BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Posted on June 2, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Here are the major issues facing healthcare according to PwC
Will a health system battered by the pandemic emerge stronger in the year ahead? The annual report predicts challenges such as profitably merging virtual and in-person care, and capitalizing on new consumer- and clinician-facing digital health tools.
Posted on June 1, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
By HEALTH CAPITAL CONSULTANTS, LLC
On May 4, 2021, the National Academies for Sciences, Engineering and Medicine (NASEM) released a major report expressing a dire need to improve primary care in the U.S.
Since January 2020, an extensive committee within NASEM has worked to develop an implementation plan that will reopen the discussion of improving primary care as a means to improving overall health and achieving health equity.
To keep up with the ever-changing healthcare industrial complex, we must learn new definitions and re-learn old terminology in order to correctly apply it to practice. By aggregating the most up-to-date abbreviations, acronyms, definitions and terms, the Health DictionarySeries offers a wealth of information to help understand the ever-changing terms-of-art in healthcare today.
Each 10,000 item handbook is essential for doctors, nurses, benefits managers, financial advisors/planners, and insurance agents, CPAs, and administrators; as well as graduate and under graduate students and professors. Our goal to for each dictionary to be designated as a Doody’s Core Title.
Dictionary of Health Insurance and Managed Care
With more than 10,000 definitions, 4,000 abbreviations and acronyms, and a 3,000 item oeuvre of resources, readings, and nomenclature derivatives, this dictionary covers the Medicare, managed care and Medicaid, private insurance, Veteran’s Administration and PP-ACA language of the entire health and long-term care insurance sector.
Dictionary of Health Economics and Finance
Health economics and finance is an integral component of the health care industrial complex. Its language is a diverse and broad-based concept covering many other industries: accounting, mathematics, the actuarial sciences, stochastics and statistics, salary reimbursements, physician payments, compensation and forecasting are all commingled arenas.
Dictionary of Health Information Technology Security
There is a myth that all healthcare stakeholders understand the meaning of information technology jargon. In truth, the vernacular of contemporary systems is unique, and often misused or misunderstood. Moreover, emerging Heath Information Technology (HIT) thru the HITECG initiatives; in the guise of terms, definitions, acronyms, abbreviations and standards; often puts the non-expert in a position of maximum uncertainty and minimum productivity.
Posted on May 26, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
The Pandemic is Ending?
How Are Hospitals Doing?
Interview with Brian Peters
Rich Helppie brings back Brian Peters, the CEO of The Michigan Health and Hospital Association to talk about the current state of Covid-19; what we may have gotten right, what we may have gotten wrong and how to move forward.
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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®
EDITOR’SNOTE: David Balat is the director of the Right on Healthcare initiative at the Texas Public Policy Foundation and founder of the patient-physician coalition, Free2Care. He has broad experience across the healthcare spectrum with special expertise in healthcare finance. He is a former congressional candidate in Texas’ 2nd Congressional District and a seasoned hospital executive with more than 20 years of healthcare industry leadership and executive management experience.
Posted on May 12, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
CCCs AND UCCs Popularity on the Rise!
EDITOR’S NOTE: Convenience Care Clinics [CCCs], including Urgent Care Centers (UCCs) and retail health clinics, have seen increasing popularity and attention in recent years. Colleague Todd Zigrang of HCC, LLC opines.
–Dr. David E. Marcinko MBA CMP®
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President Health Capital Consultants, LLC
By Todd A. Zigrang, MBA, MHA, FACHE, CVA, ASA
As the number of UCCs and retail health clinics in the U.S., as well as the number of patients they serve, grow, some experts have called for stronger state regulation and oversight in order to ensure that these convenience care centers are providing access to all, including vulnerable communities, without discrimination. (Read more…)
Posted on May 10, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Essentia Health, Ochsner Accountable Care Network, and Primaria Health win NAACOS Leaders in Quality Excellence Awards
[By David Raths]
At its Spring 2021 Conference, the National Association of Accountable Care Organizations (NAACOS) recognized three ACOs for their outstanding work to improve patient care in their communities.
NAACOS said the three inaugural winners exemplify how ACOs across the country are improving care by addressing food insecurity, making house calls to reduce preventable emergency department visits, and engaging patients in preventive services.
Posted on May 7, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
The Dramatic Rise in the Stock Market Over the Last 10 Years Has Caused Institutional Investors Like Pension Funds to Re-balance to Private Equity
By Eric Bricker MD
A Typical Pension Fund Portfolio Will Be 51% Bonds, 28% Equities, 6% Real Estate, 5% Private Equity, 4% Other and 6% Cash. As a Result of Rebalancing Money Out of Skyrocketing Equities, Private Equity Funding Has Doubled to Over $1.2 Trillion in the Last 10 Years.
Specifically in Healthcare, Private Equity Investment in Providers (i.e. Physician Groups, Surgery Centers, Imaging Centers, etc.) Doubled to $30 Billion in Just ONE YEAR. The Private Equity Investment on the Payor Side of Healthcare PALES in Comparison at Only $1 Billion. The Majority of These Private Equity Investments Plan on Making Money By INCREASING Healthcare Costs in a Fee-for-Service Payment Environment.
Healthcare Costs Don’t Rise By Accident. They Rise Because Specific People Make Specific Plans to Increase Costs to Earn a Return on Their Investment.
Posted on April 29, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Fee-For-Service Physician Reimbursement Not to be Replaced Anytime Soon!
AN EXPOSE’
By Eric Bricker MD
VALUE BASED CARE PROPONENTS?
Definition: Value-Based Care (VBC) is a health care delivery model under which providers — hospitals, labs, doctors, nurses and others — are paid based on the health outcomes of their patients and the quality of services rendered. Under some value-based contracts, providers share in financial risk with health insurance companies. In addition to negotiated payments, they can earn incentives for providing high-quality, efficient care.
VBC differs from the traditional fee-for-service model where providers are paid separately for each medical service. While quality care can be provided under both models, it’s the difference in how providers are paid, paired with the way patient care is managed, that provides the opportunity for health improvements and savings in a VBC environment.
But – During a Panel Discussion Captured on YouTube at the 2019 HLTH Conference in Las Vegas, Blue Cross Blue Shield of Arizona CEO Pam Kehaly Admitted that Only 10% of the Payments in Value-Based Contracts Were Value-Based.
NOTE: Colleagues at Health Capital Consultants (HCC) represent a team of qualified, experienced and certified healthcare valuation professionals with specific healthcare industry focus; along with in-depth understanding and extensive experience of the healthcare market on a local, regional and national basis; and strong dedication to in-depth research and analysis.
Posted on April 22, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
ON ACCOUNTABLE CARE ORGANIZATIONS
[By Staff Reporters]
What happens when you’re a healthcare policy wonk and the pilot study for your pet program has failed miserably? You declare “Success!” in the editorial pages of the New England Journal of Medicine and demand that the program become nationwide and mandatory.
I kid you not. This is exactly what happens.
Thankfully, colleague Mike Accad MD and Anish Koka are vigilant and explain the blatant obfuscations and manipulations that the central planners engage in to have their way.
A new RAND Corporation study on bundled payments in the private sector was published in the March 2021 issue of Health Affairs. The study analyzed data from over 2,000 procedures performed as part of a direct payment program by Carrum Health between 2016 and 2020, and found significant savings from this bundled payment program, without any significant changes in quality. This study adds important evidence to the argument in favor of bundled payments and is especially important because it examines the under-studied area of bundled payment models from commercial payment systems. (Read more…)
Amazon, the largest e-commerce company in the world, has made large, strategic moves over the past several years to make a place for themselves in healthcare. This article will review Amazon’s most recent advancements in the industry, including those related to Amazon’s voice-controlled personal assistant, Alexa, and Amazon’s employee healthcare system, Amazon Care, and how this non-healthcare company is changing the industry. (Read more…)
On March 11, 2021, President Joe Biden signed into law the American Rescue Plan Act of 2021 (ARPA). The law looks to alleviate the burden felt by the millions of people who lost their employer-sponsored health insurance over the first six months of the pandemic and assist the hardest-hit communities through the extension of the Patient Protection & Affordable Care Act (ACA) and Consolidated Omnibus Budget Reconciliation Act (COBRA) subsidies, expanding Medicaid coverage, increasing funding for behavioral health, ramping up COVID-19 vaccines and testing, providing financial relief for rural providers, and enacting other individual and healthcare system protections. (Read more…)
Posted on February 27, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
FINANCIAL OPINIONS OF MEDICAL PRACTICE FAIR MARKET VALUE [FMV]
Courtesy: https://lnkd.in/eBf-4vY Plastic Surgery-Medical Practice Worth, Valuation, Sales & Succession Planning
For doctor-colleagues, buying or selling a practice may be the biggest financial transaction of their lives. Reasons for appraising practice worth include: sales, merger, succession, retirement and estate planning; partnership disputes and divorce; or as an important tool for organic growth and strategic planning.
However, the transaction is fraught with many pitfalls to avoid and no medical specialty seems immune; especially when it comes to contentious fair market value [FMV] appraisals.
DEFINITION: A member of a securities exchange with the essential function of maintaining a fair and orderly market, insofar as reasonably practicable, in the stocks in which he is registered as a specialist. To do this, s/he must buy and sell for his own account and risk, to a reasonable degree, when there is a temporary disparity between supply and demand. In order to equalize trends, he must buy or sell counter to the direction of the market. DHEF:https://lnkd.in/dqdbWM9 FOREWORD: https://lnkd.in/ecwZWxu
At all times the specialist must put his customer’s interest before his own. All specialists are registered with the exchange, but are not employees of that exchange. Your thoughts are appreciated.
1. I will continue to verify any statements I make about the healthcare system by talking to physicians and operators with REAL-WORLD EXPERIENCE and not rely solely on statistical comparisons.
2. I will promote that there is a correlation between cost, quality, and access in today’s healthcare system. Those who believe health systems should approach anything close to Medicare breakeven advocate for low quality and significant service reductions.3. I will continue to promote the fact that whoever affiliates with the best doctors will win in the long run.
4. I will encourage my clients to avoid the attempt by payers and many industry desk jockeys (e.g., Rand Corp.) to commoditize healthcare delivery. The best doctors, services, and ultimately the best outcomes are not commodities; they come at a price.
5. I will not stand by and watch the payers, government, and the aforementioned academic knuckleheads destroy the hospital industry using the ‘value con’– they already destroyed the rural hospital sector.
6. I will only consider a health system to be under quality leadership if market share grows and profits meet or exceed the industry benchmark. I won’t accept ‘mission’ as an excuse.
Posted on November 29, 2020 by Dr. David Edward Marcinko MBA MEd CMP™
Healthcare Transparency
By Health Capital Consultants, LLC
On October 29, 2020, the Centers for Medicare & Medicaid Services (CMS) released the Transparency in Coverage final rule. This long-anticipated final rule stems from President Donald Trump’s June 2019 executive order on “Improving Price and Quality Transparency” and builds upon the hospital Outpatient Prospective Payment System (OPPS) price transparency requirements released in November 2019.
These requirements came under fire in a lawsuit filed by the American Hospital Association (AHA), Association of American Medical Colleges (AAMC), Children’s Hospital Association (CHA), and Federation of American Hospitals (FAH), against the Department of Health and Human Services (HHS); the requirements were upheld by the courts in June 2020 and the lawsuit is being appealed by the plaintiffs. (Read more…)
Posted on October 2, 2020 by Dr. David Edward Marcinko MBA MEd CMP™
“America First Healthcare Plan”
By Robert Gergely MD
Yesterday, The President @POTUS outlined his plans for “America First Healthcare Plan”.
In 45 min. in front of Medical Professionals he brilliantly outlined a free market, competitive and PATIENTS centered philosophy for Medical Care in America. For those who care please view the video. you can find it here:https://lnkd.in/e9pxR-U
Posted on September 28, 2020 by Dr. David Edward Marcinko MBA MEd CMP™
PART C
By John Kelly
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Medicare Advantage Plans (Private Medicare) are sold on a county-by-county basis. Attached is the market penetration of MA (compared to traditional FFS Medicare) for every county in the USA.
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Wonder why Medicare Advantage Premiums are going down (on average)? Because premiums are one of the measures by which the elderly decide what to purchase. Even though premiums are declining, not all MA plans are ‘cheaper’ than traditional FFS Medicare. Caveat Emptor.
It is also interesting to note that 3 carriers – Humana, UHC and BCBS Affiliates — cover 60% of all MA plan subscribers and use national networks of providers to offer broad service availability (compared to smaller plans, PSP’s and other narrow network options).
Medicare premiums per beneficiary typically exceed $10,000 per year. With effective ingenious use of benefit design, prior authorization, incentives, PBM contract rebates, etc., — there is a lot of money to be made in Medicare Advantage plans — accounting for the rapid growth in these plans over the last decade.
On August 3, 2020, the Centers for Medicare & Medicaid Services (CMS) released two proposed payment rules for calendar year (CY) 2021: the Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP). CMS included in the MPFS proposed rule adjustments to physician payment rates and an expansion of telemedicine services.
The proposed QPP rule, meanwhile, takes into account adjustments made for the COVID-19 public health emergency (PHE) and seeks to reduce unnecessary regulatory burden on providers by eliminating some requirements. These rules, which have garnered mixed reactions from stakeholders, are both open for comment until October 5, 2020. (Read more…)
On June 25, 2020 Atlanta’s Piedmont Healthcare, Inc. agreed to pay $16 million to the federal government to resolve two False Claims Act (FCA) allegations of kickbacks and overbilling. The relator, a former Piedmont physician, alleged Stark Law and Anti-Kickback Statute (and subsequent FCA) violations of paying an amount that was above fair market value (FMV) and commercially unreasonable in Piedmont’s 2007 acquisition of Atlanta Cardiology Group (ACG).
Additionally, Piedmont’s payments settle allegations that the hospital admitted patients without medical necessity in order to bill Medicare and Medicaid for inpatient procedures that were recommended to be performed at the less expensive outpatient or observation settings. (Read more…)
Assessment: Your thoughts are appreciated.
NOTE: I was on the courtesy medical staff of Piedmont Hospital in Atlanta for more than a decade = DEM.
“Medical Management and Health Economics Education for Financial Advisors”
As the coronavirus (COVID-19) global pandemic has wreaked havoc on the U.S. economy generally, and the healthcare industry specifically, the previously-active healthcare transactional environment has been largely stunted.
Despite (or perhaps because of) this economic turbulence, stakeholders expect that merger and acquisition (M&A) activity will soon resume with a vengeance. This potential opportunity, however, is not without pitfalls, due in part to the concern from stakeholders and regulators that well-capitalized entities may use this economic and public health crisis to prey on debilitated physician practices. (Read more…)
ASSESSMENT: Your thoughts and comments are appreciated.
BUSINESS, FINANCE, INVESTING AND INSURANCE TEXTS FOR DOCTORS:
“Of the 125 medical schools in the USA, only one of them to my knowledge offers a class related to saving or investing money.” – William C. Roberts, MD
Private Banker Jorge Russe; MBA CMP™ explains in this PPT Presentation on Net Worth; NOT Income.
The COVID-19 global pandemic has brought a time of grave uncertainty for U.S. healthcare and the greater economy.
While the focus of healthcare providers is, appropriately, on the access and delivery of care to those impacted by the COVID-19 outbreak, there are many providers who will require financial resources to persevere during a time when all sectors of the U.S economy are being significantly impacted.
The federal government has announced a myriad of programs in the form of grants and loans to reimburse hospitals and physicians for some expenses and loss of revenue. (Read more…)
Spurred by how unprepared the American healthcare system was for a pandemic, the current COVID-19 emergency may present the conditions necessary to commence a healthcare delivery model paradigm shift.
In response to the public health emergency, the federal government, which has a record of reducing regulatory “burdens” under the Trump Administration, has taken aggressive actions to create regulatory flexibilities for healthcare providers and suppliers.
At least some of the various actions taken to reduce provider burden as they treat COVID-19 patients are likely to stay intact following the end of this pandemic, potentially revising the fundamental tenets of U.S. healthcare delivery. (Read more…)
Here are 3 theories and 1 “rule” for the healthcare industrial complex that may help explain how the sector may not work correctly; from trauma, to epidemiology and to Corona; all the time.
1 – Berkson’s Paradox: Strong correlations can fall apart when combined with a larger population.
For example, among motorcycle crash victims wearing helmets are more likely to be seriously injured than those not wearing helmets. But, that’s because most crash victims saved by helmets did not need to become hospital patients, and those without helmets are more likely to die before becoming a hospital patient.
2 – Group Attribution Error: Incorrectly assuming that the views of a group member, like a physician, reflect those of the whole group in a different discipline.
3 – Baader-Meinhof Phenomenon: Noticing an idea or word every where you look as soon as it’s brought to your attention in a way that makes you overestimate its prevalence.
The 90-9-1 Rule: In social media networks, 90% of users just read content, 9% of users contribute a little content, and 1% of users contribute almost all the content.
QUERY: Does Social Media really give a false impression of what ideas are popular or “average.”
THINK: Corona Virus?
ASSESSMENT: Your thoughts and comments are appreciated.