A Review of Elder Housing Protections

Home Equity Resources, Housing and Care Options

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According to Stephanie Edelstein JD; Charles P. Sabatino JD and Nancy M. Coleman MSW MA; opining in the ElderLaw Series, until relatively recently most people in this country followed a rather typical housing pattern in their later years. They either rented or owned their homes and lived alone until they were no longer physically or economically able to manage independently, at which time they moved in with family members or into nursing homes or board-and-care homes.

Elderly Housing

Housing, particularly rental housing, provided the proverbial bricks and mortar, and, with the exception of a few facilities that offered meals and some light housekeeping, little opportunity existed for older persons to receive services in their homes. Elderly tenants who were perceived by a landlord or housing manager as unable to manage on their own were evicted, frequently without due process protections, and just as frequently would end up in a nursing home. While disabled tenants in federally assisted housing programs were accorded protections against discrimination on the basis of disability, no such protections existed for residents of private housing. Few members of the legal, healthcare or aging communities, and even fewer among the elderly, were aware of those protections that did exist.

Emerging Changes

Much has changed during the last few years, in large part due to the increasing emphasis on retaining autonomy, the trend towards aging in place, and the passage of civil rights statutes, which have raised public awareness of the legal rights of persons with disabilities.

For example, for frail or disabled older persons, including medical professionals, protection against discrimination in housing can be found in three federal statutes: [1] the Americans with Disabilities Act, [2] the Rehabilitation Act of 1973 and the [3] Fair Housing Amendments Act of 1988. Of the three, only the Fair Housing Amendments Act (FHAA) is targeted exclusively to housing and within the housing area is arguably the most far-reaching.

Rehabilitation Act

The Rehabilitation Act of 1973 (the antidiscrimination provisions of which are commonly referred to as §504) is a general civil rights statute that prohibits discrimination against any “otherwise qualified individual with handicaps” in a wide variety of programs or activities receiving federal financial assistance, including housing.  

FHAA

The scope of the FHAA, as it applies to housing is broader, and it covers virtually any housing activity or transaction, including both private and subsidized, apartments and single family dwellings, and prohibits discrimination against all individuals with handicaps, even if the discrimination cannot be attributed directly to the disability.

ADA

The Americans with Disabilities Act (ADA), which is having a profound effect on all elements of society, can be seen as complementing the other statutes. The ADA extends to all state and local programs the protections of §504, and also prohibits discrimination against people with disabilities in public accommodations.

Disability Defined

All three statutes use virtually the same definition of “handicap” or “disability.” Protection is extended to persons with a “physical or mental impairment which substantially limits one or more major life activities,” such as performing manual tasks, personal care, walking, seeing, hearing, speaking, etc. The definition includes persons “having a record of such an impairment”, whether or not the impairment still exists; and a person “regarded” as having such an impairment,” whether or not the perception is accurate. While age alone does not equate with disability, the symptoms and conditions of the aging process are likely to cause impairments that meet these definitions.

Addition Exempted

“Handicap” or “disability” does not include current illegal use of or addiction to a “controlled substance.” Moreover, none of the statutes require a housing provider to make housing available to an individual “whose presence would constitute a direct threat to the health or safety of other individuals or whose tenancy would result in substantial physical damage to the property of others.”

Legal Purposes

The intent of these laws is to provide persons with disabilities access to and enjoyment of housing and services to the same degree as if they were not disabled. They apply from point of application throughout the tenancy. Housing providers may not maintain separate admissions standards for people who are frail or disabled, nor may they inquire about an applicant’s health or ability to live independently, unless those questions are to establish eligibility for particular programs or services.

For example, the decision to lease to a particular individual must be based on program eligibility (if appropriate) and the ability of the applicant to comply with the terms of the lease, whether independently, with the assistance of a third party, or as a result of a reasonable accommodation by the provider. A prospective property owner may not require an older person to have a “sponsor,” or “guarantor,” a practice common to many senior housing programs.

Assessment

In recent years, courts have found the following policies to be discriminatory: requiring residents who must use walkers or wheelchairs to transfer to regular chairs when eating in the common dining room; failing to provide accessible parking spaces for disabled tenants; and refusing to modify a “no pet” rule for tenants with disabilities who need guide dogs or service animals.

Link: www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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Some Insight on Medicare Advantage Plans

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Enter the Bounty Hunter Insurance Agents

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[By Dr. David Edward Marcinko; MBA]

[Publisher-in-Chief]

As a health insurance agent and industry insider for more than a decade, I know first hand that the agents and brokers who enroll senior citizens in Medicare Advantage (MA) plans often make more on those members than the health plans themselves. 

Example:

For example, up to $400-600 can be spent on an insurance agent/broker fee by the health plan, contributing to a total member acquisition cost that can exceed 10% of the premium dollar. And, this commission fee or bounty on “grandma” – much like a bulls-eye target on her back – was much higher back in the day. Hence, all the “free” seminars, luncheons, trinkets and other senior citizen freebies cloaked as information dissemination.

Acquisition Costs High

Even if Medicare Advantage plans could deliver the actual health care benefits at a considerably lower cost than traditional Medicare Fee for Service (FFS); it is very possible that the entire savings could be consumed by member acquisition costs.

Assessment

Now, as a doctor, insurance agent, financial advisor, health economist and future MC patient, I believe that traditional Medicare is a very tough act to follow; and is still the best deal around, by far. Now, try to convince my dad.

Conclusion

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Health Reform, the Stimulus and Hitler’s Aktion T-4

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Overhauling the American Healthcare Industry

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dr-david-marcinko11

According to the Washington Times on February 11, 2009, a secreted House version of the new economic stimulus bill that President Barack Obama is trying to rush through Congress, may contain the germ of a major overhaul of the American health care system befitting German State of yester-year?

National Coordinator of Health Information Technology

For example, one provision causing much concern is the future role of the National Coordinator of Health Information Technology [NCHIT]. This is the organization that will be in charge of collecting and monitoring the health care being provided to every American. We have already commented, written, posted and warned our readers and subscribers about this item in our ME-P.

Link: https://healthcarefinancials.wordpress.com/2009/02/11/illuminating-the-congressional-federal-health-board

Hitler and Aktion T-4

The notion seems fully in the spirit of the partisans of efficiency, but historically may have originated from a program instituted in Hitler’s Germany – called Aktion T-4; as insinuated in the Time’s article. Under this program, elderly people with incurable diseases, young children who were critically disabled and others who were deemed non-productive, were euthanized. This was the Nazi version of efficiency, a pitiless expulsion of the “unproductive” members of society in the most expeditious way possible.

Link: http://en.wikipedia.org/wiki/T-4_Euthanasia_Program

Assessment

According to blogging tipster Matt Holt, and most right-minded folks, the Washington Times should be very careful before it starts comparing the people who support an improved national health care IT infrastructure to Hitler, and suggesting that they advocate mass slaughter of sick people.

Link: http://www.washingtontimes.com/news/2009/feb/11/health-efficiency-can-be-deadly

Industry Index Indignation Rating: 98

Conclusion

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Illuminating the Congressional Federal Health Board

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A Next-Gen -or- Last-Gen National Model  

[By Dr. David Edward Marcinko; MBA, CMP™]

[By Staff Reporters]

 

 

 

 

 

 

Beware; all Medicare and other private health insurance recipients.

Why?

On December 4, 2008, and according to Robert E. Moffit PhD, the Director of the Center for Health Policy Studies [CHPS] at The Heritage Foundation, Presidential Obama proposed the creation of an institute that would judge the “comparative effectiveness” of medical treatments, procedures, and therapies, as well as drugs, devices, and technologies.

Congressional FRB Model

This Congressional Federal Health Board [FHB] would be modeled on the Federal Reserve Board [FRB] with a governing body of politically appointed experts, but “insulated from politics” and  possess many powers similar to the proposed National Health Board [NHB], a key feature of the ill-fated Health Security Act [HSA] of 1993.

New Health Board

This new health board would also:

  • Set the rules for health insurers who would participate in a national health insurance exchange and recommend benefits coverage, including drugs and medical procedures backed by “solid evidence”;
  • “Rank” therapies and medical services based on their cost effectiveness;
  • Suggest priorities for medical research; and
  • “Align incentives with the provision of quality care,” as defined by the health board, through Medicare-style “pay for performance” rules for doctors and other medical professionals who comply with government practice guidelines.

Assessment

For ordinary Americans unsatisfied with the new Federal Health Board, there would be little recourse since it would likely be independent of Congress and the White House. For medical providers, according to Hope Hetico; RN, MHA of this Medical Executive-Post, it would be an operational nightmare that makes the managed care logistical problems of condition coverage, pre-certifications and pre-treatment authorizations, etc., seem a non-issue.

In other words, is this new FHB really the next-generation of medical collaboration and communication vis-a-vie health 2.0; or just another bloated last-generation command control model?   

Link: http://www.heritage.org/research/healthcare/wm2155.cfm

Conclusion

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Health Insurance versus Mental Health Parity

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Understanding Physical Health and Mental Health Insurance

By Carol Miller; RN, MBA

Carol S. Miller

There is a difference between the benefits covered under medical insurance compared to those covered under mental health benefits.

Mental Health Parity Act

There has always been a disparity resulting in caps on the annual number of visits allowed, higher co-pays, higher deductibles, and reduction of covered benefits such as partial hospitalization and number-of-treatment limits for mental health. Congress touched on this issue in 1996 with the Mental Health Parity Act. This federal law prevented group health plans from placing annual or lifetime dollar limits on mental health benefits that are lower¾less favorable¾than annual or lifetime dollar limits for medical and surgical benefits.

Group Health Plan Exclusions

However, the law did not require group health plans and their health insurance issuers to include mental health coverage in their benefits package¾it only applied to group health plan insurances that already did include mental health benefits in their benefit package.

MHETA Attempts at Correction

In 2003, Senators Pete Domenici, Edward Kennedy, and Representatives Patrick Kennedy and Jim Ramstad introduced S. 486 and H.R. 953, called the Mental Health Equitable Treatment Act. In March 2005, the Mental Health Equitable Treatment Act [MHETA] was passed and with the passage of this bill a loophole – insurers may no longer arbitrarily limit the number of hospital days or outpatient treatment sessions for people in need of mental health care – was closed.

Assessment

Nevertheless, even though states are encouraged by the government with this new bill to enact stronger parity laws, the final decision of parity still rests with the states.  Many states have not enforced the law and therefore, insurers may still be inclined to limit

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Why the mental versus medical health care insurance disparities?

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About ENURGI

Transforming Home Health Care Services

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According to its website, ENURGI is a revolutionary web-based healthcare services company that connects families and patients in need, with local clinical caregivers across the country.

Online Empowerment

ENURGI allows patients, family members and caregivers to independently manage the care process through on-line scheduling, messaging, referral and direct payment transactions.

A Caregiver Database

ENURGI’s goal is to transform the delivery of home health care services across the country. It is the first web-based company to aggregate and create a clinical caregiver database for families and patients in need of home health care to access and connect with.

Assessment

By harnessing the power of technology, ENURGI has accumulated over 1,000,000 clinicians within its caregiver database for families/patients in need to access when seeking a licensed clinician, certified nurses aide or home health aide.

Link: http://www.enurgi.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is this not the perfect post to conclude our four part series on: At Home or Nursing Home Care for Long Term Care? Opinions from physicians, medical case and geriatric care managers, and LTC insurance agents are especially valued.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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About Healthcare Financials.com

Healthcare Organizations [Financial Management Strategies]

By Hope Rachel Hetico; RN, MHA
Managing Editor
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This 2-volume, quarterly subscription print publication will reshape the hospital management landscape by following three important principles www.HealthcareFinancials.com

1. World Class Advisory Board

First, we have assembled a world-class editorial advisory board and independent team of contributors and asked them to draw on their experience in economic thought leadership and managerial decision making in the healthcare industrial complex. Like many readers, each struggles mightily with the decreasing revenues, increasing costs, and high consumer expectations in today’s competitive healthcare marketplace.  Yet, their practical experience and applied operating vision is a source of objective information, informed opinion, and crucial information for this manual and its quarterly updates.

2. Writing Style

Second, our writing style allows us to condense a great deal of information into each quarterly issue.  We integrate prose, applications and regulatory perspectives with real-world case models, as well as charts, tables, diagrams, sample contracts, and checklists.  The result is a comprehensive oeuvre of financial management and operation strategies, vital to all healthcare facility administrators, comptrollers, physician-executives, and consulting business advisors.

3. Compelling Content

Third, as editors, we prefer engaged readers who demand compelling content. According to conventional wisdom, printed manuals like this one should be a relic of the past, from an era before instant messaging and high-speed connectivity. Our experience shows just the opposite. Applied healthcare economics and management literature has grown exponentially in the past decade and the plethora of Internet information makes updates that sort through the clutter and provide strategic analysis all the more valuable. Oh, it should provide some personality and wit, too! Don’t forget, beneath the spreadsheets, profit and loss statements, and financial models are patients, colleagues and investors who depend on you.

Assessment

ho-journal1

Rest assured, Healthcare Organizations [Financial Management Strategies] will become an important peer-reviewed vehicle for the advancement of working knowledge and the dissemination of research information and best practices in our field. In the years ahead, we trust these principles will enhance utility and add value to both your print and this e-companion subscription.

Conclusion

Most importantly, we hope to increase your return on investment. If you have any comments or would like to contribute material or suggest topics for a future update, please contact us.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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At-Home or Nursing-Home for Long Term Care [Part III]

Cost and Duration of Long-Term Care at Home

By Dr. David Edward Marcinko; FACFAS, M.B.A., CPHQ™, CMP™

By Thomas A. Muldowney; M.S.F.S., CLU, ChFC, CFP® CMP™

By Hope Rachel Hetico; R.N., M.H.A., CPHQ™, CMPdr-david-marcinko1

This is the third post, in an exclusive four part series for the ME-P titled: At-Home or Nursing Home Care for Long-Term.”

Average Nursing Home Stays

It is generally agreed that if short, recuperative stays are excluded, the average stay in a nursing home is about 21/2 years. Nursing home studies show that residents experience four types of stay before death: 12 percent remain for less than 90 days; 21 percent stay between 91 and 365 days; 43 percent stay for up to five years; and 24 percent stay longer than five years. It is not possible to know in advance which type of stay you or your family may experience. But, put in another way, two-thirds stay more than one year and one-quarter stay more than five years. Most seniors also have home care services before entering a nursing home.

Custodial Services 

Custodial nursing home services are paid from the elder’s savings or by Medicaid. The current estimated annual cost for a nursing home resident is about $35-40,000. However, the annual cost for a nursing home in metropolitan areas may be at least twice as much.

Assessment

In the past decade, nursing home charges increased 8 percent a year. At a minimum, these costs may be expected to climb at a 5 percent annual rate in the future.

Conclusion

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WorldFocus Interviews Uwe Reinhardt PhD

How We Compare to Canada’s Healthcare System

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WorldFocus interviewed Uwe Reinhardt PhD on January 28, 2009.

In this extended interview, Dr. Reinhardt, a leading adviser on health care economics and professor of political economy at Princeton University, compares the Canadian and American health care systems.

Reinhardt criticizes the US health care culture and expresses his optimism about the new Obama administration.

Video: http://worldfocus.org/blog/2009/01/28/how-the-us-measures-up-to-canadas-health-care-system/3783/#comments

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Decide for yourself; is Uwe correct; or not? Why, or why not? Despite Democratic control, is healthcare reform even likely?

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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At-Home or Nursing-Home for Long Term Care [Part I]

Cost and Duration of Long-Term Care at Home

By Dr. David Edward Marcinko; FACFAS, M.B.A., CPHQ™, CMP™

By Thomas A. Muldowney; M.S.F.S., CLU, ChFC, CFP® CMP™

By Hope Rachel Hetico; R.N., M.H.A., CPHQ™, CMPdr-david-marcinko

This is the first post in an exclusive four part series for the ME-P titled: At-Home or Nursing Home Care for Long-Term Care.”

Remaining at Home

It is not surprisingly, eighty-five percent of married elders prefer to remain at home instead of moving to a nursing home or some other senior care facility. Staying at home is easier, more comfortable, and less traumatic. Home care statistics are limited, but three years is the estimated average number of years that elders will require custodial care services. This estimate also may combine home care followed by nursing home care. And, the anecdotal healthcare experience of two authors [DEM and HRH] confirms this period length.

Incremental LT Cost Approach

Quantifying the annual incremental costs of LTC home custodial services is difficult. Today, a high percentage of home care services are provided by unpaid family members, friends, or volunteer organizations. In the future, however, there will be fewer available unpaid caregivers, and more elders will have to pay for home custodial care.

Because of this potential shortage of caregivers, new business opportunities are springing up and, as usual, let the buyer beware. Many of these new businesses, for a fee, contract with a family that needs home LTC for a family member.  Upon contract, the new LTC business owner begins a search for a candidate caregiver who will live in your house and care for your parent or spouse. Often the in-home caregivers have difficulty speaking the language or may not be familiar with local customs.

Furthermore, many of them wish to be paid in cash rather than by check. As you might imagine, background checks, tax compliance and other legal considerations are of utmost importance.  Career education and career experience are also very important. Be sure that if you look for such a caregiver, you must exercise thorough due diligence so that your loved one will be cared for properly.

LTC Costs Vary Widely

LTC home care cost estimates vary widely by location and type of service. At present, the average annual cost for a live-in, full-time aide in the United States (especially if part-time help to relieve a full-time aide is added) is estimated at $40,000, the same as the estimated cost of staying at a nursing home for a year. If living expenses are added to costs for custodial aides, LTC home care costs can be more expensive than nursing home costs.

For three shifts of paid LTC custodial services, home care costs may exceed $100,000 annually; more than triple the current estimated cost for nursing home care. These numbers should not be surprising.  In a nursing home environment, one caregiver may be able to provide care for multiple patient/residents. This reduces the cost per patient. In your private home, your personal caregiver can give only care to a single patient.

Custodial Aide Costs

Costs for custodial aides in the fragmented, rapidly expanding, competitive home care industry may increase at a faster rate than the Consumer Price Index [CPI]. Employed aides will replace family caregivers. The Bureau of Labor Statistics [BLS] indicates that jobs for home health aides, human service workers, and personal and home care aides are expected to grow faster than any other industry in terms of total jobs.

In the next decade, there will be more than 2 million home care jobs, and they will become a larger component of total gross domestic product expenditures. Using an estimated three-year home care requirement and current estimated costs, and allowing for 15 years of inflation at 5 percent, $225,000 per person is a reasonable estimate to use for financial planning purposes.

Assessment

However, in some metropolitan or suburban areas, such as New York City, the cost should be increased by at least 100 percent. Of course, three years of required care is an estimate. About one-third of the people who require nursing home care will need it for more than three years. Presumably, nursing home care will be preceded by home care. Moreover, only one full-time aide was assumed. Some elders also will require additional part-time help.

And so, your thoughts and comments on this Medical Executive-Post, which represents the first in a series of four parts on: At Home or Nursing Home Care for Long Term Care, are appreciated. Comments from physicians and LTC insurance agents are especially valued.

Conclusion

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About Health CEOs for Healthcare Reform

A Coalition from the New America Foundation

Staff Reporters

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Many pundits posit that real health reform will entail quality, affordable coverage for all Americans and a restructured health care delivery system. And, a growing number of health industry leaders understand they must reorganize their business models to realize these goals.

Health CEOs for Reform

Recognizing that business as usual is no longer a sustainable model in health care, a diverse coalition of six CEOs from across the health care sector have come together to form Health CEOs for Health Reform [HC4HR]. The coalition, facilitated by the New America Foundation, brings together health industry leaders with a unique willingness to transform their business models to create a more sustainable health system.

Guiding Principles

According the its website, the group’s members are committed to moving past broad policy concepts toward detailed blueprints that reconcile the legislative goals and principles of lawmakers with the operational realities of our health care system. The coalition is built on the following three principles:

 

  1. Health reform is an urgent priority for our nation and should not be postponed.
  2. Meaningful health reform entails quality, affordable health coverage for all and delivery system reform. This will require all stakeholders to move away from “business as usual.”
  3. A more sustainable health system will require all health care stakeholders to offer and accept changes to their business models as part of a catalytic package that will better serve everyone.

Assessment

The CEOs announced the formation of HC4HR in an event at the National Press Club. Senator Sheldon Whitehouse [D-RI] provided a Congressional keynote for the event, stressing the importance of health reform in our national agenda and applauding the leadership shown by HC4HR.

Link: http://www.newamerica.net/events/2008/ceos_health_reform

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Do we really need another group to discuss healthcare reform? We all know the problems of divergent stakeholder interest. Is this the time for solutions, or another group reframing the problem?

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  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Myths and Solutions for Healthcare Reform

Enter the Primary Care Docs, NPs, PAs and DNPs

Staff Reportersidea

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Would more family practitioners, and professional medical care extenders, help or hinder true healthcare reform?  

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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About the AHCJ

Advancing Public Understanding of Healthcare Issues

Staff Reportersmedfrd1210

According to its website, the Association of Health Care Journalists [AHCJ] is an independent, nonprofit organization dedicated to advancing public understanding of health care issues. 

Currently, there are more than 1,000 members in the AHCJ www.HealthJournalism.org

History

The idea for an Association of Health Care Journalists was born at a conference of health care reporters in Bloomington, Ind., in March of 1997. As it happened, several journalists, who had felt the need for such a group, crossed paths at that conference, which was sponsored by the Henry J. Kaiser Family Foundation. J. Duncan Moore, a reporter for Modern Healthcare magazine, and Melinda Voss, then a health reporter for the Des Moines Register, organized the initial meeting.

Mission

The mission of the Association of Health Care Journalists is to improve the quality, accuracy and visibility of health care reporting, writing and editing. AHCJ is classified as a 501(c) (6), a nonprofit professional trade association.

Goals

  1. To support the highest standards of reporting, writing, editing, and broadcasting in health care journalism for the general public and trade publications.
  2. To develop a strong and vibrant community of journalists concerned with all forms of health care journalism.
  3. To raise the stature of health care journalism in newsrooms, the industry, and the public, as a whole.
  4. To promote understanding between journalists and sources of news about how each can best serve the public.
  5. To advocate for the free flow of information to the public.
  6. To advocate for the improvement of professional development opportunities for journalists who cover any aspect of health and health care.

Assessment

For membership and contact information:

Association of Health Care Journalists
Missouri School of Journalism
10 Neff Hall –
Columbia, MO 65211 USA

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Do we need more journalists reporting on the status of the healthcare industrial complex; or do we need real subject matter experts? Nevertheless, we are supporters of healthcare journalistic transparency.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Healthcare and the Recession

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Physician and Hospital Pricing Pressure

[By Staff Reporters]life-preserver

As reported in Modern Physician Online, by Dan Bowman, new metadata coming from the federal government suggests that the current financial meltdown and domestic recession has impacted hospital and physician charges, as implicated by their revenues.

USBLS on Physician Charges

According to data from the US Bureau of Labor Statistics [USBLS], retail prices charged by doctors rose 2.9 percent in 2008, compared with 4.1 percent the year before. Wholesale prices for physicians were up 1.2 percent last year, compared with 4 percent in 2007.

USBLS on Hospital Charges

Hospitals meanwhile, were up 5.9 percent in 2008, compared with 8.3 percent the year before. Wholesale prices for hospital services, for their part, were up 1.5 percent last year, falling from a 3.8 percent increase in 2007.

Assessment

Link: www.ModernHealthcare.com

Conclusion

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Medicare SGR Formula Fix

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The Daschle Imperative

[By Staff Reporters]caduceus

According to American Medical News, January 19, 2009, Tom Daschle, appearing at his first confirmation hearing to be Health and Human Services [HHS] secretary, pledged to replace Medicare’s sustainable growth rate [SGR] formula with a system that bundles payments in an attempt to reward good patient outcomes.

Recommendations

Apparently, Daschle also promised to examine inefficiencies in private Medicare plans, discourage tobacco use, support the training of primary care physicians and work with lawmakers in a bipartisan manner. Reports suggested that Medicare’s SGR formula “just isn’t working right.”

Expiring Patches

The latest in a series of temporary SGR reform payment patches expires at the end of 2009. If Congress doesn’t act before Jan. 1, 2010, doctors will undergo an estimated 21% Medicare pay cut. Any new formula should focus on bundling payments based on episodes of care instead of paying per procedure. Daschle said in the News reported, “I’m not one who supports the so-called performance- based approach, but I do believe that there are episodic ways with which to look at reimbursement that give us a lot more latitude” to reward better outcomes.

Assessment

He did not elaborate further.

Conclusion

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ADA Mission Creep

Will that Be “Paper” or “Electrons?”pruitt1

[By Darrell K. Pruitt; DDS]

What is the mission of the American Dental Association? Is it the ADA’s obligation to keep failing dental insurance companies afloat – regardless of how much it raises the cost of providing dental care in the nation? Even necessary fee increases limit access. And so, what can the ADA possibly be thinking?

ADA News Online 

Recently, an article written by Arlene Furlong was posted on the ADA News Online with the title, “ADA studies scanning – Paper claim filers may benefit from sending scanned, printed radiographic images.”

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3319

Of Possible Benefit 

The title promises that paper claim filers may benefit from scanned radiographic images. Do you know who definitely will benefit if radiographs don’t have to be returned to dentists? Two Dental insurance companies who were quoted in the article: American Health Insurance Plans [AHIP] and Delta Dental Plans Association [DDPA]. See: “Such a ‘Sleazy’ Company”.

https://healthcarefinancials.wordpress.com/2008/09/19/%E2%80%9Csuch-a-sleazy-company%E2%80%9D/

Outline of Arlene Furlong’s Article:

THE PROBLEM

“Dentists and their office staff report frustration in trying to keep track of varying policies.”

THE CAUSE

“Third-party payers continue to use different criteria to determine when images are needed to support claims adjudication, and if and how those radiographs will be returned to dentists.”

THE QUALIFIED SOLUTION

“Dentists who use digital radiography and file electronic claims can easily submit images electronically.”

THE COST

“Standard images, including single periapical films, panorex films and full-mouth films were scanned on four different scanners priced between $99 and $299.”

In addition, in order for a dentist to legally transmit digital patient information contained in one scanned periapical radiograph, one must be a HIPAA-covered entity. Furlong failed to mention the HIPAA liability that is not a problem with paper. It happens often when she writes articles as a favor to eHR stakeholders.

ADA CONCLUSION

Dr. Jeffrey Sameroff, a member of the ADA Councils on Dental Practice and Dental Benefit Programs (CDP) says:

“We still recommend dentists file electronic claims, but this option might be the next best thing for dentists who still submit on paper.”

THE QUALIFICATION

“Delta Dental Plans Association [DDPA} members told the councils that printed images from scanned radiographs would be adequate for initial claim review.”

Blue Cross Blue Shield Association and the National Association of Dental Plans [NADP] did not respond.

Ambiguous

The ambiguity and non-committal is obviously the reason that in spite of Dr. Sameroff’s enthusiasm, Furlong can only promise that it may or may not benefit ADA members to follow the advice in her article – but that we should nevertheless do it anyway just to get along with everyone. [The issue of whether the method of sending insurance companies radiographs affects dental care for patients is not addressed].

My Critique

This means that even after buying a scanner, Delta Dental can capriciously make the dentist still send the originals anyway. How good is that investment? Does it provide hope of a return, or does it encourage stakeholders to delay payments to dentists and pocket the interest? When insurance consultants question my ability to properly diagnose dental problems without actually meeting my patients, I will always mail them original radiographs that I expect to be returned because I think it should cost the insurance company a token amount of money to demand information from me.  Who cares if the US Post Office pockets some profit.  Postal workers need jobs too.

Unfettered

Without some sort of restraint, why should Delta Dental stop second-guessing me if delaying payment costs them nothing – even when I am expected to provide for free whatever they request to help their clients receive the benefit that Delta owes them?

What exactly is the mission of the ADA?

I would be a very foolish businessman to fall for this transparent trick – perpetrated by the ADA Councils on Dental Practice and Dental Benefit Programs (CDP). Of course, I’m not new in the neighborhood. I recall a similar article from May 9, 2006 by Arlene Furlong that most ADA members either never read or don’t remember. Its optimistic title is “It’s time to apply for a national provider identifier.” http://www.ada.org/prof/resources/topics/npi.asp

Selling Points

In order to persuade members to “volunteer” for the NPI, Furlong provided three selling points. As you can see for yourself, they are as laughable as Dr. Jeffrey Sameroff’s comments:

1. Providers, including dentists, will not have to maintain multiple, arbitrary identifiers required by dental plans, nor remember which number to use with which plan.

2. Electronic claims function more efficiently by introducing another element of standardization to processing.

3. It contains no vital intelligence about the provider’s name, location, specialty, patients or qualifications.

Rationalization

And so, to think that the best of Furlong’s three rationalizations – for “volunteering” – for an NPI number! The very best reason she gives for ADA members to trustingly expose their businesses’ proprietary information as FOIA – disclosable data – data which would otherwise be considered Constitutionally-protected private business information – is so that dental office managers will not have to remember numerous numbers.

DDPA 

What will sleazy dental insurance companies like Delta Dental do with the FOIA-disclosable information that ADA members are tricked into allowing them to manipulate?  Delta Dental, with the help of Arlene Furlong and the CDP, will determine American dentists’ reputations and pay scales according to their proprietary algorithms which will always seem to favor Delta Dental’s profitability and not their clients’ welfare.  It is called “P4P,” or Pay-for-Performance and it is part of George Bush’s mandate for healthcare reform.

Assessment

The CDP, a rogue collection of ambitious stakeholders, not practicing dentists, has expensive solutions that are desperately reaching for non-problems to solve. For every dollar I must raise my fees for even good ideas, a child in my neighborhood goes to bed with a toothache. Shouldn’t the ADA be more concerned about access to care than insurance companies’ postage expense?

Conclusion

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HIT and Privacy Issues

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Complications Retard Links to Medical Data

[By Staff Reporters]56371998

According to the New York Times, January 18, 2009, President-elect Barack Obama’s plan to link up doctors and hospitals with new information technology, as part of an ambitious job-creation program, is imperiled by a bitter and seemingly intractable dispute over how to protect the privacy of electronic medical records [eMRs and eHRs].

Health Law Policy and Administration

Lawmakers, caught in a cross-fire of lobbying by the health care industry and consumer groups, have thus far been unable to agree on privacy safeguards that would allow patients to control the use of their medical records.

Congress Steps-In

Congressional leaders plan to provide $20 billion for such technology in an economic stimulus bill whose cost could top $825 billion. The Times reported in a speech outlining his economic recovery plan, that Mr. Obama said, “We will make the immediate investments necessary to ensure that within five years all of America’s medical records are computerized.”

Assessment

Digital medical records could prevent medical errors, save lives and create hundreds of thousands of jobs, as Mr. Obama has said in the past. But, can they really? Many posts and comments on this blog suggest otherwise. 

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Conclusion

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The Health Dictionary Series

What it is – How it works

By Dr. David Edward Marcinko; MBA, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™

dhimc-book11

Each useful and up-to-date printed reference dictionary in the 3 volume comprehensive “Health Dictionary Series” Wiki project lists and defines more than ten thousand plus words, abbreviations, acronyms, slang-terms, initialisms and specialized non-clinical health terms; alphabetically.

First conceived as an ambitious and much needed project by the Institute of Medical Business Advisors Inc, in 2007, www.MedicalBusinessAdvisors.com, the “Health Dictionary Series” will contain more than 50,000 items upon completion in 2010; to be updated periodically thereafter. Three dictionaries have been released, to date 

For All Medical Specialties

Physicians, dentists, medical practitioners and allied healthcare professionals; clinic, practice and hospital administrators, managers and executives; nurses, business, graduate and medical school students; benefits managers, TPAs, HMOs and payers; financial planners, accountants, insurance agents and IT consultants; government officials, policy and decision makers, and all savvy patient consumers will find a wealth of information in these 4 volumes.

An iMBA Wiki Project

Your contributions are invited as a modern health 2.0 initiative.

Assessment

The series has even been electronically coupled as an interactive Wiki-like Collaborative Lexicon Submission Service; or social network to maintain continuous subject-matter expertise and peer-reviewed user input. And so, you too are invited to submit terms and join us.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Market Driven Healthcare

Keep Practicing Medicine

By Dr. David Edward Marcinko; MBA, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™biz-book2

In the second edition our book, the Business of Medical Practice, we cite Regina E. Herzlinger, PhD, the Nancy R. McPherson professor of business administration and chair at Harvard Business School, and mother of a physician-daughter. Regina was a guest lecturer at Piedmont Hospital, here in Atlanta, GA last year, as we were fortunate to heed her advice decades ago.

Herzlinger Speaks

In her musings, Regina opines that there is little wonder that some physicians become depressed and want to give up their careers entirely when pondering the future of medicine, managed care and related compensation issues?

Healthcare Update

In fact, the newest Medicare Trustees Report projects a 4.7% reduction in physician reimbursements in 2009 and 37% in cumulative cuts over the next nine years. It notes that each year for the next decade will feature a roughly 5% cut in doctors’ pay – unless Congress steps in – while the costs to physicians of providing care increase by more than 2%. Trustees also noted that spending on Medicare Part B continues to rise at alarming levels and puts growing strain on beneficiary and government pocketbooks.

In response, the Bush administration repeated its call for nearly $36 billion in Medicare reductions over five years to hospitals and non-physicians, and pushed again for a physician quality reporting program that would lead to reimbursements based on individual performance against predetermined standards. What path the new Obama Administration will pursue is still not known?

Market Driven Healthcare

Nevertheless, Herzlinger implores in her book, Market Driven Healthcare, “don’t give up practice, yet.” Pragmatically, the future is bright and offers great opportunity to early adaptors who have the foresight to change medicine for the better and be handsomely compensated, too! But, physicians’ inability to deal with competitive market forces is well known and many are loath to deal with them.

Assessmentcmp-logo4

And so, one way is to seek a strategic competitive advantage is with additional education through a traditional Master’s Degree in Business Administration (MBA); or a new-wave online distance-education resource like the Certified Medical Planner program in health economics and medical management for financial advisors and healthcare consultants (CMP™). Tuition, textbooks and fees may be tax deductible. In this way, doctors may maintain their place as salary and compensation leaders in the U.S. labor force www.CertifiedMedicalPlanner.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Non-Profit Hospital Accountability

Raising the Ethical Bar

Staff Reportersred-cross3

According to the Wall Street Journal, December 18 2008, Senator Charles Grassley – ranking Republican on the Senate Finance Committee – is weighing proposing legislation in early 2009 that would hold nonprofit hospitals more accountable for the billions of dollars in annual tax exemptions they enjoy.

Minimal Levels of Care Sought

The legislation would require non-profit hospitals to spend a minimum amount on charity care, and set curbs on executive compensation and conflicts of interest. Disclosure requirements would also be increased.

Assessment

Under the new legislation, penalties would be imposed on nonprofit hospitals that fail to meet the new requirements, while penalties could escalate from taxes and fines to stripping a hospital of its federal-tax exemption if it continues to misbehave.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Medical Tourism and Values Based Health Insurance

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Two Emerging Medical Business Models

[By Dr. David Edward Marcinko; MBA, CMP™]dr-david-marcinko10

Last year, nurse-executive Hope Hetico; RN, MHA from www.MedicalBusinessAdvisors.com and I wrote a chapter on physician compensation for the book Practicing Medicine in the 21st Century. The book was edited by David B. Nash; MD, MBA of Jefferson Medical College, in Philadelphia. One of us [DEM] attended medical school at Temple University, so David clearly does not hold a grudge against us. Nevertheless, in the publication, we identified these two emerging trends that have grown even stronger with the passage of time:

Values Based Health Insurance Model

According to Mark Fendrick, MD and Michael E. Chernew, PhD, instead of the one size fits all approach of traditional health insurance, a “clinically-sensitive” cost-sharing system that supports co-payments related to evidence-based value for targeted patients seems plausible.

In this model, out-of-pocket costs are based on price and a cost/quality tradeoff in clinical circumstances: low co-payments for interventions of highest value, and higher co-payments for interventions with little proven health benefit. Smarter benefit packages are designed to combine disease management with cost sharing to address spending growth.

Medical Tourism and the Global Healthcare Model

American businesses are extending their cost-cutting initiatives to include offshore employee medical benefits, and facilities like the Bumrungrad Hospital in Bangkok Thailand (cosmetic surgery), and the Apollo Hospital in New Delhi India (cardiac and orthopedic surgery) which are premier examples for surgical care. Both are internationally recognized institutions that resemble five-star hotels equipped with the latest medical technology. Countries such as Finland, England and Canada are also catering to the English-speaking crowd, while dentistry is especially popular in Mexico and Costa Rica.

Although this is still considered “medical tourism,” Mercer Health and Benefits was recently retained by three Fortune 500 companies interested in contracting with offshore hospitals and JCAHO has accredited 88 foreign hospitals through a joint international commission. To be sure, when India can discount costs up to 80%, the effects on domestic hospital reimbursement and physician compensation may be assumed to increase downward compensation pressures.

Assessment

Another commentator on this topic is hospitalist Robert Wachter, MD; a blogger at Wachter’s World.

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Conclusion

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UnitedHealth Group Shenanigans

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Ingenix’s Lack of Independence Cited

[By Dr. David Edward Marcinko; MBA]

dem2

According to Melissa Dahl, Jeff Rossen and Robert Powell of msnbc.com on Jan. 13th, 2009, UnitedHealth Group agreed to pay $50 million in a settlement after being accused of over charging millions of Americans for health care.

The Investigation

An investigation was launched after receiving hundreds of complaints about Oxford Insurance and its parent company, which claims to rely on “independent research from across the health care industry” to determine reimbursement rates.

Faux Independence

In actuality though, it relies on the well known firm, Ingenix, a research arm owned by UnitedHealth Group. The allegations are that Ingenix has been manipulating the numbers so insurance companies pay less.

Other Insurers under Investigation

Although UnitedHealth Group and Oxford Insurance were the only entities investigated, other major insurers use Ingenix, including Aetna, CIGNA and WellPoint/Empire BlueCross BlueShield.

CEO Bill McGuire

The $50 million UnitedHealth Group will pay as the settlement will be used to create a nonprofit organization that will determine reimbursement rates for patients. William W. McGuire MD was the CEO of United from 1992 until his ignominious resignation in 2006, because of his involvement in an employee stock options scandal. Hence, rise of the insider moniker; “Useless Healthcare.”

Assessment

According to blogger Robert Laszewski,

“The big losers here are the docs. The result is going to be about the same and their medical societies will now have less reason to challenge the customary and reasonable system than they did before.”

As a medical practitioner, I eschewed contracts with this company a decade ago. Relative to peers, I was never so happy! Some companies just can’t seem to learn, or change their culture. But, the more important question to ask: is this indicative of an isolated rogue company, or the entire health insurance industry?

Conclusion

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Hospice Care Flourishing

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Varying Program Types

[By Dr. David Edward Marcinko; MBA, CPHQ™, CMP™]

[By Thomas A. Muldowney; MSFS, CLU, ChFC, CFP®, CMP™]

[By Hope Rachel Hetico; RN, MHA, CPHQ™, CMP™]dhimc-book3

According to the “Dictionary of Health Insurance and Managed Care”, hospices offer custodial and health care for terminally ill people with six months or so, to live. 

In and Out-patient Programs Available

While most hospice care can be provided at the patient’s home, there are inpatient care programs at some nursing homes depending on the circumstances of the patient. Hospice services are palliative and supportive.

Payment

Hospices are usually paid by Medicare or Medicaid.

Assessment

35.5% of Patients Receiving Hospice Care in The U.S. Stayed Less Than 7 Days.‏

Conclusion

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Weighted Role of Commercial Health Insurance

Understanding Disproportional Influence

By Dr. David Edward Marcinko; MBA,

ho-journal4Most domestic health care is paid for by some type of insurance, whether private or governmental. Most private health insurance is purchased through employers who, to a great degree, make most of the buying decisions. Employer coalitions have emerged but, in general, most command leverage on price rather than quality or value. This often leaves healthcare providers as the only advocates for the quality, choice and access concerns of consumers.

Business Impact

According to Robert James Cimasi, writing and opining in the print journal: Healthcare Organizations [Financial Management Strateges] www.HealthCareFinancials.com, despite the fact that businesses bear less of the total U.S. healthcare premium dollar (approximately 25%) than government or individuals; corporate buyers and their coalitions and associations have asserted substantial, if disproportionate, influence over healthcare companies.

Best Community Interest Debate

Whether or not this is necessarily always in the best interests of consumers or the community at large is a matter of heated debate. What is generally acknowledged is that the relative bargaining position of buyers and providers in a given market has a dramatic impact on healthcare provider financial performance.

Healthcare is Different

Much like F. Scott Fitzgerald’s different-rich; keep in mind that healthcare differs in several respects from other industry sectors, in that:

  • There is more than one class of buyers: there are patients, families (proxies), insurance companies, and employers, each with different objectives.
  • The single largest payer, the government, both dictates a large portion of the healthcare pricing structure and strongly influences the rest.
  • There is a crucial divide or (“disconnect”) between consumer and payer.
  • A lack of information regarding consumer needs and quality of providers impedes the purchasers of health insurance from selecting the optimal plan.

Assessment

Of course, the impact of the Obama administration on this topic has yet to be seen. 

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is this commercial influence on health insurance good or bad; please share your experiences with us.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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About the DocSite Registry

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A Health 2.0 Information Technology Reality

By Staff Reportersstk127239rke

[What is DocSite?]

According to the website, www.DocSite.com is comprised of a passionate group of employees and customers focused on making better patient care easier for physicians across all specialties, and helping them get paid for the quantity and quality of care delivered. Physicians want to use Health IT, but rightly demand their investment be easy to use, provide immediate benefit to their patients and practice, and be affordable.

By Physicians, For Physicians

John Haughton MD, MS started working in Health IT twenty years ago as a young physician, but soon became frustrated with expensive and complex software applications delivering clinical value only after years of implementation. In 1997, he began developing an online patient registry to help physicians realize the value of using simple information technology to enhance their delivery of quality patient care.

The Creation

Encouragement from customers and colleagues led Dr. Haughton to form DocSite and create an affordable suite of tools usable by all physicians. Simple and affordable, the tools provide immediate clinical value, save time and improve care.

The Team

Today the DocSite team is a group of highly dedicated people who believe in “doing good while doing well”. They believe in their mission and understand the challenges customers face. Healthcare needs to work better and they are proud to be part of the solution.

New CMS Certification

According to the Pennsylvania State eHealth Initiative, December 9, 2008, DocSite just received CMS certification for its alternative Physician Quality Reporting Initiative [PQRI] reporting method program that allows Medicare participating physicians to qualify for a 1.5 percent Medicare fee-for-service bonus in 2008 by completing and submitting as few as 30 simple preventive care surveys through the DocSite registry.

Select Discounts Available

In a letter to members of the Pennsylvania State eHealth Initiative, Board Chairman Martin J. Ciccocioppo noted that DocSite – a PAeHI member organization – is offering this online reporting tool/program nationwide for $350 per submitting physician. DocSite has agreed to offer all Pennsylvania practicing physicians a 45 percent discount off of their normal $350 price. This drives the cost of participation down to $192.50 per submitting physician and represents the lowest negotiated price discount offered by DocSite for this service. Physicians only have until the end of this calendar year to take advantage of the 2008 1.5 percent CMS PQRI bonus opportunity.

Assessment

Making care easier, faster and better has not always been the foremost business problem in healthcare to solve. Effective Health IT solutions that truly improve care and save time must take into consideration patient safety, aging population, available broadband and continued healthcare financial pressure, along with the realization that physicians are healthcare experts not “computer-jocks” come together to demand effective solutions that truly improve care and save time.

Can a regional or national roll-out of the DocSite registry be imminent? Contact them for more info and feel free to report back to us.

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Conclusion

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Public Healthcare Cost-Shifting

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Joint Study Results

[By Staff Reporters]

The American Hospital Association, Blue Cross / Blue Shield Association, Premera Blue Cross and America’s Health Insurance Plans recently released a study on public and private health insurance payment rates prepared by the actuarial firm Milliman, Inc.

Findings-in-Brief

  • Hospitals lost $30 billion on Medicare and Medicaid
  • Hospitals earn $66 billion on commercial business
  • Hospitals lost $13 billion on uninsured patients

Privates Employers Hit

Private sector employers, employees and their families pay about 10-11% more than they would otherwise pay for health insurance – to fund the operating deficits created by Medicare and Medicaid.

Assessment

Specifically, Milliman indicated cost shifting is worth a $51 billion differential in hospital payments, and a $40 billion differential in payments to physicians.

Full report: http://www.ahip.org/content/default.aspx?docid=25216

Conclusion

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Superannuation Demographics and LTCI

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“PAYING TO AGE”

  • By Dr. David Edward Marcinko; MBA, MEd CMP™
  • By Thomas A. Muldowney; MSFS, CLU, ChFC, CFP®, AIF®, CMP™
  • By Hope Rachel Hetico; RN, MHA, CPHQ™, CMP™ 

According to the US Bureau of the Census, there were almost 49 million people in the United States who were over age 60 in 2001. There are approximately 4,000,000 people over the age of 85 living in the US and there are over 60,000 people older than age 100 estimated as of July 1st 2004. For every 100 middle aged people in the US there at present about 114 persons over the age of 65. This statistic will change as we move forward through time. In the year 2025, there will be about 253 people over age 65 for every 100 middle aged people. Today, there are more than 55 million over age 60.

The Ticking Clock

Beginning on January 1st, 2006 at midnight and every 12 seconds thereafter for fifteen years, a baby boomer will have a birthday and cross over the age threshold of age 60. In the next 30 years, the 60+ age group will more than double, becoming 25 percent of the total population, and will have to be supported by a proportionately smaller workforce.  Research published in June 2005 by AARP (based on data from 2002) estimates that: “In 2002, roughly $140 Billion was spent on nursing home and home health care, with 24% of these costs being paid out of pocket (O’Brien and Elias, 2004)

Baby Boomers

As the baby boom generation ages, their care needs will expand precipitously. Add to this, scientific and technological improvements in healthcare. These very same people will need more expensive healthcare, more expensive custodial care and they will need it for an even longer period of time. Who will pay for this expanded need is not so clear. What is clear is that it will take money and lots of it to make these payments.

Financial Variables

There are only three variables associated with the accumulation or preservation of money:  “Time, Money and Rate of Return.”  Time is reduced to the following two questions “How long until I will need my money?” and “How long will I live?” an uncertainty to be sure.  Rate of return is either a function of the financial markets or the successful maintenance of an LTC plan. Because of the volatility in the financial markets, the “money” question is equally as uncertain.  In order to accumulate sufficient assets a client must ‘tradeoff’ many other alternatives such as ‘lifestyle.”

Assessment

What is certain is this…financial planning is important.  More important is the implementation or funding of an accumulation strategy or a Long-Term-Care [LTC] investment strategy to overcome these hurdles.

Conclusion

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MedPAC Seeks Rate Increase

Update for 2010

Staff Reporters

According to Modern Healthcare, December 5, 2008, the Medicare Payment Advisory Commission [MedPAC] just drafted recommendations to increase payment rates for inpatient and outpatient services at the full rate of inflation in 2010, concurrent with the implementation of a quality incentives program.

A Non-Specific Market Basket

Although the draft didn’t provide a specific increase for hospitals, the projected market-basket update in 2010 for hospitals is 2.7 percent. MedPAC revisited a proposal it has been trying to get Congress to approve for the past several years: to reduce the indirect medical education (IME) adjustment by 1 percentage point to help finance the quality incentives program for hospitals.

Related Payment Issues

On other payment issues, the commission mulled over a draft recommendation to increase Medicare physician payments by 1.1 percent in 2010, the same increase doctors will receive in 2009, while commissioners also discussed options to make positive payment updates for ambulatory surgery centers contingent upon the submission of cost data to HHS.

Assessment

The draft recommendations will be voted on in January, 2009.

Conclusion

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Long-Term Versus Custodial Healthcare

Understanding the Domestic Model of Medical Care

By Dr. David Edward Marcinko; MBA, CMP™

By Thomas A. Muldowney; MSFS, CLU, ChFC, CFP®, AIF®, CMP™

By Hope Rachel Hetico; RN, MHA, CPHQ™, CMP™

cloudy-mtn-auto-bahn

Doctors, nurses, economists, insurance consultants and financial advisors [FAs] increasingly make a distinction between “healthcare” and “custodial care.” Too often for patients however, health and custodial services are combined and confusingly referred to as health services. The problem with this is that people often focus only on health problems and not on the serious long-term physical and financial consequences associated with these different conditions.

US Model of Care

The US medical model tries to have patients “get well” soon. Typical medical services are often “medically necessary”; short term; acute; and may include hospital stays, major operations, some skilled care to recuperate and other ongoing skilled treatment, and medications.

Dementia and Impaired Cognition

In contrast, many elder health problems are incurable and chronic. These conditions require custodial care. Seniors who have chronic or disabling conditions need full-time live-in assistance, instead of the standard short visits by care providers.

For example, today in the United States, there are about 4 million people with Alzheimer’s or other dementia who are suffering from what is referred to as cognitive impairment. Cognitive impairment is one of the major risks of aging and a source of concern for many seniors. Other conditions that limit a senior’s ability to perform activities of daily living (ADLs) include accidents, blindness, cancer, diabetes, dialysis, emphysema, heart disease, osteoporosis, Parkinson’s disease, rheumatism, strokes, or a combination of these conditions.

Assessment

The gerontologists and hospitalists were perhaps the first medical professionals to appreciate this distinction; years ago.  Nevertheless,people with these conditions may need many years of LTC services.

Conclusion

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Hospital Length-of-Stay Forecasting

An Often Inaccurate Medical Effectiveness Meter

Staff Reporters

According to Gregory O. Ginn; PhD, CPA, MBA, MS, and Assistant Professor in the Department of Healthcare Policy and Administration from UNLV, substantial day-to-day variation in hospital occupancy may lead to increases in costs.

Forecast Accuracy

Accordingly, hospitals may be able to improve their financial efficiency by preparing more accurate forecasts of stay length, and thus of their utilization of capacity. For instance, the accuracy of predicted length of stay can be improved by using multiple-regression. The patient’s characteristics (age, gender, ethnicity, marital status, admission type, and admission source) and clinical indicators for their diagnosis-related groups [DRGs] are significant predictors of length-of- stay [LOS].

Assessment

The effectiveness of medical interventions is often measured by length-of-stay. However, this is a crude measure that is contaminated by the inclusion of all days in the hospital even if they were not preceded by some type of intervention.

More info: www.HealthcareFinancials.com

Conclusion

Other experts suggest an approach that views only the slice of time after a medical intervention to measure the effect of the intervention on LOS. This may be a more precise method that can improve the accuracy of forecasting. What do you think?

As always, your thoughts and comments on this Executive-Post are appreciated.

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Dueling Universal Health Coverage Proposals

Obama and AHIP Race to the Finish Line

starting-line

According to the WashingtonPost.com, on December 6, President elect Barack Obama is inviting Americans to spend part of the holiday season talking about health care – in informal ad hoc meetings around the country called Health Care Community Discussions – to be held between December 15 and 31. And, then report the results back to him. HHS Secretary Elect Thomas A. Daschle will prepare a detailed report, complete with video, to present to the next president.

But, according to the Wall Street Journal, December 4, 2008, the AHIP – a trade group for health insurers – is already offering its own universal coverage proposal that calls for Congress to slow the growth of health care costs by 30 percent in five years, envisioning a total savings of more than $500 billion.

Health Spending [16% GDP]

In 2006, health spending in the U.S. reached $2.1 trillion, consuming 16 percent of the nation’s gross domestic product, according to economists at the federal Centers for Medicare and Medicaid Services [CMS].

The AHIP Proposal

In the insurer’s proposal, money could be used to fund coverage of the uninsured and to cut costs for those with insurance. Officials from America’s Health Insurance Plans [AHIP] called on Congress to establish a public-private advisory group to recommend action in three areas:

  • reducing wasteful spending,
  • changing how doctors and hospitals are paid,
  • and reducing administrative costs.

The AHIP reiterated its position that insurers would be required to offer individual policies to people with pre-existing illnesses; as long as all Americans were required to have health insurance.

Assessment

Obama, by applying the high-tech tools and grass-roots activism that helped him win the White House, hopes to circumvent many of the special interests groups that squelched previous health-care reform efforts. And, in yet another indication of the growing interest in health legislation, Sen. Edward M. Kennedy just announced that he will give up his seat on the Judiciary Committee to focus on health care.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How do physicians, medical executives, advisors, employers, payers and patients differ on this issue?  Is there really a race, at all? Tell Obama here:

http://change.gov/page/s/healthcare

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Domestic Economy Sickens Hospitals

AHA Reports Negative Financial-Operating News

Staff Reporters

Many hospitals are seeing the effects of the economic downturn. More than 30% of respondents to a recent American Hospital Association [AHA] survey reported a significant decline in patients seeking elective care and 40% reporting a drop in admissions overall. The majority of hospitals also noted an increase in patients unable to pay for care.

DATABANK Results

The report is based on survey results from 736 hospitals and information from DATABANK, a Web-based reporting system used in 30 states to track key hospital trends:  

  • Falling profit margins to [-] 1.6% – from [+] 6.1% year-over-year
  • Medicare and Medicaid patient care is growing
  • Reducing administrative costs (60%), staff (53%) and services (27%)
  • Borrowing for facility and technology improvements has decreased

Capital investments are also being postponed or delayed:

  • 56% delayed plans to increase capacity;
  • 45% delayed purchase of clinical technology or equipment; and
  • 39% delayed investments in new information technology.

Assessment

The report was based on data from two major sources. A survey, “The Economic Crisis: Impact on Hospitals,” provides data from 736 hospitals from late October 2008 through Nov. 10, 2008.  DATABANK figures represent early results from 557 hospitals reporting data for July through September 2007 and 2008 as of Nov. 11, 2008.

Conclusion

And so, your thoughts and comments on this Executive-Post are appreciated. How [much] has the economy affected your healthcare organization?

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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2009 Physician Fee Schedule

CMS Issues Final Rule

Staff Reporters

coinsAccording to the American Medical News on November 24, legislation enacted in July reversed a 10.6 percent cut that took effect at the beginning of that month, while starting in January 2009, a 1.1 percent across-the-board increase will replace an additional roughly 5 percent cut that would have gone into effect if lawmakers had not acted.

Bonus Opportunities

Because the rule applies payment changes related to the most recent five-year adjustment in Medicare relative values for certain services, some physician specialties might see updates slightly larger than or smaller than 1.1 percent. But, CMS stressed that two bonus opportunities exist to more than quadruple the raise that doctors will get for the year.

Example:

For example, physicians who successfully participate in the Physician Quality Reporting Initiative [PQRI] will receive a 2 percent bonus on all of their Medicare payments for the year, while the program for the first time will award a separate 2 percent bonus to physicians who successfully prescribe medications electronically for their Medicare patients.

Assessment

Although the sums will not be paid out until sometime in 2010, after Medicare has processed all of next year’s claims, this means the maximum effective raise for 2009 will be 5.1 percent.

Conclusion

What do you think about this fee increase? Your thoughts and comments on this Executive-Post are appreciated.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Obama and Health IT

Works Progress Administration

capital

By Darrell K. Pruitt; DDS

In an article posted on www.ModernHealthcare.com HITS staff writer Matthew DoBias writes: 

 

“President-elect Barack Obama said that his economic recovery plan to create 2.5 million new jobs in part will rely on ‘technology and healthcare modernization,’ a nod toward increasing the use of health information technology among physicians and hospitals as well as the trained staff who will be needed to run it.”

http://www.modernhealthcare.com/article/20081126/REG/311269965

Economic Recovery

The title of the article is “Obama links healthcare reform to economic recovery.”

http://www.modernhealthcare.com/article/20081126/REG/311269965

More Expenses

I was afraid that this would happen. It looks like American citizens are going to help pay for economic recovery through the additional medical expenses necessary for trained healthcare IT staff.  I guess it is still a far better plan for getting us out of a depression than a world war.

As a healthcare provider who has many patients who will go without dental care if I raise my fees to cover the cost of healthcare IT, plus the additional costs of HIPAA compliance, doesn’t that make Obama’s plans counter to the Hippocratic Oath?  Don’t forget the indisputable fact that electronic dental records are more likely to cause dental patients harm than good.

Assessment

Obama scares me. When a customer enters my place of business, they want to pay for safe dentistry, not mandated, busy work jobs carrying tremendous liability that are designed to stimulate the economy.

Conclusion

And so, your thoughts and comments on this Executive-Post are appreciated.

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Medicare Payment Reform for 2009-2017

AMA House of Delegates Push for SGR Changes

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[Staff Reporters]

According to the American Medical News, November 24, 2008, the AMA House of Delegates is setting the groundwork for a major push to reform Medicare physician payment next year.

AMA Lobby

The AMA will continue to lobby Congress for changes in the sustainable growth rate [SGR] formula to better reflect practice costs, to improve the accuracy of the index that gauges increases in those costs and to investigate geographic pay disparities; among other issues.

AMA Council on Medical Service

The AMA Council on Medical Service also requested physician input on payment systems that could replace or improve the current one. These newer compensation models might include:

  • bundled payments, under which physicians are paid flat rates per episode of care, rather than per service;
  • gainsharing, under which hospitals and doctors agree to share incentive pay and savings from quality improvement;
  • medical homes, under which doctors are paid for coordinating care; and,
  • pay-for-performance, under which doctors are paid based on quality measures.

Assessment

To date, it is unclear which new compensation model[s] will prevail; if any?

Conclusion

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Hospitalist Model Outcomes Study

The Human Resource Management Report

Staff Reporters

people_top

 

According to a study published in Human Resource Management, hospitals that employ the hospitalist model-of-care delivered better patient outcomes.

The Study

The study explored the differences between hospitalists and traditional models of care, measuring performance outcomes in more than 6,000 cases at Newton-Wellesley Hospital in Massachusetts between July 2001 and July 2003. At the time of the study, hospitalists treated approximately one-third of the hospital’s patients, and private practice physicians treated the remaining two-thirds.

The Results

Compared to the traditional approach, researchers found that the hospitalist model:

  • Decreased the length of patient stay by about half a day and reduced costs to the hospital by $655 per patient;
  • Reduced the risk of re-admission by 41.8 percent, a key measure of quality performance in hospitals;
  • Improved coordination of care 13.2% by increasing the strength of relationships between physicians and other members of the care provider team.

Assessment

The study was reported in the Society of Hospital Medicine, on November 17, 2008

Conclusion

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Physician Advisors: www.CertifiedMedicalPlanner.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Mercer Study Says CDHPs Rising

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HSA / HRA Offerings Jump at Large Employers*

[By Staff Reporters] 

 

2005

2006

2007

2008

Very likely to offer in 2009

Small Employers (10-499 employees)

2%

5%

7%

9%

14%

Large Employers (500 or more employees)

5%

11%

14%

20%

25%

Jumbo Employers (20,000 or more employees)

22%

37%

41%

45%

45%

*Based on either a health savings account or health reimbursement arrangement.

Source: Mercer 2008 National Survey of Employer-Sponsored Health Plans.  www.mercer.com

Conclusion

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Dental eHR Controversy Continues

Response to Valerie Powell, PhDpruitt2

By Darrell K. Pruitt; DDS

Dear Valerie, 

This is a response to statements in www.ModernHealthcare.com, although to address all of the issues will probably be more space than they will want to devote to this. So, I’ll leave it to them to decide how much, if any, they would like to post.

Starting from the Top

Valerie Powell asks whether a dentist would face liability under HIPAA if electronic health data were stolen. Of course they would.  And in six months the FTC will be interested in data breaches as well. The “Red Flag Rules” were not eliminated, they were just delayed.

Practice Interference 

She asks whether the thefts would interfere with the dentist’s practice. Yes again – in many unpleasant ways. For example, if there is a data breach connected to a series of identity thefts from a dental office, the HHS Office of Civil Rights, state investigators or even the FBI can confiscate the dentist’s computer to investigate.  A search warrant would shut down an office much more unexpectedly than paper floating away in a hurricane.  By the way, using Hurricane Katrina as a reason for dentists to go digital is merely a weak rationalization commonly used by those who would de-value paper records to increase the relative value of digital.    

Self-Reporting 

If the dentist is able to self-report the breach before finding out from law officials, even before the inspectors arrive, ready to teach the careless dentist a good lesson as an example to others, the dentist would be obligated to contact every one of his or her patients as soon as possible to tell them, “I am terribly sorry to inform you that your social security number, date of birth, health insurance information and other valuable items have been stolen from my office.  However, I will assist you in watching for identity thefts for the next few years at my expense.”

The Ponemon Institute Report 

A couple of years ago, the Ponemon Institute estimated that it costs almost $200 per patient to do this.  For a small dental practice with only 2500 active patients, that is half a million dollars – even before the fines arrive.

Economic Costs 

But wait, there is more. If the immediate financial costs do not bankrupt the practice, Ponemon once estimated that 20% of the clients will never return to a business that fumbled their identity. I think Ponemon is an optimist. Ponemon’s estimate is not based on breaches from dental practices. I think at least a third of dental patients would immediately leave and probably seek out a dentist who uses paper records. And that is when they will find me.

Conclusion

And so, your thoughts and comments on this Executive-Post, and continuing discourse, are appreciated.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Pondering the Health Insurance Overhaul

Mandates Include All Patients and Pre-Existing Conditions

Staff Reporters

According to the New York Times, November 20, 2008, the health insurance industry would support a health care overhaul requiring insurers to accept all customers, regardless of illness or disability, if Congress requires all Americans to have coverage.  

Industry Trade Groups

In separate actions, the two trade groups, America’s Health Insurance Plans and the Blue Cross and Blue Shield Association, announced their support for guaranteed coverage for people with pre-existing medical conditions, in conjunction with an enforceable mandate for individual coverage.

Assessment

In the absence of such a mandate, insurers said, many people will wait until they become sick before they buy insurance. Members of Congress said that they wanted to pass legislation next year to expand coverage and rein in health care costs, while the new position taken by the insurance industry could ease the way for passage of such legislation.

View Video [“Future of American Healthcare” by Uwe Reinhardt; PhD]: http://vodpod.com/watch/852139-uwe-reinhardt-future-of-american-healthcare-who-will-manage-the-system?pod=drdemmba

Conclusion

As always, your thoughts and comments on this Executive-Post are appreciated.

Related Information Sources:

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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The National Health Care-Scare

The Markets and Health Economics

By Dr. David Edward Marcinko; MBA, CMP™

marcinko

As a centrist fiscal conservative – social liberal – I tend to side with libertarian issues and not political parties. Nevertheless, I was dismayed with the recent presidential election and wondered what impact it would have on the stock markets. Mr. Market replied with haste.

The Question 

In the short term, the stock market collapsed back in September when most pundits opined that President-elect Barack Obama would become our new leader. In fact, the DOW has not seen its current lows since 1998, or so.

More specifically, according to one analyst from Wall Street – Paul Shread – “the Dowshould have strong support between here and 7000, which would cover the 1998 and 2002-2003 lows (7200-7400), the 50% decline mark (7100) and the October 1997 low (6971). This would be a very important place for the market to make a stand.” But other chartists see the markets falling even further, with the S&P dropping as low as 400. Why is this?

The Answer is Uncertainty, Doubt and Fear

While the mounting credit default swap and mortgage crisis has had a major role in sinking stocks, some speculators worry that Obama will follow through on promises to raise income taxes on dividends and capital gains; eliminate the estate tax exemption, rescue the auto-industry and  the: airlines, home builders, furniture, footgear and apparels, textiles, glassware, tobacco, beer brewers and perhaps a few others, and generally make it difficult for private employers to resist unionizing drives. In other words – there is a rising level of fear, doubt and uncertainty over the seeming potential of Keynesianism and governmental guarantees and protectionism – rather than the opportunities of capitalism. All disguised in the “cloak of change”.

Enter the Politicians

Some economists – tax and policy experts – fear that if Obama, Speaker Nancy Pelosi and Senate Majority Leader Harry Reid bailout these manufacturing segments instead of filing for Chapter 11, the country may face a very long recession. Just look to Japan some two decades ago, when the country bailed out its failing banks and corporations instead of letting them fall so that innovative competitors could take their place.

According to Niall Ferguson, a scholar who has studied the relationship between political, banking and financial fortunes –”you can stick money into every orifice of the big banks — their mouth, their nose, their ears, wherever — but if they can’t make loans because they have to reserve against future losses, and if they won’t make loans because there’s a recession, it won’t do any good,” Ferguson says. “If they can’t lend, there’s no money multiplier — they’re stuck, they’re zombies. It’s Japan all over again.” And, some ghoulish traders are indeed hoping for a deep recession. Today, Japan is still in worse shape than we are.

Phoenix Rising

Following such a debacle, the failed companies might then re-organize with some of their current workers under revamped union contracts. Reorganization, new labor contracts and new employee and retiree health benefit plans would make them competitive and profitable after emerging from bankruptcy; much like the proverbial Phoenix.

National Health Insurance, et al

Our physician clients and investors also are also worried that if national health insurance becomes a reality, defense spending is reduced and/or onerous regulations imposed on the surviving banks and Wall Street, the economy will be in for ride rougher than the one we have experienced to-date. No wonder a recent poll suggested that more than half of all doctors did not encourage their offspring to follow their career footsteps.

Other pressing issues for the medical profession, according to the HealthCare Group – Co-Chaired by Angela Braly of Wellpoint Inc., Dr. Denis Cortese of the Mayo Clinic, Jeffrey Kindler from Pfizer Inc., and Dr. Daniel Vasella from Novartis AG – include tort reform,defining and measuring medical value, payment reform, and building the health care workforce of the future with an emphasis on primary care, nursing and other allied health professionals. Moreover, true healthcare reform must involve integrating issues like Single Payer Systems, Consumer Directed Health Plans, Pharmaceutical Price Competition, Advanced Electronic Medical Records, and Quality & Outcomes Disclosure, etc.

The Obama Cabinet

President-elect Obama’s staff and cabinet appointments will also offer important clues for the markets, going forward. In addition to Rahm Emanuel, as the President-elect’s Chief of Staff, hearsay suggests Laura Tyson or Bill Richardson for Secretary of Commerce, Hillary Clinton as Secretary of State and Timothy Geithner as Treasury Secretary. Other considerations include Renee Glover for Secretary of Housing and Urban Development [HUD], Max Cleland as Secretary for Veteran’s Affairs, Janet Napolitano for Homeland Security, Jim Jones as National Security Advisor; and Richard Danzig and/or Chuck Hagel for other Cabinet Posts. Yet, Tom Daschle as Secretary of HHS is not exactly an “agent of change”, as the term is commonly understood.

Assessment

As the world’s markets sink, the pressure on our new administration will be to clarify these issues. Only then, will a stock market bottom be reached, and the dismal economy begins to reverse itself. Hopefully, the health care-scare will then be mitigated.

Conclusion

Your thoughts and comments on this Medical Executive-Post are appreciated.

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 

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Medicaid MD Acceptance Slows

Delayed Reimbursements Cited as Root Cause

Staff Reporters

According to the Wall Street Journal, November 18, 2008, fewer doctors are accepting Medicaid patients. And, it’s not just because fees are so low – but because it often takes months to get paid.

Health Affairs Analysis

An analysis by the Center for Studying Health System Change says Byzantine bureaucracies can delay Medicaid payments for months. Using data provided by Athenahealth, a specialist in processing claims and payments for doctors, researchers at the Center for Studying Health System Change found that even in states with relatively high Medicaid payments yet long delays, only 50 percent of doctors took all new Medicaid patients.

Assessment

By contrast, in states with higher and speedier payments, doctor participation was 64 percent. Variations in payment delays varied wildly state to state – from a low of 37 days in Kansas to a high of 115 days in Pennsylvania.

Conclusion

What do you think is the reason for the Medicaid patient slowdown; delayed cash-flow or some other cause? As always, your thoughts and comments on this Executive-Post are appreciated

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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The Healthcare Capital Budgeting Crisis

Your Vote Counts 

Staff Reporters

Did you know that South Carolina’s Department of Health and Environmental Control [SCDHEC] will likely close some of its rural health clinics due to the state’s budget woes? It’s true; according to reports from The State of Columbia, SC. Moreover, the SCDHEC would also offer early retirement to its employees.

Hospital Bankruptcies

On another front, hospitals filing bankruptcy last quarter included: a two-hospital system in Honolulu; one in Pontiac, MI; Trinity Hospital in Erin, Tennessee; Century City Doctors Hospital in Beverly Hills, Lincoln Park Hospital in Chicago, and four hospital system Hospital Partners of America, in Charlotte. 

Private Medical Practice Impact

And, according to consultants from the Institute of Medical Business Advisors, in Atlanta [www.MedicalBusinessAdvisors.com], similar negative impacts have occurred in private medical practices, and clinics, as well.

Assessment

Will the current economic crisis have a chilling effect on your healthcare organization’s capital spending?

Conclusion

Please vote.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com or Bio: http://www.medicalbusinessadvisors.com/marcinkobio.asp and www.stpub.com/pubs/authors/MARCINKO.htm

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Consumer-Driven Healthcare

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An Emerging Trend Vital to Hospitals

[By Staff Reporters]

 According to Associate Professor Gregory O. Ginn; PhD, MBA, CPA, MEd., of the University of Las Vegas, an important emerging trend today is consumer-driven healthcare [CDHC] as patients become more knowledgeable and demanding about the quality of care they receive.

Definition

According to the Dictionary of Health Insurance and Managed Care, CDHC refers to health insurance plans that allow members to use personal Health Savings Accounts (HSAs), or similar medical payment products to pay routine health care expenses directly, while a high-deductible health insurance policy protects them from catastrophic medical expenses. High-deductible policies cost less, but the user pays routine medical claims using a pre-funded spending account, often with a special debit card provided by a bank or insurance plan. If the balance on this account runs out, the user then pays claims just like under a regular deductible. Users keep any unused balance or “rollover” at the end of the year to increase future balances, or to invest for future expenses.

Benefits Managers and Corporate America

Benefits managers in particular are proponents of consumer-driven healthcare. They argue that employers should focus on which plans create the most value, go with quality, get employees to pay more, and move to a defined contribution approach. The concept of consumer-driven healthcare is being implemented in employer strategies to change participant and provider strategies. This trend stimulates competition among providers based on both price and quality and forces providers to offer more information about cost and quality. Providers who successfully differentiate their strategies to respond to this trend may benefit financially.

Hospital Operations

Consumer-driven healthcare will have major ramifications for the operations management function in hospitals. In order for hospitals to compete on both price and quality, they will need to develop greater flexibility in order to differentiate their service offerings. Such flexibility is not likely to occur without sophisticated information systems that allow for data integration.

Assessment

Of course, considerable staffing and training changes may be in order to provide this type of service. 

***

hospital bills

***

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Conclusion

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State Mandated Health Insurance Laws

A Growing Listho-journal1

By Staff Reporters

State laws inform health insurers what health coverage they must offer as state mandates. For example, if a state says “behavioral health coverage,” then health insurance policies issued in that state must provide coverage for behavioral health benefits for the insured and dependents But, recall that no two states impose the same set of mandates, and coverage changes regularly. So, here is a list:

Alabama

  • Alcohol treatment
  • dependent coverage (from the moment of birth, including abnormalities)
  • mammograms
  • open selection of pharmacy

Alaska

  • Alcohol/drug treatment
  • dependent coverage (from the moment of birth, including abnormalities, and those who are adopted)
  • mammography
  • pap smears
  • prostate cancer screenings
  • phenylketonuria

Arizona

  • Dependent coverage (from the moment of birth, including those who are physically or mentally handicapped, and those who are adopted) mammography
  • outpatient care
  • home health care
  • mastectomy reconstruction
  • emergency care
  • diabetes self-management; mail-order pharmacies may not be required
  • prescription contraceptives (exceptions exist for religious employers)

California

  • Alcohol/drug/nicotine treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • lead screening for children
  • preventative care for children
  • home health care
  • infertility treatment
  • mastectomy and other reconstruction
  • diabetes self-management
  • pap smears
  • temporomandibular joint disorder
  • prosthetic devices
  • osteoporosis
  • off-label drugs
  • DES effects
  • prostate cancer screening

Colorado

  • Alcohol treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including those with abnormalities, and those who are adopted)
  • mammography
  • home health care
  • hospice care
  • maternity coverage for women
  • pregnancy complications
  • prostate cancer screenings
  • coverage may not be denied to an individual solely on the basis that the individual casually or professionally participates in skiing or snowboarding activities

Connecticut

  • Alcohol/drug treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • home health care
  • comprehensive rehabilitation
  • occupational therapy
  • long-term care
  • metabolic disorders
  • mastectomy reconstruction
  • breast implant removal
  • diabetes
  • ambulance services
  • cancer
  • accidental ingestion of controlled drugs

Delaware

  • Mental health coverage
  • dependent coverage (from the moment of birth, including abnormalities)
  • cancer screening (including Pap tests, mammograms, ovarian cancer, and prostate screenings)
  • lead screening
  • children’s immunizations

District of Columbia

  • Alcohol/drug treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including abnormalities and preventive care)
  • mammography
  • Pap tests

Florida

  • Alcohol/drug treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • second surgical opinions
  • HIV testing/infection
  • fibrocystic breast disease
  • ambulatory surgical care
  • mastectomy
  • reconstructive surgery
  • home health care
  • acupuncture
  • mammograms
  • diabetes
  • temporomandibular joint disorders
  • osteoporosis

Georgia

  • Alcohol/drug treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • pregnancy complications
  • mammography
  • Pap tests
  • bone marrow transplants
  • prostate cancer screening
  • diabetes
  • heart transplants
  • outpatient services
  • osteoporosis
  • chlamydia screening
  • pharmacy open choice

Hawaii

  • Alcohol/drug treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including abnormalities, those who are mentally or physically handicapped, and those who are adopted,)
  • maternity expenses if employee covered for past nine months
  • mammography
  • in vitro fertilization
  • contraceptive services
  • emergency services
  • telehealth

Idaho

  • Dependent coverage (from the moment of birth
  • including abnormalities
  • those who are mentally or physically handicapped, and those who are adopted)
  • if mastectomy covered so must mammography be
  • elective abortions must be excludable
  • involuntary complications of pregnancy

Illinois

  • Alcohol treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • examinations of criminal assault or abuse victims
  • infertility when maternity is covered
  • mastectomy
  • reconstructive surgery
  • nonexperimental organ transplants
  • treatment for DES children
  • blood processing
  • temporomandibular joint disorders
  • ambulance service
  • off-label cancer drugs
  • fibrocystic breast disease
  • breast implant removal
  • colorectal cancer screening
  • diabetes

Indiana

  • Dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • mastectomy reconstruction
  • diabetes self-management
  • off-label drugs
  • infant screening exams where maternity is covered
  • prostate cancer screening
  • colorectal cancer exams
  • morbid obesity
  • pervasive developmental disorders
  • mental health

Kansas

  • Alcohol/drug treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including abnormalities, and adopted children)
  • mammograms
  • Pap smears
  • emergency care

Kentucky

  • Alcohol treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including abnormalities)
  • mammography and reconstruction where mastectomy is covered
  • ambulatory surgery care
  • home health care
  • long-term care
  • bone marrow transplants
  • temporomandibular joint disorders
  • endometriosis
  • diabetes self-management
  • off-label cancer drugs
  • hearing aids and related services

Louisiana

  • Dependent coverage (from the moment of birth, including abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • Pap tests
  • ambulatory surgery care
  • immunizations for children
  • mastectomy reconstruction
  • diabetes self-management
  • prostate cancer screening
  • emergency care
  • off-label cancer drugs
  • outpatient surgery
  • use of mail-order pharmacies cannot be mandatory

Maine

  • Alcohol/drug treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including abnormalities, and those who are adopted)
  • mammography
  • home health care
  • AIDS coverage (cannot be more restrictive than for other illnesses)
  • mastectomy reconstruction
  • diabetes self-management
  • Pap tests
  • outpatient services
  • off-label cancer and HIV drugs
  • prostate cancer screening
  • breast prostheses for mastectomies
  • clinical trials
  • emergency services

Maryland

  • Alcohol/drug treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including abnormalities, and adopted children or grandchildren)
  • hospice care
  • home health care
  • child wellness
  • metabolic disorders
  • mammograms
  • infertility if maternity is covered
  • certain blood products
  • mastectomy reconstruction
  • diabetes
  • prostate cancer screenings
  • temporomandibular joint disorders
  • outpatient care
  • osteoporosis
  • pharmacy of choice
  • tuberculosis
  • off-label drugs
  • contraceptives
  • chlamydia screening
  • hospice care
  • emergency care

Massachusetts

  • Alcohol/drug treatment (only if you have more than five employees)
  • mental health coverage
  • dependent coverage (from the moment of birth, including abnormalities, and those who are adopted)
  • mammography
  • infertility treatments
  • home health care
  • pregnancy and childbirth
  • hospice care
  • ABMT (treatment for breast cancer)
  • preventive care for children
  • enteral nutrition
  • DES-related conditions
  • diabetes management
  • Pap tests
  • off-label drugs for HIV/AIDS
  • scalp hair prostheses
  • cardiac rehabilitation

Michigan

  • Dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped)
  • mastectomy reconstruction and prosthetics
  • emergency care
  • off-label cancer drugs
  • hospice care

Minnesota

  • Alcohol/drug treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • home health care
  • well-baby care
  • emergency care
  • some diabetes treatment
  • prenatal care
  • mammograms and other cancer screening
  • breast-implant-related conditions
  • reconstructive surgery
  • exposure to DES
  • phenylketonuria
  • port wine stains
  • Lyme disease
  • Pap tests
  • temporomandibular joint disorders
  • outpatient care
  • off-label cancer drugs
  • fibrocystic breast disease
  • scalp hair prostheses

Missouri

  • Alcohol/drug treatment
  • dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • preventive care for children
  • bone marrow transplants
  • reconstructive surgery after mastectomy
  • phenylketonuria
  • diabetes self-management
  • speech or hearing loss
  • elective abortions may be covered only under separate policy riders for which additional premiums are paid

Mississippi

  • Alcohol treatment
  • dependent coverage (from the moment of birth, including abnormalities and those who are physically or mentally handicapped)
  • temporomandibular joint disorders
  • open choice of pharmacy
  • off-label cancer drugs
  • mammography
  • diabetes
  • dental anesthesia

Montana

  • Alcohol/drug treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • home health care
  • inpatient care for breast surgery
  • mastectomy reconstruction
  • phenylketonuria
  • metabolic disorders
  • open choice of pharmacy

Nebraska

  • Mental health coverage
  • dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped)
  • childhood immunizations
  • mammograms
  • emergency care
  • off-label cancer and HIV/AIDS drugs
  • temporomandibular joint disorders
  • diabetes
  • abortions only to prevent death of mother
  • use of mail-order pharmacies can’t be mandatory

New Hampshire

  • Mental health coverage
  • dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted)
  • nonprescription enteral formulas
  • mammograms
  • bone marrow transplants
  • mastectomy reconstruction
  • diabetes self-management
  • certain hair-loss prostheses
  • dental anesthesia

New Jersey

  • Alcohol treatment
  • dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped)
  • mammography
  • Pap smears
  • second and third (sometimes) surgical opinions
  • reconstructive breast surgery and prostheses
  • home health care
  • blood tests
  • glaucoma tests
  • adult immunizations
  • wellness examinations
  • childhood immunizations for plans with over 49 enrollees
  • metabolic disorders
  • bone marrow transplants
  • maternity care
  • hemophilia blood products
  • diabetes self-management
  • lead poisoning screenings
  • prostate cancer screening
  • colon screening
  • open choice of pharmacy
  • off-label drugs
  • dental anesthesia

New Mexico

  • Dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • childhood immunizations
  • diabetes
  • Pap tests
  • ambulance service for childbirth

Nevada

  • Alcohol/drug treatment
  • dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • mastectomy
  • reconstructive surgery and prosthetics
  • enteral formulas and special food products ordered by a physician
  • diabetes self-management
  • Pap tests
  • temporomandibular joint disorders
  • pregnancy and childbirth

New York

  • Alcohol/drug treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped and those who are adopted)
  • mammography
  • home health care
  • preadmission tests
  • second surgical opinions
  • infertility treatment
  • preventive pediatric care
  • prescription enteral formulas
  • mastectomy reconstruction
  • maternity care
  • diabetes self-management
  • Pap tests
  • emergency care
  • nursing home care
  • hospice care
  • off-label cancer drugs

North Carolina

  • Dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted or foster children)
  • mammography
  • Pap tests
  • mastectomy reconstruction
  • diabetes self-management
  • prostate cancer screening
  • open choice of pharmacy
  • off-label cancer drugs

North Dakota

  • Alcohol/drug treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • free choice of pharmacy
  • prostate cancer screening
  • temporomandibular joint disorder
  • dental anesthesia

Ohio

  • Alcohol/drug treatment
  • dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • mammograms
  • Pap tests

Oklahoma

  • Dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • childhood immunizations
  • mastectomy reconstruction
  • diabetes
  • bone density tests
  • dental anesthesia
  • prostate surgery side effects
  • prostate cancer screenings

Nevada

  • Alcohol/drug treatment
  • dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • mastectomy
  • reconstructive surgery and prosthetics
  • enteral formulas and special food products ordered by a physician
  • diabetes self-management
  • Pap tests
  • temporomandibular joint disorders
  • pregnancy and childbirth

Pennsylvania

  • Alcohol/drug treatment
  • dependent coverage (including those who are mentally or physically handicapped)
  • annual gynecological exams and Pap smears
  • mammograms
  • mastectomy reconstruction and prosthetics
  • phenylketonuria
  • diabetes self-management

Rhode Island

  • Alcohol/drug treatment, mental health coverage, dependent coverage (including those who are adopted)
  • home health care
  • pediatric preventive care
  • mammograms
  • mastectomy reconstruction and prosthetics
  • new cancer therapies
  • diabetes
  • Pap tests
  • second surgical opinions
  • infertility treatments
  • bone marrow donor testing abortion may be covered only under a separate rider, and only if mother endangered, rape, or incest

South Carolina

  • Dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • off-label cancer drugs
  • gynecological exams
  • mammograms
  • mastectomy reconstruction
  • Pap tests
  • prostate cancer screenings
  • emergency care
  • open choice of pharmacy

South Dakota

  • Dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • phenylketonuria
  • open choice of pharmacy
  • diabetes self-management
  • emergency care

Tennessee

  • Dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • mastectomy reconstructions
  • phenylketonuria
  • diabetes
  • prostate cancer screening
  • emergency care

Texas

  • Alcohol/drug treatment
  • dependent coverage (from the moment of birth, including those with abnormalities, those who are physically or mentally handicapped, and those who are adopted)
  • coverage for AIDS (including HIV and HIV-related conditions)
  • infertility including in vitro fertilizations where pregnancy/childbirth is covered
  • childhood immunizations
  • mammograms
  • mastectomy reconstruction
  • diabetes
  • prostate cancer screening
  • temporomandibular joint disorders
  • free choice of pharmacy
  • home health care
  • telemedicine
  • emergency care

Utah

  • Dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • metabolic disorders
  • maternity benefits for birth mothers in adoptions
  • genetic information may not be used for purposes other than treatment

Vermont

  • Alcohol treatment
  • mental health coverage
  • dependent care coverage (from the moment of birth, including abnormalities, those with physical or mental handicaps, and those who are adopted)
  • mammography
  • certain cancer therapies
  • diabetes self-management
  • home health care
  • metabolic disorders
  • craniofacial disorders

Virginia

  • Alcohol/drug treatment
  • mental health coverage
  • dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • pregnancy treatment after rape or incest
  • HDC/ABMT (breast cancer treatment)
  • Pap tests
  • temporomandibular joint disorders
  • emergency care
  • early intervention therapies for children
  • open choice of pharmacy
  • off-label drugs
  • contraceptives
  • mastectomy reconstruction
  • hemophilia
  • diabetes
  • prostate cancer screening
  • cancer pain
  • hospice care

Washington

  • Alcohol/drug treatment
  • dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • home health care
  • mammography
  • breast reconstruction
  • hospice care

West Virginia

  • Dependent coverage (from the moment of birth, including abnormalities and those who are adopted)
  • home health care
  • primary care nursing
  • rehabilitation services
  • mammograms
  • diabetes
  • Pap tests
  • temporomandibular joint disorders
  • emergency care
  • childhood immunizations
  • cannot cancel if diagnosed with AIDS

Wisconsin

  • Dependent coverage (from the moment of birth, including those with abnormalities, those who are mentally or physically handicapped, and those who are adopted)
  • mammography
  • diabetes supplies
  • HIV drugs
  • home health care
  • kidney disease treatments
  • skilled nursing care
  • maternity care
  • emergency care
  • open choice of pharmacy

Wyoming

  • Dependent coverage (from the moment of birth, including abnormalities and those who are mentally or physically handicapped, and those who are adopted)

###

Alcohol Treatment: http://www.altamirarecovery.com/alcohol-treatment/

Conclusion

What do you think? As always, your thoughts and comments on this Executive-Post are appreciated.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com or Bio: http://www.medicalbusinessadvisors.com/marcinkobio.asp and www.stpub.com/pubs/authors/MARCINKO.htm

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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A National Health Insurance Proposal

Transitioning from HIE-to-HIE

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Staff Reporters

Did you know that according to the New York Times, on November 12, 2008, Senator Max Baucus (D- Montana) would eventually require everyone – not just children – to have health insurance coverage, with federal subsidies for those who could not otherwise afford it, and possible enforcement through the federal tax-system?

The Proposed Health Insurance Exchange

The proposal would create a nationwide “health insurance exchange” [HIE] where people could compare and buy insurance policies, with an option of private insurance and a new public plan similar to Medicare. Insurers could not deny coverage to people who had been sick, and would be limited in their ability to charge higher premiums because of a person’s age or prior illness.

Adults also Insured

Adults aged 55 to 64 would be able to buy Medicare coverage if they do not have access to a public insurance program or a group health plan; Medicaid would be available to everyone below the poverty level. The State Children’s Health Insurance Program [SCHIP] would also be expanded to cover all uninsured youngsters in families with incomes at or below 250 percent of the poverty level; and legal immigrants would no longer be barred from Medicaid and the children’s health program in their first five years in the United States.

Small Business Assistance

The plan would also offer tax credits to small businesses to help them defray the costs of providing health benefits to employees, and would offer tax credits to individuals and families with incomes at or below four times the poverty level who buy coverage on their own.

Assessment

According to the Dictionary of Health Information and Technology, a health information exchange [HIE] may be defined as:

the mobilization of healthcare information electronically across organizations within a region, community or national infrastructure; especially disparate systems with the aim to facilitate access to – and retrieval of – clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care.

So, now it seems that we may be progressing from a health information exchange, to a health insurance exchange [www.HealthDictionarySeries.com]

Conclusion

What do you think? As always, your thoughts and comments on this Executive-Post are appreciated.

Speaker:If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

 

 

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Evidence-Based Medicine

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An Emerging Trend Vital to Physicians

[Staff Reporters]

According to Associate Professor Gregory O. Ginn, PhD; MBA, CPA, MEd., of the University of Las Vegas, an emerging trend for all medical providers is evidence-based medicine that offers the promise of improving the quality of clinical services. And, some argue that evidence-based medicine is a trend that will prevail for the foreseeable future.

Definition

According to the Dictionary of Health Insurance and Managed Care, EBM involves the judicious use of the best current evidence in making decisions about the care of the individual patient. Evidence-based medicine (EBM) is meant to integrate clinical expertise with the best available research evidence and patient values. EBM was initially proposed by Dr. David Sackett and colleagues at McMasters University in Ontario, Canada.

Expert Driven Standards of Care

In the past, standards of care were often set by panels of experts. Today, however, there is a greater demand for empirical evidence to establish the efficacy of clinical protocols. Evidence-based medicine can directly affect financial performance because it facilitates the elimination of therapies that cannot be demonstrated to be effective.

Example:

For example, evidence-based medicine can reduce a hospital’s prescription drug costs. Evidence-based medicine may also affect operations management if it shows that multiple approaches to treatment can be efficacious. Of course, in order to accommodate different modalities of treatment, hospitals will need more sophisticated information systems that allow for data integration.

Assessment

Evidence-based medicine may also be used to support another trend, the development of alternative and complementary medicine.

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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.

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Health Economists and the Economy

“The Not-So-Dismal Science”

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Fenway Park Dr. Marcinko

Economics was labeled the “dismal-science” by Thomas Carlyle a century ago. Since then, its tradition of negativity carries into the present recessionary environment. As the corporate credit and home mortgage crisis escalates, the financial and pharmaceutical industries implode and the population ages, hospitals are shuttered, re-sized or merely struggle onward with trepidation. And, daily, the media focuses on the increasing number of our citizens without health insurance.

To “Afflict the Comfortable and Comfort the Afflicted”

Such media coverage is expected entering into a general economic contraction, recession and/or depression for the healthcare sector, and economy as a whole.

But, in their zeal to “afflict the comfortable and comfort the afflicted”, the media victimizes the for-profit class, while it champions public hospitals, not-for-profit clinics and nanny-state medical care. The news is pre-occupied with calamity even when the health sector is fundamentally strong.

A Print Guide for us All

OK, premium print guides like Healthcare Organizations [Financial Management Strategies] know that bad news draws more subscribers than good news.

When all is well, physicians, executives and administrators are not keen on constructive change. There are also fewer reasons to log-on to this Medical Executive-Post blog. It’s all a matter of perspective!

Q: But, why is the media’s take on economic issues so important?

A: Because it has significant impact on how patients view the entire healthcare industrial complex! It influences how doctors, insurers and politicians adjust their own lobbying and legislative initiatives. And, it governs how CFOs invest in capital expenditures, as well.

Historical Review

Yet, media glare on our industry is not new. It began in 1963 with the article “Uncertainty and the Welfare of Medical Care,” and again in 1972 when Nobel Laureate Kenneth J. Arrow PhD shocked academe’ by identifying health-economics as a separate and distinct field. He codified seemingly disparate insurance, econometric, statistical, business and financial management principles for us all. And, he argued that the marketplace was incapable of insuring against the uncertainties we face in the healthcare arena.

Another View

Of course, the opposing viewpoint argues that, without the existence of a competitive market, individuals lose their freedom to choose, or are allowed to consume medical care for “free.” Therefore, the marketplace cannot learn what an individual values most.  Nevertheless, to informed executives and our readers and subscribers, Arrow served as progenitor to the modern strategic health advisory era. In 2004, he was awarded the National Medal of Science for his innovative views.

Economy as Excuse for Self-Pity

Unfortunately for some hospitals, disinformation and exaggeration about health economics is just the excuse needed for self-pity, or to reduce or cease operations. “It’s not our fault, we can’t compete in a free-market economy and our patient satisfaction rates are falling. The malaise is sapping our morale”; etc, and ad nausea 

A More Positive Approach

For others, there is the more positive proactive track of your editors, contributing authors and enlightened consultants.

Example:

In a recent budget meeting, one young hospital CFO cautioned physician-executives and healthcare administrators to watch every dollar in anticipation of a softening economy. Yet, his more seasoned CEO responded:

Fiscal prudence is important, but if you are asking me to take my foot off the gas pedal, my position is that we should choose not to participate in this recession.”

He further opined that we all must anticipate changing cycles, recessions and adverse demographics. But, let’s not make it a self-fulfilling prophecy. It is the astute CEO who realizes that strong financial statements lie in effective negotiation skills and the management of revenue cycles.

Subscribe

And conversely, that strong entity management and informed decision-making is the basis of an enhanced revenue cycle. In practical terms, this means understanding the process and targeting core aspects revenue growth to fine-tune and support the entire healthcare enterprise.

And so, if you are not a subscriber to this blog, or to our print journal, we trust you will review, communicate, use and profit from both. Let Healthcare Organizations [Financial Management Strategies] enhance your knowledge of modern [new-wave] health-economics, finance and collaborative medical management and avoid its confusion with the traditional [non-Healthcare 2.0] dismal-science.

PS: Don’t forget to review-read-rave and rant online at this communications forum.

Conclusion:

Your thoughts and comments are appreciated; especially from our print journal guide subscribers and all readers of this professional network.

Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

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

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

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 

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Barack Obama and Health Policy

What Do -U- Think?

Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Dr David E Marcinko MBAFirst it was Nixon’s supply-side national healthcare proposal; then it was managed care and HMO’s; next came HillaryCare, and finally the Republican’s “Contract with America”. So, will the next domestic healthcare policy initiative be; “Obama Care?”

Number 44 is Official

Now, that the United States has officially elected Barack H. Obama – the 44th president with 62 million popular votes – what does it mean to you as a doctor, financial advisor, politician, healthcare administrator, CEO, physician or nurse executive? And, what will this mean for – healthcare policy and administration  – patients and virtually all of us going forward?

Election

After nearly two years of campaigning – countless debates about McCain versus Obama’s health plan – and the possibility of reform; the US has a president-elect and put Democratic majorities in both the House of Congress and the US Senate.

Opinions Vary

And so, what do you predict the next four years will bring? This is your chance to reflect, comment, opine and debate. Please share your thoughts, and let’s get a vigorous discussion going. Medical practitioner input is especially appreciated.

Assessment

Don’t forget to integrate your opinions with the current dismal economic scene; include challenges like the aging population, personal biomedical and genetic engineering initiatives, and related competitive healthcare 2.0 concepts. As an inside – or outsider – what is the future? 

Conclusion

Your thoughts and comments on this Medical Executive-Post are appreciated.

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.

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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

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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

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Healthcare Business Information Review

Breaking News – “U Can Use”

Staff Reporters

Mental Health Policy: The Senate adopted HR.-6049 with mental-health parity. Bipartisan lawmakers are working to make the bill law before 2009.

Regulations: Under new Medicare regulations, doctors, with a financial stake in hospitals, must tell referred patients about ownership links.

Compliance: CMS proposed October 1, 2011, for full implementation of the International Classification of Diseases, Tenth Revision (ICD-10), code sets.   

Policy:  Congress [S. 2041 and HR 4854] is considering changes to the False Claims Act that could lead to more vigorous qui tam litigation.

Accreditation: CMS approved Norwegian company Det Norske Veritas [DNV] to accredit hospitals for Conditions of Participation [COP] standards. Authority to also certify ISO 9001 compliance runs, through 2012.

Bankruptcy: Hospitals filing bankruptcy this quarter include: a two-hospital system in Honolulu; one in Pontiac, MI; Trinity Hospital in Erin, Tennessee; Century City Doctors Hospital in Beverly Hills, Lincoln Park Hospital in Chicago, and the four-hospital-system Hospital Partners of America, in Charlotte. 

Insurance: First Professionals Insurance Company told the SEC that it held securities with an amortized cost of $4.1 million in Lehman Brothers, $2.1M in American International Group, $2.5M in Morgan Stanley, $2.1M in Washington Mutual and $300,000 in Fannie Mae.

Business: Emdeon, a developer of revenue and payment cycle health management products, acquired the patient statement business of GE HIT.

Finance: Minnesota’s HealthPartners new Web tool provides prices for 83 procedures in its primary care and radiology network.

More info: www.HealthcareFinancials.com print-journal and November 2008 – February 2009 issue: http://healthcarefinancials.com/Nov08Jan2009.aspx

Disclosure: Dr. David Edward Marcinko is the editor of Healthcare Organizations: [Financial Management Strategies].

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Exposing Medicare and Insurance Sales Commission Scams

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Some Agents and Brokers May Be Cashing-In

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

According to the Associated Press, on October 25, 2008, Medicare Advantage’s agents stand to make $500 to $550 this year. This happens by enrolling a beneficiary into one of their HMO type managed care type plans, while the agents could make another $500 for every year the beneficiary stays with the plan. It represents a financial reward that is raising concerns that agents and brokers will work too aggressively to enroll people into HMO plans that don’t meet their health needs; or where traditional Medicare may be a better personal fit.

CMS to Take Action

Representative Peter Stark (D-California) has urged the Centers for Medicare and Medicaid Services [CMS] to consider capping the commissions, while Kerry Weems, the acting administrator for CMS, said the agency plans to take action soon.

Insurance Policy “Twisting” and “Churning”

According to the Dictionary of Health Insurance and Managed Care, and others:www.HealthDictionarySeries.com:

  • Policy Twisting is the use of trickery to get someone to lapse an insurance policy and purchase a new one; usually in another company.

  • Policy Churning is a related fraudulent practice where an agent tricks a policy holder to fund a new one with the same insurer. Important information about the full consequences of their action is dishonestly withheld.

Both tactics are typically done to increase sales agent/broker commission income.

Scam Alerts

Although much more common with life insurance policies, each state has an insurance department that will help you if you think you’ve been scammed. Visit their website or office and you’ll get help on what to do. Many reputable insurance companies will quickly compensate you once it’s established that you were a victim of such fraud. Make sure you don’t waste you time by complaining to an insurer’s branch office. Contact the main office for swift response.

Assessment

America‘s Health Insurance Plans [AHIPs], the trade group representing insurers, encouraged CMS to develop clear and consistent standards, while two of the major players in the program, Humana Corporation and UnitedHealth Group both said that they welcomed regulation of insurance agent commissions. WellPoint and Cigna are the two other major health insurance companies in this country.

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

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