BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Posted on May 15, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters and MCOL
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Outcomes of In-Person and Tele-Health Encounters During COVID-19
• Ambulatory encounters decreased by 1.0% and the number of in-person encounters per enrollee decreased by 17.0% from 2019 to 2020. • For members with an initial telehealth encounter for a new acute condition, the adjusted odds ratio was 1.44 for all follow-ups combined and 1.11 for an emergency department encounter. • For members with an initial telehealth encounter for a new chronic condition, the adjusted odds ratios were 0.94 for all follow-ups combined and 0.94 for in-patient admissions.
During this period, the standard deviation of quarterly real gross domestic product (GDP) declined by half and the standard deviation of inflation declined by two-thirds, according to figures reported by former U.S. Federal Reserve Chair Ben Bernanke. The Great Moderation can be summed up as a multi-decade period of low inflation and positive economic growth.
But, what about health economics, writ large? And, the actual practice of medicine by physicians in the trenches. Consider this historical review.
GOLDEN AGE OF MEDICINE
The ‘golden age of medicine’ – the first half of the 20th century, reaching its zenith with Jonas Salk’s 1955 polio vaccine – was a time of profound advances in surgical techniques, immunization, drug discovery, and the control of infectious disease; however, when the burden of disease shifted to lifestyle-driven, chronic, non-communicable diseases, the golden era slipped away. Although modifiable lifestyle practices now account for some 80% of premature mortality, medicine remains loathe to embrace lifestyle interventions as medicine Here, we argue that a 21st century golden age of medicine can be realized; the path to this era requires a transformation of medical school recruitment and training in ways that prioritize a broad view of lifestyle medicine. Moving beyond the basic principles of modifiable lifestyle practices as therapeutic interventions, each person/community should be viewed as a biological manifestation of accumulated experiences (and choices) made within the dynamic social, political, economic and cultural ecosystems that comprise their total life history. This requires an understanding that powerful forces operate within these ecosystems; marketing and neoliberal forces push an exclusive ‘personal responsibility’ view of health – blaming the individual, and deflecting from the large-scale influences that maintain health inequalities and threaten planetary health. The latter term denotes the interconnections between the sustainable vitality of person and place at all scales. We emphasize that barriers to planetary health and the clinical application of lifestyle medicine – including authoritarianism and social dominance orientation – are maintaining an unhealthy status quo.
To listen to all those desperate to reform health care, you get the impression that physicians are pretty horrible people. We are all sexist, greedy, money grubbing tyrants who will perform unnecessary tests and procedures just to make money. We don’t care about quality or cost. We are killing off 250,000 patients every year with our ignored “errors.”
We purposely keep our patients in pain, or we addict them to narcotics just to shut them up. We are constantly told by lawyers that lawsuits are necessary to protect patients from doctors. We provide unsafe drugs just because the drug reps give us free pens and coffee cups. The government must step in to clean up the mess.
The U.S. government is the largest payor of medical costs, through Medicare and Medicaid, and has a strong influence on reimbursement for home healthcare services. In 2020, Medicare and Medicaid accounted for an estimated $829.5 billion and $671.2 billion in healthcare spending, respectively. The outsized prevalence of these public payors in the healthcare marketplace often results in their acting as a price setter, and being used as a benchmark for private reimbursement rates. This effect may be even stronger in the home health industry.
The third installment of this home health valuation series will discuss the reimbursement environment in which these organizations operate. (Read more…)
Posted on April 28, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
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By Eric Bricker MD
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According to One Survey, only 4% of People Understand the Basic Insurance Terms of Deductible, Co-Insurance, Copay and Out-of-Pocket Maximum.
In Another Survey by United Healthcare Itself, Only 9% Understood the Terms Premium, Deductible, Co-Insurance and Out-of-Pocket Max.
This Lack of Understanding is Not the Fault of the Employee Benefits Professionals or the Employees… Rather, the Health Insurance Plan Designs Are Just Too Complicated.
Posted on April 20, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
About Four-Twenty Day
[By Anonymous DEA Agent]
Today is … 420, 4:20, or 4/20 (pronounced four-twenty)
And, it refers to consumption of cannabis and, by extension, a way to identify oneself with cannabis subculture. Observances based on the number include the time (4:20 p.m.) as well as the date (April 20).
Again … that’s today as this ME-P was published @ 4:20 p.m., EST!
THE DEA DESTROYS A POT FARM
PHOTOS:
Photo taken after the “grow” was eradicated. There is still no “pot” of gold at the end of the rainbow.
DEA taking one of many seized vehicles/equipment.
The marijuana farm was operating under the name “Brian’s Green Thumb Farm.”
Inside the barn, Agents found rows and rows of drying marijuana.
Over 2,000 pounds of drying marijuana from the barn, bagged and ready for destruction.
Air view of the massive “grow” from the guard tower.
One of two sleeping shelters, each guarding the middle perimeter. In the back, one of four tents, each positioned in the corners for guards.
The plant being ripped out of the ground by the backhoe.
In 2019: Carl’s Jr. was become the first major fast-food chain to debut a cannabis-infused burger.
Conclusion
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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:
Hospitals, a local family practice office, a pharmaceutical company, all likely have one thing in common. Somewhere within these companies or partnerships, there are key employees or profit makers. Due to their expertise, management skills, knowledge, or “history of why,” they have become indispensable to their employers.
If this key employee were to die prematurely, what would potentially happen to the company? In many cases, especially in smaller companies, it would have a devastating effect on the bottom line, or even precipitate a bankruptcy. In these circumstances, a form of business insurance, called key person coverage, is recommended in order to alleviate the potential financial problems resulting from the death of that employee.
The business would purchase and own a life insurance policy on the key person. Upon the death of the employee, the life insurance proceeds could be used to:
Pay off bank loans.
Replace the lost profits of the company.
Establish a reserve for the search, hiring and training of a replacement.
[B] Business Continuation Funding
See the chapters on buy-sell agreements and asset protection planning.
[C] Executive Bonus Plan
An executive bonus plan (or § 162 plan) is an effective way for a company to provide valued, select employees an additional employment benefit. One of the main advantages to an executive bonus plan, when compared to other benefits, is its simplicity. In a typical executive bonus plan, an agreement is made between the employer and employee, whereby the employer agrees to pay for the cost of a life insurance policy, in the form of a bonus, on the life of the employee.
The major benefits of such a plan to the employee are that he or she is the immediate owner of the cash values and the death benefit provided. The only cost to the employee is the payment of income tax on any bonus received. The employer receives a tax deduction for providing the benefit, improves the morale of its selected employees, and can use the plan as a tool to attract additional talent.
[D] Non-Qualified Salary Continuation
Commonly referred to as deferred compensation, this is a legally binding promise by an employer to pay a salary continuation benefit at a specific point in the future, in exchange for the current and continued performance of its employee. These plans are normally used to supplement existing retirement plans.
Although there are different variations of deferred compensation, in a typical deferred compensation agreement, the employer will purchase and own a life insurance policy on the life of the employee. The cash value of the policy grows tax deferred during the employee’s working years. After retirement, these cash values can be withdrawn from the policy to reimburse the company for its after-tax retirement payments to the employee.
Upon the death of the employee, any remaining death benefit would likely be received income tax free by the employer (Alternative Minimum Taxes could apply to any benefit received by certain larger C corporations). The death benefit could then be used to pay any required survivor benefits to the employee’s spouse, or provide partial or total cost recovery to the employer.
In a typical plan, the terms of the agreement are negotiated as to the amount of benefit received by the employee, when retirement benefits can begin, how long retirement benefits will be paid, and if benefits will be provided for death or disability. The business has established what is commonly referred to as “golden handcuffs” for the employee. As a result, the benefit will only be received if the employee continues to work for the company until retirement. If the employee is terminated or quits prior to retirement, the plan would end and no benefits would be payed.
[E] Split Dollar Plans
Split dollar arrangements can be a complicated and confusing concept for even the most experienced insurance professional or financial advisor. This concept is, in its simplest terms, a way for a business to share the cost and benefit of a life insurance policy with a valued employee. In a normal split dollar arrangement, the employee will receive valuable life insurance coverage at little cost to them. The business pays the majority of the premium, but is usually able to recover the entire cost of providing this benefit at termination of employment, death or surrender of the policy.
Following the publication of IRS Notices 2002-8 and 2002-59, there are currently two general approaches to the ownership of business split-dollar life insurance: Employer-owned or Employee-owned.
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[1] Employer-Owned Method
In the employer-owned method the employer is the sole owner of the policy. A written split-dollar agreement usually permits the employee to name the beneficiary for most of the death proceeds. The employer owns all the cash value and has the unfettered right to borrow or withdraw it as necessary. At the end of the formal agreement, the business can generally (1) continue the policy as key person insurance, (2) transfer ownership to the insured and report the cash values as additional income to the insured, (3) sell the policy to the insured, or (4) use a combination of these methods. This is commonly referred to as “rollout.”
Practitioners should be careful not to include rollout language in the split-dollar agreement. The reason the rollout should not be included is that if the parties formally agree that after a specified number of years—or following a specific event—related only to the circumstances surrounding the policy, that the policy will be turned over to the insured, the IRS could declare that the entire transaction was a sham and that its sole purpose was to avoid taxation of the premiums to the employee, generating substantial interest and penalties in addition to the additional taxes due.
The death proceeds available to the insured employee’s beneficiary is considered a current and reportable economic benefit (REB), and it is an annually taxable event to the employee. If an individual policy is involved, the REB is calculated by multiplying the face amount times the government’s Table 2004 rates or the insurance company’s alternative term rates, using the insured’s age. If a second-to-die policy is involved, the government’s PS38 rates or the company’s alternative PS38 rates will be used. Any part of the premium actually paid by the employee is used to offset any REB dollar-for-dollar.
[2] Employee-Owned Method
With the employee-owned method, the insured-employee is generally the applicant and owner of the policy. Any premiums paid by the business are deemed to be loans to the employee and the employee reports as income an imputed interest rate on the cumulative amount of loan based on Code § 7872. A collateral assignment is made for the benefit of the business to cover the cumulative loan amount. In some cases, the assignment may allow the assignee to have access to the cash values of the policy by way of a policy loan. This method is unavailable for officers and executives of publicly- held corporations because of the current restrictions on corporate loans (the Sarbanes-Oxley Act of 2002).
The employee-owned method is somewhat similar to the older collateral assignment form of split-dollar. The benefits for the employee are both the ability to control large amounts of death proceeds as well as developing equity in the policy. Whether or not this new method catches on will depend greatly on the imputed interest rate published by the IRS every July. If set low enough, this may be an excellent opportunity for the employee to use inexpensive business dollars to pay for life insurance.
Posted on April 9, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
MANAGEMENT STRATEGIES, TOOLS TEMPLATES AND CASE STUDIES
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Reviews:
Hospitals and Health Care Organizationsis a must-read for any physician and other health care provider to understand the multiple, and increasingly complex, interlocking components of the U.S. health care delivery system, whether they are employed by a hospital system, or manage their own private practices.
The operational principles, methods, and examples in this book provide a framework applicable on both the large organizational and smaller private practice levels and will result in better patient care. Physicians today know they need to better understand business principles and this book by Dr. David E. Marcinko and Professor Hope Rachel Hetico provides an excellent framework and foundation to learn important principles all doctors need to know. ―Richard Berning, MD, Pediatric Cardiology
… Dr. David Edward Marcinko and Professor Hope Rachel Hetico bring their vast health care experience along with additional national experts to provide a health care model-based framework to allow health care professionals to utilize the checklists and templates to evaluate their own systems, recognize where the weak links in the system are, and, by applying the well-illustrated principles, improve the efficiency of the system without sacrificing quality patient care. … The health care delivery system is not an assembly line, but with persistence and time following the guidelines offered in this book, quality patient care can be delivered efficiently and affordably while maintaining the financial viability of institutions and practices. ―James Winston Phillips, MD, MBA, JD, LLM
Posted on April 9, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By American Journal of Public Health
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DEFINITION: Public health is “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals”.
Posted on April 2, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Eric Bricker MD
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1) Traditional Medicare: Health Insurance for Seniors 65 and older. Medicare Part A is coverage for hospital services. Medicare Part B is coverage for doctor, physical therapist and other provider services and for outpatient services such as labs and imaging.
2) Medicare Advantage: Health Insurance for Seniors 65 and older administered through a private health insurance company. It is sometimes referred to as Medicare Part C. It can be chosen instead of Traditional Medicare and often includes Dental Insurance, Vision Insurance, Hearing Aid Insurance and Prescription Drug Coverage.
3) Medicare Part D Prescription Coverage: Additional insurance for people on Traditional Medicare to cover their prescription medications as well. Medicare Part D is administered by private insurance companies.
4) Medicare Supplement Plans: Insurance that can be purchased in addition to Traditional Medicare to cover the expenses that Traditional Medicare does not cover, such as hospitalization deductibles and Medicare Part B co-insurance.
5) Medicaid: The health insurance program administered by each state for it’s economically disadvantaged residents. It is funded in part by the Federal Government and in part by each state. It is administered by private health insurance companies.
6) Affordable Care Act (ACA) Exchange Plans: Health insurance for people under 65 who make too much money to qualify for Medicaid, but do not received health insurance through their employer. ACA Exchange Plans are subsidized by the Federal Government and administered by private insurance companies.
Posted on March 28, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
BY HEALTH CAPITAL CONSULTANTS, LLC.
DEFINITION: The False Claims Act, also called the “Lincoln Law”, is an American federal law that imposes liability on persons and companies who defraud governmental programs. It is the federal Government’s primary litigation tool in combating fraud against the Government. The law includes a provision that allows people who are not affiliated with the government, called “relators” under the law, to file actions on behalf of the government. Persons filing under the Act stand to receive a portion of any recovered damages.
On February 1, 2022, the U.S. Department of Justice (DOJ) announced their recovery of $5.6 billion in settlements and judgments from civil cases involving fraud and false claims for fiscal year (FY) 2021. Over $5 billion was recouped from the healthcare industry for federal losses alone, and included recoveries from drug and medical device manufacturers, managed care providers, hospitals, pharmacies, hospice organizations, laboratories, and physicians.
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This figure is more than double the amount of healthcare-related recoveries secured in FY 2020, which totaled $1.8 billion. (Read more…)
Posted on March 22, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Eric Bricker MD
C.O.N. Legislation is Not New!
Certificate of need laws are state-level regulations that require healthcare institutions to obtain approval from state officials before moving forward on large capital expenditure projects, such as the construction of a new facility or the purchase of expensive new equipment.
Posted on March 17, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Eric Bricker MD
An accumulator is a running total of money you’ve paid towards your out-of-pocket max for covered services. This includes any copayments, coinsurance, and other health care costs, but not your monthly premium payments.
Posted on March 16, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
A Professional and Personal look at Health Insurance, with Karl Albrecht
Rich talks with the president of Action Benefits, Karl Albrecht about the state of Health Insurance.
Albrecht also gives a candid insight to his personal fight with pancreatic cancer and how being a Health Insurance executive as well as a patient, has given him a unique perspective on how things work, and how they could improve.
Beginning in 2022, there will be few situations in which a patient can receive a bill for out-of-network care they believed would be covered by their insurance company. This new rule should especially benefit patients in emergency situations who don’t have the time or luxury to dig up the details on every provider they encounter.
The No Surprises Act also requires insurance companies to provide patients with at least 90 days of coverage if an in-network provider moves out of network. That way, patients aren’t forced to switch providers immediately if such a move happens while they’re in the middle of a treatment plan.
Now, the No Surprises Act does have its limitations. Patients can still get a bill for out-of-network care if they visit an urgent care clinic for non-emergency purposes. Also, if consumers are informed that the care they’re about to receive is out of network and they give written consent to move forward, then they may get billed for that care even once the new rule takes effect.
QPADEFINITION: The qualifying payment amount is generally the median of contracted rates for a specific service in the same geographic region within the same insurance market as of January 31, 2019. The rate will be adjusted per the Consumer Price Index for All Urban Consumers (CPI-U).
After an understandable slowdown in 2020, due to the onset of the COVID-19 pandemic, merger & acquisition (M&A) activity in the healthcare industry accelerated in 2021, and the industry is expected to continue the high number of deals and high deal volume in 2022.
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This Health Capital Topics article will review the U.S. healthcare industry’s M&A activity in 2021, and discuss what these trends may mean for 2022. (Read more…)
Posted on February 23, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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33.6% of COVID Infections Were in Unvaccinated Persons
According to a recent CDC study. Among 422,966 reported SARS-CoV-2 infections in LAC residents aged ≥18 years during November 7, 2021–January 8, 2022:
• 33.6% were in unvaccinated persons • 13.3% were in fully vaccinated persons with a booster • 53.2% were in fully vaccinated persons without a booster • Unvaccinated persons were most likely to be hospitalized, representing 2.8% of COVID infections • Unvaccinated persons were most likely to be admitted to an ICU, or 0.5% of COVID infections • Unvaccinated persons were most likely to be require intubation for mechanical ventilation, or 0.2% of COVID infections.
Posted on February 16, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Entry-level Revenue Cycle Recruitment Takes 84 Days on Average
A recent AKASA survey of 514 chief financial officers and revenue cycle leaders at hospitals and health systems in the U.S. found:
• Entry-level revenue cycle talent (0-5 years): On average, costs $2,167 for recruitment and takes 84 days to fill vacant roles. • Mid-level revenue cycle talent (6-10 years): On average, costs $3,581 for recruitment and takes 153 days to fill vacant roles. • Senior-level revenue cycle talent (10+ years): On average, costs $5,699 for recruitment and takes 207 days to fill vacant roles.
DEFINITION: The Medicare Payment Advisory Commission is an independent, non-partisan legislative branch agency headquartered in Washington, D.C. MedPAC was established by the Balanced Budget Act of 1997.
*** In a January 2022 meeting of MedPAC, commissioners reviewed various recommendations related to the Medicare fee schedule for various health sectors, and unanimously agreed to update Medicare payments to hospitals and keep physician payment rates the same for 2023. This Health Capital Topics article will review the recommendations made by MedPAC for each of the health sectors and their respective payment systems. (Read more…)
Notes: U.S. value obtained from National Health Expenditure data. Data from Australia, Belgium, Canada, Japan and Switzerland are from 2019. Data for Australia, France, and Japan are estimated. Data for Austria, Canada, Germany, Netherlands, and Sweden are provisional. Health consumption does not include investments in structures, equipment, or research. Data for 2020 except as noted. Source: KFF analysis of National Health Expenditure (NHE) and OECD data, January 21, 2022
Posted on January 28, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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According to reporter Neal Freyman, Tech giant Oracle said it’s paying $28.3 billion to buy electronic medical records company Cerner, because anything that makes paperwork less excruciating seems like a savvy business play.
Oracle is known for being aggressive with acquisitions (it even rallied a group to try and buy TikTok last year), but Cerner is Oracle’s biggest purchase in its history. The deal is further evidence that health care is “on par with banking in terms of the importance to our future,” as cofounder Larry Ellison told analysts earlier this month.
In Cerner, Oracle will get the Klay Thompson of the electronic medical records market—a very influential player, but in second place behind Epic, which owns a 31% market share.
Bottom line: Big tech companies see a golden opportunity in bringing the health care industry to the cloud, given its size (health care spending accounts for almost 20% of US GDP), and its old-school record-keeping process. A Mayo Clinic study cited by Oracle showed that doctors and nurses spend an average of 1–2 hours on desk work for every hour they take to see patients.
Posted on January 25, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
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Average Medical Trend in the U.S. is Projected at 7.6% in 2022
The 2022 Global Medical Trends Survey shows variation in healthcare cost increases. Increases across different regions next year are expected to range from:
• 14.2% in Latin America • 10.6% in the Middle East • 10.6% in Africa • 7.6% in Asia Pacific • 6.7% in Europe • 7.6% in the U.S.
Posted on January 23, 2022 by Dr. David Edward Marcinko MBA MEd CMP™
By Staff Reporters
Medical education in the U.S. and Canada has changed considerably in the last several decades.
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According to the AMA, the major changes are the following:
Reducing medical school programs leading to the medical degree to three years. Since graduate medical education (i.e., residency) is many years in duration and includes virtually all the information, that would be part of the typical fourth year..
Introducing clinical medicine early in the curriculum.
Including medical information and activities into the basic science component of the curriculum.
De-emphasizing inactive learning by markedly reducing the number of lectures and employing problem-based learning (PBL) which typically takes place in small groups (e.g., 6-8 students led by a single faculty member).
Employing objective structured clinical examinations (OSCE) in which students are asked to solve a problem in which they are faced with a simulated patient and are asked to solve a clinical problem. Students are evaluated as to how well they communicate/interact with patients, take a medical history, arrive at a clinical diagnosis, and come up with a treatment plan. The simulated patients are trained to act as if they were actual patients. The OSCE includes individual students interacting with a single patient, emulating a real patient-doctor interaction. How well the student performs is evaluated by a faculty member observing the activity via video and by the simulated patient who evaluates the student doctor for such activities as his/her communication skills.
A Pandemic (from Greek πᾶν pan “all” and δῆμος demos “people”) is an epidemic of disease that has spread across a large region; for instance multiple continents, or even worldwide. A widespread endemic disease that is stable in terms of how many people are getting sick from it is not a pandemic.
Further, flu pandemics generally exclude recurrences of seasonal flu. Throughout history, there have been a number of pandemics, such as smallpox and tuberculosis. One of the most devastating pandemics was the Black Death, which killed an estimated 100 million people in the 14th century. Some recent pandemics include: HIV, Spanish flu, 2009 flu pandemic and H1N1.
An Epidemic is the rapid spread of infectious disease to a large number of people in a given population within a short period of time, usually two weeks or less.
For example, in meningococcal infections, an attack rate in excess of 15 cases per 100,000 people for two consecutive weeks is considered an epidemic.
Epidemics is the outbreak of the disease in a community while pandemic is the outbreak of the disease globally.
SARS was an epidemic while AIDS was an pandemic.
Pandemic disease has the same origin or source where so ever it gets spread while the same disease is spreading with different sources in each country, it refers to epidemic.
Epidemic when extending to greater levels becomes a pandemic.
ENDEMIC: If you translate it literally, endemic means “in the population.” It derives from the Greek endēmos, which joins en, meaning “in,” and dēmos, meaning “population.” “Endemic” is often used to characterize diseases that are generally found in a particular area; malaria, for example, is said to be endemic to tropical and subtropical regions. This use differs from that of the related word epidemic in that it indicates a more or less constant presence in a particular population or area rather than a sudden, severe outbreak within that region or group.
Utilizing data from FAIR Health, the Urban Institute conducted an October 2021 study which reviewed commercial insurance claims across the U.S. (for approximately 60 insurers and third-party administrators covering over 150 million Americans under age 65) from March 2019 through February 2020.
This study assessed the gap between commercial insurance payments and Medicare payments for professional physician services to determine whether the payment gap between Medicare and commercial insurance differs by specialty. (Read more…)
When President Joe Biden was elected in 2020, there was much anticipation and speculation regarding what his election would mean for the U.S. healthcare industry in the coming years.
As an ardent supporter of the Patient Protection and Affordable Care Act (ACA) who campaigned on offering a public insurance option similar to Medicare, many in the healthcare industry assumed that the Biden Administration would be a strong proponent of continuing the shift to value-based care, which shift was largely spurred by his predecessor and former boss, Barack Obama, with the passage of the ACA. (Read more…)
Let’s say a physician decided to sell his practice and move to another state. The value of the sale was based, in part, on the yearly gross of the practice. The physician accepted installment payment terms from the buyer and moved to the new state. The buyer began to practice medicine at his new office. Although he was busy, his gross never approached the gross of the prior physician.
Eventually the buyer defaulted on the loan. The selling physician sued for the deficit. The defaulting physician and his forensic consultants then performed an in-depth evaluation of the seller’s practice. The buyer and his team noticed some discrepancies in the billing patterns and practices of the seller. Considering these discrepancies to constitute Medicare and insurance billing fraud, the seller counter-sued the buyer on the grounds of misrepresentation, alleging the gross receipts of the practice purchase price, was grossly inflated.
ASSESSMENT: Therefore, the buyer determined that the seller had fraudulently misrepresented the potential of the practice. He also notified state and federal authorities and filed complaints of insurance fraud against the seller.
The seller thought that he would move to the good life in the new state, but his old practice kept him in constant legal trouble.
Posted on November 19, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Hospitals Must Treat All Patients
BY ERIC BRICKER MD
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The Emergency Medical Treatment and Active Labor Act is an act of the United States Congress, passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act
Health Insurance Companies Paid for Hospital Outpatient Services at an Even Higher Average Rate of 293% of Medicare.
A Detailed Look at the RAND Analysis Reveals that the ‘Basket’ of Services at Each Hospital Had Very Little Data.
For Example, the RAND Study’s Data for the Baylor Scott & White Hospital System in Dallas – Fort Worth Represented Only 0.4% of the Hospital’s Total Revenue.
For the Texas Health Hospital System Also in Dallas – Fort Worth, the RAND Study’s Data Only Represented 0.96% of the Hospital’s Total Revenue.
That Sample Size Is Likely Too Small to Make Accurate Comparisons from One Hospital System to Another Regarding their Commercial Insurance Prices Relative to Medicare.
ASSESSMENT: Your thoughts and comments are appreciated.
A June 2021 PricewaterhouseCoopers (PwC) report found that healthcare costs have been on a steady decline for the past decade, but trailing effects from the COVID-19 pandemic could cause increases above anticipated rates over the next several years.
In 2007, the annual cost growth for healthcare spending was 11.9% and declined steadily until 2017, where it floated between 5.5% and 6.0% until 2020. However, projected healthcare cost growth for 2022 is expected to reach 6.5% due to factors such as deferred or forgone care, increased mental health issues, preparation for future pandemics, and investment in digital tools. (Read more...)
Posted on October 12, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
By Bernie Portal
The Consolidated Omnibus Budget Reconciliation Act of 1985 is a law passed by the U.S. Congress on a reconciliation basis and signed by President Ronald Reagan that, among other things, mandates an insurance program which gives some employees the ability to continue health insurance coverage after leaving employment.
COBRA compliance can be difficult, especially if you’re handling it yourself. Now, it’s even more complicated thanks to recent stimulus bill changes that implemented a 100% free COBRA subsidy for eligible employees and employers.
In this episode, host Ryan McCostlin talks through the ins and outs of this important component of healthcare law that’s designed to help out employees during the pandemic.
In Response to a Question Regarding the Ending of Haven Healthcare–the Joint Venture Among Berkshire Hathaway, JP Morgan Chase and Amazon to Improve Healthcare for their Employee Health Plan Members–Warren Buffett Made the Following Statement:
“Healthcare is the Tapeworm of the US Economy and the TAPEWORM WON.”
Additionally, Warren Buffett Goes on to Say that ‘Prestigious‘ People in the Community Run Hospital Boards and These People Are ‘Fairly Happy‘ with the Healthcare System the Way It Currently Is.
It is Likely that Warren Buffett Formed Some of This Opinion in Speaking About Healthcare with the Vice Chairman of Berkshire Hathaway, Charlie Munger, and Berkshire Board Member and Famous CEO, Tom Murphy.
Charlie Munger Has Served on the Board of a Los Angeles Hospital for 31 Years and Tom Murphy Currently Serves on the NYU Langone Hospital System Board of Directors.
The Support of the Status Quo by ‘Prestigious,’ ‘Fairly Happy’ Hospital Board Members Cannot Be Understated… It Blocks Change and Warren Buffett Appears to Think Similarly.
The first World Financial Planning Day was held on October 4, 2017. The Financial Planning Standards Board (FPSB) hosts the day. Every year, the FPSB partners with the International Organization of Securities Commissions (IOSCO).
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Today, it is always held during the first Wednesday of October during IOSCO’s World Investor Week.
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QUERY: But, what about the entire ecosystem of personal and professional financial planning, investing, risk, business and medical practice management for physicians and healthcare professionals? A vital, unique and complicated niche!
ANSWER: According to the Institute of Medical Business Advisors, Inc., WFP Day is every day for CERTIFIED MEDICAL PLANNER® professional certification holders.
So – If you are in this WFPD industry – Become a fiduciary focused board CERTIFIED MEDICAL PLANNER with extreme healthcare industry ecosystem specificity.
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