FINANCIAL PLANNING: Strategies for Doctors and their Advisors

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BY DR. DAVID E. MARCINKO MBA CMP®

SPONSOR: http://www.CertifiedMedicalPlanner.org

CMP logo

REVIEWS:

Written by doctors and healthcare professionals, this textbook should be mandatory reading for all medical school students—highly recommended for both young and veteran physicians—and an eliminating factor for any financial advisor who has not read it. The book uses jargon like ‘innovative,’ ‘transformational,’ and ‘disruptive’—all rightly so! It is the type of definitive financial lifestyle planning book we often seek, but seldom find.
LeRoy Howard MA CMPTM,Candidate and Financial Advisor, Fayetteville, North Carolina

I taught diagnostic radiology for over a decade. The physician-focused niche information, balanced perspectives, and insider industry transparency in this book may help save your financial life.
Dr. William P. Scherer MS, Barry University, Ft. Lauderdale, Florida

This book was crafted in response to the frustration felt by doctors who dealt with top financial, brokerage, and accounting firms. These non-fiduciary behemoths often prescribed costly wholesale solutions that were applicable to all, but customized for few, despite ever-changing needs. It is a must-read to learn why brokerage sales pitches or Internet resources will never replace the knowledge and deep advice of a physician-focused financial advisor, medical consultant, or collegial Certified Medical Planner™ financial professional.
—Parin Khotari MBA,Whitman School of Management, Syracuse University, New York

In today’s healthcare environment, in order for providers to survive, they need to understand their current and future market trends, finances, operations, and impact of federal and state regulations. As a healthcare consulting professional for over 30 years supporting both the private and public sector, I recommend that providers understand and utilize the wealth of knowledge that is being conveyed in these chapters. Without this guidance providers will have a hard time navigating the supporting system which may impact their future revenue stream. I strongly endorse the contents of this book.
—Carol S. Miller BSN MBA PMP,President, Miller Consulting Group, ACT IAC Executive Committee Vice-Chair at-Large, HIMSS NCA Board Member

This is an excellent book on financial planning for physicians and health professionals. It is all inclusive yet very easy to read with much valuable information. And, I have been expanding my business knowledge with all of Dr. Marcinko’s prior books. I highly recommend this one, too. It is a fine educational tool for all doctors.
—Dr. David B. Lumsden MD MS MA,Orthopedic Surgeon, Baltimore, Maryland

There is no other comprehensive book like it to help doctors, nurses, and other medical providers accumulate and preserve the wealth that their years of education and hard work have earned them.
—Dr. Jason Dyken MD MBA,Dyken Wealth Strategies, Gulf Shores, Alabama

I plan to give a copy of this book written
by doctors and for doctors’ to all my prospects, physician, and nurse clients. It may be the definitive text on this important topic.
—Alexander Naruska CPA,Orlando, Florida

Health professionals are small business owners who need to apply their self-discipline tactics in establishing and operating successful practices. Talented trainees are leaving the medical profession because they fail to balance the cost of attendance against a realistic business and financial plan. Principles like budgeting, saving, and living below one’s means, in order to make future investments for future growth, asset protection, and retirement possible are often lacking. This textbook guides the medical professional in his/her financial planning life journey from start to finish. It ranks a place in all medical school libraries and on each of our bookshelves.
—Dr. Thomas M. DeLauro DPM,Professor and Chairman – Division of Medical Sciences, New York College of Podiatric Medicine

Physicians are notoriously excellent at diagnosing and treating medical conditions. However, they are also notoriously deficient in managing the business aspects of their medical practices. Most will earn $20-30 million in their medical lifetime, but few know how to create wealth for themselves and their families. This book will help fill the void in physicians’ financial education. I have two recommendations: 1) every physician, young and old, should read this book; and 2) read it a second time!
—Dr. Neil Baum MD,Clinical Associate Professor of Urology, Tulane Medical School, New Orleans, Louisiana

I worked with a Certified Medical Planner™ on several occasions in the past, and will do so again in the future. This book codified the vast body of knowledge that helped in all facets of my financial life and professional medical practice.
Dr. James E. Williams DABPS, Foot and Ankle Surgeon, Conyers, Georgia

This is a constantly changing field for rules, regulations, taxes, insurance, compliance, and investments. This book assists readers, and their financial advisors, in keeping up with what’s going on in the healthcare field that all doctors need to know.
Patricia Raskob CFP® EA ATA, Raskob Kambourian Financial Advisors, Tucson, Arizona

I particularly enjoyed reading the specific examples in this book which pointed out the perils of risk … something with which I am too familiar and have learned (the hard way) to avoid like the Black Death. It is a pleasure to come across this kind of wisdom, in print, that other colleagues may learn before it’s too late— many, many years down the road.
Dr. Robert S. Park MD, Robert Park and Associates Insurance, Seattle, Washington

Although this book targets physicians, I was pleased to see that it also addressed the financial planning and employment benefit needs of nurses; physical, respiratory, and occupational therapists; CRNAs, hospitalists, and other members of the health care team….highly readable, practical, and understandable.
Nurse Cecelia T. Perez RN, Hospital Operating Room Manager, Ellicott City, Maryland

Personal financial success in the PP-ACA era will be more difficult to achieve than ever before. It requires the next generation of doctors to rethink frugality, delay gratification, and redefine the very definition of success and work–life balance. And, they will surely need the subject matter medical specificity and new-wave professional guidance offered in this book. This book is a ‘must-read’ for all health care professionals, and their financial advisors, who wish to take an active role in creating a new subset of informed and pioneering professionals known as Certified Medical Planners™.
—Dr. Mark D. Dollard FACFAS, Private Practice, Tyson Corner, Virginia

As healthcare professionals, it is our Hippocratic duty to avoid preventable harm by paying attention. On the other hand, some of us are guilty of being reckless with our own financial health—delaying serious consideration of investments, taxation, retirement income, estate planning, and inheritances until the worry keeps one awake at night. So, if you have avoided planning for the future for far too long, perhaps it is time to take that first step toward preparedness. This in-depth textbook is an excellent starting point—not only because of its readability, but because of his team’s expertise and thoroughness in addressing the intricacies of modern investments—and from the point of view of not only gifted financial experts, but as healthcare providers, as well … a rare combination.
Dr. Darrell K. Pruitt DDS, Private Practice Dentist, Fort Worth, Texas

This text should be on the bookshelf of all contemporary physicians. The book is physician-focused with unique topics applicable to all medical professionals. But, it also offers helpful insights into the new tax and estate laws, fiduciary accountability for advisors and insurance agents, with investing, asset protection and risk management, and retirement planning strategies with updates for the brave new world of global payments of the Patient Protection and Affordable Care Act. Starting out by encouraging readers to examine their personal ‘money blueprint’ beliefs and habits, the book is divided into four sections offering holistic life cycle financial information and economic education directed to new, mid-career, and mature physicians.

This structure permits one to dip into the book based on personal need to find relief, rather than to overwhelm. Given the complexity of modern domestic healthcare, and the daunting challenges faced by physicians who try to stay abreast of clinical medicine and the ever-evolving laws of personal finance, this textbook could not have come at a better time.
—Dr. Philippa Kennealy MD MPH, The Entrepreneurial MD, Los Angeles, California

Physicians have economic concerns unmatched by any other profession, arriving ten years late to the start of their earning years. This textbook goes to the core of how to level the playing field quickly, and efficaciously, by a new breed of dedicated Certified Medical Planners™. With physician-focused financial advice, each chapter is a building block to your financial fortress.
Thomas McKeon, MBA, Pharmaceutical Representative, Philadelphia, Pennsylvania

An excellent resource … this textbook is written in a manner that provides physician practice owners with a comprehensive guide to financial planning and related topics for their professional practice in a way that is easily comprehended. The style in which it breaks down the intricacies of the current physician practice landscape makes it a ‘must-read’ for those physicians (and their advisors) practicing in the volatile era of healthcare reform.
—Robert James Cimasi, MHA ASA FRICS MCBA CVA CM&AA CMP™, CEO-Health Capital Consultants, LLC, St. Louis, Missouri

Rarely can one find a full compendium of information within a single source or text, but this book communicates the new financial realities we are forced to confront; it is full of opportunities for minimizing tax liability and maximizing income potential. We’re recommending it to all our medical practice management clients across the entire healthcare spectrum.
Alan Guinn, The Guinn Consultancy Group, Inc., Cookeville, Tennessee

Dr. David Edward Marcinko MBA CMP™ and his team take a seemingly endless stream of disparate concepts and integrate them into a simple, straightforward, and understandable path to success. And, he codifies them all into a step-by-step algorithm to more efficient investing, risk management, taxation, and enhanced retirement planning for doctors and nurses. His text is a vital read—and must execute—book for all healthcare professionals and physician-focused financial advisors.
Dr. O. Kent Mercado, JD, Private Practitioner and Attorney, Naperville, Illinois

Kudos. The editors and contributing authors have compiled the most comprehensive reference book for the medical community that has ever been attempted. As you review the chapters of interest and hone in on the most important concerns you may have, realize that the best minds have been harvested for you to plan well… Live well.
Martha J. Schilling; AAMS® CRPC® ETSC CSA, Shilling Group Advisors, LLC, Philadelphia, Pennsylvania

I recommend this book to any physician or medical professional that desires an honest no-sales approach to understanding the financial planning and investing world. It is worthwhile to any financial advisor interested in this space, as well.
David K. Luke, MIM MS-PFP CMP™, Net Worth Advisory Group, Sandy, Utah

Although not a substitute for a formal business education, this book will help physicians navigate effectively through the hurdles of day-to-day financial decisions with the help of an accountant, financial and legal advisor. I highly recommend it and commend Dr. Marcinko and the Institute of Medical Business Advisors, Inc. on a job well done.
Ken Yeung MBA CMP™, Tseung Kwan O Hospital, Hong Kong

I’ve seen many ghost-written handbooks, paperbacks, and vanity-published manuals on this topic throughout my career in mental healthcare. Most were poorly written, opinionated, and cheaply produced self-aggrandizing marketing drivel for those agents selling commission-based financial products and expensive advisory services. So, I was pleasantly surprised with this comprehensive peer-reviewed academic textbook, complete with citations, case examples, and real-life integrated strategies by and for medical professionals. Although a bit late for my career, I recommend it highly to all my younger colleagues … It’s credibility and specificity stand alone.
Dr. Clarice Montgomery PhD MA,Retired Clinical Psychologist

In an industry known for one-size-fits-all templates and massively customized books, products, advice, and services, the extreme healthcare specificity of this text is both refreshing and comprehensive.
Dr. James Joseph Bartley, Columbus, Georgia

My brother was my office administrator and accountant. We both feel this is the most comprehensive textbook available on financial planning for healthcare providers.
Dr. Anthony Robert Naruska DC,Winter Park, Florida

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

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RECESSION: Healthcare Industry Layoffs

Not even the healthcare industry is recession-proof

By Staff Reporters

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According to Kristine White of Healthcare Brew, New York City-based Memorial Sloan Kettering Cancer Center (MSK), one of the country’s top cancer treatment facilities, laid off 337 employees on Jan. 17 in response to ongoing financial challenges, according to a New York State Department of Labor filing.

The 337 employees, who worked across 14 sites and in multiple departments, represent about 1.5% of MSK’s 22,500 employees. This is a slight decrease from the expected 3% of layoffs announced in November 2022.

“This reduction was necessary to ensure that MSK can continue to invest in the future of cancer care, research, and education for the benefit of generations to come, and every effort has been made to ensure that patient care is not impacted,” spokesperson John Connolly said in a statement shared with Healthcare Brew.

The institution’s operating losses totaled $116.1 million for Q3 of 2022, compared to a loss of $8.7 million during the same period in 2021, according to a quarterly financial report released in November last year.

Factors such as increased patient activity, wages, and supply costs from inflation pushed the system’s operating expenses up by 7.5% from Q3 of 2021 to Q3 of 2022. The cancer center hired more staff in 2022 with the expectation that patient volume would increase, according to the financial report.

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

Health systems like MSK often reevaluate their biggest expense (workers) when business is down, Lori Kalic, a healthcare senior analyst at consulting firm RSM, told Healthcare Brew.

Just this year, multiple hospitals and health systems have also announced layoffs, including Tufts Medicine in Boston and Integris Health in Oklahoma, according to White.

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Medical CBD: No FDA Advocacy

By Staff Reporters

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The Food and Drug Administration said it can’t vouch for the safety of cannabidiol (CBD)—a nonpsychoactive compound found in marijuana and hemp plants—and because of that, it can’t regulate it. Instead, it’s calling on lawmakers to help supervise $12 CBD lavender sodas.The FDA said that CBD doesn’t fit the mold of the dietary supplements and food additives it typically monitors, such as ginseng and caffeine.

POT: https://contrarianedge.com/should-you-invest-in-marijuana-stocks/?uid=5f78aa3cd815b&utm_source=IMA++-+Main+Articles&utm_campaign=b43e790647-MARIJUANA_STOCKS_RESEND&utm_medium=email&utm_term=0_f1c90406d1-b43e790647-55139025

The agency claims the science is lacking on the safety of long-term CBD use, let alone on any potential perks—like preventing diabetes or aiding sleep.

No-2-Drugs: https://medicalexecutivepost.com/2022/04/20/just-say-no-to-drugs/

Derived from Hemp

Congress legalized hemp four years ago, and most CBD is derived from hemp, not marijuana. As a result, CBD got kicked off the controlled substances list and got lobbed from the Drug Enforcement Administration’s desk to the FDA’s.

Mental Health Drugs: https://medicalexecutivepost.com/2022/10/07/drugs-and-county-mental-health-programs/

Since then, the FDA’s been less active in regulating CBD than a teen in a ’90s anti-marijuana ad. That’s resulted in a chaotic and confusing marketplace, and CBD industry players were hoping the FDA would soon start reining it in.

Drug Middlemen: https://medicalexecutivepost.com/2022/03/14/drugs-money-and-the-middleman/

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INTEL: Raises Alarm for the Computer Micro-Chip Industry

BUT … NOT SAMSUNG

By Staff Reporters

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Due to a lack of demand for chips and a slowdown in its data processing center business, Intel just reported its worst financial results since the dot-com bubble popped at the turn of the century. Though the stock only ended up falling 6.4% by the time the market closed yesterday, Wall Street definitely took notice of the company’s troubles.

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

And so, twenty-one analysts slashed what they thought it was worth, and many did not hold back in describing the chip maker’s fall. “No words can portray or explain the historic collapse of Intel,” one said according to Bloomberg.

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Samsung Electronics Co., however, made a surprisingly aggressive decision to keep capital spending at the same level as last year, defying expectations it would go along with rivals in pulling back to alleviate pressure on an already-battered semiconductor industry. The result will be more pressure on chip pricing than if the Korean giant had pulled back spending on new machinery and factory capacity.

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PODCASTS: Corporate Practice of Medicine Laws

Private Equity Owning Doctor Practices

LEGALITY?

By Eric Bricker MD

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PODCAST: https://www.youtube.com/watch?v=2epmk4_-kUI

These Laws Were Put Into Place So That Doctors Would Not Put Shareholders Before Patients and So That Corporations Would Not Interfere with Doctor Judgement.

Corporate Practice of Medicine Laws are at the State Level, NOT the Federal Level.

Each State Has Its Own Exceptions Such as 1) Doctors Can Work for Companies That Are Owned by Other Doctors and 2) Doctors Can Work for Hospitals.

Accordingly, Private Equity Firms Have Been on a Physician Practice Buying Binge.

Private Equity Firms Bought 355 Physician Practices from 2013 – 2016.

Two of the Largest Purchases Were KKR’s Purchase of Envision’s 25,000 Doctors for Almost $10 Billion and Blackstone’s Purchase of Team Health’s 20,000 Doctors for $6 Billion.

If Corporate Practice of Medicine Laws Say that Doctors Cannot Work for a Corporation, How are Private Equity Purchases of Physician Practices Legal?

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

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

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Artificial Intelligence Passes U.S. Medical Licensing Exam

ChatGPT

By Staff Reporters

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Two papers show that large language models, including ChatGPT, can pass the USMLE. The papers highlighted different approaches to using large language models to take the USMLE, which is comprised of three exams: Step 1, Step 2 CK, and Step 3. ChatGPT is an artificial intelligence (AI) search tool that mimics long-form writing based on prompts from human users. It was developed by OpenAI, and became popular after several social media posts showed potential uses for the tool in clinical practice, often with mixed results.

According to Victor Tseng, MD, of Ansible Health in Mountain View, California, and colleagues, the results showed “new and surprising evidence” that this AI tool was up to the challenge. Tseng and team noted that ChatGPT was able to perform at >50% accuracy across all of the exams, and even achieved 60% in most of their analyses. While the USMLE passing threshold does vary between years, the authors said that passing is approximately 60% most years.

Source: Michael DePeau-Wilson, Medpage Today [1/19/23]

RELATED: https://medicalexecutivepost.com/2013/06/21/will-future-doctors-need-a-medical-license/

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PRIVATE EQUITY: Ownership in Physician Practices

By NIHCM

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Private equity acquisition of physician practices continues to grow nationwide. New research focused on specialists in dermatology, gastroenterology, and ophthalmology shows the impact of the trend.

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

Novel evidence by NIHCM grantee Jane Zhu, MD, and her team, reveals shifts in workforce composition and hiring patterns after private equity firms obtain physician practices. The researchers’ findings are particularly important for policymakers and practices considering selling to private equity firms. Highlights include:

  • A significant yearly increase in the number of advanced practice providers at private equity-acquired practices, specifically nurse practitioners and physician assistants. 
  • In acquired practices, entering clinicians replaced exiting clinicians at a higher rate than at non-private equity-acquired practices.

This work adds to the research team’s previous findings, including the geographic variations in private equity ownership across six medical specialties, and the impact of private equity on health care costs and utilization.

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PODCAST: Medicare Traditional [A and B] v. Advantage [C] v. Part [D] v. Supplements

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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HOSPITALS: Financial Management Update

By Staff Reporters

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

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Hospitals saw a slight financial boost in November 2022, despite continued negative operating margins throughout the year, according to a new Kaufman Hall National Hospital Flash Report, as reported in Healthcare Brew.

Lower expenses and increased outpatient revenue help buoy their performance and increase margins by 12% month over month from October 2022. But Kaufman Hall, a management consulting firm, reported that its year-to-date operating margin index reflected an actual negative figure of -0.2% in November 2022.

The findings underscore the financial challenges hospitals continue to face as they recover from the Covid-19 pandemic.

And, Erik Swanson, senior vice president of data and analytics at Kaufman Hall, wrote that the “November data, while mildly improved compared to October, solidifies what has been a difficult year for hospitals amidst labor shortages, supply chain issues, and rising interest rates.”

ORDER: https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

The monthly report, which is based on data from more than 900 hospitals, partially attributed November’s lowered expenses to a decline in patient volume and slightly shorter lengths of stay. Decreased labor costs, likely due to a drop in a reliance on contract labor, also helped lower expenses, the Kaufman analysis found.

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

Hospitals further saw a 10% increase year over year in outpatient revenue in November 2022, despite inpatient revenue remaining flat, according to the report. Swanson said “[h]ospital leaders should continue to develop their outpatient care capabilities amid ongoing industry uncertainty and transformation.”

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MEDICARE SUPPLEMENT INSURANCE: Part G

What is it and How Does it Work?

By Staff Reporters

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Did you know that Medicare Plan G is the most popular Medicare Supplement with Baby Boomer clients? Everyone has heard of Plan F, but what is Medicare Supplement Plan G? What does Plan G cover?

Medicare Plan G coverage is very similar to Plan F, which is no longer available for people new to Medicare on or after January 1st, 2020. Plan G offers great value for beneficiaries willing to pay a small annual deductible. After that, Plan G provides full coverage for all of the gaps in Medicare. It pays for your Medicare Part A hospital deductible, co-pays, and coinsurance. It also covers the 20% that Medicare Part B doesn’t cover. Doctors and other healthcare providers must accept a Medigap Plan G if they accept Original Medicare. Plan G policies can be used across the U.S. since they do not have network limitations, and the premium costs can be very reasonable for the coverage you receive.

As you can see below, Supplement Plan G covers almost everything that F does, except for the Part B deductible.

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Medicare Plan G, also called Medigap Plan G, is an increasingly popular Supplement

Reasons:

First, Plan G covers each of the gaps in Medicare except for the annual Part B deductible. This deductible is only $226 in 2023. In fact, if you have a Plan F that has been in place for years, it can probably help you on premiums by looking at Plan G. When you shop for benefits, you can often find a Supplement Plan G that saves quite a bit in premiums over Plan F, usually substantially more than the $226 deductible that you’ll pay out.

Second, it has great coverage. For hospital stays, it covers all your hospital expenses. Most importantly, it pays the hospital deductible, which is over $1,600 in 2023. It also covers the expensive daily co-pays that you might encounter for a hospital stay that runs longer than 60 days. It provides an additional 365 days in the hospital after your Medicare benefits run out, and it covers your skilled nursing facility co-insurance, too.

What Other Medical Services Does Plan G Cover?

Medicare Supplement Plan G covers your percentage of any medical benefit that Original Medicare covers, except for the outpatient deductible. So, it helps to pay for inpatient hospital costs, such as the first three pints of blood, skilled nursing facility care, and hospice care. It also covers outpatient medical services such as doctor visits, lab work, diabetes supplies, cancer treatment, durable medical equipment, x-rays, ambulance, surgeries and much more. This means Plan G covers the coverage gaps with Original Medicare and all Plan G products must provide you with the exact same coverage.

Medicare pays first, then Plan G pays the remaining amount after you pay the once annual deductible. In addition, Plan G Medicare Supplements offer up to $50,000 in foreign travel emergency benefits (up to plan limits).

Related Article: Medicare Costs for 2023

CITE: https://www.r2library.com/Resource/Title/082610254

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DAILY UPDATE: Elon Musk Wins but SPACS Do Not

By Staff Reporters

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A judge just ruled that a group of laid-off Twitter employees suing the business over their severance compensation, have to pursue their claims individually rather than as part of a class action, according to a Bloomberg report. About 500 of the roughly 3,700 Twitter employees Elon Musk laid off since taking control of the company last year have already filed individual arbitration claims, according to Shannon Liss-Riordan, the lawyer who filed those claims on the workers’ behalf.

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SPAC SEEKING SPAC: Money-losing companies that recently went public via SPAC are combining with other SPACs to secure more funding and stay afloat. The ultimate goal is one giant SPAC?

DEFINITION: https://medicalexecutivepost.com/2022/06/13/spac-v-direct-listing-v-ipo/

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

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BEWARE: Ransomware Attacks in Healthcare

HHS CYBER SECURITY PROGRAM

By Staff Reporters

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According to Healthcare Brew, the rising tide of ransomware attacks in healthcare is exacting a hefty price from hospitals and other medical providers who’ve had their data locked up by cyberattacks.

Healthcare providers face potential costs arising from more than just the initial ransom; targeted systems have seen lost patient revenue, the need for remediation, and additional recovery costs. And even the largest health systems in the country aren’t immune to the costly ripple effects, such as delayed patient care, including surgeries, that can linger even after an initial attack.

“Not only is the frequency [of ransomware attack] picking up, but I’d say the magnitude or the size is also getting bigger,” said Brian Tanquilut, a healthcare services analyst at Jefferies.

CommonSpirit Health, one of the nation’s largest hospital chains, was hit with a high-profile cyberattack in October. The system has not publicly disclosed the financial fallout, but a Dec. 1 update published on the company’s website said that the cyberattackers gained access to personal information for some patients and that an investigation is ongoing. Chad Burns, a spokesperson for CommonSpirit, declined requests for an interview.

A report from the cybersecurity firm Sophos determined that “the average remediation cost [from a ransomware attack] went up from $1.27 million in 2020 to $1.85 million in 2021.” For others, it’s much more costly.

CITE: https://www.r2library.com/Resource/Title/082610254

Tenet Healthcare, a Dallas-based healthcare company, reported a loss of about $100 million attributed to a ransomware attack in April, according to its second-quarter earnings report. San Diego-based Scripps Health said a ransomware attack cost it nearly $113 million in May and June 2021 primarily due to lost revenue, along with recovery costs. Keep reading here.

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AFFORDABILITY: Healthcare on Notice for Patients

By Staff Reporters

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People living in the US are finding it increasingly difficult to afford needed health services—even with employer-sponsored health insurance, a new analysis suggests.

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

Researchers at the NYU School of Global Public Health (GPH) examined data from the National Health Interview Survey—an annual CDC survey—that was collected from 2000 to 2020 for 230,000+ adults who received health insurance through an employer or union. Both men and women found most healthcare services to be less affordable now compared to the early 2000s, according to the finding of the NYU analysis reported in a December 2022 JAMA abstract. Women, in particular, found all types of health services to be less affordable than men.

From a nationally representative survey which is conducted annually, researchers included data from 5,545 women and 5,353 men sampled in 2020, and found that about 6% of women reported they couldn’t afford needed medical care. This compares to just 3% of slightly larger sample groups from 2000, per the analysis. By contrast, about 3% of men gave that response in 2020, compared to 2% in 2000.

Avni Gupta, a doctoral student in the public health policy and management department at NYU GPH and the lead author of the analysis, offered that “lower incomes and higher healthcare needs among women could be driving these differences in reported affordability.”

And, José Pagán, the department chair and co-author of the JAMA analysis, said people with employer-sponsored coverage—the largest source of health insurance for people living in the US—“generally think they are protected.”

“[B]ut our findings show that health-related benefits have been eroding over time,” he said; according to Healthcare Brew

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ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCASTS: The Physician-Patient Population Health Mis-Match

By Eric Bricker MD

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PODCAST: https://medicalexecutivepost.com/2022/10/23/podcast-help-your-medical-practice-embrace-population-health/

Population Health: https://medicalexecutivepost.com/2022/07/12/enter-population-health-management/

CITE: https://www.r2library.com/Resource/Title/082610254

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More Orthopedic Physicians Sell Out to Private Equity Firms, Raising Alarms About Costs and Quality

STAFF REPORTERS

Private Equity Partnerships in Orthopedic Groups: Current State and Key Considerations

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

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READ HERE: https://journaloei.scholasticahq.com/article/17721-private-equity-partnerships-in-orthopedic-groups-current-state-and-key-considerations

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The META Class Action Lawsuit Settlement

By Staff Reporters

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Meta will pay real money to settle data privacy claims

The company has agreed to pay Facebook users in the US $725 million to resolve a lawsuit stemming from that time it gave political consulting firm Cambridge Analytica access to data from ~87 million users during the 2016 election.

The settlement, which the plaintiffs say may be the largest deal in a US privacy class action ever, still needs a judge’s approval before anyone gets cash, though.

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ORDER: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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PODCAST: “All OR Nothing” Hospital Contracts

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Value Based Healthcare Delivery by Dr. Michael Porter PhD

HARVARD BUSINESS SCHOOL

By Staff Reporters

CITE: https://www.r2library.com/Resource/Title/082610254

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MEDICAL PRIOR AUTHORIZATION: Proposed Modernization from CMS

By Health Capital Consultants, LLC

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CMS Proposes Modernizing Prior Authorizations

On December 6, 2022, the Centers for Medicare & Medicaid Services (CMS) proposed a modernization of the prior authorization process for health insurance. The proposed rule seeks to require certain insurers to implement electronic prior authorization, shorten decision timeframes, and make the process more transparent and efficient.

CITE: https://www.r2library.com/Resource/Title/082610254

The rule includes “five key provisions and five Requests for Information,” aiming to “improve patient and provider access to health information and streamline processes related to prior authorization for medical items and services.” This Health Capital Topics article will review those provisions and requests for information, as well as stakeholder responses to the proposals. (Read more…)

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Omicron Sub-Variant XBB Rapidly Gaining Ground in the U.S.A.

By Staff Reporters

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he emerging Omicron subvariant XBB contributes to an increasingly high number of COVID-19 cases in the U.S., rivaling the sister strains BQ.1.1 and BQ.1, according to the latest estimates from the Centers for Disease Control and Prevention (CDC).

Recent studies have indicated that the updated bivalent COVID-19 booster performed poorly against BQ.1.1, with even a weaker antibody response against XBB.

In late November, citing its poor neutralization effect on BQ.1 and BQ.1.1., the FDA pulled the emergency use authorization granted for bebtelovimab, a COVID-19 antibody therapy developed by Eli Lilly (LLY) and AbCellera Biologics (ABCL).

The CDC estimates for the week ending Dec. 24 show that XBB has made up ~18% of COVID cases in the U.S. compared to ~11% a week ago. Meanwhile, BQ.1.1 has led to ~36% of cases unchanged from a week ago, and BQ.1 caused ~27% of cases, a decline from ~29% last week.  

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ORDER: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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HOSPITAL FORMS: Be Aware BEFORE You Sign

By Staff Reporters

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You don’t have to sign all the forms to be treated

Part of being a patient is signing stacks of forms, most of which you barely read much less understood. This is a mistake, Charlotte O’Leary says. Look for any “blank check” clauses on intake forms—it’s the part that reads, “I will be responsible for all costs not covered by insurance.”

CITE: https://www.r2library.com/Resource/Title/082610254

Instead, Charlotte Hilton Andersen, MS recommends crossing it out and writing, “I will be responsible for all costs that are medically necessary, that are not the responsibility of my insurer, are competitively priced, and that I am made aware of prior to treatment if they are not part of standard operating procedures.”

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Digital Health Insurance Tracking Devices

By Staff Reporters

Blue Cross Blue Shield has deployed several trackers on its website, according to the web extension Ghostery, a tool that can tell you what kind of technology web pages are using.

  • Ghostery returned a list of trackers from Twitter, Google, and LinkedIn.

Though we don’t know specifically what kind of data is being transferred, these pixels are usually installed to help marketing departments. Tracking pixels, for the uninitiated, are hidden or embedded graphics that can give a more complete picture of a customer’s journey: what they’ve clicked on, if they’ve searched for something specific, if they’ve put something in a shopping cart, or whether an advertisement drove them to, say, Blue Cross Blue Shield’s homepage. For example, if an insurer wants to show that its ads are working, it can use a pixel to determine that it was their ad that got someone to finally sign up for health insurance, not Susan in HR.

CITE: https://www.r2library.com/Resource/Title/082610254

Trackers are ubiquitous, but experts and consumers have raised serious questions about the data that’s shared between companies. For example, investigative reporting outlet The Markup found that hospitals shared sensitive information with Facebook through the Meta pixel. And just this month, Indianapolis-based Community Health Network reported that pixels may have affected 1.5 million of its patients.

For more, read Marketing Brew’s interview with sociologist Mary F.E. Ebeling, who wrote a book about the collection of sensitive health data.

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TURQUOISE HEALTH? Compare Prices Before Receiving Medical Care

By Staff Reporters

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Last year, all hospitals were required to list their prices for elective services on an annual basis. Whether you have insurance or plan to pay cash – find and compare prices.

CITE: https://www.r2library.com/Resource/Title/082610254

So, just like you wouldn’t buy a car, rent an apartment or even order food without knowing the cost, you shouldn’t pay blindly for healthcare.

Now you can compare prices before showing up for treatment.

READ MORE: https://turquoise.health/

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MEDICARE: Part “C” Plans = Double Standard

By Anonymous

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The HHS OIG Fall 2022 report was recently released to Congress. On page 20, there are many referrals to seven inappropriate payments to a variety of Medicare “Advantage” Plans. Topping the list is Humana. The OIG claims that Humana in the time period studied falsified records to receive $34.4M worth of payments they received from CMS for risk diagnosis code risk assessments. If even half this amount is true, it is unconscionable that Humana is not severely fined, their executives terminated and subjected to criminal proceedings, and they should be banned from the Medicare program for ten years. This is no different from how other healthcare providers are criminalized, so the question is, why is the insurance industry treated different and preferentially when they commit fraud?

CITE: https://www.r2library.com/Resource/Title/082610254

These OIG studies are great reads, but up until now, they have done nothing to stop the insurance industry’s abusive practices of denying “clean claims”, denying claims after prior authorization, ignoring CCI edits, “losing” charts sent for review and then claiming higher error rates to Congress, paying providers often less than 50% of Medicare, and this the last draw… falsifying data so they can be paid more from CMS. When will this madness stop? When will providers have the gumption to actually act out the famous quote, “I’m mad as hell and I’m not going take it anymore!” (from the movie Network), and Peter Finch it!

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ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCAST: Financial Deception in Healthcare

THIRTY EXAMPLES

By Eric Bricker MD

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

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

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ELIXIR: Rite Aid’s New PBM [mail order pharmacy]

By Staff Reporters

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When Rite Aid dropped roughly $2 billion in 2015 to buy its pharmacy benefit management (PBM) subsidiary now known as Elixir, the company had framed the investment as a strategic move to compete in the healthcare marketplace among rivals like CVS and Walgreens.

The deal quickly helped make Rite Aid $4.1 billion in its newly formed pharmacy services segment—including Elixir and other pharmacy services, according to the company—bolstering its financial standing the next fiscal year. Maybe it would no longer be the ugly duckling next to the cooler, sleeker swans.

It seemed to be working—for a while at least. But by 2018, analysts were recommending Rite Aid sell off Elixir to reduce the parent company’s debt. Still, Rite Aid stuck with Elixir in hopes of boosting its competitiveness in the retail pharmacy scene.

CITE: https://www.r2library.com/Resource/Title/082610254

This year, Rite Aid President and CEO Heyward Donigan was still painting a rosy picture of Elixir, saying in earnings calls that the PBM was gaining more members and Elixir’s operating margins were improving.

But a month after its latest earnings call in September, Rite Aid was hit with a class-action lawsuit accusing the company of making “false and/or misleading statements” to investors about Elixir’s status between April and September of this year.

READ: https://www.healthcare-brew.com/stories/2022/12/09/rite-aid-faces-a-class-action-lawsuit-over-its-pharmacy-benefits-subsidiary

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PODCAST: Never Pay Your First Medical Bill?

Marshall Allen Has a New Healthcare Book Out Called Never Pay the First Bill.”

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Medical Workplace Violence Prevention Guidelines

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Earliest Guidelines in California Program

By Eugene Schmuckler; PhD MBA MEd CTS

By Dr. David E. Marcinko MBA

UPDATE

At least 5 people are dead and multiple people are injured following a shooting at the Natalie Building at St. Francis Hospital in Tulsa, Oklahoma.

Link: https://apnews.com/article/tulsa-oklahoma-c29a239d1c2ac7f7f0bfdc161b72f6f2

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The impact of medical workplace violence became widely exposed on November 6, 2009 when 39 year old Army psychiatrist Maj. Nidal M. Hasan MD, a 1997 graduate of Virginia Tech University who received a medical doctorate in psychiatry from the Uniformed Services University of the Health Sciences in Bethesda, Maryland, and served as an intern, resident and fellow at the Walter Reed Army Medical Center in the District of Columbia, went on a savage 100 round shooting spree and rampage that killed 13 people and injured 32 others. In April 2010 he was transferred to Bell County Jail in Belton, Texas awaiting trial.

Federal Government Guidelines

The federal government and some states have developed guidelines to assist employers with workplace violence prevention. For instance, one of the earliest sets of guidelines for a comprehensive workplace violence prevention program was published in 1993 by California OSHA. This resulted from the murder of a state employee. In 1996, Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers was published by OSHA.

Book Link:  www.BusinessofMedicalPractice.com

OSHA Guidelines

In its guidelines, OSHA sets forth the following essential elements for developing a violence prevention program:

  • Management commitment — as seen by high-level management involvement and support for a written workplace violence prevention policy and its implementation.
  • Meaningful employee involvement — in policy development, joint management-worker violence prevention committees, post-assault counseling and debriefing, and follow-up are all critical program components.
  • Worksite analysis — includes regular walk-through surveys of all patient care areas and the collection and review of all reports of worker assault. A successful job hazard analysis must include strategies and policies for encouraging the reporting of all incidents of workplace violence, including verbal threats that do not result in physical injury.
  • Hazard prevention and control — includes the installation and maintenance of alarm systems in high-risk areas. It may also include the training and posting of security personnel in emergency departments. Adequate staffing is an essential hazard prevention measure, as is adequate lighting and control of access to staff offices and secluded work areas.
  • Pre-placement and periodic training and education — must include educationally appropriate information regarding the risk factors for violence in the healthcare environment and control measures available to prevent violent incidents. Training should include skills in aggressive behavior identification and management, especially for staff working in the mental health and emergency departments.

On May 17, 1999, Governor Gary Locke signed the New Workplace Violence Prevention Act for the state of Washington. This act mandates that each healthcare setting in the state implement a plan to reasonably prevent and protect employees from violence.

New Washington Workplace Violence Prevention Act

According to this act, prevention plans need to address security considerations related to:

  • physical attributes of the healthcare setting;
  • staffing, including security staffing;
  • personnel policies;
  • first aid and emergency procedures;
  • reporting of violent acts; and
  • employee education and training.

Prior to the development of an actual plan, a security and safety assessment needs to be conducted to identify existing or potential hazards. The training component of the plan must include the following topics:

  • general safety procedures;
  • personal safety procedures;
  • the violence escalation cycle;
  • violence-predicting factors;
  • means of obtaining a patient history form from a patient with violent behavior;
  • strategies to avoid physical harm;
  • restraining techniques;
  • appropriate use of medications as chemical restraints;
  • documenting and reporting incidents;
  • the process whereby employees affected by a violent act may debrief;
  •  any resources available to employee for coping with violence; and
  • the healthcare setting’s workplace violence prevention plan.

Assessment

The act further mandates that any hospital operated and maintained by the State of Washington for the care of the mentally ill is required to provide violence prevention training to affected employees identified in the plan on a regular basis and prior.

Front Matter: Front Matter BoMP – 3 

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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MEDICAL RISK MANAGEMENT, Liability Insurance and Asset Protection Strategies

FOR PHYSICIANS AND THEIR FINANCIAL ADVISORS

SPONSOR: http://www.CertifiedMedicalPlanner.org

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REVIEWS:

“Physicians who don’t understand modern risk management, insurance, business, and asset protection principles are sitting ducks waiting to be taken advantage of by unscrupulous insurance agents and financial advisors; and even their own prospective employers or partners. This comprehensive volume from Dr. David Marcinko and his co-authors will go a long way toward educating physicians on these critical subjects that were never taught in medical school or residency training.”
Dr. James M. Dahle, MD, FACEP, Editor of The White Coat Investor, Salt Lake City, Utah, USA


“With time at a premium, and so much vital information packed into one well organized resource, this comprehensive textbook should be on the desk of everyone serving in the healthcare ecosystem. The time you spend reading this frank and compelling book will be richly rewarded.”
—Dr. J. Wesley Boyd, MD, PhD, MA, Harvard Medical School, Boston, Massachusetts, USA

ASSESSMENT: Your thoughts are appreciated.

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PODCAST: “Real ACOs Haven’t Been Tried Yet!”

What is an Accountable Care Organization?

DEFINITION: ACOs are groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending health care dollars more wisely, the ACO will share in the savings.

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

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QUESTION: What happens when you’re a healthcare policy wonk and the pilot study for your pet program has failed miserably? 

ANSWER: You declare “Success!” in the editorial pages of the New England Journal of Medicine and demand that the program become nationwide and mandatory. I kid you not.  This is exactly what happens.

Thankfully, Anish Koka is vigilant and explains the blatant obfuscations and manipulations that the central planners engage in to have their way.

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And so, In this video, Anish and colleague Michel Accad, MD, will reveal the machinations, take the culprits to task, and discuss pertinent questions regarding health care organization: 

  • Does “capitation” reduce costs? 
  • Do employed physicians necessarily utilize fewer resources? 
  • What happens when a HMO and a traditional fee-for-service health system operate side-by-side in a community?
BMC and Accountable Care - Boston Medical Center

Enjoy!

PODCAST: http://alertandoriented.com/real-acos-havent-been-tried-yet/

Your thoughts are appreciated.

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How to THRIVE in Private Independent Medical Practice, Today?

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PODCAST: CMS Over-Payments to Medicare Advantage [Part C] Plans

By Eric Bricker MD

RISK ADJUSTMENTS EXPLAINED

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What is a Social Impact Bond?

New Financial Product – or Societal Economic Hammer

By Dr. David Edward Marcinko MBA CMP™

At a time when government finances are stretched there is growing interest in finding new ways to fund public services [healthcare, for example] which improve social outcomes [public health]. And, one new funding model currently being tested, for the past decade in the United Kingdom, is Social Impact Bonds (SIBs).

Definition

A SIB is a form of payment by results (PBR) in which funding is obtained from private investors to pay for interventions to improve social outcomes. If these interventions succeed in improving outcomes, they should result in savings to the Government and provide wider benefits to society. Of course, as part of a SIB, the Government agrees to pay a proportion of these savings back to the investors. If outcomes do not improve, investors do not receive a return on their investment.

Link: http://en.wikipedia.org/wiki/Social_impact_bond

Wall Street’s Securitization

Wall Street can securitize almost any asset for a commission, or to hold it for profit or loss. Remember David Bowie bonds?

“Securitization” is the process through which an issuer creates a financial instrument by combining other financial assets and then marketing different tiers of the repackaged instruments to investors. The process can encompass any type of financial asset and promotes liquidity in the marketplace.

Link: http://thehealthcareblog.com/blog/2012/03/05/could-social-impact-bonds-help-restore-public-budgets/

SIBs

SIBs may be an example of securitization. By combining small debt into one large pool, the issuer can divide the large pool into smaller pieces based on each individual bond’s inherent risk of default, and then sell those smaller pieces to investors. The process creates liquidity by enabling smaller investors to purchase shares in a larger asset pool. Individual retail buyers, like physician-investors and others, are able to purchase portions the bond. Without the securitization, retail investors might not be able to afford to buy into a large pool of bonds.

Read more: http://www.investopedia.com/terms/s/securitization.asp#ixzz1oGtOPTvZ

Assessment

This is the first time we’ve discussed SIBs on this ME-P. But, they should get much more attention from our CPA, investment advisor [IA] and financial advisory [FA] readers now that President Obama has announced his support for this British idea like getting private investors to pay for public services such as housing for the homeless, health care for vulnerable populations; or even education. It could work for anything that can save the Government money in the long run, but costs money up front, as long as we can measure it.

Link: http://www.fastcompany.com/1728321/the-most-exciting-00003-of-obama-s-budget-social-impact-bonds

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Product Details  Product Details

MEDICAL DEBT: Banks and Private Equity Cash In When Patients Can’t Pay Bills

By Noam N. Levey and Aneri Pattani

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Robin Milcowitz, a Florida woman who found herself enrolled in an AccessOne loan at a Tampa hospital in 2018 after having a hysterectomy for ovarian cancer, said she was appalled by the financing arrangements.“Hospitals have found yet another way to monetize our illnesses and our need for medical help,” said Milcowitz, a graphic designer.

She was charged 11.5% interest — almost three times what she paid for a separate bank loan. “It’s immoral,” she said.

READ: https://khn.org/news/article/how-banks-and-private-equity-cash-in-when-patients-cant-pay-their-medical-bills/

MORE: https://khn.org/news/article/medical-debt-hospitals-dallas-fort-worth/

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PODCAST: What is Public Health?

By American Journal of Public Health

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Public health is now part of the political conversation but everyone doesn’t understand it in the same way. Hence the idea of interviewing Governor John Kasich, former governor of Ohio, who has been promoting a greater attention to public health, about what is public health for him.

CITE: https://www.r2library.com/Resource/Title/082610254

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INSURANCE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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TECH: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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Podcasts: WHAT IS FREE-MARKET “RENT-SEEKING” BEHAVIOR IN HEALTHCARE?

What About “Rent-Seeking” in Banking and Financial Services?

By Dr. David E. Marcinko, MBA

Courtesy: www.CertifiedMedicalPlanner.org

Rent-Seeking is a public choice, and economics, theory that involves methods to increase one’s share of existing wealth without creating new wealth [no added value].

Rent-Seeking results in reduced economic efficiency through misallocation of resources, reduced wealth-creation, lost government revenue, heightened income inequality, and potential national decline.

LINK: https://www.amazon.com/Dictionary-Health-Economics-Finance-Marcinko/dp/0826102549/ref=sr_1_6?ie=UTF8&s=books&qid=1254413315&sr=1-6

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Assessment: But, what about rent-seeking behavior in the healthcare industrial complex, banking and financial services industry, today”

ESSAY: https://pnhp.org/news/the-economist-rent-seeking-in-americas-health-care-system/

MORE: https://www.the-american-interest.com/2014/06/05/health-care-rent-seeking-in-90-seconds/

MORE: https://www.marketwatch.com/story/nobel-economist-takes-aim-at-rent-seeking-banking-and-healthcare-industries-2017-03-06

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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

THANK YOU

8Product DetailsProduct Details

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PODCAST[s]: Medicare Re-Admission Penalties

UPDATE 83% Penalized!

By Eric Bricker MD

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HRRP PODCAST: https://www.youtube.com/watch?v=mwRrKM83CVQ

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PODCAST: What is a Quality-Adjusted Life Year?

NOT A Generic Obscure Measure

By Dr. David E. Marcinko MBA

http://www.CertifiedMedicalPlanner.org

The quality-adjusted life year or quality-adjusted life-year (QALY) is a generic measure of disease burden, including both the quality and the quantity of life lived.

It is used in economic evaluation to assess the value for money of medical interventions. One QALY equates to one year in perfect health. If an individual’s health is below this maximum, QALYs are accrued at a rate of less than 1 per year.

LINK: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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ASSESSMENT: To be dead is associated with 0 QALYs. QALYs can be used to inform personal decisions, to evaluate programs, and to set priorities for future programs

MORE: http://www.msn.com/en-us/money/healthcare/obscure-model-puts-a-price-on-good-health-and-drives-down-drug-costs/ar-AAJP8Nm?li=BBnbfcN

VIDEO: https://www.youtube.com/watch?v=OTmXnv2RAHw

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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Product DetailsProduct Details

ELECTIONS: Money and Markets

Historical Review

By Staff Reporters

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Now that the voting is behind us, it might be safe to start checking your portfolio. In recent history, stocks have only gone up after midterm elections:

  • In the year following every midterm election since 1950, the S&P 500 has risen—no matter which party won.
  • A divided government, which could happen if the GOP retakes at least the House, delivers the best market results: Data going back to 1932 shows average annual S&P returns of 13% when there’s a GOP-controlled Congress under a Democratic president, compared to 10% when Democrats have both, per RBC Capital Markets.

Why?

There’s some debate, but partisan gridlock can be advantageous for business because it minimizes the chance of major changes to taxes or other laws that impact companies. It also doesn’t hurt to have the uncertainty of the election in the rear-view mirror.

Right now however, investors are more focused on the FOMCs’ rate hikes in response to inflation. While politicians from both sides of the aisle have criticized Jerome Powell’s recent decisions, he’s unlikely to change course due to the election outcome. Plus, economists seem pretty convinced the US is headed toward a recession, regardless of who’s in control in Washington.

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MEDICAL BILLING: Down and Up Coding?

By Staff Reporters

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DEFINITION

Upcoding is a type of fraud where healthcare providers submit inaccurate billing codes to insurance companies in order to receive inflated reimbursements. These false “current procedural technology” (CPT) submissions indicate that doctors provided patients with treatments that were more complex, costly, and time-consuming than what they actually received. This unlawful scheme is a violation of the False Claims Act (FCA) because it defrauds federal programs including Medicare, Medicaid, and Tricare.

CITE: https://www.r2library.com/Resource/Title/082610254

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There are nearly 7,800 CPT codes used by healthcare providers. Collectively, these codes represent all of the procedures, conditions, and drugs that are currently reimbursable by the health insurance industry. Each one of them has an associated cost for individuals and insurance companies, based upon the urgency of the issue and the complexity of the decision-making required of the healthcare provider. Medicaid and Medicare reimburse providers based on this system.
For example, a five-minute consultation with a nurse for a minor medical question would receive a different, less expensive CPT than the one for a full examination by a doctor lasting 45-minutes. However, if the physician charges the federal programs for the more expensive 45-minute examination when the five-minute consultation is what actually occurred, this would constitute upcoding.

Unbundling

Unbundling is another common form of upcoding. This fraudulent scheme involves billing for individual procedures that are usually performed and billed together under a single CPT code. In some cases, the billing codes for complicated medical operations have associated components built into their CPTs. For example, a hip replacement surgery may factor in the costs of the surgeon’s as well as the use of the operating room. Unbundling occurs when a healthcare provider submits each component within a CPT to Medicare or Medicaid separately. This creates a cost redundancy where wrongdoers can unlawfully seek reimbursement for the same procedure several times over.

CMS: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf

What Is Downcoding?

Downcoding is the opposite of upcoding. If you perform a service but record the CPT for a lower-level service, that is downcoding. Downcoding also leaves you vulnerable to an audit, which is never good. But, it can also cost a practice thousands of dollars a year in lost revenue because you’re not getting the higher rate of pay that you would if you had recorded the service properly.

According to the National Correct Coding Initiative (NCCI): “Physicians must avoid downcoding. If an HCPCS/CPT code exists that describes the services performed, the physician must report this code rather than report a less comprehensive code with other codes describing the services not included in the less comprehensive code.”

MORE: https://zeemedicalbilling.com/what-is-upcoding-and-downcoding-in-medical-billing/

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HERE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649706/

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

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What is the INDIAN HEALTH SERVICE?

ABOUT THE I.H.S

By Dr. Dvid Edward Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

According to Wikipedia, the Indian Health Service (IHS) is an operating division (OPDIV) within the U.S. Department of Health and Human Services (HHS). IHS is responsible for providing direct medical and public health services to members of federally-recognized Native American Tribes and Alaska Native people. IHS is the principal federal health care provider and health advocate for Indian people.

The IHS provides health care in 36 states to approximately 2.2 million out of 3.7 million American Indians and Alaska Natives (AI/AN). As of April 2017, the IHS consisted of 26 hospitals, 59 health centers, and 32 health stations. Thirty-three urban Indian health projects supplement these facilities with a variety of health and referral services. Several tribes are actively involved in IHS program implementation. Many tribes also operate their own health systems independent of IHS. It also provides support to students pursuing medical education in order staff Indian health programs.

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EDITOR’S NOTE: I did a rotation at a Federally Qualified Health Center through the I.H.S. when I was a surgical fellow back in the day. I enjoyed it immensely. Consulting services since then.

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Indian Health Service Announces Expansion of Specialty ...

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GOVERNMENT: https://www.ihs.gov/

CONGRESS: https://blog.petrieflom.law.harvard.edu/2021/06/03/indian-health-service-biden-congress/

ASSESSMENT: Your thoughts are appreciated.

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

THANK YOU

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What is a Federally Qualified Health Center?

ABOUT F.Q.H.C.s

By Dr. David E. Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

I worked at several FQHCs as a medical student and intern, back in the day, both in urban and suburban settings. But, I never was sure what this entity was, exactly. Probably because I was from an under served area, myself.

DEFINITION:

A Federally Qualified Health Center (FQHC) is a reimbursement designation from the Bureau of Primary Health Care and the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services. This designation is significant for several health programs funded under the Health Center Consolidation Act (Section 330 of the Public Health Service Act).

It is a community-based organization that provides comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status.

Thus, they are a critical component of the health care safety net. FQHCs are called Community/Migrant Health Centers (C/MHC), Community Health Centers (CHC), and 330 Funded Clinics. FQHCs are automatically designated as health professional shortage facilities.

CMS: https://www.cms.gov/Center/Provider-Type/Federally-Qualified-Health-Centers-FQHC-Center

FQHC.org: https://www.fqhc.org/what-is-an-fqhc/

Your thoughts are appreciated.

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

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MEDICARE: “Dis” Advantage Plan Marketing

CMS Cracks Down on Medicare Advantage TV Marketing

Dr. David Edward Marcinko MBA

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CMS is cracking down on deceptive marketing practices and will no longer allow Medicare Advantage or Part D prescription drug plans to advertise on television without agency approval first. The new policy is effective Jan. 1st and was discussed in an Oct. 19th memo from CMS to MA and Part D providers. The agency said it issued the new policy after reviewing thousands of beneficiary complaints regarding confusing, misleading or inaccurate information from plans — plan sponsors are also responsible for all marketing activities from brokers and third-party agencies.

“CMS has conducted so-called ‘secret shopping’ by calling numbers associated with television advertisements, mailings, newspaper advertisements and internet searches to monitor the experience beneficiaries have engaging these entities,” the agency wrote.

“Our secret shopping activities have discovered that some agents were not complying with current regulation and unduly pressuring beneficiaries, as well as failing to provide accurate or enough information to assist a beneficiary in making an informed enrollment decision.”

Source: Jakob Emerson, Becker’s Payer Issues [10/27/22]

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OIG: https://oig.hhs.gov/oei/reports/OEI-09-18-00260.asp

RELATED: https://medicalexecutivepost.com/2021/05/21/podcast-medicare-advantage-plans-insurance-company-goldmine

MORE: https://medicalexecutivepost.com/2022/04/29/probe-medicare-advantage-part-c-plans-deny-needed-care-to-tens-of-thousands-of-patients/

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ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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ELON MUSK’S TWITTER FOR DOCTORS: Same, Change, Grow or Die?

By Staff Reporters

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NEWS FLASH!

Elon Musk, the richest person on the planet, is the CEO of the world’s most valuable automaker TESLA, heads up a $125 billion aerospace giant, and as of yesterday, is the owner of a social media company Twitter.

According to multiple reports, Musk closed the $44 billion deal last night, less than 24 hours before today’s 5pm ET deadline. He began his reign as “Chief Twit” by firing at least four executives, including CEO Parag Agrawal (who was reportedly escorted out of Twitter’s SF headquarters). Later today, Musk is expected to address anxious employees, who might be worried they’ll face the same fate as their former leader. Historically:

  • Musk acquired a large stake in Twitter and later signed a deal to buy all of it.
  • Then he tried to back out, citing bot issues, but Twitter sued him to enforce the agreement.
  • Musk blinked weeks ahead of a trial, and said he would buy Twitter.

Now What?

So begins Musk’s attempt to, in his words, “help humanity” by trying to turn Twitter into a “common digital town square.”

We know that Musk has ultra-ambitious goals for the company: 5x Twitter’s revenue by 2028, supercharge the subscriptions business, and turn Twitter into a super app called “X.” But murkier is the path he intends to take to get there, and he’s already sending mixed signals about his intentions. And what about doctors and the healthcare industrial complex? Will it remain the same or change?

History

Back in early 2014 the first list of the “Top 100 Twitter Accounts For Healthcare Professionals To Follow” was born. Then, the biggest social media-related question to hurdle wasn’t, “Who should I be following on social media?” but rather, “Should I even be on social media at all?”

Many years later, it’s safe to say that social media has firmly established itself in the healthcare industry. By finding healthcare Twitter accounts that are related to your specialty, you can have access to the best information and always remain within the loop.

Top 100 Healthcare Twitter Accounts T...

But, with the Elon Musk takeover of Twitter, the medicine and healthcare accounts available may change, remain static or grow, and finding the most valuable medical accounts to follow has become more challenging than ever.

Today

Today, the question truly is, “Who should I be following?” Thankfully, you have been covered since 2020.

HERE: https://emedcert.com/blog/top-healthcare-twitter-accounts-to-follow

Now, colleagues should follow the rest of the Musk story in 2022 and beyond.

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ORDER: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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PODCAST: Nine [9] Ways to Pay Doctors

“Behavioral Economic Strategies”

By Eric Bricker MD

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As Published in the Annals of Internal Medicine by an All-Star Cast of Researchers:

1) Limitations of Information
2) Inertia/Status Quo Bias
3) Choice Overload
4) Immediacy
5) Loss Aversion
6) Relative Social Ranking
7) Threshold Effect
8) Limits of Willpower
9) Mental Accounting

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BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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Hospitals in the RED

By Staff Reporters

Hospitals this year are seeing more red than black as growing financial challenges, like spiked labor costs and inflation on medical supplies, puts them on pace to have the worst financial performance into the pandemic thus far.

More than half of hospitals (53% of more than 900 sampled) are projected to have negative margins by the end of the year, compared to 39% in 2019, according to a September report from management consulting firm Kaufman Hall, on behalf of AHA. The firm put the median operating margin for hospitals at about -1%, which could mean service cuts, and for more vulnerable hospitals, including rural ones, closing their doors.

But why is the financial outlook so bleak for hospitals? A few factors are conspiring:

Labor costs: The top reasons hospitals are struggling financially in 2022 are “labor, labor, and labor,” said Kevin Holloran, senior director at Fitch Ratings. The healthcare labor shortage doesn’t just extend to nurses, but across the board.

Rising supply prices: Blame inflation. AHA reported that the “costs for energy, resins, cotton, and most metals surged in excess of 30%” between fall 2020 and early 2022.

Sicker patients, longer stays: Intensive care units across the country were overwhelmed with Covid-19 patients at the outset of the pandemic, but more recently hospitals have been caring for sicker non-Covid patients, said Aaron Wesolowski, AHA’s vice president for policy research and analytics

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

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OPERATIONS: https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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