Coordinated Actions Indicate Growing Scrutiny of Tele-Medicine

By Health Capital Consultants, LLC

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GROWING SCRUTINY OF TELE-MEDICINE

On July 20, 2022, the Office of Inspector General (OIG) of the U.S. Department of Health & Human Services (HHS) released a Special Fraud Alert on telemedicine. On the same day, the U.S. Department of Justice (DOJ) announced a “nationwide coordinated law enforcement action” against 36 defendants, and the Centers for Medicare & Medicaid Services (CMS) Center for Program Integrity announced administrative actions against 52 providers, related to alleged telemedicine arrangements. These coordinated actions indicate a growing scrutiny of telemedicine arrangements by federal government regulators. (Read more...) 

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RELATED: 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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PODCAST: Healthcare Brokers in Cars

By Eric Bricker MD

Price and Quality Transparency Data

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CMS: “Open Payments” Pre-Publication Review & Dispute

NOW AVAILABLE

By Staff Reporters via CMS

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Open Payments is a national disclosure program that promotes a transparent and accountable healthcare system. Open Payments houses a publicly accessible database of payments that reporting entities, including drug and medical device companies, make to certain healthcare providers, which are referred to as covered recipients.

Pre-publication review and dispute for the Program Year 2022 Open Payments data opened on April 1st and is available through May 15th, 2023. Disputes must be initiated by May 15th, 2023 in order to be reflected in the June 2023 data publication. 

CITE: https://www.r2library.com

For more information on review and dispute timing and publication, refer to the Review and Dispute Timing and Data Publication Quick Reference Guide.

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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WORLD HEALTH ORGANIZATION: World Health Day

Happy 75th Birthday

By Staff Reporters

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It’s World Health Day and the 75th birthday of the World Health Organization (WHO). Thanks to the WHO, we have almost eradicated diseases like polio and smallpox, and the organization led the largest-ever response to a global health crisis against the Covid-19 pandemic.

So, why not Celebrate this World Health Day by taking care of yourself? It doesn’t have to be tough or uninteresting to eat a well-balanced, nutrient-dense diet, reduce alcohol intake or go for a walk or other exercise. And, stick around for next year!

READ: https://www.who.int/westernpacific/news-room/events/detail/2023/04/07/western-pacific-events/world-health-day-2023

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PODCAST: The CXO “Rapid Resolutions Team” in Health Insurance

CLAIMS DENIED

By Eric Bricker MD

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Valuation of Medicare Advantage Plans and the Competitive Environment

By Health Capital Consultants, LLC

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Medicare Advantage (MA) plans, also known as Part C plans, serve as a supplement or an alternative to Original (also called Traditional) fee-for-service (FFS) Medicare Part A and Part B coverage, but they are still part of the Medicare program.

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

Most of these plans also include Part D (drug) coverage. MA was created by Congress to offer seniors an alternative to Original Medicare – with an emphasis on treating and managing the health of the whole patient. MA plans are offered to Medicare beneficiaries by Medicare-approved private companies, known as MA Organizations (MAOs), that must follow rules set by Medicare. (Read more…) 

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PODCAST: Hospitals Co-Ordinate Care for Medicare Patients

USUALLY NOT PRIVATE INSURERS!

By Eric Bricker MD

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RELATED: 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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ORGAN TRANSPLANTS: Overhauling the System

By Staff Reporters

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The Biden administration just unveiled a plan to revamp the problem-ridden system for organ procurement and transplants.

Health 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

One nonprofit, United Network for Organ Sharing, has had a monopoly on running the system for nearly four decades, but the government’s proposal includes potentially bringing more organizations in, as well as upping funding and modernizing the computer systems involved.

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

NOTE: There are ~104,000 people currently waiting for an organ transplant, and 17 people die per day while waiting.

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Harvesting: https://medicalexecutivepost.com/2017/09/05/on-organ-harvesting/

Dialysis: https://medicalexecutivepost.com/2021/09/22/podcasts-more-dialysis-center-investigative-reporting/

Body Brokers: https://www.msn.com/en-us/news/us/new-cbs-reports-documentary-body-brokers-explores-realities-of-donating-bodies-to-science/vi-AA18WVZ8?ocid=U521DHP&pc=U521&cvid=11f7cdab99224f1aa9290a2a3dbed05b&ei=33

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PHYSICIANS: “Aging Out”

By Staff Reporters

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According to HealthcareBrew, thousands of doctors are expected to reach retirement age in the next three years, and their replacements won’t be physicians. Instead, physician assistants (PAs) and nurse practitioners (NPs) will increasingly provide primary care services, according to a report from consulting firm Mercer.

By 2026, 21% of family medicine, pediatric, and obstetrics and gynecology physicians—or about 32,000 doctors—will be 65 or older, and Mercer anticipates about 23,000 physicians will leave the profession permanently. At the same time, demand for primary care physicians is expected to grow 4%, the report found.

PAs and NPs—also called advanced practice providers (APPs) or physician extenders—are highly trained medical professionals. To become a PA, you have to have both a bachelor’s and a master’s, some clinical work experience, pass the Physician Assistant National Certifying Exam, and then apply to get licensed in your state (you know, easy peasy). It takes seven to nine years to go through that process, compared to 11+ years to become an MD.

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

To become an NP, you must have both a bachelor’s and a master’s in nursing, become a registered nurse, and pass a national NP board certification exam. It takes between six to eight years to become an NP.

Compared to physicians, PAs and NPs are “considerably younger professions with less than half the retirement risk,” the Mercer report stated. Roughly 40,000 PAs and NPs join the workforce annually.

“We’re certainly going to see increasing demand for APPs,” David Mitchell, a partner in Mercer’s career consulting business and a specialist in the healthcare industry, told Healthcare Brew.

While most state licensing boards require a physician to oversee APPs, both PAs and NPs have the authority to do many services primary care physicians do, like seeing and diagnosing patients, ordering lab tests, and writing prescriptions, said Mitchell.

READ HERE: https://www.healthcare-brew.com/stories/2023/03/16/non-mds-will-provide-primary-care?cid=30859907.17846&mid=349b552221c994e2540a304649746d7c&utm_campaign=hcb&utm_medium=newsletter&utm_source=morning_brew

MORE: https://www.aamc.org/data-reports/data/2022-physician-specialty-data-report-executive-summary

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PODCAST: Value Based Care

THE EVOLUTION OF VBC

By Digital Health New York

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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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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: Behavior Modification and the Science of Change in Healthcare

By Eric Bricker MD

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

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NAPA Update for Inova Loudoun Hospital

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By Anonymous Letter Leaker

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DAVE – This is what happens when private equity takes over anesthesiologists and other medical services. Private equity has squeezed so much out of physician lives and their practices, that practice has become intolerable. They are all so burnt out that the physician anesthesiologist must now strike out against their own private equity group owners (NAPA). The trickle-down effect becomes with the hospital now caught in the middle, contracted with a private equity group which  provides anesthesia, but they have no anesthesiologist employees.

Where does patient care survive?

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February 2023
Colleagues,

As you may be aware, Inova contracts with North American Partners in Anesthesia (NAPA) to provide anesthesia services at Inova Loudoun Hospital. This week, we received notice that our anesthesiologists at Inova Loudoun Hospital have submitted 90-day notice letters of resignation to NAPA. In the spirit of full transparency, we are sharing this news with our physicians.

Here’s what you need to know:

Although we are monitoring this situation, Inova is not a participant in discussions. They are held solely between the anesthesiologists and NAPA. We are actively working to ensure minimal disruptions to current workflows at our care sites.      Our anesthesiologists are among the best in the country, and we fully expect that our team members will continue to provide world-class healthcare to the communities we are privileged to serve.

Per our care mandate, people are at the center of everything we do, and we take any situation that affects the work environment of our team members very seriously. We will continue to communicate with NAPA and keep you apprised of pertinent developments.

If you have questions about this situation, please contact Loren Rufino, Senior Vice President, Perioperative Services.

Thank you,

John J. Moynihan, MD, FACS               
President, Surgery Service Line          

Loren A. Rufino        
SVP, Perioperative Services   
Administrator Surgery Service Line

Paula R. Graling, DNP, RN, CNOR, NEA-C,
FAAN
VP, Nursing, Surgery Service Line

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F.A. HAYEK versus J.M. KEYNES

 Keynes VERSUS Hayek 

By staff reporters

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Necessary Pillars to Expand the Free Medical Markets

  By Jay Kempton

[Free Market Medical Association]

Download the presentation Here

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct Details

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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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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

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8Product DetailsProduct Details

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AMAZON: Buys One Medical Parent “1 Life Healthcare”

By Staff Reporters

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According to Bloomberg — Amazon.com Inc. says it has completed its purchase of One Medical parent 1Life Healthcare Inc., sealing the $3.49 billion acquisition after the US Federal Trade Commission declined to challenge it.

The deal gives the e-commerce giant a network of primary-care doctors, Amazon’s biggest move to date into the health care industry. One Medical operates more than 200 medical offices in 26 markets in the US. Customers pay a subscription fee for access to its physicians and digital health services. 

Bloomberg just reported that the FTC, which has been probing Amazon’s market power for years, had decided not to challenge the deal. Instead the agency is issuing a letter warning Amazon and One Medical that the FTC investigation remains open. That paved the way for Amazon to finalize the acquisition. 

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

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PODCAST: Out-Patient Hospital Pricing Explained

By Eric Bricker MD

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Ending Childhood Obesity on “Fat” Tuesday

A Fat Tuesday Message in 2023

[By Staff Reporters]

More than a decade ago, First Lady Michelle Obama kicked off a campaign to try to end childhood obesity within a generation.

Of course, with the impending Lenten season about to start, the timing could not be more prescient for a re-dedication to this goal.

Let’s Move

The campaign to end obesity is called: “Let’s Move“; local to Savannah, GA.

LINK: https://www.prlog.org/12621769-enmarket-raised-15000-for-the-partnership-for-healthier-america-to-help-end-childhood-obesity.html

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ME-P Mardi Gras Mask on Fat Tuesday

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MORE: https://medicalexecutivepost.com/2018/03/02/us-childhood-obesity-trends/

ADULTS: https://medicalexecutivepost.com/2016/03/25/an-obesity-pic/

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 DetailsProduct Details

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GSK: Zantac Risks and American Depository Receipt Shares

By Staff Reporters

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GlaxoSmithKline

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GSK (GSK) American Depository Shares lost ~2% pre-market yesterday after a new report from Bloomberg Businessweek claimed that the British drug maker chose to keep quiet on the cancer risks of the recalled heartburn medication Zantac. Zantac, also known as ranitidine, was pulled from the U.S. market in 2020 amid concerns over the unacceptable levels of potential human carcinogen, N-nitrosodimethylamine (NDMA).

Since then, the makers of Zantac generics, including Sanofi (SNY) (OTCPK:SNYNF), GSK (GSK), Pfizer (PFE), and Boehringer Ingelheim GmbH, have faced thousands of lawsuits for failure to adequately warn health risks of the antacid.

Citing court filings, studies, FDA transcripts, and new drug applications obtained through the Freedom of Information Act requests, Bloomberg said that the FDA considered the cancer risks when green lighting the medication, but GSK (GSK) withheld key study data.

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

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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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FTC: Proposes Banning [Healthcare] Non-Compete Employment Contract Clauses

By Health Capital Consultants, LLC

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FTC Proposes Banning Non-Compete Clauses

On January 5, 2023, the Federal Trade Commission (FTC) published a proposed rule that would ban employers from imposing non-competes on their employees. The FTC asserted that this practice is widespread and often exploitative, and such actions can suppress wages, hamper innovation, and block entrepreneurs from starting their own businesses. Notably, while the proposed rule will affect all industries, not just healthcare, this proposal comes at a time when healthcare employers across the U.S. are struggling with staffing shortages.

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

This Health Capital Topics article will discuss the proposed rule, reactions from healthcare industry stakeholders, and potential implications. (Read more…)

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FINANCIAL HEALTH INSURANCE CO-PAY CARDS & DRUG COUPONS?

The “Real Deal”

A co-payment is a fixed amount ($20, for example) you pay for a covered health care service after you’ve paid your deductible.

Let’s say your health insurance plan’s allowable cost for a doctor’s office visit is $100. Your copayment for a doctor visit is $20.

  • If you’ve paid your deductible: You pay $20, usually at the time of the visit.
  • If you haven’t met your deductible: You pay $100, the full allowable amount for the visit.
  • Partial deductible payments incur hybrid fees.

Copayments (sometimes called “copays”) can vary for different services within the same plan, like drugs, lab tests, and visits to specialists. Generally plans with lower monthly premiums have higher copayments. Plans with higher monthly premiums usually have lower copayments.

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

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Invite Dr. Marcinko | The Leading Business Education Network for Doctors,  Financial Advisors and Health Industry Consultants

BY DR. DAVID E. MARCINKO MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

Co-Pay Cards May Be Creating More Controversy Instead of Solutions

Instead of reducing the actual price of their excessively priced medications, many companies have opted to provide co-pay cards / coupons as an affordable solution. However, co-pay cards may only lower the cost for some consumers and patients.

Novartis: https://www.copay.novartispharma.com/nvscopay/#

Pfizer: https://www.pfizerpro.com/co-pay-cards-patient-savings-offers

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But – The insurer is still left to pay the high price, which will eventually be passed back on to the patient / consumers in the form of higher health insurance deductibles. So – It doesn’t really seem like much of a solution when we all end up paying for these co-pay cards / coupons; does it?

Find out more here. (Source: Rebecca Mayer Knutsen, MM&M, 8/26/16)

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MEDICAL OFFICE CREDIT CARDS:

We stopped taking credit cards altogether. The only credit cards we take are for call-in payments of balances. We have placed ATM machines in our lobbies and we educate patients in advance of their visits that we only take cash or check. Our cash income has increased, our credit card fees have decreased, and we make $1.50 from each transaction through our ATM. Our patients have taken to the idea so much that they use the ATM for personal cash for other transactions because our fee is the lowest of any ATM. It has been a win-win-win.  

Dr. Farshid Nejad, Beverly Hills, CA [PM Magazine]

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For anyone contemplating taking credit cards for payments or copayments in your office, please be aware that some of the credit card companies require you to sign a contract. Don’t do that! If you do and you either have a problem with the company or find out that they are overcharging you, they will hold you responsible for the contract and may take you to court. There are enough credit card companies out that that do not require contracts and are highly competitive. 

-Dr. Elliot Udell, DPM, Hicksville, NY [PM Magazine]

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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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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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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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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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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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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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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: 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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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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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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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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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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MEDICAL RISK MANAGEMENT, Liability Insurance and Asset Protection Strategies

FOR PHYSICIANS AND THEIR FINANCIAL ADVISORS

SPONSOR: http://www.CertifiedMedicalPlanner.org

CMP logo

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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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How to THRIVE in Private Independent Medical Practice, Today?

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

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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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