BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Biostatistics are the development and application of statistical methods to a wide range of topics in biology. It encompasses the design of biological experiments, the collection and analysis of data from those experiments and the interpretation of the results.
The following topics of#biostatisticsare discussed in this course
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.
BE AWARE ALL ADVISORS … NEXT GEN FINANCIAL ADVICE IS HERE?
Are you a financial planner, insurance agent or investment advisor seeking to assist your physician clients with medical practice enhancement solutions, along with healthcare targeted financial planning services, but don’t know where to turn for help?
OR, maybe you’ve already had a bad experience with a young physician or astute healthcare professional client that was actually more informed than you in these areas?
OR, a doctor/nurse client who demanded a true fiduciary advisor [not fee-based advice, with no dual licenses and no arbitration clauses] documented in writing].
An August 2021 study published in the Journal of the American Medical Association (JAMA) analyzed medical and surgical episodes of care in U.S. hospitals to determine whether outcomes differed in hospitals that participated in Medicare’s Bundled Payments for Care Improvement (BPCI) Initiative depending on whether the patient being treated was attributed to a Medicare Shared Savings Program (MSSP) accountable care organization (ACO).
This Health Capital Topics article will discuss the study’s findings and potential policy implications.(Read more…)
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.
Below is a listing of the Nine largest for-profit health insurance Companies. The Annual financial statements are linked to the year for each Company and a four page summary report is linked to the name of the health insurance company at the top of the listing.
The relevant pages in each financial statement I used to prepare my summaries are listed next to each year’s statement. Aetna and Coventry’s summaries are combined because they merged in 2012. Health Net also Merged with Centene in 2016 leaving only seven major health insurance companies.
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.
As a leader in a community health system, Laura talks about how the COVID 19 pandemic has affected the economics of healthcare. Laura Glenn joined Munson Healthcare as the Vice President of the Physician Network in December, 2017.
In July, 2019 her role expanded and she was appointed the President of Ambulatory Services and Value Based Care. In this role, she remains responsible for integration of the employed and aligned physician practices across the system. In addition, she is responsible for advancing population health strategies including the Munson Clinical Integration Network and other value based payment models as well as providing leadership to the home health division, MHC’s clinical service lines and clinical business intelligence.
How much will it cost you to start a dental practice – with Business Plan?
There are many costs to consider to set up a successful dental practice. Note that the following values are not the exact amount but an average of setting up a dental practice:
Purchase price – this includes valuation fees of between $1,000-4,500, solicitor fees of between $4,000 – 17,000, accountancy and bank fees of around $3,000, and bank solicitors, which can be up to $3,500. Many of these can be reduced or obliterated.
Materials – $40,000
Lab fees – $36,000
Staff costs – $82,000
Other costs (associates fees) – [$245,000 – $295,000]
Other Factors
“Big” Tech – Many startup doctors want to include CBCT or CAD/CAM or 3D printing in their startup, any of which can add $25,000-$175,000. In other situations, waiting is the best option.
Cabinetry Preferences – Costs for cabinetry can range from $5,000 to $175,000.
Practice Management Software (PMS) – Pricing will range from a few thousand dollars to $25,000; OR none at all.
Mechanical Delivery – Typically referred to as chairs, lights, and units, this category of dental equipment costs will range between $5,000 and $100,000 based on your startup plans.
Vision – Ignore the so-called “experts” who will try to create a cookie-cutter model for your equipment costs. That is the thinking of corporate dentistry. You want a customized private practice vision that allows you to create a model matching your standards. Prioritize your vision, so your values and philosophy will lead your dental equipment budget and purchasing decisions. Your equipment budget will be—and should be—customized.
It has been well documented that the COVID-19 pandemic resulted in unprecedented increases in telemedicine utilization across the U.S. However, rural providers and patients, as evidenced by their lower rates of telemedicine usage during this time, have not been able to take advantage of the opportunities provided by telemedicine to the same extent as urban providers.
On August 18, 2021, the Health Resources and Services Administration (HRSA) of the Department of Health and Human Services (HHS) announced the latest attempt to ameliorate this issue – the distribution of nearly $20 million to 36 recipients for the purpose of strengthening telehealth services in rural and underserved communities and expanding innovation and quality. (Read more…)
Approximately 250 hospitals across the U.S. are completely or partially physician owned. These physician-owned hospitals (POHs) can offer a variety of services, from general care to specialty services, such as cardiovascular or orthopedic care, known as “focused factories.”
Over the past several decades, healthcare providers and policymakers have claimed that POHs have a negative impact on the healthcare industry, suggesting that: (1) POHs “cherry-pick” the most profitable patients; (2) the quality of care provided at POHs is substandard; and, (3) conflicts of interest exist due to the financial incentive for physician owners to refer patients to their POHs. (Read more…)
Uwe Reinhardt PhD was a Princeton Healthcare Economist Who Passed Away in 2017. He Was Possibly the Most Well Known Healthcare Economist in America and Even the World.
Being an entrepreneur is not necessarily easy, and many people that try to become entrepreneurs wind up failing. It’s important to recognize the risk of failure before you decide to walk down this path. Being an entrepreneur is very rewarding, and you can find success if you can do things right.
Keep reading to learn about common entrepreneurial mistakes that you can avoid to give yourself a better chance of realizing your entrepreneurial goals.
The New York Times Posted an Article Explaining Hospital Prices for Patients on Private Insurance Plans Such as Blue Cross, United Healthcare, Cigna and Aetna.
Former: CEO and Founder Superior Consultant Company, Inc. [SUPC-NASD]
EDITOR’S NOTE:I first met Rich in B-school, when I was a student, back in the day. He was the Founder and CEO of Superior Consultant Holdings Corp. Rich graciously wrote the Foreword to one of my first textbooks on financial planning for physicians and healthcare professionals. Today, Rich is a successful entrepreneur in the technology, health and finance space.
-Dr. David E. Marcinko MBA CMP®
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By Richard Helppie
Today for your consideration – How to fix the healthcare financing methods in the United States?
I use the term “methods” because calling what we do now a “system” is inaccurate. I also focus on healthcare financing, because in terms of healthcare delivery, there is no better place in the world than the USA in terms of supply and innovation for medical diagnosis and treatment. Similarly, I use the term healthcare financing to differentiate from healthcare insurance – because insurance without supply is an empty promise.
This is a straightforward, 4-part plan. It is uniquely American and will at last extend coverage to every US citizen while not hampering the innovation and robust supply that we have today. As this is about a Common Bridge and not about ideology or dogma, there will no doubt be aspects of this proposal that every individual will have difficulty with. However, on balance, I believe it is the most fair and equitable way to resolve the impasse on healthcare funding . . . .
Let me start in an area sure to raise the ire of a few. And that is, we have to start with eliminating the methods that are in place today. The first is the outdated notion that healthcare insurance is tied to one’s work, and the second is that there are overlapping and competing tax-supported bureaucracies to administer that area of healthcare finance.
Step 1 is to break the link between employment and health insurance. Fastest way to do that is simply tax the cost of benefits for the compensation that it is. This is how company cars, big life insurance policies and other fringe benefits were trimmed. Eliminating the tax-favored treatment of employer-provided healthcare is the single most important change that should be made.
Yes, you will hear arguments that this is an efficient market with satisfied customers. However, upon examination, it is highly risky, unfair, and frankly out of step with today’s job market.
Employer provided health insurance is an artifact from the 1940’s as an answer to wage freezes – an employer could not give a wage increase, but could offer benefits that weren’t taxed. It makes no sense today for a variety of reasons. Here are a few:
1. Its patently unfair. Two people living in the same apartment building, each making the same income and each have employer provided health insurance. Chris in unit 21 has a generous health plan that would be worth $25,000 each year. Pays zero tax on that compensation. Pat, in unit 42 has a skimpy plan with a narrow network, big deductibles and hefty co-pays. The play is worth $9,000 each year. Pat pays zero tax.
3. The insurance pools kick out the aged. Once one becomes too old to work, they are out of the employer plan and on to the retirement plan or over to the taxpayers (Medicare).
4. The structure is a bad fit. Health insurance and healthy living are longitudinal needs over a long period of time. In a time when people change careers and jobs frequently, or are in the gig economy, they are not any one place long enough for the insurance to work like insurance.
5. Creates perverse incentives. The incentives are weighted to have employers not have their work force meet the standards of employees so they don’t have to pay for the health insurance. Witness latest news in California with Uber and Lyft.
6. Incentives to deny claims abound. There is little incentive to serve the subscriber/patient since the likelihood the employer will shop the plan or the employee will change jobs means that stringing out a claim approval is a profitable exercise.
7. Employers have difficulty as purchasers. An employer large enough to supply health insurance has a diverse set of health insurance needs in their work force. They pay a lot of money and their work force is still not 100% happy.
Net of it, health insurance tied to work has outlived its usefulness. Time to end the tax-favored treatment of employer-based insurance. If an employer wants to provide health insurance, they can do it, but the value of that insurance is reflected in the taxable W-2 wages – now Pat and Chris will be treated equally.
Step 2 is to consolidate the multiple tax-supported bureaus that supply healthcare. Relieve the citizens from having to prove they are old enough, disabled enough, impoverished enough, young enough. Combine Medicare, Medicaid, CHIP, Tricare and even possibly the VA into a single bureaucracy. Every American Citizen gets this broad coverage at some level. Everyone pays something into the system – start at $20 a year, and then perhaps an income-adjusted escalator that would charge the most wealthy up to $75,000. Collect the money with a line on Form 1040.
I have not done the exact math. However, removing the process to prove eligibility and having one versus many bureaucracies has to generate savings. Are you a US Citizen? Yes, then here is your base insurance. Like every other nationalized system, one can expect longer waits, fewer referrals to a specialist, and less innovation. These centralized systems all squeeze supply of healthcare services to keep their spend down. The reports extolling their efficiencies come from the people whose livelihoods depend on the centralized system. However, at least everyone gets something. And, for life threatening health conditions, by and large the centralized systems do a decent job. With everyone covered, the fear of medical bankruptcy evaporates. The fear of being out of work and losing healthcare when one needs it most is gone.
So if you are a free market absolutist, then the reduction of vast bureaucracies should be attractive – no need for eligibility requirements (old enough, etc.) and a single administration which is both more efficient, more equitable (everyone gets the same thing). And there remains a private market (more on this in step 3) For those who detest private insurance companies a portion of that market just went away. There is less incentive to purchase a private plan. And for everyone’s sense of fairness, the national plan is funded on ability to pay. Bearing in mind that everyone has to pay something. Less bureaucracies. Everyone in it together. Funded on ability to pay.
Step 3 is to allow and even encourage a robust market for health insurance above and beyond the national plan – If people want to purchase more health insurance, then they have the ability to do so. Which increases supply, relieves burden on the tax-supported system, aligns the US with other countries, provides an alternative to medical tourism (and the associated health spend in our country) and offers a bit of competition to the otherwise monopolistic government plan.
Its not a new concept, in many respects it is like the widely popular Medigap plans that supplement what Medicare does not cover.
No one is forced to make that purchase. Other counties’ experience shows that those who choose to purchase private coverage over and above a national plan often cite faster access, more choice, innovation, or services outside the universal system, e.g., a woman who chooses to have mammography at an early age or with more frequency than the national plan might allow. If the insurance provider can offer a good value to the price, then they will sell insurance. If they can deliver that value for more than their costs, then they create a profit. Owners of the company, who risk their capital in creating the business may earn a return.
For those of you who favor a free market, the choices are available. There will be necessary regulation to prevent discrimination on genetics, pre-existing conditions, and the like. Buy the type of plan that makes you feel secure – just as one purchases automobile and life insurance.For those who are supremely confident in the absolute performance of a centralized system to support 300+ million Americans in the way each would want, they should like this plan as well – because if the national plan is meeting all needs and no one wants perhaps faster services, then few will purchase the private insurance and the issuers will not have a business. Free choice. More health insurance for those who want it. Competition keeps both national and private plans seeking to better themselves.
Step 4 would be to Permit Access to Medicare Part D to every US Citizen, Immediately
One of the bright spots in the US Healthcare Financing Method is Medicare Part D, which provides prescription drug coverage to seniors. It is running at 95% subscriber satisfaction and about 40% below cost projections.
Subscribers choose from a wide variety of plans offered by private insurance companies. There are differences in formularies, co-pays, deductibles and premiums.
So there you have it, a four part plan that would maintain or increase the supply of healthcare services, universal insurance coverage, market competition, and lower costs. Its not perfect but I believe a vast improvement over what exists today. To recap:
1. Break the link between employment and healthcare insurance coverage, by taxing the benefits as the compensation they are.
2. Establish a single, universal plan that covers all US citizens paid for via personal income taxes on an ability-to-pay basis. Eliminate all the other tax-funded plans in favor of this new one.
3. For those who want it, private, supplemental insurance to the national system, ala major industrialized nations.
4. Open Medicare Part D (prescription drugs) to every US citizen. Today.
Culture is a factor to consider with healthcare. Depending on the culture they may seek alternative treatment such as homeopathic and treatment they have been raised with in their country Some cultures will get medications from their country because they believe in their medical system more then what is offered.
BY IHME
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Dr. Joseph L. Dieleman, Associate Professor in the Department of Health Metric Sciences at the University of Washington, is the lead author of the study “US Health Care Spending by Race and Ethnicity, 2002-2016,” published August 17, 2021 in the Journal of the American Medical Association
Offering a blend of active and passive styles of management, a smart beta portfolio is low cost due to the systematic nature of its core philosophy – achieving efficiency by way of tracking an underlying index (e.g., MSCI World Ex US). Combining with optimization techniques traditionally used by active managers, the strategy aims at risk/return potentials that are more attractive than a plain vanilla active or passive product.
Originally theorized by Harry Markowitz in his work on Modern Portfolio Theory (MPT), smart beta is a response to a question that forms the basis of MPT – how to best construct the optimally diversified portfolio. Smart beta answers this by allowing a portfolio to expand on the efficient frontier (post-cost) of active and passive. As a typical investor owns both the active and index fund, most would benefit from adding smart beta exposure to their portfolio in addition to their existing allocations.
Assessment: The smart beta approach is an arguably perfect intersection between traditional value investing and the efficient market hypothesis. But, is it worth the cost?
There are two types of tests for COVID-19. Viral tests tell you if you have a current infection, and antibody tests tell you if you’ve been previously infected.
If you’re experiencing symptoms or think you’ve been exposed to COVID-19, contact your health care provider or your state or local public health department to find out where you can get tested. Tests are available at many health centers and some pharmacies. Call in advance to see if an appointment is required. The testing process and timeline for results vary by location.
But – Rather than having a doctor or health professional get all up in your nostrils, you can swab yourself and get the results in less than an hour. At-home rapid tests (known as “antigen” tests) are less reliable than the lab-based PCR [polymerase chain reaction] test, but experts say they can be an extremely useful tool for allowing life to proceed semi-normally.
NOTE: PCR means polymerase chain reaction. It’s a test to detect genetic material from a specific organism, such as a virus. The test detects the presence of a virus if you have the virus at the time of the test. The test could also detect fragments of the virus even after you are no longer infected.
Problem is, in the US over-the-counter rapid tests are expensive and scarce.
Abbott Laboratories sells a two-pack for $24, and Quidel’s QuickVue sells a test for $15. But even if you are willing to shell out for one, good luck finding a rapid test on pharmacy store shelves or on e-commerce websites, where they’re often sold out.
According to the Dupont Decomposition Equation – which involves the conglomeration of net operating income, revenues, expenses and average operating assets – ROI and economic profit is increased in three prioritized ways:
Cost and expense reductions.
Revenue increases [Rev]
Reduced average operating assets [AOO]
Note: ROI = NOI / Rev X Rev / AOO
Cost and expense reductions
Although many hospitals have reduced expenses, postponed projects and put clinical or information technology projects on hold because of the MU conundrum, this may be unwise and quality may suffer. And, mental health care programs are almost always the first cost center to be reduced in tough times.
Upgrades today, especially with concurrent marketing and advertising promotions, may well be considered a strategic competitive advantage, and at bargain basement prices for those with cash or credit. This cost reduction is easy because it gives the biggest buck-bang in the ROI equation, and is the first line of ROI augmentation by savvy administrators and CEOs. It is also intuitive and wholly “wrung-out” in the marketplace, to date.
Revenue increases
On the other hand, revenues can usually be only incrementally increased by improving services like emergency care, urgent care, wellness, out-patient and/or surgical departments. This is the more difficult part of the equation and yields a positive, but lesser return in the ROI equation.
The following medical practice procedures will markedly increase upfront office collections:
Train staff to handle exceptions. What is your policy if the patient payment is significant? Will you allow 25% payments—one today and three over the next three months? Communicate your policy to all staff. What will you do if a patient shows up without an insurance card? There will be other exceptions. Train employees to call the appropriate practice-management contact when an exception does not fit in the categories you provide and make sure those managers are responsive.
Understand that not everyone will shine in collections. The value of this new front-desk function should be reflected in job descriptions and wages. Track staff performance and hold employees accountable for collection goals. The most successful practices collect in the 90% range.
Provide professional signage that states your basic policy. “Payments are due at time of service.” Avoid typewritten, lengthy explanations taped to walls or desks that look like clutter.
Reduced average operating assets
Finally, any delay in updating facilities – while easy and may reduce operating assets – there is little ROI advantage and profit potential. Of course, facility asset upgrades mean borrowing funds through tax-exempt bonds – the main source of debt for most hospitals – and is currently difficult or impossible in this climate. Loans from banks, private investors, angels, venture capitalists or other financial institutions are similarly difficult to obtain. Thus, this part of the equation may often be neglected; as is the case now.
In response, lawmakers are considering a broad range of policy options, including one that would allow the federal government to negotiate prescription drug prices on behalf of Medicare beneficiaries and people enrolled in private plans, a proposal that has strong bipartisan public support.
This brief describes the current status of drug price negotiation proposals, looks back at the history of proposals to give the federal government the authority to negotiate drug prices in Medicare, describes the negotiation provisions in key legislation (H.R. 3), and discusses the potential spending effects for the federal government and individuals.
Current reimbursement structures involve the submission and payment of medical CPT® coded claims. But, some doctors feel they need to “up-code” to maximize revenue or “down-code” for fear of having a claim denied. Contradictory business goals bastardize the system into a payer versus provider tug-of-war, with patient care as a potential bargaining chip. Instituting quality metrics should be included in this equation and, a hybrid reimbursement model may be a viable option while integrating quality care metrics and reducing costs for all stakeholders.
This hybrid reimbursement system might use a two-payment structure.
For the first payment, claims would be paid at hypothetical rate of 60% within one week of submission.
The second payment, consisting of the remaining zero to 40% of some total maximum allowable fee, be paid quarterly. It would be based on scores like patient satisfaction and stewardship of healthcare resources by analyzing a statistically valid sample of patient encounters taken from the electronic health record.
Such a hybrid system would remove unnecessary steps, like re-submitting claims, and would lower the operational and administrative costs of claims processing. These changes would decrease operational cost and drive quality stewardship of the healthcare dollar.
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
Navigating a course where sound organizational management is intertwined with financial acumen requires a strategy designed by subject-matter experts. Fortunately, Financial Management Strategies for Hospital and Healthcare Organizations: Tools, Techniques, Checklists and Case Studies provides that blueprint. ―David B. Nash, MD, MBA, Jefferson Medical College, Thomas Jefferson University
It is fitting that Dr. David Edward Marcinko, MBA, CMP™ and his fellow experts have laid out a plan of action in Financial Management Strategies for Hospital and Healthcare Organizations that physicians, nurse-executives, administrators, institutional CEOs, CFOs, MBAs, lawyers, and healthcare accountants can follow to help move healthcare financial fitness forward in these uncharted waters. ―Neil H. Baum, MD, Tulane Medical School
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