Healthcare Experts versus Health Journalists

Posted on March 9, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Appreciating the Distinction

By Dr. David Edward Marcinko; MBA

Publisher-in-Chief

As the healthcare reform, and eMR controversy unfolds, I am struck by the more-than-linguistic distinction between the terms “healthcare expert” and “health journalist.”

Link: www.HealthDictionarySeries.com

Historical Perspectives

Historically, as a peer-reviewed writer, editor, medical expert witness and now electronic publisher for almost four decades, I always sought the journalist’s title. I think the longing began in my formative years when I read that after the French Revolution, Sir Edmund Burke, looked up at the Press Gallery of the House of Commons, and said, ‘”Yonder sits the Fourth Estate, and they are more important than them all.”

Link: www.MedicalBusinessAdvisors.com

Expert versus Reporter

However, I no longer covet this title. Why? I’ve finally realized that it is far better to be a real subject-matter expert, than a journalist [read reporter]. The former creates news through knowledge, informed deeds and thought-leadership; while the later simply writes about various topics without same.

Link: www.HealthcareFinancials.com

Assessment

And so, in light of the eHR controversy, perhaps a word to the “wise” AMA, ADA, APMA, AOA and CCHIT leadership is sufficient; with apologies to Sir Edmund? Regardless of specialty, our guiding medical principles should always be; Omnia pro Aegroto [all for the patient].

Link: https://healthcarefinancials.wordpress.com/2009/01/31/about-the-ahcj/

Conclusion

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

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Filed under: Ethics, Experts Invited, Health Insurance, Managed Care, Research & Development | Tagged: david marcinko, healthcare experts, healthcare reporters, hope hetico | 7 Comments »

Video about Gaming4Health

Posted on March 7, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A Health Care – Gaming Industry – Social Network

By Staff Writers

Gaming4Health is an interactive social network for the health care industry. The company provides its’ community with the information, resources and services to support the adoption of healthy gaming as a means to improve health education, condition management, fitness and quality of life.

The Social Network

The communities established by the users of the network site allow people with similar health goals, conditions, research ideas or challenges to communicate with other like-minded people from all over the world. It also facilitates interaction and commerce between researchers and developers of healthy games, devices and resources and health and wellness organizations.

The Experts

The G4H network of experts in the medical, fitness, rehabilitation, weight-loss, simulation and other fields supposedly provide the most up-to-date information, resources, research and solutions in the healthy gaming industry.

The Competitor

Games for Health is a competitor. And, in business circles, it is said that competition makes a market. Games for Health develops best practice platforms for the numerous games being built for health care applications. To date the project has brought together researchers, medical professionals, and game developers to share information about the impact games on medicine.

Link: www.gamesforhealth.org

Assessment

Additionally, the firms’ GameBase is the most robust and current database of healthy games available – including basic information on every game (company, contact, price, etc.), demos and other downloads, as well as plenty of community feedback, ratings and reviews.

Videos: http://www.gaming4health.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Virtual reality and related simulation software, especially when used to desensitize patients with various phobias and obsessive compulsive disorders, is an accepted theory and clinical psychological practice. Will this gaming concept become same? Is it cost effective with a positive ROI? Should it be a covered service under health insurance policies? Any input or thoughts from our early adopter ME-P subscribers?

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Sherlock Health Plan Management Navigator

Posted on March 6, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Information System Implications on Health Plans

By Douglas B. Sherlock; MBA, CFA

Messrs. and Mesdames

Attached, please find the February 2009 edition of our Health Plan Management Navigator.
Link: sherlock-company

The Sherlock Expense Evaluation Report

In this month’s edition, we endeavor to better understand the functional area of information systems [IS] and its implications on health plans. Information systems, based on the results from out 2008 Sherlock Expense Evaluation Report (SEER) displayed overall anti-scalability in costs. In order to better comprehend IS and its influence on health plans overall, we performed numerous analyses that looked at relationships between IS and other aspects, such as scalability, variety of product offerings, commitment to ASO products and other functional areas.

Assessment

The results suggest that scale does not appear to play a role in IS costs and that more of a concentration in ASO products seemed to lower IS costs. It also appears that management of information systems, in the context of its support to other functional areas, is an inexact science.

Conclusion

Additional information about SEER is available at www.sherlockco.com/seer.shtml or; by contacting me at: sherlock@sherlockco.com

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Problems with HIT in Minnesota

Posted on March 6, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The Continuing eHR Saga

By Darrell K. Pruitt; DDS

If you were one of fifty governors who decide to jump off a cliff because flying looks so cool, would you proudly race to be the first to grab the air? Blissfully, Minnesota Governor Tim Pawlenty is way ahead of the pack. He’s so confident in healthcare information technology [IT] that he doesn’t even have to watch where he’s going – leaving him free to smile for the cameras. Now that’s cool.

Initial Ambitious Plans

Attention ME-P readers! Please gather around to watch a world-class belly-flop of a gutsy statewide eHR mandate. A few years ago, Governor Pawlenty had ambitious plans to lead the nation with an interoperable eHR system that was touted to include all providers – that means Minnesota dentists as well. Your landing could be vertical and abrupt, Pawlenty.

CCHIT Approved?

In fairness to a brick, back in 2005 Pawlenty could not have predicted the economic collapse that began three years later, nor could he have known about the subsequent $19 billion eHR money that would be made available to providers – but only if they purchase healthcare IT software that is approved by the Certification Commission for Healthcare Information Technology (CCHIT).

CCHIT Laggards

Even if the descending Pawlenty could have predicted the recent changes in the terrain, including the CCHIT qualification, he would have never guessed that to this day in March of 2009, the certifying commission would still be yet to certify even one single electronic dental record – thereby blocking Minnesota dentists from copious federal help in their efforts to become compliant in Pawlenty’s brave new state.

“The government is actually looking for places to spend the money where there is a strong likelihood of success stories”.

–Mike Ubl

Executive Director Minnesota Health Information Exchange

[Owned by Blue Cross Blue Shield of Minnesota, HealthPartners, Medica, Fairview Health Services, UCare and the Minnesota Department of Health].

Link: http://www.twincities.com/ci_11830085

“And that after this is accomplished, and the brave new world begins – When all men are paid for existing and no man must pay for his sins”.

-Rudyard Kipling

The CCHIT qualification was incredibly bad luck for Pawlenty’s nifty ideas of interoperability with all providers. When Minnesota dentists discover that they must pay $30 thousand for software they don’t want in order to practice in paradise, some may just swallow their pride, sell the portable ice-fishing house, and move to slow-moving Iowa.

Dentists, MDA and the ADA News

Why the surprisingly quick landing? If Pawlenty actually gave any consideration for dentistry at all, just like everyone else, he must have assumed that dentists’ concerns about digital records would be adequately attended to by the Minnesota Dental Association [MDA] and the American Dental Association. It was easy to make that mistake because of the enthusiasm for eDRs radiating from ADA Headquarters and expressed in confident terms in ADA News Online articles that have since stopped appearing. Most eDR enthusiasts naturally assumed that by now the majority of dentists in the nation would be saving money, lives and trees with paperless practices. However, the ADA has been nowhere to be found for a long time. As it turns out, the professional organization has still not yet even contacted the certifying commission. We know this, because when I personally contacted CCHIT a few weeks ago, it caught them off guard. I was told that I was one of the first to ever mention dentistry.

Link: https://healthcarefinancials.wordpress.com/2009/03/02/cchit-is-prejudiced-and-lacks-diversity-%e2%80%93-an-indictmen

No Endorsements

To show how far the ADA has slipped, and as an example of its flagging influence on membership, I doubt that more than 5% of American dentists have made the ADA-endorsed leap from paper to digital. Why should they? It makes good business sense to wait, and most dentists are not techno-silly. Consider this; Even if a dentist is happy with a costly eDR system that demanded unanticipated time and effort to learn, in less than a year, CCHIT could determine that his or her favorite system is not worthy of certification because it does not integrate with physicians’ one-size-fits-all, CCHIT-certified eMRs. Tough luck, Minnesota dentists! Uncertified eDRs will be outlawed, while favored, large healthcare IT companies in Madison and Chicago will profit and pay more state taxes with Twin-Cities’ dollars. By then, all the stimulus money will be gone and lawmakers will no longer be giddy about eHRs due to the imminent explosion of data breaches everywhere caused by moving too fast. No return on investment [ROI] there.

Assessment

Still, Tim Pawlenty could have never known, yet away he sails with a stupid grin on his face.

Conclusion

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

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Filed under: Career Development, Health Insurance, Information Technology, Op-Editorials | Tagged: ADA, American Dental Association, Blue Cross, Blue Shield of Minnesota, CCHIT, Certification Commission for Healthcare Information Technology, Darrell Pruitt, david marcinko, DDS, DMS, eDRs, EHRs, EMRs, HealthPartners, HIPAA, HIT, IT, MDA, Medica, Mike Ubl, Minnesota Department of Health, ROI, Tim Pawlenty, UCare | 1 Comment »

Introducing Douglas B. Sherlock MBA CFA

Posted on March 5, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

About Our Newest Thought-Leader

By Ann Miller; RN, MHA

Douglas B. Sherlock CFA is President of Sherlock Company which assists health plans, their business partners and their investors in the treasury and control functions of finance.

Resume

Prior to the founding of Sherlock Company, Mr. Sherlock was Vice President of Financial Analysis of U.S. Healthcare, Inc. where he directed the company’s merger and joint venture activity, its investor relations program and its HMO product for Medicare beneficiaries. Sherlock was formerly Vice President of Salomon Brothers, Inc where he specialized in the financial research of prepaid health plans and hospital systems, and assisted in the capital formation and merger activities of health care companies. He was the Greenwich Survey First Place HMO Analyst and a runner-up in the Institutional Investor polls.

Professional Associations and Memberships

Mr. Sherlock is a Chartered Financial Analyst. He has been a member of the Financial Accounting Policy Committee of the CFA Institute. He has served on the Editorial Board of Inquiry, a journal of health care organization, provision and financing published by the Blue Cross Blue Shield Association, and is a reviewer for Chartered Financial Analyst. He has been a member of the Financial Accounting Policy Committee. Sherlock is a frequent speaker before health care groups including the American Association of Health Plans, the HealthCare Financial Management Association, and the Blue Cross Blue Shield Association. The research of Sherlock Company has recently been cited in such periodicals as The New York Times, Forbes, Investor’s Business Daily, Modern Healthcare, Hospitals, The Wall Street Journal, HMO Managers Letter, Business Week and The Medical Business Journal.

Educational Background

Mr. Sherlock holds an M.B.A. in finance from Loyola College in Maryland. He received his bachelor’s degree in economics from Franklin and Marshall College, Lancaster, Pennsylvania.

Conclusion

We look forward to his contributions and now professionally welcome him warmly, as our newest ME-P thought-leader.

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About the Hospital Debt Justice Project

Posted on March 5, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Aggressive Debt Collectors Take to the Web

By Staff Reporters

Thousands of patients face crippling debt to hospitals and healthcare systems across the country; even though they may have qualified for free care.

www.HealthcareFinancials.com

Yale-New Haven Health System

Now, the Yale-New Haven Health System, Yale-New Haven Hospital and Bridgeport Hospitals are pursuing aggressive debt-collection practices—including liens, wage garnishments and foreclosures—even though they have millions of dollars set aside for free care for patients who can’t pay. Others have colossal endowments as well, and often pay their CEOs handsomely.

Assessment

But, according to their website, the Hospital Debt Justice Project is only fighting for fair treatment and accountability from our community hospitals.

Link: http://www.hospitaldebtjustice.org

Industry Indignation Index: 85

Conclusion

Your thoughts and comments on this Medical Executive-Post are appreciated. Isn’t it a charity hospital standard that not-for-profits typically charge the poor and indigent up to four times the UCR of insured patients? Your experiences are welcomed.

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ME-P Sponsor of Intellectual Capital

Posted on March 2, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

www.HealthcareFinancials.com

By Ann Miller; RN, MHA

Executive Director

All hospitals, healthcare systems and organizations use a variety of teaching, educational and didactic techniques to bring value to patients, payers, providers, governments and third-party intermediaries.

Intellectual Capital

This intellectual capital is the sum total of all knowledge and expertise used to serve the healthcare industrial complex and its’ stakeholders. Leaders, CXOs, CEOs, CFO, managers, administrators and employees provide most all of this current cognitive capital.

Print Journal Guide

We believe that Healthcare Organizations: [Financial Management Strategies] adds to this intellectual capital by guiding you, empowering your organization, and creating value for your patients, employees, investors and clients by bridging the intersection of medical mission and profit margin.

Assessment

www.HealthcareFinancials.com seeks to “Bridge the Intersection of Medical Mission and Profit Margin”; using the aggregated free-labor knowledge of those in the industry. There is just no better method available.

Visit and Order Now

Specialty Technical Publishers

8 – 14th Street

Blaine, WA 98230

1-800-251-0381

orders@stpub.com

http://www.stpub.com/pubs/ho.htm

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New-Wave Medical Quality Resources

Posted on March 1, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Beyond Traditional Administrative Databases

Staff Reporters

Physician blogger, and Harvard University CTO, John Halamka MD recently opined about some emerging new medical quality data sources for the industry.

Traditional Sources

As all ME-P subscribers know, traditional data sources are derived from, and usually include, administrative claims data information aggregated from many sources and silos.

www.HealthcareFinancials.com

Emerging Sources

But, newer sources of data for medical quality analysis go beyond administrative data and includes electronic repositories like eHRs, PHRs, eMRs and Healthcare Information Exchange [HIE] resources, where available.

www.HealthDictionarySeries.com

Assessment

For a few more examples:

Link: http://www.thehealthcareblog.com/the_health_care_blog/2009/02/index.html

Conclusion

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

Are these database silos secure, and do patients know that, or how, their hopefully blinded information is redacted and used? Will the health insurance industry use this information to further “slice and dice” ratings levels for their insured’s? Will it then be securitized, re-aggregated and resold again for non-healthcare related purposes like home, auto or life insurance; or other yet to be developed risk-management products and services?

Is this transparent and fair to patients? What are the legal and ethical implications, if any? Thought leaders please opine?

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Filed under: Ethics, Health Insurance, Health Law & Policy, Information Technology, Quality Initiatives, Research & Development | Tagged: Brent Metfessel, CTO, david marcinko, EHRs, EMRs, Harvard, health information technology, healthcare financials, HealthcareFinancials.com, healthDictionarySeries.com, HIE, HIT, John Halamka, Richard Mata, www.medicalbusinessadvisors.com | 3 Comments »

The Future of Hospitals

Posted on February 28, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Between a “Rock and Hard Place”

By Dr. David Edward Marcinko; MBA, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™

A recent white paper by the Joint Commission suggests that hospitals must respond in new ways to meet the increasing complexity of patient care and to address rising health care costs. Duh! What an insight. Why did it take so long for them to declare same?

The Hospital Accreditation Competition Heats-Up

Was it because of competition from DNV Healthcare Inc? Was it their new ability to determine if hospitals are in compliance with Medicare Conditions of Participation [COP]? DNV joins the Joint Commission on the Accreditation of Healthcare Organizations [JCAHO], and the American Osteopathic Association [AOA], as the only national hospital accrediting agency approved by the Centers for Medicare and Medicaid Services [CMS].

Link: https://healthcarefinancials.wordpress.com/2008/10/03/hospital-accreditation

Recommendations

Nevertheless, the JCAHO report recommends action in five areas:

Economic viability and ROI
Technology adoption and use
Patient-centered collaborative care
Medical and human resources staffing
Hospital architectural design

Patient Centered-Philosophy

Of course, it is no surprise that patient-centered care should be philosophically at the core of any partnership between a patient and his/her hospital and medical providers. Yet, just think of the last time you saw your HMO doctor and tried to engage in a collaborative health 2.0 discussion with him/her? Na-da!

Health Information Technology

The Joint Commission, despite the interoperable eHR controversy often presented on this blog, suggests that technology adoption can play a major role in improving patient care, safety and quality.

Link: https://healthcarefinancials.wordpress.com/2008/12/19/the-case-against-inter-operable-ehrs

This transformation from paper to electronic records, according to the report, will involve:

Making the business case for ROI and funding
Redesigning business processes with HIT implementation
Extending the digital footprint to the “medical-home”
Engaging IT leaders for guidance on prior mistakes
Improve workflow – minimize labor intensive activities

Of Hospital “Insider” Administrators

One local hospital administrator insider, here in Atlanta, confidentially tells us that a single hospital bed is currently worth about a million bucks a year to the institution; private or public. And, the mantra of most hospital CEOs to staff doctors, is: “fill the beds”; “schedule the procedures”; and/or “book the operating rooms.” So, the priorities outlined in the report really don’t seem appropriate; do they?

IOW: Put the hospital first; not the patient? And, this echoed our experience in hospital administration two decades ago. Has anything changed?

Assessment

Nevertheless, it may be refreshing to see an approach to healthcare technology implementation that seems to leverage the experience and knowledge of other industries. Privacy concerns however, are the biggest obstacle to HIT and true inter-operable eMRs, in our opinion. Yet, it doesn’t need to be. Who cares if grandma has a bunion, or dad had his cataracts repaired. They aren’t running for public office; are they?

The road to the Hospital of the Future will be bumpy, but we are hopeful enough to trust the benefits will be great once we arrive.

Full report: hosptals-future

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Are hospitals today “between a rock and hard place?” Is technology and business process reorganization being offered as a substitute for critical thinking and true collaborative medicine? Especially, in light of the healthcare capitalistic thrust to: “do more – in order to earn more.”

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Filed under: Health Economics, Health Insurance, Healthcare Finance, Information Technology, Research & Development | Tagged: ADA, AMA, AOA, CMS, DNV Healthcare, Hetico, JCAHO, Kenneth A. Powers, Marcinko | 3 Comments »

Big Blue and UHG’s New Health Plan Model

Posted on February 23, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Innovative Model -or- Just another Paradigm Shift

By Staff Reporters

According to Reed Abelson, and David Kadlubowski of the electronic New York Times [NYT].com edition, on February 6, 2009, a new medical practice business plan and health care insurance reimbursement model could allow family physicians to practice medicine the way they used to practice. How so?

Exit UHG

The giant insurer UnitedHealth Group is testing a new model of health care that some policy experts say holds great promise, but has yet to prove itself. An earlier trial of the model by UnitedHealth, in Florida, never got off the ground because doctors refused to participate.

Enter IBM

This time however, the insurer is teaming up with seven doctors’ groups to make another attempt, in Arizona, at the prodding of one of the state’s big employers, and IBM. UnitedHealth will try giving doctors more authority and money than usual in return for closely monitoring their patients’ progress, even when patients go to specialists or require hospitalization.

Link: http://www.nytimes.com/2009/02/07/business/07medhome.html?_r=3&ref=health

Moving toward Value-Added Models and Episodes of Care

The insurer will also move away from paying doctors solely on the basis of how many services they provide via CPT® codes and will start rewarding them more for overall quality of patient care [value added and/or episodes of care model].

Link: https://healthcarefinancials.wordpress.com/2009/01/28/a-medical-payment-paradigm-shift

Assessment

One comment heard through the grapevine was “caveat and vendor emptor”; while another sarcastic observer wondered if this was the same “Useless Healthcare Group that we all despise?” And, who is to define the term “medical quality -or- value added care”?

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Early-adopter insight and reports from Arizona participating practitioners is appreciated.

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Filed under: Career Development, Health Insurance, Practice Management, Quality Initiatives | Tagged: Big Blue, CPT codes, episodes of care, IBM, UHC, United Health Care, value added healthcare | Leave a comment »

Dismal World Video-View of American Healthcare

Posted on February 20, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

BBC Documentary Takes on Obama’s Plan

Staff Reporters

Did you know that a new British Broadcasting Corporation [BBC] documentary takes on newly elected President Barack S. Obama’s plans for American health care system?

Emotional Pleas Tug at Citizenry Heart Strings

According to Nick Cargo – of the BBC on January 25 – a January 19th episode of BBC’s One’s Panorama, the world’s longest running television documentary show, tackles the dismal state of health care in the United States. Of course, it emotionally parses on the lengths to which our estimated [high-side] 45 million uninsured citizens [only 8 million remain uninsured for 2 years, or more] go in pursuit of care, the pharmaceutical industry’s rigged pricing against the American patient, and the insurance industry’s efforts to deny care whenever possible.

About Health Care for America Now

According to documentary comments regarding freedom-of-choice in our medical care; “It’s really a system of legalized bribery,” said Richard Kirsch of Healthcare for America Now. “As one congressman says, we’re the only people in the world who are expected to take money from strangers and provide nothing in return.”

Health Care for America Now is a national grassroots campaign organizing millions of Americans to win a guarantee of quality, affordable health care for all. Their goal is to create organizations that can mobilize people at work, at home, in their neighborhoods, and online www.healthcareforamericanow.org

Assessment

Due to licensing restrictions, the Panorama episode, “What Now, Mr. President?” is not for domestic consumption and is only officially available to view online from connections within the United Kingdom. However, it has also been uploaded to YouTube, where it appears in three parts below.

Video: http://rawstory.com/news/2008/BBC_documentary_takes_on_Obamas_plans_0125.html

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Watch the video and decide for yourself; then opine here. Is the BBC view equal to the world view of US healthcare modernity?

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Hospital Cafeteria Plan Elections

Posted on February 19, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

On Health and Dependent Care

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

I wrote a bit about hospital cafeteria plans in an earlier blog post.

Link: https://healthcarefinancials.wordpress.com/2008/04/02/hospital-cafeteria-plans/

Now, any hospital, or other employee given the opportunity to participate in a cafeteria plan should consider the following important two elections; health and dependent care.

Healthcare [Working Spouse]

If the employee is married and has a spouse who also works, and the employer-provided health benefits are better under the spouse’s plan, then the employee should elect to be covered by the spouse’s plan and choose another nontaxable benefit or a cash benefit that would be taxable under his or her own cafeteria plan, such as dependent-care coverage or group term insurance coverage. Switching health insurance requires planning to eliminate potential gaps in coverage created by insurance enrollment criteria. If the employee does not need the salary or cafeteria-plan benefits to meet current expenses, he or she should consider contributing the cash to a 401(k) plan and defer the tax liability.

Healthcare [Non-Working Souse]

If the employee has no working spouse and the employee’s plan is the only source for certain health benefits, the employee should consider what type of benefits he or she really needs for his or her family. In other words, can the employee get the necessary benefits under the company plan cheaper than he or she could individually, after taking into account that individual coverage will be paid with after-tax dollars, whereas under a cafeteria plan such benefits can be paid with before-tax dollars?

For example, if an employee who is in the 30% tax bracket is provided a $6,000 plan by her employer. He or she would have to be able to get a comparable plan independently for only $3,741 to be in the same position on an after-tax basis. ($6,000 minus income taxes of $1,800 = $4,200, $4,200 minus $459 of avoided FICA

Dependent-Care

An employee who has a choice of including dependent-care costs may be entitled to an income-tax credit for such expenses if, the employer does not reimburse them. Thus, if a credit is worth the same or more than the payment under the cafeteria plan, the employee may choose to contribute those dollars toward additional health or life insurance.

Assessment

There is no doubt why healthcare and dependent care are the two most important cafeteria plan election determinants that clients seek in our advisory practice. The issues are that vital to all employees.

Conclusion

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A Review of Elder Housing Protections

Posted on February 17, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Home Equity Resources, Housing and Care Options

Staff Reporters

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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Filed under: Financial Planning, Health Insurance, Health Law & Policy, Insurance Matters, Risk Management | Tagged: ADA, Americans with Disabilities Act, charles sabatino, elder housing, elder law, eldercare, Fair Housing Amendment, FHAA, nancy coleman, Rehabilitation Act of 1973, stephanie edelstein | 1 Comment »

Some Insight on Medicare Advantage Plans

Posted on February 14, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Enter the Bounty Hunter Insurance Agents

dem21

[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

Posted on February 13, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Overhauling the American Healthcare Industry

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

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

Posted on February 11, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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

Posted on February 9, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Physical Health and Mental Health Insurance

By Carol Miller; RN, MBA

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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Filed under: Health Insurance, Health Law & Policy, Healthcare Finance, Insurance Matters | Tagged: Health Insurance, insurance, insurance agents, mental health, Mental Health Equitable Treatment Act, mental health parity, MHETA | 8 Comments »

About ENURGI

Posted on February 7, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Transforming Home Health Care Services

Staff Reporters

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.

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About Healthcare Financials.com

Posted on February 6, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Healthcare Organizations [Financial Management Strategies]

By Hope Rachel Hetico; RN, MHA
Managing Editor

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

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.

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

Posted on February 4, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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™, CMP

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

Posted on February 3, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

How We Compare to Canada’s Healthcare System

Staff Reporters

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?

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

Posted on February 2, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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™, CMP

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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FINANCE: Financial Planning for Physicians and Advisors
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Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: "Doctors Only", Funding Basics, Health Economics, Health Insurance, Healthcare Finance, iMBA, Insurance Matters, Research & Development, Risk Management | Tagged: david marcinko, hope hetico, long term care insurance, LTC, LTC insurance, nursing homes, thomas muldowney | 4 Comments »

About Health CEOs for Healthcare Reform

Posted on February 2, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A Coalition from the New America Foundation

Staff Reporters

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:

Health reform is an urgent priority for our nation and should not be postponed.
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.”
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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Filed under: Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Insurance Matters, Managed Care | Tagged: CEOs, david marcinko, HC4HR, health reform, HMOs, hope hetico, Managed Care, MCOs, National Press Club, New America Foundation, Sheldon Whitehouse | 1 Comment »

Myths and Solutions for Healthcare Reform

Posted on February 1, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Enter the Primary Care Docs, NPs, PAs and DNPs

Staff Reporters

According to most Americans, many politicians, members of the Medical Executive-Post, and vocal primary care doctor Monte Uyemura MD, successful healthcare reform is critical to the well-being of our nation and a few myths need to be exploded.

Link: https://healthcarefinancials.wordpress.com/2008/08/06/doctor-patient-relationships/

But, who has the Answers?

As a rural physician, he shouts in vain that politicians are:

“backing the trailer up to the wrong barn.”

Furthermore, he feels that:

“reform proposals utilizing creative accounting keep conjuring up healthcare expenditure savings where they don’t exist, and even if the proposed mythological information technology utopia could be achieved, it would be ‘mere cough medicine’ for our healthcare system’s pneumonia.”

Link: https://healthcarefinancials.wordpress.com/2009/01/25/an-open-letter-on-emrs-from-hayward-zwerling-md/#comment-2702

The Myths

According to the ME-P, and Uyemura, these myths include: evidence-based-medicine [EBM], health information technology [HIT] and electronic Medical Records (eMRs), quality improvement initiatives and, of course, universal healthcare coverage.

Link: https://healthcarefinancials.wordpress.com/2008/12/08/eight-fallacies-of-managed-care

The Answer

Uyemura believes the answer is a mass-infusion of family practitioners, or what he calls an:

“army of primary care physicians.”

Link: http://www.thehealthcareblog.com/the_health_care_blog/2009/02/index.html

Assessment

Of course, we could not agree with him more and would include grass-roots level Nurse Practitioners [NPs], Physician Assistants [PAs] and Doctors of Nursing Practice [DNPs].

Link: https://healthcarefinancials.wordpress.com/2008/05/29/stemming-the-primary-care-exodus

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?

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About the AHCJ

Posted on January 31, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Advancing Public Understanding of Healthcare Issues

Staff Reporters

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

To support the highest standards of reporting, writing, editing, and broadcasting in health care journalism for the general public and trade publications.
To develop a strong and vibrant community of journalists concerned with all forms of health care journalism.
To raise the stature of health care journalism in newsrooms, the industry, and the public, as a whole.
To promote understanding between journalists and sources of news about how each can best serve the public.
To advocate for the free flow of information to the public.
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.

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Filed under: Career Development, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Insurance Matters, Managed Care, Practice Management, Quality Initiatives | Tagged: AHCJ, Hetico, J. Duncan Moore, Kaiser, Marcinko, Melinda Voss, Modern Healthcare | Leave a comment »

Healthcare and the Recession

Posted on January 29, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Physician and Hospital Pricing Pressure

[By Staff Reporters]

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

Posted on January 24, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The Daschle Imperative

[By Staff Reporters]

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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Filed under: Breaking News, Health Economics, Health Insurance, Healthcare Finance | Tagged: Daschle, HHS, SGR | 33 Comments »

ADA Mission Creep

Posted on January 22, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Will that Be “Paper” or “Electrons?”

[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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Filed under: Health Insurance, Health Law & Policy, Information Technology, Op-Editorials, Practice Management | Tagged: ADA, EHRs, EMRs, HIT | 31 Comments »

HIT and Privacy Issues

Posted on January 22, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Complications Retard Links to Medical Data

[By Staff Reporters]

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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ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Career Development, Ethics, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Information Technology, Insurance Matters, Research & Development | Tagged: barack obama, HIT, Information Technology, IT | 10 Comments »

The Health Dictionary Series

Posted on January 20, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

What it is – How it works

By Dr. David Edward Marcinko; MBA, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™

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.

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Filed under: Accounting, Book Reviews, Career Development, Estate Planning, Glossary Terms, Health Economics, Health Insurance, Healthcare Finance, iMBA, Inc., Information Technology, Insurance Matters, Managed Care, Recommended Books | Leave a comment »

Market Driven Healthcare

Posted on January 19, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Keep Practicing Medicine

By Dr. David Edward Marcinko; MBA, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™

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.

Assessment

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.

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Non-Profit Hospital Accountability

Posted on January 19, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Raising the Ethical Bar

Staff Reporters

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.

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Filed under: Ethics, Health Insurance, Healthcare Finance, Quality Initiatives | Tagged: charity care, non-profit hospitals, pro-bono medical care | 5 Comments »

Medical Tourism and Values Based Health Insurance

Posted on January 18, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Two Emerging Medical Business Models

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

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.

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Filed under: Book Reviews, Career Development, Health Economics, Health Insurance, Healthcare Finance, Managed Care, Media Mentions and PR, Op-Editorials, Practice Management | Tagged: David Nash, Hetico, Marcinko, Mark Fendrick, medical tourism, Robert M. Wachter | 3 Comments »

UnitedHealth Group Shenanigans

Posted on January 16, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Ingenix’s Lack of Independence Cited

[By Dr. David Edward Marcinko; MBA]

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Filed under: Health Economics, Health Insurance, Managed Care, Op-Editorials, Practice Management, Research & Development, Risk Management | Tagged: Aetna, Bill McGuire, Cigna, Ingenix, UnitedHealth Group, WellPoint/Empire BlueCross BlueShield | 6 Comments »

Hospice Care Flourishing

Posted on January 14, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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™]

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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Filed under: Glossary Terms, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Insurance Matters, Retirement and Benefits | 4 Comments »

Weighted Role of Commercial Health Insurance

Posted on January 13, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Disproportional Influence

By Dr. David Edward Marcinko; MBA,

Most 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.

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Filed under: Book Reviews, Ethics, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Insurance Matters, Managed Care, Op-Editorials | Tagged: Health Insurance, hospitals, Managed Care | 1 Comment »

About the DocSite Registry

Posted on January 6, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A Health 2.0 Information Technology Reality

By Staff Reporters

[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.

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

Filed under: "Doctors Only", Health Insurance, Information Technology, Practice Management | Tagged: DocSite | 1 Comment »

Public Healthcare Cost-Shifting

Posted on December 27, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

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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Filed under: Health Economics, Health Insurance, Research & Development, Surveys and Voting | 1 Comment »

Superannuation Demographics and LTCI

Posted on December 23, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

“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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Filed under: Funding Basics, Health Economics, Health Insurance, Healthcare Finance, Insurance Matters, Risk Management | Tagged: long term care, long term care insurance, LTC, LTCI | 11 Comments »

MedPAC Seeks Rate Increase

Posted on December 19, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

***

Filed under: Health Economics, Health Insurance, Healthcare Finance, Practice Management | Tagged: MedPAC | 2 Comments »

Long-Term Versus Custodial Healthcare

Posted on December 17, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

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™

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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Filed under: Health Economics, Health Insurance, Healthcare Finance, Insurance Matters, Risk Management | Tagged: long term care insurance, LTCI | 1 Comment »

Hospital Length-of-Stay Forecasting

Posted on December 10, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

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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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

Filed under: Health Economics, Health Insurance, Managed Care, Quality Initiatives | Tagged: LOS | Leave a comment »

Dueling Universal Health Coverage Proposals

Posted on December 7, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Obama and AHIP Race to the Finish 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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Filed under: Health Insurance, Health Law & Policy, Research & Development | 2 Comments »

Domestic Economy Sickens Hospitals

Posted on December 5, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

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?

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Filed under: Health Economics, Health Insurance, Healthcare Finance, Monthly Reports, Research & Development | Tagged: AHA | Leave a comment »

2009 Physician Fee Schedule

Posted on December 5, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

CMS Issues Final Rule

Staff Reporters

According 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.

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

Filed under: Career Development, Health Insurance, Healthcare Finance, Practice Management | Tagged: CMS, fee schedule | 2 Comments »

Obama and Health IT

Posted on December 3, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Works Progress Administration

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.

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

Filed under: Health Insurance, Health Law & Policy, Information Technology, Practice Management | Tagged: dental IT, HIT, IT | 4 Comments »

Medicare Payment Reform for 2009-2017

Posted on December 2, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

AMA House of Delegates Push for SGR Changes

[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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DICTIONARIES: http://www.springerpub.com/Search/marcinko
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PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
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Filed under: Health Insurance, Healthcare Finance, Quality Initiatives | Tagged: SGR, sustainable growth rates | 8 Comments »

Hospitalist Model Outcomes Study

Posted on November 29, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

The Human Resource Management Report

Staff Reporters

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

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

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

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

Filed under: Career Development, Health Economics, Health Insurance, Healthcare Finance, Monthly Reports | Tagged: hospital medicine, hospitalists | 7 Comments »

Mercer Study Says CDHPs Rising

Posted on November 28, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

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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Filed under: Health Economics, Health Insurance, Monthly Reports, Practice Management | Tagged: CDHPs, Mercer | 2 Comments »

Dental eHR Controversy Continues

Posted on November 28, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Response to Valerie Powell, PhD

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.

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

Filed under: Health Insurance, Information Technology, Op-Editorials, Practice Management | Tagged: EHRs, EMRs, HIT | 5 Comments »

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