conclusion

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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:

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Practice Management: http://www.springerpub.com/product/9780826105752

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Health Economics, Health Insurance, Health Law & Policy, Information Technology, Op-Editorials, Videos | Tagged: Ben Carson MD | 5 Comments »

The Monetary Value of Human Life

Posted on January 8, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

How Much are We Worth?
By Matthew Pelletier
[Director of Public Relations]
Compliance and Safety LLC

###

Assessment

• Japan places the highest value on a human life, spending $11,728,000 to save a single life through improvements in public safety.
• South Korea spent the least, at a measly $878,000.00 per life saved.
• Health insurance companies value life at $50,000 per year of quality life, a depressingly low number compared to what government entities will pay. Keep your workforce healthy with proper Health & Wellness training.
• The families of suicide bombers receive just $25,000 per suicide.
• While the families that lossed a loved one on 9/11 received an average of $2.1 million per death, families of fallen soldiers receive a maximum of just $400,000. Rush Limbaugh did an interesting piece about this huge disparity back in 2002.

Conclusion

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Filed under: Ethics, Health Insurance, Insurance Matters | Tagged: Health Insurance, life insurance, Matthew Pelletier, Rush Limbaugh, Value of a Human Life | 2 Comments »

The Case for Domestic Healthcare Change—Why Bother?

Posted on November 20, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

A Crisis of Volume and Cost

By Jennifer Tomasik MS

“Fee-for-service” has been the dominant financial dynamic in the US healthcare system for decades, whereby providers are reimbursed for the quantity of visits, tests, or procedures that are performed, often without adequate regard for the cost of the interventions relative to patient outcomes.

Atul Speaks

This focus has arguably fueled incredible advances in medical devices, diagnostic tests, pharmaceuticals, and other innovations. Atul Gawande MD, surgeon and author, describes how far medicine has come since the days before penicillin—when convalescence in the shelter of a hospital was the best of only a few treatment options and, therefore, “when what was known you [as a doctor] could know. You could hold it all in your head, and you could do it all.”

The surge in the number of diagnoses and treatments that physicians have access to today is transforming their profession from a field of autonomous craftsmen wielding basic tools to what Gawande suggests should be race-car like “pit crews” that together can deliver on the scientific promise of 4,000 medical and surgical procedures and 6,000 drugs.

A Double-Edged Sword

This is a double-edged sword, as the autonomous mentality on which the field developed is now often at odds with the machine-like functioning expected of an effective and efficient “pit crew.” Together with the fee-for-service incentive structure, these realities have collided in a perfect storm propelling tremendous growth in healthcare spending characterized by fragmentation and high volume, a high cost per episode, and inconsistent quality.

Assessment

And so, we are now witnessing the costly “failure of success” from focusing so extremely on “sick care” while ignoring “well care” attempts to keep individuals and populations healthy from the start.

More info Link: http://www.routledge.com/books/details/9781466558731/

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Our Newest Textbook Release

Learn How to Profit and Thrive in the PP-ACA Era

BOOK FOREWORD / TESTIMONIAL

Filed under: Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance | Tagged: Atul Gawande, Domestic Healthcare Change, fee for service, Jennifer Tomasik | Leave a comment »

The Challenges of Pricing Health Insurance for the 2014 Exchanges

Posted on October 25, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Expert Voices Essay – NIHCM Foundation

By Ann Miller RN MHA

The PP-ACA has introduced sweeping market changes that bring new uncertainty to the task of developing premiums for products to be offered in the health insurance exchanges beginning in 2014. The added complexity greatly increases the chances that these premiums will be off the mark.

In this essay, Alice Rosenblatt explains how actuaries set premiums, shows how key provisions of the ACA will affect their pricing for the October 2013 open enrollment period and describes what’s at stake if they don’t get it right.

Conclusion

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Filed under: Experts Invited, Health Insurance, Information Technology | Tagged: ACA, Alice F. Rosenblatt, Health Insurance Exchanges, HIE's | 3 Comments »

How Hospital Billing Impacts the Patient Experience

Posted on October 11, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

It’s About … the Invoice

By Staff Reporters

Here, Connance visually shows how hospital billing process is directly correlated to the patient experience.

Assessment

Patients who encounter problems with their physician’s billing office are less likely to recommend that physician/clinician to others.

www.BusinessofMedicalPractice.com

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Our Newest Textbook Release

Learn How to Profit and Thrive in the PP-ACA Era

BOOK FOREWORD / TESTIMONIAL

Filed under: Health Insurance, Practice Management | Tagged: Connance, CPT codes, Hospital Billing, medical invoices, Patient Experience | 2 Comments »

Accounting for the Cost of US Health Care

Posted on September 28, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Center for U.S. Health System Reform

By McKinsey & Company [A Re-Print]

Link: http://healthreform.mckinsey.com/Home/Insights/Latest_thinking/Accounting_for_the_cost_of_US_health_care.aspx

Conclusion

Your thoughts and comments on this ME-P are appreciated. What are your thoughts on the pre-reform trends and the impact of the recession?

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.

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Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Our Newest Textbook Release

Learn How to Profit and Thrive in the PP-ACA Era

BOOK FOREWORD / TESTIMONIAL

Filed under: Accounting, Book Reviews, Health Economics, Health Insurance, Healthcare Finance | Tagged: Accounting for the Cost of US Health Care | 1 Comment »

The NBER Bulletin on Aging and Health

Posted on September 23, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

The National Bureau of Economic Research — 2012 No. 2

The 2012 No. 2 Bulletin includes the articles below:

1) Can Low-Cost Interventions Affect Retirement Saving Behavior?

by Gopi Shah Goda, Colleen Flaherty Manchester, and Aaron Sojourner – #17927
by James Choi, Emily Haisley, Jennifer Kurkoski, and Cade Massey – #17843

http://www.nber.org/aginghealth/2012no2/w17927.html

2) Labor Market Effects of the Massachusetts Health Insurance Reform

by Jonathan Kolstad and Amanda Kowalski

http://www.nber.org/aginghealth/2012no2/w17933.html

3) Can Germany’s Riester Pensions Fill the Pension Gap?

by Axel Boersch-Supan, Michela Coppola, and Anette Reil-Held

http://www.nber.org/aginghealth/2012no2/w18014.html

4) Retirement Before the Social Security Entitlement Age

by Kevin Milligan

http://www.nber.org/aginghealth/2012no2/w18051.html

5) Are Consumers Forward-Looking in Responding to Health Care Prices?

by Aviva Aron-Dine, Liran Einav, Amy Finklestein, and Mark Cullen

http://www.nber.org/aginghealth/2012no2/w17802.html

NBER Profile: Patricia Danzon

http://www.nber.org/aginghealth/2012no2/danzon.html

NBER Profile: Doug Staiger

http://www.nber.org/aginghealth/2012no2/staiger.html

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Retirement and Benefits | Tagged: Doug Staiger, Health Care Prices?, Massachusetts Health Insurance Reform, National Bureau of Economic Research, NBER, NBER Bulletin on Aging and Health, Patricia Danzon, Pension Gap?, Retirement Saving Behavior, Social Security Entitlement Age | Leave a comment »

About the RetireMark Planning System

Posted on August 8, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

From HealthView Services (HVS)

By Staff Reporters

According to their website, HealthView Services (HVS) is one of the only firms in the country that builds solutions for the financial services industry to address out-of-pocket health care costs that individuals will face during retirement.

Founding

HVS was founded in 2008 by a team of experienced executives who identified a serious deficiency in financial planning in relation to retirement planning. In order to fill this void, HVS founders employed a group of expert physicians, experienced actuaries, and healthcare industry programmers to develop the HVS RetireMark Planning System.

Financial Planning and Health-Risk Assessment Tools

At its core, RetireMark is a combination of financial planning and health-risk assessment tools that provide financial institutions, independent advisors, and healthcare related firms with web-based reports. These customized reports project personalized out-of-pocket healthcare costs, life expectancy, and the Income Floor—a sophisticated and revolutionary approach to income distribution for retirement protection.

Customization

HVS’s product offerings can be customized to meet each institution`s exclusive needs and be seamlessly integrated into existing marketing and branding platforms. In addition to the software, HVS provides clients with training programs, seminars, and customized presentations in order to expand sales and grow revenues.

Assessmernt

In collaboration with industry leaders such as the Retirement Income Industry Association (RIIA), HVS has developed innovative solutions to address the growing needs of investors in transition. HVS is also a regular contributor to the HealthWatch segment of Retirement Weekly, a www.MarketWatch.com publication. By partnering with such prominent organizations, the firm hopes to become a pioneer in this emerging field.

Conclusion

So, give em’ a click and tell us what you think www.hvsfinancial.com

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Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Financial Planning, Health Insurance, Research & Development, Retirement and Benefits | Tagged: About the RetireMark Planning System, health care costs., HealthView Services, HealthWatch, Retirement Income Industry Association | Leave a comment »

Succeed with the “Business of Medical Practice” Textbook

Posted on August 8, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

ADVERTISEMENT

[Transformational Health 2.0 Skills for Doctors]

By Ann Miller RN, MHA

www.BusinessofMedicalPractice.com

December 23rd, 2011 – The Institute of Medical Business Advisors [iMBA] Inc, in Atlanta, GA www.MedicalBusinessAdvisors.com and Springer Publishing Company of New York, just released the third edition of “The Business of Medical Practice” [Transformational Health 2.0 Skills for Doctors] edited by iMBA founder Dr. David Edward Marcinko MBA, CMP™ and President Hope Rachel Hetico RN, MHA, CPHQ, CMP™

Internal Contents

The 37 chapter, 750 page hard-cover textbook provides a comprehensive resource for those physicians, medical professionals, practice managers, nurse executives, health care administrators and graduate students seeking working knowledge on running a private facility or medical clinic.

Three Major Sections

The BoMP is comprised of three enterprise-wide sections: [1] Qualitative Office Operations, [2] Quantitative Aspects of Medical Practice and [3] Health Policies, Ethics and Leadership. Topics like ARRA, HITECH, ACA and the social networking aspects and ramifications of health 2.0 connectivity for all stakeholders are included for modernity.

Tools and Templates

Tools used throughout the book help readers reference and retain complex information. These tools include:

Sidebars. Key terms, key concepts, key sources, associations, and factoids all serve to enhance and reinforce the core takeaways from each chapter.
Tables. Tables are used to display and reference benchmark data, draw comparisons, and illustrate industry data trends.
Figures. Graphical depictions of concepts help you comprehend the material.
Charts. Charts allow easily referenced standard industry taxonomies alongside comparisons of related topics.

Assessment

For a further description of the Business of Medical Practice, with online “live’ community, please click: www.BusinessofMedicalPractice.com

To order directly: http://www.springerpub.com/product/9780826105752

Conclusion

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Filed under: Book Reviews, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc., Information Technology, Practice Management, Recommended Books | Tagged: Business of Medical Practice, david marcinko, hope hetico, www.BusinessofMedicalPractice.com, www.medicalbusinessadvisors.com | 21 Comments »

What Health Care Fraud Costs Us

Posted on August 2, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Scrutiny Needed from the Patient Citizenry – Too?

As health care takes the center stage at the forefront of contemporary politics it is under scrutiny from several angles.

The Fraud Rate

One aspect of the health care system that has been garnering growing levels of interest is the rate at which medical fraud occurs. As the developed world steeps itself further and further into the digital age, things like medical history and billing records become more easily susceptible to fraud since they’re accessible from virtually anywhere.

Expensive Care

And, the fact of the matter is that trying to stay healthy is an expensive business. Each year, 300 million Americans spend about $2 trillion on health care, but the amount of that money that is lost to fraud seems to have grown a great deal in recent years.

Types

The government continues to crack down and identify fraudsters in all their forms—and they do come in many forms. Perhaps the most common type of health care fraud concerns how medical care providers bill. This type of fraud relies heavily on the fact that many patients don’t take the proper amount of time to really scrutinize their medical bills and invoices.

Source: InsuranceQuotes.org

Assessment

Fraud can cost a huge amount of money for victim, insurance companies and society. The best defense against fraud remains understanding EOBs forms and what’s on your medical bills.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Ethics, Health Insurance, Health Law & Policy | Tagged: health abuse, health costs, health fraud | 6 Comments »

Update on Health Insurance Claims Processing Costs

Posted on July 22, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Paper versus Electronic

[By Matias Klein]

[Senior VP Technology Portico Systems Integrated Provider Management Solutions]

The average cost of processing a single, clean, paper-based or electronic claim can range from 85 cents to $1.58.

However, according to AHIP, nearly half of all claims (48 percent) were pended due to the submission of duplicate claims (35 percent), lack of complete information or other information needed to justify the claim (12 percent), or invalid codes (1 percent).

The manual adjudication of these duplicate or incorrect claim submissions increases the cost of administration to $2.05. The $2.05 scenario is a best case calculation. In our actual field experience the cost can be as high as $10.00 per claim.

Payment Delays

In addition to the increased administrative cost, one must not forget about the delayed payment to the provider. As stated by AHIP, a duplicate claim can take 9 days to remediate and missing information on a claim can take up to 11 days. This kind of delay damages the relationship between the provider and the health plan, which in terms of costs is priceless.

Enter ID Management

To solve this problem, some healthcare organizations are implementing Master Identity Management (IDM)—a valuable approach to creating an enterprise “source of truth” for provider identity information. But when it comes to payment integrity and claims processing, IDM without a Provider Information Management (PIM) system doesn’t work. Provider relationship and contract data are far too complex, and both types of data are needed to supplement provider identity data in support of claims administration.

Provider Information Management

When IDM is fully integrated with PIM, payers can successfully establish a single, accurate and effective source of truth. An integrated approach also:

Ensures quality – by standardizing, cleansing, cross-referencing and consolidating relevant data, while removing duplicate entries.
Mitigates risk – reducing the downstream impact of inaccurate data on all claims processing, contracting, credentialing, provider directory and connected systems.
Saves millions of dollars – by reducing duplicate entries by even a fraction of a percent, thus ensuring that claims are being processed in an efficient and effective manner.

Assessment

IDM plays a pivotal role in the future of healthcare. As new, collaborative and accountable care delivery models evolve, reliable provider identity management is absolutely critical. Combining IDM with PIM gives payers the most powerful solution for assuring payment integrity while improving provider identity and duplication management.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Our Newest Textbook Release

Learn How to Profit and Thrive in the PP-ACA Era

BOOK FOREWORD / TESTIMONIAL

Filed under: Health Insurance, Information Technology | Tagged: AHIP, ARs, electronic health care claims, Health Insurance Claims Processing Costs, Hospital Revenue Cycle Management, Integrated Provider Management, Master Identity Management, Matias Klein, medical accounts receivable, paper-based health insurance claims, Portico Systems, Provider Information Management | 5 Comments »

Sign-Up for the Healthcare Payment Reform Webinar

Posted on July 13, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

State & Private Sector Collaborations

By NIHCM Foundation

While uncertainty remains regarding the full implementation of the Affordable Care Act, there is intensifying pressure for a system-wide focus on controlling health care costs.

Improving Payment Models

The U.S. spent nearly 18 percent of GDP on health care in 2010, and many state governments and insurers are collaborating to reduce spending growth to a more sustainable level by improving provider payment models.

The WEBINAR

This webinar will explore current approaches to payment reform that offer insight for future federal and state policies, including:

the Health Care Payment Improvement Initiative underway in Arkansas,
the Alternative Quality Contract developed by Blue Cross Blue Shield of Massachusetts,
the recent Massachusetts cost containment legislation, and
the use of value-based purchasing for controlling costs.

Assessment

Visit our website to view an agenda. Please register by noon (EDT) on August 3rd.

This event is part of a new NIHCM webinar series, Transforming the Health Care Landscape.

LINK: http://nihcm.org/component/content/article/324-transforming-the-health-care-landscape/659-payment-reform-state-a-private-sector-collaborations

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Health Economics, Health Insurance, Videos | Tagged: ACA, Affordable Care Act., Alternative Quality Contract, GDP, health care costs., Health Care Payment Improvement Initiative, NIHCM Foundation, Sign-Up for the Healthcare Payment Reform Webinar, Transforming the Health Care Landscape. | Leave a comment »

About the Institute of Medical Business Advisors, Inc

Posted on July 8, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

iMBA, Inc

[www.MedicalBusinessAdvisors.com]

Championing the Financial Success of

Doctors and their Consulting Advisors

[Career Development Products and Services]

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Your Personal DR. Invitation: Letterhead.iMBA_Inc.

Filed under: "Advisors Only", "Doctors Only", Career Development, CMP Program, Financial Planning, Health Insurance, iMBA, Inc., Information Technology, Insurance Matters, Investing, Marketing & Advertising, Portfolio Management, Practice Management, Practice Worth, Professional Liability, Recommended Books, Retirement and Benefits, Risk Management | Tagged: Championing the Success of, CMP, doctors, Dr. Marcinko, financial advisors, institute of medical business advisors, podiatrists, www.CertifiedMedicalPlanner.org, www.medicalbusinessadvisors.com, www.PodiatryPrep.com | 2 Comments »

How Health Reform Could Expand Medicaid

Posted on July 4, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

PP-ACA Results State-by-State

By Lena Groeger
ProPublica

Experts estimate that nearly 16 million Americans could be added to the Medicaid rolls by 2019 under an expansion in the Affordable Care Act. But, the Supreme Court ruled last Thursday that states can opt out without risk of losing federal support for Medicaid, raising the stakes that some may do so.

The Big Picture

Here is a look at forecast growth in state Medicaid rolls under the expansion. Twenty-six challenged the act in court.

IMAGE LINK: http://www.propublica.org/special/state-by-state-how-health-reform-could-expand-medicaid

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Breaking News, Health Insurance, Health Law & Policy, iMBA | Tagged: How Health Reform Could Expand Medicaid, Lena Groeger, Medicaid, PP-ACA, ProPublica | 3 Comments »

The Supreme Court Permits Healthcare Taxation “Penalty”

Posted on July 2, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

On the PP-ACA

By Children’s Home Society of Florida Foundation

In 2010 Congress passed the Patient Protection and Affordable Care Act (PPACA). A key part of the Act is an individual mandate for health insurance. All individuals must have health insurance by 2014 or pay a tax-penalty.

The Tax Penalty

The tax-penalty starts at the greater of $285 per family or 1% of income in 2014. However, by 2016, the tax-penalty increases to $2,085 per family or 2.5% of income, whichever is larger.

Commerce Clause

Many states sued the federal government and asked that the individual mandate be held invalid. While the various courts had different positions on the issue, some federal judges were concerned that requiring a person to purchase insurance could be a violation of the Commerce Clause of the U.S. Constitution.

CJSC John Roberts

Chief Justice of the Supreme Court John Roberts wrote the opinion for a 5-4 majority in the PPACA case. First, he determined whether or not the Court was prohibited from ruling on the case under the Anti-Injunction Act. He decided that the required payment would be a “penalty” for purposes of that Act and not a tax. Therefore, the Supreme Court could issue a ruling.

Second, Chief Justice Roberts reviewed the powers of government under the Commerce Clause. He agreed with the other four justices opposing PPACA that Congress had the right to regulate commerce, but does not have the right to regulate non-activity. Therefore, requiring individuals to purchase health insurance is not a permitted power under that provision. PPACA could not be approved under the Commerce Clause.

However, Roberts observed that it is permissible for the Court to consider the validity of PPACA under the power of the government to tax. He determined that the individual mandate to purchase insurance or pay a penalty-tax is permitted under that power. Roberts stated, “Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.” He carefully approved the use of the power without discussing the appropriateness of PPACA provisions.

Roberts found several reasons for permitting the taxing power. The tax-penalty will be paid when filing IRS Form 1040. As is true with other tax provisions, lower-income individuals are excluded from this tax-penalty. The tax-penalty is part of the Internal Revenue Code and will be collected by the IRS.

Dissenters

The four dissenting Justices would have determined that PPACA fails to meet the requirements of the Commerce Clause and would have invalidated the entire bill.

Editor’s Note: The taxes to pay for PPACA include a new tax on medical devices that will increase costs to individuals and healthcare providers. There also is a new 3.8% Medicare tax. It applies in 2013 to income and capital gains. If the expected post-election tax bill extends the current 15% capital gain rate, then the capital gains tax rate will be 18.8% in 2013. However, if the 15% federal capital gains tax rate is increased to 20%, then the new rate in January of 2013 will be 23.8%. The increase in capital gains rate may influence charitable gifts of appreciated property in 2013.

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Breaking News, Health Insurance, Health Law & Policy, Taxation | Tagged: ACA, Children's Home Society of Florida Foundation, Commerce Clause, John Roberts, Obama care, Patient Protection and Affordable Care Act, PP-ACA, SCOTOS, Supreme Court Permits Healthcare Taxation | 2 Comments »

Taxes and the SCOTUS ACA Decision

Posted on July 1, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

My Synopsis for Physician Investors

By Dr. David Edward Marcinko FACFAS MBA CMP™

www.CertifiedMedicalPlanner.org

[Publisher-in-Chief]

I was at Emory University this past weekend for an unrelated colloquium. But all the chatter, of course, was about SCOTUS, taxes and the just announced ACA decision.

Most doctors I know – just don’t like paying needless taxes. So, what’s the buzz for physicians and other medical professional investors, and their financial advisors [FAs]?

The Synopsis

The taxes to pay for the Affordable Care Act include a new tax on medical devices that will increase costs to individuals and healthcare providers.

There also is a new 3.8% Medicare tax. It applies in 2013 to income and capital gains.

If the expected post-election tax bill extends the current 15% capital gain rate, then the capital gains tax rate will be 18.8% in 2013. However, if the 15% federal capital gains tax rate is increased to 20%, then the new rate in January of 2013 will be 23.8%.

In addition to dividend seeking investors, the increase in capital gains rate may also influence charitable gifts of appreciated property in 2013.

Assessment

Please weigh-in all you FAs and healthcare focused CPAs. What is a physician investor supposed to do, now?

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Health Insurance, Health Law & Policy, iMBA, Taxation, Touring with Marcinko | Tagged: ACA, CMP, Dr. David Edward Marcinko MBA, Health Insurance, SCOTUS, Taxes and the ACA SCOTUS Decision, www.certifiedmedicalplanner.com | 4 Comments »

Community Rating and Guaranteed Issue in the Individual Health Insurance Market

Posted on June 29, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Expert Voices

[By Staff Reporters]

In this essay Dr. Anthony Lo Sasso provides empirical evidence of the adverse selection that resulted when states adopted community rating and guaranteed issue requirements in their individual health insurance markets but did not implement complementary mechanisms to keep lower risk individuals in the insurance risk pools.

Results of Adverse Selection

Such adverse selection can raise premiums, destabilize markets and even lead to market failure through the following cycle of events:

Community rating prohibits differential premiums based on health status, effectively lowering premiums for individuals in poorer health and increasing them for healthier individuals.
Guaranteed issue allows people to purchase coverage when they get sick, decreasing the need to maintain insurance coverage.
Healthy individuals respond by dropping coverage and entering the market only when they need coverage, thus the pool of enrollees becomes increasingly older and sicker.
This adverse selection pushes premiums for all remaining enrollees higher, provoking further departures by those at the healthier end of the spectrum.
Premiums increase again to reflect the ever-worsening risk pool of enrollees.
The cycles continue, further destabilizing the market and potentially leading to complete market collapse.

Assessment

Dr. Lo Sasso’s findings highlight the importance of providing effective mechanisms to protect the integrity of the risk pool in conjunction with the community rating and guaranteed issue provisions contained in the SCOTUS upheld Patient Protection and Affordable Care Act.

Link: EV-LoSassoFINAL

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Health Insurance | Tagged: ACA, Advertise with Us?, Anthony Lo Sasso, Community Rating and Guaranteed Issue in the Individual Health Insurance Market, Health Insurance, Individual Health Insurance, NIHCM Foundation, Patient Protection and Affordable Care Act | 3 Comments »

ACA – UPHELD

Posted on June 28, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

The Patient Protection and Affordable Care Act

S.C.O.T.U.S.

UPHELD

Read the Entire Court Ruling

Filed under: Breaking News, Health Insurance, Health Law & Policy | Tagged: ACA, healthcare law, Patient Protection and Affordable Care Act, PP-ACA, SCOTUS | 23 Comments »

How Americans Embrace Medicare Reform

Posted on June 26, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

The 2012 Elections … and Medigap

[By Staff Reporters]

Americans are spending more on Medicare than is coming in.

In fact, Rand Paul states, “It’s your grandparents’ fault for having too many kids and then your fault for not having enough kids. It’s a demographic problem.”

Source: www.mostmedicare.com

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Health Insurance, Healthcare Finance | Tagged: healthcare reform, How Americans Embrace Medicare Reform, medicare, medigap | 9 Comments »

Cash May Soon be King in Hospital Care

Posted on June 12, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Forget About Health Insurance, Darling!

Only the little people pay with insurance.

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

www.CertifiedMedicalPlanner.org

Like many other doctors, I remember my dismay when I saw uninsured patients paying full price for their medical care. Insurance companies used their market clout and patient volumes to negotiate discounts for their insureds that have always been unavailable to the uninsured, MSA, HSA participants or individual healthcare consumers.

The Insider Gossip

There is even industry hearsay that some charity-care and non-profit hospitals charge their indigent patients up to four times more than their insured patients in order to have huge write-offs [bad-debt expenses] so as to secure private and public monetary grants. After all; many non-profit CEOs are well paid, indeed.

But, the tide may be turning on the healthcare institutional level as cash becomes king in the new economy and world of healthcare 2.0

Cash Patients Rule – Insured Patients Drool

Of course, we’ve written about direct care, concierge care and cash care medical practice business models before on this ME-P. And, I’ve been ranting and raving, opining and testifying, as well. It is being written about in the blog-o-sphere, on the hospital level, increasingly.

Link: http://www.kevinmd.com/blog/2012/06/hide-health-insurance-status-pay-cash.html

We even have an entire Chapter 29 devoted to the codified topic in our newest book The Business of Medical Practice.

Link: http://businessofmedicalpractice.com/chapter-29/

Source: Austin Frakt PhD’s TIE cartoon via Brad Flansbaum.

The Coming Payment Apocalypse

The days of paying more when paying cash may be coming to an end. Doctors and hospitals are starting to do what every other business has done since the beginning of time – give a discount for cash. States are beginning to require pricing transparency and hospitals and physicians are starting to publish their “cash prices” for all to see.

And, why not when it can take up to two years to be reimbursed a fraction of the billed amount from Medicaid and Medicare payers, and CMS, etc? Now, don’t get me started on some highly discounted private payers and managed care plans.

Assessment

What do you think of this trend as a healthcare provider; Financial Advisor, medical management consultant or patient? Are you in favor of this private business arrangement; or do you favor the proposed public Obama Care business model? Is it even legal? How about keeping the status-quo?

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Health Economics, Health Insurance, Op-Editorials, Touring with Marcinko | Tagged: cash care, concierge medicine, david marcinko, direct care, discount medicine, Dr. Marcinko, wholesale medicine | 11 Comments »

What If Broccoli Were Like Buying Health Insurance?

Posted on June 4, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Some Food for Thought

Source: Jen Sorensen via Austin Frakt PhD of the Incidental Economist.

Assessment

Many a true word hath been spoke in jest. [c 1665 in Roxburghe Ballads (1890) VII. 366].

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Pre-Order Now!

http://www.crcpress.com/product/isbn/9781439879900

Filed under: Health Insurance, Jokes and Puns | Tagged: Austin Frakt PhD, If Broccoli Were Like Buying Health Insurance, incidental economist, Jen Sorensen, SlowPoke | 1 Comment »

Emergency Room Doctor Pet Peeves [A Humorous Video]

Posted on May 27, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

An Insider’s Look Around

[By Staff Reporters]

Are you tired of those long Emergency Room wait times and the overcrowding once inside? The ERs are usually jammed on weekends, and holidays, right?

***

Assessment

Well – This video is an example of the many issues an emergency department will unlikely be able to help you with this Memorial day weekend. But, those medical personnel, and ME-P readers, who work in the EMS or ER setting can hopefully relate to this encounter. A word to the …wise!

Video Link: http://www.youtube.com/watch?v=1KYmcwVGo9w&feature=related

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Hospitals & Healthcare Organizations: Management Strategies, Operational Techniques, Tools, Templates and Case Studies

Filed under: Career Development, Health Insurance, Practice Management, Videos | Tagged: ED, emergency room, Emergency Room Doctor Pet Peeves, EMS, ER | 5 Comments »

Understanding Health Insurance Plan Coverage [A Video]

Posted on May 22, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Knowing Managed Care Terminology, too!

In this YouTube encore video presentation, Ricki Hasou from the MD Anderson Cancer Center talks about knowing your health insurance plan coverage and knowing the terminology behind managed care.

Link: http://www.youtube.com/watch?v=bDSm6vyHVVE&feature=related

Assessment

It is very important to understand how your health plan works when you sign up, before you begin making plans for cancer or any other type of medical treatment, and especially if you are leaving your designated healthcare service area.

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Glossary Terms, Health Insurance, Videos | Tagged: Dictionary Health Insurance Managed Care, glossary managed care, health insurance glossary, health insurance terms, HMO, managd care terminology, MD Anderson, PPO, Ricki Hasou, Understanding your Health Insurance Plan Coverage | 1 Comment »

Anatomy of Health Insurance

Posted on May 17, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

An Overview

Health insurance is a hotly debated topic in this year’s presidential elections. Obama-care has some doctors and citizens fuming over the possibility of universal healthcare. But, before preaching, one should get a full grasp of what health insurance entails for a typical buyer.

This infographic gives an overview of how the health insurance industry works. One thing for sure, the health insurance industry is a booming business, as the typical 22-year old will pay $400,000 for health care and insurance in his or her lifetime.

Assessment

So study up with our handbooks, textbooks, dictionaries and this ME-P so you can responsibly select an insurance plan that is right for you.

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Health Insurance, Health Law & Policy | Tagged: ACA, Anatomy of Health Insurance, Health Insurance, personal health insurance plans, PP-ACA | 2 Comments »

On the Genetic Information Non-Discrimination Act

Posted on May 10, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

A Review of GINA – 2008

[By Carol Miller RN MBA]

This Act prohibits the use of genetic information to make health insurance coverage determinations and in employment-related decisions.

GINA supports a patient’s privacy. Forty states have enacted legislation related to genetic discrimination in health insurance and thirty-one states have adopted laws regarding genetic discrimination in the workplace according to the National Human Genome Research Institute.

Assessment

For more info: www.genome.gov

***

UPDATE 2020

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Glossary Terms, Health Insurance, Health Law & Policy, Research & Development | Tagged: Carol Miller RN, Genetic Information Non-Discrimination Act, genomic medicine, GINA, National Human Genome Research Institute, personalized medicine, www.genome.gov | 4 Comments »

Evaluating ACOs at Mid-Launch

Posted on May 9, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Moving Forward but Challenges Ahead

[By ME-P Staff]

Accountable Care Organizations [ACOs] are generating considerable attention for their potential to improve the value of our health care spending through better coordination of care and new payment incentives that focus on quality and efficiency of care.

The Challenges

Yet, even as ACOs develop at a fairly rapid clip across the nation, they face substantial challenges.

For example, In this essay, Steven Lieberman reviews the ACO landscape in both the public and private sectors and examines the major obstacles confronting these emerging organizations, including limited tools for influencing patient choice, the need for immediate and sustained cost savings, and system-wide concerns about rising costs due to enhanced market power.

Assessment

Link: http://nihcm.org/images/stories/EV_Lieberman_FINAL.pdf

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Filed under: Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc., Practice Management | Tagged: Accountable Care Organizations, ACOs, NIHCM Foundation, Steven Lieberman PhD | 19 Comments »

May Patients Privately Contract with their Doctors?

Posted on May 3, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Ask-An-Advisor

QUESTION: A question to ME-P readers and subscribers.

Medicare may disallow private contracting by federal law. But, can private insurances, whether PPO or managed care, legally prevent a patient from privately contracting with their doctor for services or goods above the contracted rates, as long as informed consent and appropriate waivers are executed in advance of the service?

IOWs: Do private managed care insurance companies have the legal right to limit a person’s liberty to seek care above the constraints of the health insurers contract, if the patient so desires? I understand that an insurer by contract with provider and patient is obligated to pay only a negotiated fee for a specific service or good, but if the patient desires a more accommodating service or extra features to a durable good, do they have the right to privately contract for such services beyond the contract payment or benefit restraints. I believe that this goes into state law safeguards for patient welfare in as much as most non-federal or non-ERISA health insurances are guided by state law.

Assessment

This is not a naïve question for I have posed it to various plan medical directors in our area and have had surprisingly varied responses.

I welcome your crowd-sourced comments with thanks in advance.

Dr. Mark D. Dollard

Loudoun Foot and Ankle Center

46440 Benedict Drive

Suite #111 – Sterling, VA 20164

703 444-9555 [ph] 703 444-1190 [fax]

mdollard@erols.com

Conclusion

Your thoughts and comments on this ME-P are appreciated; especially from our healthlaw attorney readers, plan subscribers, consultants and medical directors. 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.

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Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: "Ask-an-Advisor", Health Insurance, Health Law & Policy, Practice Management | Tagged: ABN, ERISA, Mark Dollard, May Patients Privately Contract with their Doctors?, medicare | 1 Comment »

The Best, Most Revealing Reporting on Our Healthcare System

Posted on April 12, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Reading and Reviewing

By Blair Hickman and Cora Currier

ProPublica, March 30, 2012, 1:44 pm

As we wait for the Supreme Court to issue its verdict on the health-care reform law we rounded up some of the most revealing reporting on the issues.

They’re grouped roughly into articles on high costs and those on insurance.

Assesment

Link: http://www.propublica.org/article/top-muckreads-the-best-most-revealing-reporting-on-our-healthcare-system

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Hospitals & Healthcare Organizations: Management Strategies, Operational Techniques, Tools, Templates and Case Studies

Filed under: Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance | Tagged: ACA, Blair Hickman, Cora Currier, Health Economics, Health Insurance, health law and policy, health reform, healthcare costs, Most Revealing Reporting on Our Healthcare System, Obama care, PP-ACA, ProPublica, The Best | 1 Comment »

On the Control of Birth Control

Posted on April 7, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

The cost of FDA-approved contraceptive drugs

When President Obama signed the Patient Protection and Affordable Care Act in 2012, the bill included a requirement that companies cover the cost of FDA-approved contraceptive drugs and services with no charge to employees.

The provision became controversial among religious conservatives, forcing Obama to shift responsibility for contraceptive costs to insurance providers when employers object on moral grounds.

Assessment

This infographic created with GOOD looks to answer the question: what is the state of birth-control coverage in America, and where do people stand on the issue?

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Breaking News, Health Economics, Health Insurance | Leave a comment »

NBER Bulletin on Aging and Health

Posted on April 5, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Year 2012 – Number One [Selected ME-P Reading Suggestions]

View a printable PDF copy of the 2012 No. 1 NBER Bulletin on Aging and Health at http://www.nber.org/aginghealth/2012no1/2012no1.pdf

The 2012 No. 1 Bulletin includes the articles below:

1) Why Are Recessions Good for Your Health? by Ann Huff Stevens, Douglas Miller, Marianne Page, and Mateusz Filipski http://www.nber.org/aginghealth/2012no1/w17657.html

2) How Did the Great Recession Affect Near Retirement-Age Households? by Alan Gustman, Thomas Steinmeier, and Nahid Tabatabai http://www.nber.org/aginghealth/2012no1/w17547.html

3) The Draw-Down of Retirement Savings by James Poterba, Steven Venti, and David Wise http://www.nber.org/aginghealth/2012no1/w17536.html

4) Abstracts of Selected Recent NBER Working Papers: http://www.nber.org/aginghealth/2012no1/WorkingPaperSummaries.html

Assessment

NBER Profile: David Neumark http://www.nber.org/aginghealth/2012no1/Neumark.html
Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Health Economics, Health Insurance, Healthcare Finance | Tagged: David Neumark, NBER Bulletin on Aging and Health | 1 Comment »

Healthcare Reform Thru 2018

Posted on March 28, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

An Evolving System

Conclusion

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Health Insurance, Health Law & Policy | Tagged: ACA, healthcare reform, Obaba Care, Obama healthcare reform, PP-ACA | 2 Comments »

ACO Opinion and Voting Poll

Posted on March 26, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Are Accountable Care Organizations Another Form of Medical Capitation Reimbursement?

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Filed under: Health Insurance, Practice Management, Voting Polls | Tagged: Accountable Care Organizations, ACOs, Are Accountable Care Organizations Another Form of Medical Capitation Reimbursement?, capitation, Medical Capitation Reimbursement | 2 Comments »

On the Protecting Access to Healthcare (PATH) Act

Posted on March 22, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

ADA Makes Progress Against McCarran-Ferguson

By D. Kellus Pruitt DDS

The ADA makes real progress against McCarran-Ferguson. I’ve watched the American Dental Association fight long and hard against the unfair McCarran-Ferguson Act of 1945. ADA leaders and I still don’t agree on the need for transparency in the professional organization instead of proud unresponsiveness, but nevertheless, I’ve always been publicly supportive of their efforts to repeal the M-F Act.

Insurance Industry

The insurance industry is powerful in Washington. Over the short term, common sense has proven to be far less influential than their generous campaign contributions – making this a long haul for ADA officials. Yet the amendment to H.R. 5, Protecting Access to Healthcare (PATH) Act, which was offered by Rep. Paul Gosar (R-Ariz.), a dentist, is finally scheduled to come up for a vote on Thursday, March 22, 2012

Good Work – ADA

http://www.ada.org/news/6926.aspx

If passed, the legislation will restore the application of antitrust laws to the business of health insurance. Makes sense, right? After all, if every other business in the nation, including professional organizations, can be prosecuted by the FTC for collusion, why should Delta Dental, BCBSTX and other members of the National Association of Dental Plans (NADP) be exempt from antitrust laws which protect their clients.

I and others are hopeful that this will end many of dental insurers’ current business practices which unfairly force dentists to accept take it or leave it terms that would be unacceptable in a fair market. Maybe the repeal will also make insurance lawyers think twice before alerting the FTC when ADA News speaks honestly about the harm caused by suspiciously similar policies of numerous NADP members.

Assessment

Even if the M-F is repealed, here is an example of truth in dental care that I bet ADA leaders still won’t be able to share with Americans: Unfair downward pressure on contracted dentists’ payments always hurts clueless dental patients the most. Delta Dental’s greed will never be satisfied and dentists’ ethics aren’t free.

NADP, meet the FTC.

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

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Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

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Filed under: Health Insurance, Health Law & Policy, Insurance Matters, Pruitt's Platform | Tagged: ADA, amendment to H.R. 5, BCBSTX, D. Kellus Pruitt DDS, delta dental, FTC, McCarran-Ferguson, National Association of Dental Plans, Protecting Access to Healthcare (PATH) Act, Rep. Paul Gosar (R-Ariz.) | 3 Comments »

Challenging the NPI Requirement of Blue Cross Blue Shield of Texas Again

Posted on March 4, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

How Far Can They be Pushed?

By D. Kellus Pruitt DDS

Command-and-control organizations like BCBSTX find Facebook difficult to control. Even a small nidus of a complaint posted by a client named Mark about poor service can attract a huge bolus of payback by a dentist, and nobody respects anonymous gatekeepers for huge, unresponsive companies like BCBSTX anyway:

https://www.facebook.com/bluecrossblueshieldoftexas

Mark, as a dentist, I’m very familiar with BCBSTX’s inconsiderate behavior in our communities. At least the anonymous moderator invited your feedback. When I sincerely asked her on Wednesday what federal employees are told about BCBSTX’s NPI requirement, she acted as if the absurd policy hadn’t already wasted enough of my time that day when she provided me an irrelevant link to nowhere – just to get rid of me.

Secret Requirement?

I would actually love to treat federal employees who have BCBSTX insurance because they are some of the nicest people I’ve met. But, BCBSTX’s secret requirement that their clients see only dentists with arbitrary NPI identification numbers (not required by law) makes their employment benefit purchased with taxpayer money worthless if they receive treatment in my office. My office has been told that it has become impossible for paper claims to enter BCBSTX’s modern, computerized system without NPI numbers, and nothing humanly possible can be done to correct the unfortunate problem for dentists who choose not to be HIPAA covered entities.

Evasion?

The moderator’s evasion confirms that even though BCBSTX’s federal customers are led to believe that they can use their dental benefits to help pay for treatment at any licensed dentist’s office, they are not being informed of the NPI requirement, and if they pay the dental bill in full for work done by a dentist without an NPI number, BCBXTX pockets the reimbursement. It just cannot be helped. That’s technology. Tough-luck!

BCBSTX executives naturally prefer that my office manager tell their clients about the obscure restrictions of the dental plans they sell. She catches most federal employees before blocking out time in our schedule to treat them, but nevertheless, one got through on Wednesday morning. It wasted my time as well as the federal employee’s.

Congressional Action?

It’s troublesome to know that the government callously encourages such waste of small business owner’s time and money, not to mention the inconvenience to patients. I’m simply fed up with open appointments for uninformed BCBSTX clients. What’s it take to force BCBSTX to take some responsibility in the community and warn their customers about the limitations of their dental policy before they call my office? Congressional action?

Assessment

I do hope the anonymous BCBSTX employee doesn’t choose to delete this post. Since it seems obvious that their windfall profit is a powerful disincentive for BCBSTX to warn their clients about the NPI restriction any time soon, the more federal employees I can ethically warn through BCBSTX Facebook, the fewer open appointments I’ll have, and less taxpayer money will be wasted on silliness.

cc: Senator John Cornyn

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
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ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Ethics, Health Insurance, Information Technology, Practice Management, Pruitt's Platform | Tagged: Blue Cross, Blue Shield, Challenging Blue Cross Blue Shield of Texas Again, D. Kellus Pruitt DDS, Facebook, HIPAA, NPI Number, NPI requirement, Senator John Cornyn | 8 Comments »

Health Industry Collaboration and e-Patients

Posted on February 24, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

More on Inter and Intra Healthcare Stakeholder Relationships

According to Jennifer Tomasik MS [jtomasik@cfar.com], writing in the soon to be released ME-P textbook from iMBA Inc www.MedicalBusinessAdvisors.com: “Healthcare Organizations” [Management Strategies, Tools, Techniques and Case Studies], now in-process from (c) Productivity Press for 2012:

We are in a time of great change in healthcare. No one is certain how the future landscape will unfold, but it is clear that changes in regulation, reimbursement, technology, the economy, and science will significantly impact the work of those clinicians and administrators who dedicate their careers to improving patient care.

More Collaboration Needed

Experience has shown that better collaboration between patients and among the many different parts of the healthcare delivery system holds great potential to improve the quality of care and the relationships of those delivering it. It has also shown that the opportunities to improve collaboration are widespread.

Our focus, therefore, should be to introduce and share a selected set of tools that can be used to improve collaboration along several dimensions:

Clarifying roles and authority through decision charting,
Understanding the “give” and the “get” needed to establish effective alliances through the current state, and
Working jointly to establish and test a set of refined expectations through a physician-administrator compact.

Assessment

In the end, improved collaboration can help medical institutions with everything from inter professional productivity, to patient satisfaction to the most critical service of all: caring for patients and saving lives.

Link: http://www.crcpress.com/product/isbn/9781439879900

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Please 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.

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Practice Management: http://www.springerpub.com/product/9780826105752

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

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Filed under: Book Reviews, CMP Program, Ethics, Health Insurance, iMBA, Inc., Managed Care, Quality Initiatives, Recommended Books | Tagged: david marcinko, e-patients, Health Industry Collaboration and e-Patients, Healthcare Organizations” [Management Strategies, hope hetico, Jennifer Tomasik, Techniques and Case Studies, Tools, www.certifiedmedicalplanner.com, www.medicalbusinessadvisors.com | 4 Comments »

The ACA and Rising Healthcare Costs?

Posted on February 13, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Effects of Affordable Care Act on Private Health Care Costs Remain to be Seen

[By Staff Reporters]

###

The latest data on economic growth shows the American economy spent the last quarter growing at a rate equal to 2.5 percent a year. That’s neither recession-level bad nor full employment recovery-level good, but it’s worth diving into the numbers to see exactly what’s driving this slow expansion.

###

A significant part of the growth came from personal spending on health care as insurance premiums continue to rise, meaning a lot of that growth wasn’t very productive. That health care costs are rising—and rising faster than most other expenses—is a problem that businesses and policymakers have struggled with for years: It’s the major cause of federal budget deficits and the reason behind the health care law passed in 2010. While the effects of the Affordable Care Act on private health care costs remain to be seen—many of its provisions will not go into affect for another two years—health care economists like Harvard’s David Cutler say it draws on nearly every idea that exists to lower costs.

###

But, Cutler adds that while we wait for pilot programs to succeed and scale or fail, more changes to the system—including a public insurance option and further incentives for health providers to reform delivery—should be on the table.While policymakers in Washington and state capitals wait on politics and legal challenges to the 2010 law, consumers can take action themselves to lower costs. Innovative health care companies are coming up with new ways to make cost savings easier to find.

Source: Simplee

Conclusion

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HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
PODIATRISTS: www.PodiatryPrep.com
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance | Tagged: ACA, Affordable Care Act., David Cutler, Health Economics, Health Insurance, Healthcare Finance, The ACA On Rising Healthcare Costs? | 16 Comments »

Public versus Private Healthcare

Posted on February 11, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

Around the World

Conclusion

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Health Dictionary Series: http://www.springerpub.com/Search/marcinko

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Filed under: Health Economics, Health Insurance, Healthcare Finance | Tagged: Public versus Private Healthcare | 2 Comments »

January 2012 [Health] Plan Management Navigator

Posted on January 25, 2012 by Dr. David Edward Marcinko MBA MEd CMP™

With 2012 Benchmarking Study Invitation

By Marco Georeno

Health Care Analyst

Dear Dr. Marcinko and ME-P Readers

At the risk of appearing overwhelmed with New Year’s enthusiasm, we think the attached edition of Plan Management Navigator is especially interesting:

1. We report on the cost decisions made by low cost Blue Cross Blue Shield plans. Low cost plans make decisions that differ from their higher cost peers. Hallmarks of these decisions include levels and distributions of expenses between functions, the levels and distribution of staff between functions, the levels of compensation and its distribution between functions and the distribution between functions, and levels of, non-labor expenses. Overall, low cost Blue Cross Blue Shield Plans have “tactical” administrative expenses that were $5.63 PMPM, or 29%, lower than their higher cost counterparts. These tactical expenses are all administrative expenses excluding medical management and sales and marketing.

2. We provide an update on the most recent operating and financial results for firms participating in our monthly Dashboard.

3. We invite appropriate ME-P readers to participate in the 2012 benchmarking study. Participation is very timely given that the weak economy is placing great pressure on commercial enrollment, creating the risk that administrative expenses could be a source of negative operating leverage.

Assessment

A more detailed version of this analysis is available to licensed users of Blue Cross Blue Shield Sherlock Expense Evaluation Report (SEER). Please call us for further information if you have an interest.

Link: Navigator Late January 2012

Sherlock Company

mgeoreno@sherlockco.com

Ph: 215-628-2289

Fax: 215-542-0690

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Filed under: Health Economics, Health Insurance, iMBA, Inc. | Tagged: Blue Cross Blue Shield, health plan benchmarking, January [Health] Plan Management Navigator, Marco Georeno, Sherlock Company, Shield Sherlock Expense Evaluation Report | Leave a comment »

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