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TERMS & DEFINITIONS FOR PHYSICIANSAND ALL INVESTORS:
PRUDENT BUYER: The efficient purchaser of market balance between value and cost.
PRUDENT MAN RULE: An 1830 court case stating that a person in a fiduciary capacity (a trustee, executor, custodian, etc) must conduct him/herself faithfully and exercise sound judgment when investing monies under care. “He is to observe how men of prudence, discretion and intelligence manage their own affairs, not in regard to speculation, but in regard to the permanent distribution of their funds, considering the probable income as well as the probable safety of the capital to be invested.” Allows for mutual funds and variable annuities.
PRUDENT INVESTOR RULE: A fiduciary is required to conduct him/herself faithfully and exercise sound judgment when investing monies and take measured and reasonable investment risks in return for potential future rewards. Allows for mutual funds, stocks, bonds, variable annuities asset allocation & Modern Portfolio Theory.
EDITOR’SNOTE: We interviewed noted authority Ben Aikin AIF® on this topic more than a decade ago. He was ahead of his time regarding fiduciary accountability and we appreciate his insights.
Impact of Moving Older Adults from Employer Coverage to Medicare
Peterson-KFF’s recent brief “How Lowering the Medicare Eligibility Age Might Affect Employer-Sponsored Insurance Costs” explores potential percent reduction in employer health plan spending if all enrollees in age group leave large employer-sponsored coverage.
The brief found:
• Ages 60-64 would cause a 15% reduction • Ages 55-64 would cause a 30% reduction • Ages 50-64 would cause a 43% reduction
American businesses are extending their cost-cutting initiatives to include offshore employee medical benefits, and facilities like the Bumrungrad Hospital in Bangkok, Thailand (cosmetic surgery), the Apollo Hospital in New Delhi, India (cardiac and orthopedic surgery) are premier examples for surgical care. Both are internationally recognized institutions that resemble five-star hotels equipped with the latest medical technology.
Foreign countries where I studied medicine and surgery, and practiced briefly, such as Finland, England, Canada and Germany are also catering to the English-speaking crowd, while dentistry is especially popular in Mexico and Costa Rica. Although this is still considered “medical tourism,” Mercer Health and Benefits was retained a decade ago by three Fortune 500 companies interested in contracting with offshore hospitals and The Joint Commission [TJC] has accredited 88 foreign hospitals through a joint international commission.
To be sure, when India can discount costs up to 80%, the effects on domestic hospital reimbursement and physician compensation may be assumed to increase downward compensation pressures.
Technology stocks have largely been in favor since the COVID-19 pandemic began, but re-openings in the U.S. and elsewhere as vaccines take hold have pushed investors toward value stocks, which are geared more toward the economy. But lately, stronger growth expectations are also sparking worries of higher inflation, and a potential tapping of the brakes by central banks.
Therefore, an important concept for physicians and all investors to understand is the Current Rate of Return (CCR).
So, What Exactly is CRR?
According to this principle, the current rate of a taxable return must be evaluated in reference to a similar non-taxable rate of return. This allows you to focus on your portfolio’s real (after-tax return), rather than its’ nominal, or stated return. Since most medical professionals own a combination of both vehicles, it is important to calculate the average rate of return (ARR), as demonstrated in the following matrix. Usually, this will result in the assumption of more risk, for the possibility of great return.
To compare after tax yields, with taxable yields, use the following formulas:
Tax equivalent yield = yield / (1 – MTB), while taxable yield X (1-tax rate) = tax exempt yield.
Example: if the yield on a tax exempt municipal bond was 6%, and you are in a 28% tax bracket; the equivalent taxable yield (ETY), is 8.3%, calculated in the following manner: 06 / 1.00 – .28 =.083, or, 8.3% ETY.
This means that you would need a taxable instrument paying almost 9 % to equal the 6 percent tax exempt bond.
Capitated reimbursement is predominantly, but not exclusively, within the realm of physician providers. But, a decade ago Community Nursing Organization project examined an innovative approach to community nursing and ambulatory care services for Medicare beneficiaries. The hypothesis was that provision of such services would promote the timely and appropriate use of health care and to reduce the use of costly acute care services.
Organizations participating in the CNO demonstration were paid a fixed per-member-per-month capitated rate for covered services. But, the participating CNOs were only at risk under capitation for a subset of Medicare benefits [partial-capitation or carve-out]. The financial incentive was to minimize utilization covered under the capitated payment, but not necessarily to minimize utilization of services not covered because traditional Medicare, not the CNO, would be at risk.
Assessment
Final results indicated that the CNO model under partial capitation led to increased Medicare costs based on findings consistent across several analytic approaches. The cost differences between treatment and control or reference groups persisted after the application of increasingly complex risk-adjustment methods.
Moreover, the differences increased over time and were robust to changes in the way CNO participation was defined.
Lastly, there was no statistically significant evidence of increase in physical or social functioning of the treatment group, as compared with the control group. CNOs cost more without providing any health benefits along dimensions measured
[Source: Voluntary Partial Capitation: The CNO Medicare Demonstration Project, Austin Frakt, Steve Pizer, Robert Schmitz, and Soeren Mattke – Health Care Financing Review 2005).
According to Wikipedia, a non-fungible token (NFT) (previously referred to as Bitcoin 2.0) is a unit of data stored on a digital ledger, called a blockchain, that certifies a digital asset to be unique and therefore not interchangeable. NFTs can be used to represent items such as photos, videos, audio, and other types of digital files. Access to any copy of the original file, however, is not restricted to the buyer of the NFT. While copies of these digital items are available for anyone to obtain, NFTs are tracked on blockchains to provide the owner with a proof of ownership that is separate from copyright.
In 2021, there has been increased interest in using NFTs. Blockchains like Ethereum, Flow, and Tezos have their own standards when it comes to supporting NFTs, but each works to ensure that the digital item represented is authentically one-of-a-kind. NFTs are now being used to commodify digital assets in art, music, sports, and other popular entertainment. Most NFTs are part of the Ethereum blockchain; however, other blockchains can implement their own versions of NFTs.
The NFT market value tripled in 2020, reaching more than $250 million. The rise of NFT transactions has also led to increased environmental criticism. The computation-heavy processes associated with proof-of-work blockchains, the type primarily used for NFTs, require high energy inputs that are contributing to global warming. The carbon emissions produced by the energy needed to maintain these blockchains has forced some in the NFT market to rethink their carbon footprint.
“Physicians have a significantly low propensity to accumulate substantial wealth.”
Thomas Stanley – Author “The Millionaire Next Door”
[New York Times]
How come doctors fail to get rich? Re-read the above!
By Dr. David Edward Marcinko MBA CMP®
The Institute of Medical Business Advisors Inc identified several reasons based on observations working with medical professional and physician clients over the years.
A late start
By the time doctors finish medical school and residency they’re typically in their middle or late thirties. Many have families to feed, and substantial student loans to pay off. It will be years before they can even start accumulating wealth. Consider that physicians typically enter careers at later ages, often with larger debts from training. Some specialties may not lead a case until 10 years of practice, and many specialties have limited longevity. Peak earning years may also be shorter for health care providers than other professionals. Financial survival skills are paramount for converting the limited earnings time period to personal financial security.
Challenging socio-political environment
It is increasingly challenging to practice medicine. With the Medicare Trust Fund slated to go bust in 2019, the Center for Medicare and Medicare Service (CMS) is increasingly resorting to cutting physician reimbursements and implementing capitation and bundled value based medical payments models. The medical reimbursement effects of the PP-ACA are not yet fully discerned; but appear to continue the decline in compensation. And to illustrate this potential governmental control, in what other industry can participants debate the simple question, “who is the customer?”
Lifestyle expectations
Society expects a doctor to live like a doctor, dress like a doctor, and drive like a doctor. Meeting social expectations can be quite expensive.
Time and energy
A doctor can’t be just a doctor any more. S/he also has to deal with ever increasing regulatory mandates, paperwork requirements by state and federal agencies and capricious insurance companies. It is estimated that for every hour spent on patient care, and additional half-hour is spent on paperwork. To-date, the use of electronic medical records has exacerbated; not ameliorated this problem. The demand on their time is mind-boggling. A typical doctor works a ten- to twelve-hour day. After work and family, they simply don’t have time and energy left to do comprehensive financial planning.
Financially naïve
Doctors are smart. They’re highly trained in their area of expertise. But, that doesn’t translate into understanding about finance or economics. Because they are smart, it’s easy for them to think they can easily master and execute concepts of personal financial planning, as well. Often, they don’t.
Lack of trust and delegation
Many doctors don’t trust financial advisors working for major Wall Street banks. They have the good instinct to realize that their interests are not aligned. Not knowing there are independent advisors out there who observe a strict fiduciary standard, they tend to do everything by themselves.
In fact, Paul Larson CFP®, President-CEO of the firm LARSON Financial Group LLC, noted a disquieting trend among physician client in his firm [personal communication]. Almost 90% of them fail to take care of their own family finances in a comprehensive manner; while only 10% are succeeding. The strategies in this chapter and book are common to their success.
Too Trusting
Another aspect of naivety, many physicians do not realize that the financial advisory industry lacks the same discipline and regulation that the average physician operates in. A primary care doctor would never even attempt a complicated surgery on a patient, but is trained to refer such patients to a specialist in the field with the proper training and experience. Financial Advisors often come from a sales background and are trained to keep a client in house even if the advisor is lacking in expertise. Also, many physicians are not trained to discern a qualified financial advisor from a sales person dressed up like a financial advisor. It is illegal to call yourself a physician in the United States unless you have the credentials to back it up; yet, anyone in the US can legally call themselves a financial advisor or a financial planner.
The Federal Trade Commission (FTC) recently announced plans to examine the consequences of physician group consolidation with healthcare facilities.
The agency said it had sent orders for 6 years’ worth of patient claims data to six insurers to inform this review: Cigna, United Healthcare, Anthem, Florida Blue, Aetna, and Health Care Service Corporation.
The following are some of the most common psychological biases. Some are learned while others are genetically determined (and often socially reinforced). While this essay focuses on the financial implications of these biases, they are prevalent in most areas in life.
[A] Incentives
It is broadly accepted that incenting someone to do something is effective, whether it be paying office staff a commissions to sell more healthcare products, or giving bonuses to office employees if they work efficiently to see more HMO patients. What is not well understood is that the incentives cause a sub-conscious distortion of decision-making ability in the incented person. This distortion causes the affected person – whether it is yourself or someone else – to truly believe in a certain decision, even if it is the wrong choice when viewed objectively. Service professionals, including financial advisors and lawyers, are affected by this bias, and it causes them to honestly offer recommendations that may be inappropriate, and that they would recognize as being inappropriate if they did not have this bias. The existence of this bias makes it important for each one of us to examine our incentive biases and take extra care when advising physician clients, or to make sure we are appropriately considering non-incented alternatives.
[B] Denial
Denial is a well known, but under-appreciated, psychological force. Physicians, clients and professionals (like everyone else) are prone to the mistake of ignoring a painful reality, like putting off an unpleasant call (thus prolonging a problematic situation and potentially making it worse) or not opening account statements because of the desire not to see quantitative proof of losses. Denial also manifests itself by causing human beings to ignore evidence that a mistake has been made. If you think of yourself as a smart person (and what professional doesn’t?), then evidence pointing to the conclusion that a mistake has been made will call into question that belief, causing cognitive dissonance. Our brains function to either avoid cognitive dissonance or to resolve it quickly, usually by discounting or rationalizing the disconfirming evidence. Not surprisingly, colleagues at Kansas State University and elsewhere, found that financial denial, including attempts to avoid thinking about or dealing with money, is associated with lower income, lower net worth, and higher levels of revolving credit.
[C] Consistency and Commitment Tendency
Human beings have evolved – probably both genetically and socially – to be consistent. It is easier and safer to deal with others if they honor their commitments and if they behave in a consistent and predictable manner over time. This allows people to work together and build trust that is needed for repeat dealings and to accomplish complex tasks. In the jungle, this trust was necessary to for humans to successfully work as a team to catch animals for dinner, or fight common threats. In business and life it is preferable to work with others who exhibit these tendencies. Unfortunately, the downside of these traits is that people make errors in judgment because of the strong desire not to change, or be different (“lemming effect” or “group-think”). So the result is that most people will seek out data that supports a prior stated belief or decision and ignore negative data, by not “thinking outside the box”. Additionally, future decisions will be unduly influenced by the desire to appear consistent with prior decisions, thus decreasing the ability to be rational and objective. The more people state their beliefs or decisions, the less likely they are to change even in the face of strong evidence that they should do so. This bias results in a strong force in most people causing them to avoid or quickly resolve the cognitive dissonance that occurs when a person who thinks of themselves as being consistent and committed to prior statements and actions encounters evidence that indicates that prior actions may have been a mistake. It is particularly important therefore for advisors to be aware that their communications with clients and the press clouds the advisor’s ability to seek out and process information that may prove current beliefs incorrect. Since this is obviously irrational, one must actively seek out negative information, and be very careful about what is said and written, being aware that the more you shout it out, the more you pound it in.
[D] Pattern Recognition
On a biological level, the human brain has evolved to seek out patterns and to work on stimuli-response patterns, both native and learned. What this means is that we all react to something based on our prior experiences that had shared characteristics with the current stimuli. Many situations have so many possible inputs that our brains need to take mental short cuts using pattern recognition we would not gain the benefit from having faced a certain type of problem in the past. This often-helpful mechanism of decision-making fails us when past correlations or patterns do not accurately represent the current reality, and thus the mental shortcuts impair our ability to analyze a new situation. This biologic and social need to seek out patterns that can be used to program stimuli-response mechanisms is especially harmful to rational decision-making when the pattern is not a good predictor of the desired outcome (like short term moves in the stock market not being predictive of long term equity portfolio performance), or when past correlations do not apply anymore.
[E] Social Proof
It is a subtle but powerful reality that having others agree with a decision one makes, gives that person more conviction in the decision, and having others disagree decreases one’s confidence in that decision. This bias is even more exaggerated when the other parties providing the validating/questioning opinions are perceived to be experts in a relevant field, or are authority figures, like people on television. In many ways, the short term moves in the stock market are the ultimate expression of social proof – the price of a stock one owns going up is proof that a lot of other people agree with the decision to buy, and a dropping stock price means a stock should be sold. When these stressors become extreme, it is of paramount importance that all participants in the financial planning process have a clear understanding of what the long-term goals are, and what processes are in place to monitor the progress towards these goals. Without these mechanisms it is very hard to resist the enormous pressure to follow the crowd; think social media.
[F] Contrast
Sensation, emotion and cognition work by contrast. Perception is not only on an absolute scale, it also functions relative to prior stimuli. This is why room temperature water feels hot when experienced after being exposed to the cold. It is also why the cessation of negative emotions “feels” so good. Cognitive functioning also works on this principle. So one’s ability to analyze information and draw conclusions is very much related to the context with in which the analysis takes place, and to what information was originally available. This is why it is so important to manage one’s own expectations as well as those of clients. A client is much more likely to be satisfied with a 10% portfolio return if they were expecting 7% than if they were hoping for 15%.
[G] Scarcity
Things that are scarce have more impact and perceived value than things present in abundance. Biologically, this bias is demonstrated by the decreasing response to constant stimuli (contrast bias) and socially it is widely believed that scarcity equals value. People who feel an opportunity may “pass them by” and thus be unavailable are much more likely to make a hasty, poorly reasoned decision than they otherwise would. Investment fads and rising security prices elicit this bias (along with social proof and others) and need to be resisted. Understanding that analysis in the face of perceived scarcity is often inadequate and biased may help professionals make more rational choices, and keep clients from chasing fads.
[H] Envy / Jealousy
This bias also relates to the contrast and social proof biases. Prudent financial and business planning and related decision-making are based on real needs followed by desires. People’s happiness and satisfaction is often based more on one’s position relative to perceived peers rather than an ability to meet absolute needs. The strong desire to “keep up with the Jones” can lead people to risk what they have and need for what they want. These actions can have a disastrous impact on important long-term financial goals. Clear communication and vivid examples of risks is often needed to keep people focused on important financial goals rather than spurious ones, or simply money alone, for its own sake.
[I] Fear
Financial fear is probably the most common emotion among physicians and all clients. The fear of being wrong – as well as the fear of being correct! It can be debilitating, as in the corollary expression on fear: the paralysis of analysis.
According to Paul Karasik, there are four common investor and physician fears, which can be addressed by financial advisors in the following manner:
Fear of making the wrong decision: ameliorated by being a teacher and educator.
Fear of change: ameliorated by providing an agenda, outline and/or plan.
Fear of giving up control: ameliorated by asking for permission and agreement.
Fear of losing self-esteem: ameliorated by serving the client first and communicating that sentiment in a positive manner.
Now, as human beings, our brains are booby-trapped with psychological barriers that stand between making smart financial decisions and making dumb ones. The good news is that once you realize your own mental weaknesses, it’s not impossible to overcome them.
In fact, Mandi Woodruff, a financial reporter whose work has appeared in Yahoo! Finance, Daily Finance, The Wall Street Journal, The Fiscal Times and the Financial Times among others; related the following mind-traps in a September 2013 essay for the finance vertical Business Insider; as these impediments are now entering the lay-public zeitgeist:
Anchoring happens when we place too much emphasis on the first piece of information we receive regarding a given subject. For instance, when shopping for a wedding ring a salesman might tell us to spend three months’ salary. After hearing this, we may feel like we are doing something wrong if we stray from this advice, even though the guideline provided may cause us to spend more than we can afford.
Myopia makes it hard for us to imagine what our lives might be like in the future. For example, because we are young, healthy, and in our prime earning years now, it may be hard for us to picture what life will be like when our health depletes and we know longer have the earnings necessary to support our standard of living. This short-sightedness makes it hard to save adequately when we are young, when saving does the most good.
Gambler’s fallacy occurs when we subconsciously believe we can use past events to predict the future. It is common for the hottest sector during one calendar year to attract the most investors the following year. Of course, just because an investment did well last year doesn’t mean it will continue to do well this year. In fact, it is more likely to lag the market.
Avoidance is simply procrastination. Even though you may only have the opportunity to adjust your health care plan through your employer once per year, researching alternative health plans is too much work and too boring for us to get around to it. Consequently, we stick with a plan that may not be best for us.
Loss aversion affected many investors during the stock market crash of 2008. During the crash, many people decided they couldn’t afford to lose more and sold their investments. Of course, this caused the investors to sell at market troughs and miss the quick, dramatic recovery.
Overconfident investing happens when we believe we can out-smart other investors via market timing or through quick, frequent trading. Data convincingly shows that people who trade most often under-perform the market by a significant margin over time.
Mental accounting takes place when we assign different values to money depending on where we get it from. For instance, even though we may have an aggressive saving goal for the year, it is likely easier for us to save money that we worked for than money that was given to us as a gift.
Herd mentality makes it very hard for humans to not take action when everyone around us does. For example, we may hear stories of people making significant profits buying, fixing up, and flipping homes and have the desire to get in on the action, even though we have no experience in real estate.
According to colleague David K. Luke MIM, MS-PFP, CMP™ the current structure of the life insurance industry regarding cash-value life insurance policies with most major insurance companies is to reward the selling agent with the entire commission upfront on a newly issued policy. The criticism to this practice is that this of course reduces the needed client-agent reviews and interaction and generates more “churning” and “flipping”. Unscrupulous agents are tempted to sell physician-clients another policy for another commission rather than encourage them to maintain and keep their existing policy, which most likely would have lower costs than any new policy considering the client was younger and most likely in better health with the existing contract. A model in which the insurance agent would have a financial incentive for their client’s continued patronage could create a win-win for both parties. We see this “pay as you” model currently operating successfully with wealth advisors and property/casualty agents, why not life insurance agents [personal communication]?
There are some flaws to this argument. The reality is that the captive life insurance industry and their agents prefer this form of lump compensation. The claim is that selling an individual a life insurance policy (the ultimate intangible product) is hard work, and likewise the 70% – 110% of the first year premium is fair compensation for the efforts. For existing agents to reduce their current income to a fraction of this commission upfront, but convert it into a trail over a multiyear period is actually quite distasteful. Therefore, this change will likewise not be initiated from the Insurance agent or insurance industry side unless other forces prevail.
The drive by the consumer to change this up front lump form of compensation has not yet presented itself in full force. After all, why does the consumer care about how the agent is paid if the consumer is satisfied with the end result? One must acknowledge that the drive to reduce commissions and up front loads in the investment advisory business was driven by the consumer that insisted on lower fees and costs.
However, the relevant costs of a life insurance policy are not quite as obvious. Only by comparing a quote from different companies can a consumer compare costs, and even then it is unknown and not understood how the pricing mechanisms used by the insurance company work. The advent of non-agent sold policies however is decreasing the cost of life insurance (there is no big commission check written to the selling agent) and is hitting the radar of consumers. The consumer can notice this difference if the consumer compares the proposed agent sold policy premium with one sold directly by a financial institution such as USAA or AARP. These companies have a work force of sales people that are compensated primarily on salary. Likewise the company can structure more competitive pricing, and in effect offers a levelized cost (in place of commission) insurance product.
For example, Mark Maurer CFP® of Low Load Insurance Services believes that a levelized compensation basis will not occur unless all the insurance companies were to go to such a plan all at once. If an agent can “pick and choose” he/she may use a “levelized compensation” policy when in a competitive situation, as such a policy should in theory make a policy more inexpensive. An agent would then use the higher “front-end” policy when there is a large up-front premium or in a scenario with limited competition. Mark believes the answer to the whole argument is full disclosure. Both agents and home offices would not want the purchaser to know that 100% or more of their premium is going to sales costs and then products would then get better [personal communication].
The insurance industry has a powerful lobby in Washington. Only market pressure will cause a change in this decades old insurance industry practice that has made many life insurance policies expensive and inefficient. Pricing from non-agent sold life insurance companies will be the impetus that drives the old-line Insurance companies to restructure their commissions to agents.
Insurance agents also remember the days of 8% load mutual fund commissions and minimum $60 dollar commissions on stock trades in the late 1980’s! That is an inflation equivalent of more than $130 per trade, minimum commission, today. The current investing world would laugh at these costs [charges] today. When the physician-consumer realizes, through full disclosure and outside competitive market pressures, that life insurance protection can be more affordable from other non-traditional channels, then s/he will insist on a better, more affordable product.
Ultimately, the big agent driven life insurance companies will have to change their commission structure. The transition is currently in process. Only time will tell now [personal communication].
One thing for certain about 2020 is that uncertainty was everywhere.
So, we now ask:
What will 2021 look like for the free market medical movement?
Will the political landscape move toward more centralized control of healthcare under a Biden presidency?
Will a more conservative-leaning Supreme Court strike down the Affordable Care Act?
There are so many unknowns. Entrepreneurs are always navigating through a world of uncertainty and the government always has a tendency to make things more uncertain.
I fully agree with the title of Jeremy Horpedahl’s latest reply on the value of life. To say that the life of an 80-year-old is worth 1% or .1% as much as the life of a 10-year-old is not deny the high value of elderly lives, because 10-year-old lives are immensely valuable.
However, I disagree with almost all of Jeremy’s arguments. To wit:
PresidentBiden Talks Up Benefits of Vaccines After New Mask Guidance
By Dr. David E. Marcinko MBACMP®
It is time to practice smiling with your teeth again, because the CDC just updated its mask-wearing guidance yesterday from “mostly always” to “mostly just inside.” The agency said that fully vaccinated folks can do the following activities sans masks:
Dine outside with non-roommates
Go on walks, hikes, or bike rides alone or with household members
Attend small, outdoor events, even if some attendees haven’t been vaccinated.
Why now?
29% of Americans are fully vaccinated, and almost 43% have received 1+ dose. Plus, researchers’ understanding of Covid-19 has come a long way since every Amazon package was treated like an Area 51 special delivery, and public health experts say it’s rare for the virus to spread outdoors.
The pace of vaccinations has slowed down in the US, and the Biden administration hopes that FOMO from seeing vaccinated friends tandem-biking (as friends do) will spur the un-jabbed to act.
Assessment: In the words of President Biden, “For those who haven’t gotten their vaccine yet…this is another great reason to go get vaccinated now.”
I was lucky to meet Dani Shapiro through HMS Bioethics when she came to speak in a class I taught there about her book Inheritance. That meeting ultimately resulted in Josh North, Rennie Burke, Yvette Ollada, Gali Katznelson and I surveying individuals who were donor conceived about their thoughts, feelings, and reactions to finding out about the nature of their conception. We wrote up our findings here in the HMS Journal of Bioethics.
Gali and I then wrote a blog on Psychology Today highlighting our findings.
EDITOR’S NOTE: Colleague J. Wesley Boyd, M.D., Ph.D., is a professor of psychiatry and medical ethics at Baylor College of Medicine. He is also a lecturer on global health and social medicine at Harvard Medical School. He writes on issues of social justice, human rights, immigration and asylum, access to care, and substance use disorders. He is the author of the book, Almost Addicted, which won the Will Solemine Award for Excellence in Medical Writing from the New England American Medical Writer’s Association.
Effective forms management improves healthcare data quality
By Shahid N. Shah
NOTE: Colleague Shahid Shah is an internationally recognized enterprise software guru that specializes in digital health with an emphasis on e-health, EHR/EMR, big data, iOT, data interoperability, med device connectivity, and bioinformatics.
President Biden will soon propose nearly doubling the capital gains tax for wealthy people to 39.6%, according to Bloomberg.
PS: Wealthy people = individuals earning $1 million or more.
Biden is expected to announce the tax hike next week as part of the pitch for his “American Families Plan,” the highly anticipated sequel to the $2.3 trillion infrastructure proposal he released a few weeks ago.
To pay for the first plan, which includes spending on bridges and broadband, Biden wants to hike taxes on corporations.
To pay for his second proposal, which includes spending on childcare and paid leave for workers, he wants to hike taxes on wealthy investors.
NOTE: Physicians and all investors knew this dramatic hike was coming (the proposal was in candidate Biden’s tax plan), but the report jarred Wall Street nonetheless. It could lead to a lot of asset sales before 2021’s out.
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.
Telephonic or electronic advice for medical professionals that is:
Objective, affordable, medically focused and personalized
Rendered by a pre-screened financial consultant or medical management advisor
Offered on a pay-as-you-go basis, by phone or secure e-mail transmission.
The iMBA Discussion Forum™ is a physician-to-advisor telephone or e-mail portal that connects independent financial professionals and medical management consultants, with doctors or healthcare executives desiring affordable and unbiased financial or business advice on an as-needed, pay-per-use basis.
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.
What’s the difference between an IPO, a special purpose acquisition company (SPAC), and a direct listing?
[By staff reporters]
IPOs are a 6–12 month journey where a company works with investment banks and underwriters, who buy a bunch of shares and then sell them to investors in the public market during the actual IPO. Early investors are able to liquidate their shares, and the company raises new funds.
Direct listings skip the underwriting hullabaloo. But without that stability guarantee, direct listings can result in a more volatile opening. Some companies, like Coinbase, find that it’s worth it to keep their hard-earned money out of bankers’ hands.
SPACs, aka “blank-check companies,” offer yet another alternative path to public markets. A SPAC is a shell company that raises money through the traditional IPO process, then merges with a private company and takes it public.
We are pleased to present the May 2021 issue of AJPH. It features a special dossier on “COVID-19/Public Health Preparedness and Response” with research and perspectives on the importance of strengthening public health systems before disasters strike.
The issue also includes research on anti-Asian bias, use of cannabis for harm reduction among people at high risk for overdose, the changing epidemiology of hepatitis C infections in the U.S. and much more.
Here are a few of the many articles in the May 2021 issue.
For a couple of decades now, healthcare has professed to be patient centered.
But the prevailing culture of “quality” (and the reality of getting paid for what you do) has us spending at least half our time documenting for outsiders, who are non-clinicians, the substance and value of our patient interactions. That means our patients get half of our attention and others get half.
Today on Health in 2 Point 00, Jess DaMassa claims to be blameless for the drama between Jonathan Bush and Glen Tullman. On Episode 198, we talk about Microsoft buying Nuance for $16 billion and $3 billion in debt – is Microsoft taking over healthcare, and is this going to slow Nuance down?
IPOs
Cohere Health raises $36 million in a Series B, working on improving prior authorizations between health plans and providers. We wrap up with a lightning round of IPO rumors regarding Privia Health, VillageMD, and Bright Health.
As of January 2021, price transparency is being mandated for hospitals. But what exactly does that mean for company healthcare plans, third-party administrators, healthcare sharing organizations, employers, and employees?
Our colleague Matthew Dale breaks it down and discusses why platform technology is the way forward.
Providers and payers alike recognize the impact chronic conditions have on member and patient health and healthcare expenditure. An easy-to-use digital health platform that successfully marries IoT sensors, data visualization, and AI can be a powerful tool in the management and prevention of chronic conditions.
And, when “high tech” tools are combined with the “high touch” elements such as digital health coaching, members and patients are truly empowered and supported.
Are you providing a holistic digital health platform to your members and patients?
62% of health care workers say COVID-19 is impacting mental health
The coronavirus pandemic has had a major impact on the mental health of frontline health care workers. Highlights from the new KFF/Washington Post Frontline Health Care Workers Survey, finds that among frontline healthcare workers:
• A majority (62%) say worry or stress related to COVID-19 has a negative impact on their mental health. • More than half (56%) say that worry or stress related to COVID-19 has caused them to experience trouble with sleeping or sleeping too much (47%), frequent headaches or stomachaches (31%), or increased alcohol or drug use (16%). • 13% say they have received mental health services or medication specifically due to worry or stress related to COVID-19 and an additional one in five (18%) say they thought they might need such services, but did not get them.
In general terms, healthcare entity or medical practice compliance is the organization’s adherence to rules, regulations, guidelines, and specifications relevant to performing its day-to-day operations.
This includes the observance of all applicable Medicare billing guidelines; state, local, and Federal regulations impacting the practice; ethical, privacy and security requirements; and the steps and processes to avoid potential fraud and abuse.
Due to the increasing number of regulations placed on medical practices and the need for operational transparency, provider offices are adopting the use of consolidated and harmonized sets of compliance controls to ensure that all necessary governance requirements can be met without unnecessary duplication of effort or too extensive processes that could take away from patient care.
As we complete our first quarter-century of service to the podiatric community, it is only fitting to update our colleagues of the extreme changes taking place in the individual board exam testing space.
Some of these changes are perfunctory with little practical impact; while others are so profound as to cause extreme consternation in the practitioner community writ-large.
For example:
Nomenclature:
FROM: American Board of Podiatric Surgery -TO- American Board of Foot and Ankle Surgery.
FROM: American Board of Primary Podiatric Medicine and Orthopedics -TO- American Board of Foot and Ankle Medicine and Orthopedics.
The Surgery Certification and Qualification tests now rely less on rote memorization and more on applied cognitive content, and may be very different from any other test you have ever taken, to date [ie., multiple choice or fill-in-the-blank].
The Primary Medicine and Orthopedics Certification and Qualification tests now rely less on rote memorization and more on applied cognitive content, and may be very different from any test you have ever taken, to date [ie., multiple choice or fill-in-the-blank].
Traditional human ORAL questions have been usurped by [non-human] computerized Clinical Pathology Conference [CPC] queries; AKA: Computer Based Testing [CBT] or Clinical Scenario Questions [CSQs].
American Board of Medical Specialities now includes over a dozen general categories; including podiatry.
The Re-Certification tests for Maintenance of Certification [MOC] now rely much less on rote memory, as in the past; and more on deeply experiential content. It is also becoming more competitive, to-date.
So-called “wrong” questions by-design are called psychological “stressor questions” and are used to evoke emotional volatility and waste precious time. So, BEWARE!. Moreover; the so-called “points-to-pass” AND “points-to-fail” philosophy may be re-emerging.
This is the dynamic PODIATRY PREP difference [Unique Competitive Advantage] between our customized Study Guide File Programs with customized board exam preparation content, and the static general “off-shelf” books or Web guides of the past; and/or traditional CEU educational seminars.
SAMPLE QUESTIONS: Traditional Rote ISTITUTIONAL RESIDENCY Questions versus Experiential and Cognitive Styled INDIVIDUAL PRACTITIONER [CBT/CBS] Formats
“Clinician EHR Workload, Cognitive Efforts Double After EHR Adoption – Providers reported significant cognitive workload increases, such as higher levels of frustration and mental demands following EHR adoption”
Jason: “Clinician workload and cognitive efforts doubled after the first six months of EHR adoption, according to a study published in Applied Ergonomics. Clinicians also experienced increased EHR workload over 2.5 years following EHR implementation. This adds to the evidence showing a connection between EHR usability and clinician burnout. EHR usability issues typically increase cognitive load and errors, leading to patient safety issues. An increase in cognitive load adds to EHR use, which then leads to clinician burnout.”
Compared to physicians, the business of dentistry is like a lemonade stand. Electronic dental records offer only convenience – expensive, complicated and dangerous convenience.
Clinical equipoise, also known as the principle of equipoise, provides the ethical basis for medical research that involves assigning patients to different treatment arms of a clinical trial.
The term was first used by Benjamin Freedman in 1987, although references to its use go back to 1795 by Dr. Edward Jenner. In short, clinical equipoise means that there is genuine uncertainty in the expert medical community over whether a treatment will be beneficial. This applies also for off-label treatments performed before or during their required clinical trials.
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…)
Right Side VERSUS Left Side Cerebral Vascular Accidents
[By staff reporters]
A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients [occlusive and hemorrhagic]. Within minutes, brain cells begin to die.A stroke is a medical emergency. Prompt treatment is crucial. Early action can minimize brain damage and potential complications.The good news is that strokes can be treated and prevented, and many fewer Americans die of stroke now than in the past.
Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).
When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, behavior and the ability to think clearly.
Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any.
Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counseling (psychotherapy).
A medical science liaison is a healthcare consulting professional who is employed by pharmaceutical, biotechnology, medical device, and managed care companies. Other job titles for medical science liaisons may include medical liaisons, clinical science liaisons, medical science managers, regional medical scientists, and regional medical directors.
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