Drs. Beware the Rise of Home Owner Associations?

Important Information for Medical Professionals

By Staff Reporters

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With 62 million Americans governed by HOA’s and $35 billion dollars in operating revenues and growing, HOATown.com thought is was time to bring clarity to the homeowner association with this one-of-a-kind infographic.

Assessment

In Atlanta, for example, the affluent developments are Country Club of the South, and the St. Marlo gated communities. Both are governed by HOAs and house doctors and medical professionals of all types.

Source: hoatown.com

Conclusion     

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

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Product Details  Product Details

Health Plan Management Navigator

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July 2010 Edition

By Erin Sawchuk

erinsawchuk@sherlockco.com

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Dear ME-P Readers

Please find attached the early July 2010 Edition of our health Plan Management Navigator. In this month’s edition, we suggest an approach to quantifying best practice of administrative activities of health plans. Determining best practice for health plans is a knotty problem because of the complexity of the product and because some of what makes for best practice cannot be captured in the current year’s administrative expense line. We offer a solution that we hope to implement but we would be grateful for any insights you wish to share on this matter.

Financial and Operating Results

Navigator also summarizes some of the May financial and operating results of health plans reporting in our Dashboard. Operating earnings are weak on soft revenues and compressing margins. Enrollment trends in Medicare, Medicaid and ASO products are relative bright spots. Plans are adapting by reducing staffing ratios.

Link: Early July 2010 Navigator[1]

Web Casts

Please save 2:00 on July 16, and 2:00 on August 5 for two important web conferences. The first will summarize the results of this year’s SEER benchmarks for Independent / Provider-Sponsored plans. The second will summarize this year’s SEER benchmarks for Blue Cross Blue Shield Plans.

The Plan Management Navigators containing the respective peer group data will be sent to you a day or so before the web conference. There is no charge to participate, but we would be grateful if you would let us know in advance. Please reply back to me.

Assessment

Erin Sawchuk [Sherlock Company]

P.O. Box 413

Gwynedd, PA 19436

www.sherlockco.com

215-628-2289 – Phone

Conclusion

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Around the Healthcare Financial Blog-O-Sphere

News and Economics Updates in Thirty Minutes or Less 

By Staff Reporters

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1. Unions pressure Democrats on health insurance tax
Associated Press via Google, December 10, 2009

2. Is there a doctor in the corporation? Maybe soon
Reuters, December 9, 2009

3. Sebelius Statement on Benefits of Health Insurance Reform for Businesses
HHS Press Release, December 3, 2009

4. Majority of employers would reduce health benefits to avoid proposed excise tax
Mercer Press Release, December 3, 2009

5. U.S. unemployed face higher healthcare premiums
Reuters, December 2, 2009

6. Public support for health-care reform is high, but some CFOs take a different view
CFO.com, December 1, 2009

7. Survey: Growing worker stress seen in benefits use
Associated Press via Google, November 30, 2009

8. Employers Play Dr. Mom to Limit Swine Flu Impact
Associated Press via Google, November 30, 2009

9. Health Care Savings Could Start in the Cafeteria
The New York Times, November 28, 2009

10. Ford, GM Face $2.5 Billion First VEBA Bill
Workforce Management, November 24, 2009

11. Plan credits healthy habits – Employer cuts costs by allowing workers to ‘earn’ lower rates
Business Insurance, November 23, 2009

12. Health Care: GE Gets Radical
Business Week, November 19, 2009

Conclusion

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Physicians Seeking Financial Support from Hospitals

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Results of a New Survey

[By Staff Reporters]

Since domestic economic conditions began to deteriorate in September 2008, the number of doctors seeking financial support from hospitals has increased, according to a new report from the American Hospital Association. 

Study Results

  • Overall: 70%
  • Physicians Seeking Increased Pay for On-Call or other Services Provided to Hospital: 79%
  • Physicians Seeking Hospital Employment: 74%
  • Physicians Seeking to Sell Their Practice: 36%
  • Physicians Seeking to Partner on Equipment Purchases: 26%
  • Other: 13%

Source: American Hospital Association. The Economic Crisis: Ongoing Monitoring of Impact on Hospitals: Results from an AHA Rapid Response Survey, August/September 2009. www.aha.org

Channel Surfing the ME-P

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

Conclusion

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

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

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Events Planner: December 2009

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Events-Planner: DECEMBER 2009

Staff Writers

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“Keeping track of important health economics and financial industry meetings, conferences and summits”

Welcome to this issue of the Medical Executive-Post and our Events-Planner. It contains the latest information on conferences, news, and relevant resources in healthcare finance, economics, research and development, business management, pharmaceutical pricing, and physician/entity reimbursement!  Watch for a new Events-Planner each month.

First, a little about us! The Medical Executive-Post is still a relative newcomer. But today, we have almost 25,000 visitors and readers each month from all over the country, in addition to our growing subscriber base. We have been a successful collaborative effort, thanks to your contributions.  As a result, we are adding new resources daily.  And, we hope the website continues to provide the best place to go for journals, books, conferences, educational resources, tools, and other things you need to establish the value your healthcare consulting and financial advisory intervention. And so, enjoy the Medical Executive-Post and our monthly Events-Planner with our compliments. 

A Look Ahead this Month

December 1: Print Edition Healthcare Journalism: If you would like to “step-up-your-game” and be considered as a peer-reviewed contributor to the third print edition of: The Business of Medical Practice [Health 2.0 Profit Maximizing Techniques for Savvy Doctors]; contact Ann at: MarcinkoAdvisors@msn.com. There are several chapter topics still available. Now, the important dates:

Dec 1: Investment Advisors Association Workshop, Los Angeles, CA

Dec 3: Equity research and Valuation, CFA Institute NY, NY

Dec 6: IMCA Practice Management Conference, INCA, Park City, UT

Dec 7: HFMA Fall Seminar, Chicago, ILL.

Dec 8: CBI Pharmaceutical Conference, Philadelphia, PA

Please send in your meetings and dates for listing in the next issue of our ME-P Events-Planner.

MarcinkoAdvisors@msn.com

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

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HCG Forecast: Fall/Winter 2009 Edition

The Health Care Group  

By Cheryl Sprows

Three new topics in this issue:

 

  1. New Regulations for Business Associates
  2. New Breach Notification Requirement under HIPAA
  3. Workplace Harassment – Did you hear the one about?

Link: https://www.thehealthcaregroup.com/Productdownloads/2009fallwinterforecast.pdf

Visit HCG’s website: http://www.thehealthcaregroup.com

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Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register.  

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Sponsors Welcomed

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Recovery Asset Contractor Survey Poll

RAC RESULTS TO-DATE [Beta]

By Staff Reporters

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According to the Centers for Medicare and Medicaid Services [CMS], RACs collected about $1-B in improper payments during their recent beta testing period. Of these payments; 96% were over-payments, 4% were under-payments; and 77% of providers failed to appeal, 7% appealed successfully and 15% appealed unsuccessfully.

Going forward there will be a three year “look-back period”, and a 10% contingency payment level for the four regional RACs currently in the program:

  1. Connolly Consulting
  2. PRG-Schultz
  3. HealthDataInsights
  4. Diversified Collections Services

By 2010, the RAC program is scheduled to launch in all 50 states. And so, please cast your vote in our exlcusive ME-P RAC program survey poll.

Conclusion

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

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

 

Product DetailsProduct DetailsProduct Details

Update on the Medicare Oriented Universe

October Plan Management Navigator 

By Douglas B. Sherlock; MBA, CFAStetho-Claim

Please find attached the October 2009 edition of our Plan Management Navigator.

Medicare-Orientated Universe

In this month’s edition, we update ME-P and all readers on the results for the Medicare-Oriented universe, and provide summary functional area breakouts as well as expense trends. Holding constant the universe, and the product mix offered, administrative expense growth was higher than last year.

For example, eleven Medicare-Oriented plans serving 1.1 million beneficiaries participated in this year’s benchmarking study. In addition, the results from Blue Cross Blue Shield Plans and Independent / Provider-Sponsored Plans are also summarized. With these additional plans, we provide selected information on health plans serving 2.1 million Medicare beneficiaries, comprising approximately 22% of Medicare Advantage members during 2008.

Assessment

The analysis is based on materials from our Sherlock Expense Evaluation Report (SEER) for the Medicare-Oriented Plans. Additional information about SEER is available at www.sherlockco.com/seer.shtml or by contacting me.

Link: Navigator 10-09 

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Health Plan Management Navigator

August 2009 Edition

By Douglas B. Sherlock; CFA, MBALibrary

Linked below is the August 2009 edition of Plan Management Navigator. In this month’s edition, we update readers on the results for the Blue Cross Blue Shield universe, and provide product breakouts, summary functional area breakouts as well as expense trends. Cost increases are lower this year than last, though higher if product mix is considered. Twenty-two Blue Cross Blue Shield Plans serving 31.3 million members participated in this year’s benchmarking study.  Growth in Information Systems and Medical Management costs explained more than 40% of the total increase.

Link: Navigator August 09

Sherlock Expense Evaluation Report

This analysis is based on materials from our Sherlock Expense Evaluation Report (SEER) for Blue Cross Blue Shield Plans. Additional information about SEER is available at http://www.sherlockco.com/seer.shtml or by contacting us.

Assessment

In coming weeks, Plan Management Navigator will summarize other results of this year’s performance benchmarking studies. We expect to publish Medicare and Medicaid editions in late August or early September. Independent / Provider-Sponsored plan results were published two weeks ago in Plan Management Navigator and the associated presentation and transcript are found at  http://www.sherlockco.com/

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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

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Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

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Health Plan Management Navigator

July 2009 Edition

By Douglas B. Sherlock; CFA, MBALibrary

 

Attached below, find the July 2009 Edition of Plan Management Navigator.  In this month’s edition, we summarize the results of Independent / Provider-Sponsored Healthcare Plans. The 16 plans collectively serve 5.7 million members and are leaders in their communities.

 Link: Navigator_07-09

 

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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

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Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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Sponsors Welcomed

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Sherlock Expense Evaluation Report [SEER]

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Plan Management Navigator

By Marco Georeno

Ph:  215-628-228956372274      

Please find attached the April 2009 edition of Plan Management Navigator. In it we provide an update on the timing of the Blue Cross Blue Shield universe and the Independent / Provider-Sponsored editions of the Sherlock Expense Evaluation Report (SEER). In addition, we expect to circulate the benchmarking surveys for the Medicaid and Medicare universes on or about June 1st, for completion by July 20th, 2009.

Benchmarking Studies

If you are interested in participating in our benchmarking studies please contact us as soon as possible. Additional information about SEER is available at www.sherlockco.com/seer.shtml or by contacting Doug Sherlock (sherlock@sherlockco.com).

Best Practices for the Healthcare Enterprise

We also endeavor to provide an enterprise view of best practice. Best practice is typically considered to be the most efficient way of achieving a desired outcome. We believe that the best way of determining the best practice in its most practical application is to start with an overall objective and weigh all particular practices in light of how they contribute to that overall objective.

In that vein, over the next several months, Sherlock Company will be offering web conferences focused on best practices. The first conference will address activities within Customer Services, as well as activities or effects in other functional areas. This web conference will be held on Wednesday May 20th at 2:30 PM, Eastern Time. The costs will be $225. Participation is free of charge to health plans participating in our 2009 benchmarking studies. If you are interested in participating, please email Erin Sawchuk (erinsawchuk@sherlockco.com) or call at 215-628-2289.

Assessment

This edition of Navigator also discusses the latest private health plan Dashboard results for the trailing three months ended January 31, 2009.

Link: navigator

Sincerely,
Sherlock Company

Marco Georeno – Analyst
mgeoreno@sherlockco.com

Fax: 215-542-0690

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated?

Link: http://feeds.feedburner.com/HealthcareFinancialsthePostForcxos

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

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Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Consumer Directed Health Plan Survey

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Costs Hold Steady

[By Staff Reporters]

ho-journalAccording to Tracey Walker, Senior Editor of Healthcare Executive News on March 13, 2009, US employers expect healthcare cost increases to hold steady at 6%. Additionally, more plan to adopt consumer-directed health plans [CDHPs] in 2010, in an effort to control health cost increases.

Watson Wyatt – National Business Group Survey on Health

And, a survey by Watson Wyatt and the National Business Group on Health, found that:

  • Approximately half of companies now offer workers a CDHP, up from 47% in 2008, and another 8% are expected to adopt a CDHP by 2010.
  • CDHPs are helping employers control costs—companies with at least half of their workers enrolled in a CDHP have a two-year cost trend (4.6%) that is 25% lower than non-CDHP sponsors (6.1%).
  • Two-thirds of employers (67%) cite the poor health habits of their employees as a considerable challenge to managing their health costs.
  • While companies will be taking a close look at benefit offerings because of the recession, most do not plan major changes.
  • Nearly 30% of employers have revamped their healthcare strategy with another 30% planning to do so in 2009.

Assessment

The growth in CD-HPs has made it more important than ever for health plans to provide their members actionable information and pricing transparency to navigate the healthcare system. According to Dr. David Edward Marcinko;

“Members like our firm – and many others – are incented to be savvy consumers, but that’s a difficult task if not provided with the pricing and related information we need to make wise choices. And, to make matters even worse for lay patients; providers and hospitals are not often keen to supply information about same.”

But, there is some hope according to Hope Rachel Hetico; RN, MHA, CMP™ of www.MedicalBusinessAdvisors.com

“The overall transparency milieu today has definitely improved this last decade as we have participated in CDHPs for all our employees.” 

Channel Surfing the ME-P

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

Conclusion

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

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

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Sherlock Health Plan Management Navigator

Information System Implications on Health Plans

By Douglas B. Sherlock; MBA, CFAcomputer-hardware

Messrs. and Mesdames

Attached, please find the February 2009 edition of our Health Plan Management Navigator.
Link: sherlock-company

The Sherlock Expense Evaluation Report

In this month’s edition, we endeavor to better understand the functional area of information systems [IS] and its implications on health plans. Information systems, based on the results from out 2008 Sherlock Expense Evaluation Report (SEER) displayed overall anti-scalability in costs. In order to better comprehend IS and its influence on health plans overall, we performed numerous analyses that looked at relationships between IS and other aspects, such as scalability, variety of product offerings, commitment to ASO products and other functional areas.

Assessment

The results suggest that scale does not appear to play a role in IS costs and that more of a concentration in ASO products seemed to lower IS costs. It also appears that management of information systems, in the context of its support to other functional areas, is an inexact science.

Conclusion

Additional information about SEER is available at www.sherlockco.com/seer.shtml or; by contacting me at: sherlock@sherlockco.com

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An Interview with Bennett Aikin AIF®

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On Financial Fiduciary Accountability

[By Dr. David E. Marcinko MBA & Prof. Hope Rachel Hetico; RN, MHA, CMP™]

[By Ann Miller; RN, MHA]

Currently, there is a growing dilemma in the financial sales and services industry. It goes something like this:

  • What is a financial fiduciary?
  • Who is a financial fiduciary?
  • How can I tell if my financial advisor is a fiduciary?

Now, in as much as this controversy affects laymen and physician-investors alike, we went right to the source for up-to-date information regarding this often contentious topic, for an email interview and Q-A session, with Ben Aikin.ben-aikin

About Bennett Aikin AIF® and fi360.com

Bennett [Ben] Aikin is the Communications Coordinator for fi360.com. He oversees all communications for fi360. His responsibilities include messaging, brand management, copyrights and trademarks, and publications. Mr. Aikin received his BA in English from Virginia Tech in 2003 and is currently an MS candidate in Journalism from Ohio University.

Q. Medical Executive Post 

You have been very helpful and gracious to us. So, let’s get right to it, Ben. In the view of many; attorneys, doctors, CPAs and the clergy are fiduciaries; most all others who retain this title seem poseurs; sans documentation otherwise.

A. Mr. Aikin

You are correct. Attorneys, doctors and clergy are the prototype fiduciaries. They have a clear duty to put the best interests of their clients, patients, congregation, etc., above their own. [The duty of a CPA isn’t as clear to me, although I believe you are correct]. Furthermore, this is one of the first topics we address in our AIF training programs, and what we call the difference between a profession and an industry.  The three professions you name have three common characteristics that elevate them from an industry to a profession:

  1. Recognized body of knowledge
  2. Society depends upon practitioners to provide trustworthy advice
  3. Code of conduct that places the clients’ best interests first

Q. Medical Executive Post 

It seems that Certified Financial Planner®, Chartered Financial Analysts, Registered Investment Advisors and their representatives, Registered Representative [stock-brokers] and AIF® holders, etc, are not really financial fiduciaries, either by legal statute or organizational charter. Are we correct, or not? Of course, we are not talking ethics or morality here. That’s for the theologians to discuss.

A. Mr. Aikin

One of the reasons for the “alphabet soup”, as you put it in one of your white papers [books, dictionaries and posts] on financial designations, is that while there is a large body of knowledge, there is no one recognized body of knowledge that one must acquire to enter the financial services industry.  The different designations serve to provide a distinguisher for how much and what parts of that body of knowledge you do possess.  However, being a fiduciary is exclusively a matter of function. 

In other words, regardless of what designations are held, there are five things that will make one a fiduciary in a given relationship:

  1. You are “named” in plan or trust documents; the appointment can be by “name” or by “title,” such as CFO or Head of Human Resources
  2. You are serving as a trustee; often times this applies to directed trustees as well
  3. Your function or role equates to a professional providing comprehensive and continuous investment advice
  4. You have discretion to buy or sell investable assets
  5. You are a corporate officer or director who has authority to appoint other fiduciaries

So, if you are a fiduciary according to one of these definitions, you can be held accountable for a breach in fiduciary duty, regardless of any expertise you do, or do not have. This underscores the critical nature of understanding the fiduciary standard and delegating certain duties to qualified “professionals” who can fulfill the parts of the process that a non-qualified fiduciary cannot.

Q. Medical Executive Post 

How about some of the specific designations mentioned on our site, and elsewhere. I believe that you may be familiar with the well-known financial planner, Ed Morrow, who often opines that there are more than 98 of these “designations”? In fact, he is the founder of the Registered Financial Consultants [RFC] designation. And, he wrote a Foreword for one of our e-books; back-in-the-day. His son, an attorney, also wrote as a tax expert for us, as well. So, what gives?

A. Mr. Aikin

As for the specific designations you list above, and elsewhere, they each signify something different that may, or may not, lend itself to being a fiduciary: For example:

• CFP®: The act of financial planning does very much imply fiduciary responsibility.  And, the recently updated CFP® rules of conduct does now include a fiduciary mandate:

• 1.4 A certificant shall at all times place the interest of the client ahead of his or her own. When the certificant provides financial planning or material elements of the financial planning process, the certificant owes to the client the duty of care of a fiduciary as defined by CFP Board. [from http://www.cfp.net/Downloads/2008Standards.pdf]

•  CFA: Very dependent on what work the individual is doing.  Their code of ethics does have a provision to place the interests of clients above their own and their Standards of Practice handbook makes clear that when they are working in a fiduciary capacity that they understand and abide by the legally mandated fiduciary standard.

• FA [Financial Advisor]: This is a generic term that you may find being used by a non-fiduciary, such as a broker, or a fiduciary, such as an RIA.

• RIA: Are fiduciaries.  Registered Investment Advisors are registered with the SEC and have obligations under the Investment Advisers Act of 1940 to provide services that meet a fiduciary standard of care.

• RR: Registered Reps, or stock-brokers, are not fiduciaries if they are doing what they are supposed to be doing.  If they give investment advice that crosses the line into “comprehensive and continuous investment advice” (see above), their function would make them a fiduciary and they would be subject to meeting a fiduciary standard in that advice (even though they may not be properly registered to give advice as an RIA).

• AIF designees: Have received training on a process that meets, and in some places exceeds, the fiduciary standard of care.  We do not require an AIF® to always function as a fiduciary. For example, we allow registered reps to gain and use the AIF® designation. In many cases, AIF designees are acting as fiduciaries, and the designation is an indicator that they have the full understanding of what that really means in terms of the level of service they provide.  We do expect our designees to clearly disclose whether they accept fiduciary responsibility for their services or not and advocate such disclosure for all financial service representatives.

Q. Medical Executive Post 

Your website, http://www.fi360.com, seems to suggest, for example, that banks/bankers are fiduciaries. We have found this not to be the case, of course, as they work for the best interests of the bank and stockholders. What definitional understanding are we missing?

A. Mr. Aikin

Banks cannot generally be considered fiduciaries.  Again, it is a matter of function. A bank may be a named trustee, in which case a fiduciary standard would generally apply.  Banks that sell products are doing so according to their governing regulations and are “prudent experts” under ERISA, but not necessarily held to a fiduciary standard in any broader sense.

Q. Medical Executive Post 

And so, how do we rectify the [seemingly intentional] industry obfuscation on this topic. We mean, our readers, subscribers, book and dictionary purchasers, clients and colleagues are all confused on this topic. The recent financial meltdown only stresses the importance of understanding same.

For example, everyone in the industry seems to say they are the “f” word. But, our outreach efforts to contact traditional “financial services” industry pundits, CFP® practitioners and other certification organizations are continually met with resounding silence; or worse yet; they offer an abundance of parsed words and obfuscation but no confirming paperwork, or deep subject-matter knowledge as you have kindly done. We get the impression that some FAs honesty do-not have a clue; while others are intentionally vague.

A. Mr. Aikin

All of the evidence you cite is correct.  But that does not mean it is impossible to find an investment advisor who will manage to a fiduciary standard of care and acknowledge the same. The best way to rectify confusion as it pertains to choosing appropriate investment professionals is to get fiduciary status acknowledged in writing and go over with them all of the necessary steps in a fiduciary process to ensure they are being fulfilled. There also are great resources out there for understanding the fiduciary process and for choosing professionals, such as the Department of Labor, the SEC, FINRA, the AICPA’s Personal Financial Planning division, the Financial Planning Association, and, of course, Fiduciary360.

We realize the confusion this must cause to those coming from the health care arena, where MD/DO clearly defines the individual in question; as do other degrees [optometrist, clinical psychologist, podiatrist, etc] and medical designations [fellow, board certification, etc.]. But, unfortunately, it is the state of the financial services industry as it stands now.

Q. Medical Executive Post 

It is as confusing for the medical community, as it is for the lay community. And, after some research, we believe retail financial services industry participants are also confused. So, what is the bottom line?

A. Mr. Aikin

The bottom line is that lay, physician and all clients have a right to expect and demand a fiduciary standard of care in the managing of investments. And, there are qualified professionals out there who are providing those services.  Again, the best way to ensure you are getting it is to have fiduciary status acknowledged in writing, and go over the necessary steps in a fiduciary process with them to ensure it is being fulfilled.

Q. Medical Executive Post 

The “parole-evidence” rule, of contract law, applies, right? In dealing with medical liability situations, the medics and malpractice attorneys have a rule: “if it wasn’t written down, it didn’t happen.”  

A. Mr. Aikin

An engagement contract accepting fiduciary status should trump a subsequent attempt to claim the fiduciary standard didn’t apply. But, to reiterate an earlier point, if someone acts in one of the five functional fiduciary roles, they are a fiduciary whether they choose to acknowledge it or not.  I have attached a sample acknowledgement of fiduciary status letter with copies of our handbook, which details the fiduciary process we instruct in our programs, and our SAFE, which is basically a checklist that a fiduciary should be able to answer “Yes” to every question to ensure the entire fiduciary process is being covered.

Q. Medical Executive Post 

It is curious that you mention checklists. We have a post arguing that very theme for doctors and hospitals as they pursue their medial error reduction, and quality improvement, endeavors. And, we applaud your integrity, and wish only for clarification on this simple fiduciary query?

A. Mr. Aikin

Simple definition: A fiduciary is someone who is managing the assets of another person and stands in a special relationship of trust, confidence, and/or legal responsibility.

Q. Medical Executive Post 

Who is a financial fiduciary and what, if any, financial designation indicates same?

A. Mr. Aikin

Functional definition: See above for the five items that make you a fiduciary.

Financial designations that unequivocally indicate fiduciary duty: Short answer is none, only function can determine who is a fiduciary. 

Q. Medical Executive Post 

Please repeat that?

A. Mr. Aikin

Financial designations that indicate fiduciary duty: none. It is the function that determines who is a fiduciary.  Now, having said that, the CFP® certification comes close by demanding their certificants who are engaged in financial planning do so to a fiduciary standard. Similarly, other designations may certify the holder’s ability to perform a role that would be held to a fiduciary standard of care.  The point is that you are owed a fiduciary standard of care when you engage a professional to fill that role or they functionally become one.  And, if you engage a professional to fill a non-fiduciary role, they will not be held to a fiduciary standard simply because they have a particular designation.  One of the purposes the designations serve is to inform you what roles the designation holder is capable of fulfilling.

It is also worth keeping in mind that just being a fiduciary doesn’t equate to a full knowledge of the fiduciary standard. The AIF® designation indicates having been fully trained on the standard.

Q. Medical Executive Post 

Yes, your website mentions something about fiduciaries that are not aware of same! How can this be? Since our business model mimics a medical model, isn’t that like saying “the doctor doesn’t know he is doctor?” Very specious, with all due respect!

A. Mr. Aikin

I think it is first important to note that this statement is referring not just to investment professionals.  Part of the audience fi360 serves is investment stewards, the non-professionals who, due to facts and circumstances, still owe a fiduciary duty to another.  Examples of this include investment committee members, trustees to a foundation, small business owners who start 401k plans, etc.  This is a group of non-sophisticated investors who may not be aware of the full array of responsibilities they have. 

However, even on the professional side I believe the statement isn’t as absurd as it sounds.  This is basically a protection from both ignorant and unscrupulous professionals.  Imagine a registered representative who, either through ignorance or design, begins offering comprehensive and continuous investment advice.  Though they may deny or be unaware of the fact, they have opened themselves up to fiduciary liability. 

Q. Medical Executive Post 

Please clarify the use of arbitration clauses in brokerage account contracts for us. Do these disclaim fiduciary responsibility? If so, does the client even know same?

A. Mr. Aikin

By definition, an engagement with a broker is a non-fiduciary relationship.  So, unless other services beyond the scope of a typical brokerage account contract are specified, fiduciary responsibility is inherently not applicable.  Unfortunately, I do imagine there are clients who don’t understand this. Furthermore, AIF® designees are not prohibited from signing such an agreement and there are some important points to understand the reasoning.

First, by definition, if you are entering into such an agreement, you are entering into a non-fiduciary relationship. So, any fiduciary requirement wouldn’t apply in this scenario.

Second, if this same question were applied into a scenario of a fiduciary relationship, such as with an RIA, this would be a method of dispute resolution, not a practice method. So, in the event of dispute, the advisor and investor would be free to agree to the method of resolution of their choosing. In this scenario, however, typically the method would not be discussed until the dispute itself arose.

Finally, it is important to know that AIF/AIFA designees are not required to be a fiduciary. It is symbolic of the individuals training, knowledge and ongoing development in fiduciary processes, but does not mean they will always be acting as a fiduciary.

Q. Medical Executive Post 

Don’t the vast majority of arbitration hearings find in favor of the FA; as the arbitrators are insiders, often paid by the very same industry itself?

A. Mr. Aikin

Actual percentages are reported here: http://www.finra.org/ArbitrationMediation/AboutFINRADR/Statistics/index.htm However, brokerage arbitration agreements are a dispute resolution method for disputes that arise within the context of the securities brokerage industry and are not the only means of resolving differences for all types of financial advisors.  Investment advisers, for example, are subject to respond to disputes in a variety of forums including state and federal courts.  Clients should look at their brokerage or advisory agreement to see what they have agreed to. If you wanted to go into further depth on this question, we would recommend contacting Brian Hamburger, who is a lawyer with experience in this area and an AIFA designee. Bio page: http://www.hamburgerlaw.com/attorneys/BSH.htm.

Q. Medical Executive Post 

What about our related Certified Medical Planner® designation, and online educational program for financial advisors and medical management consultants? Is it a good idea – reasonable – for the sponsor to demand fiduciary accountability of these charter-holders? Cleary, this would not only be a strategic competitive advantage, but advance the CMP™ mission to put medical colleagues first and champion their cause www.CertifiedMedicalPlanner.org above all else. 

A. Mr. Aikin

I think it is a good idea for any plan sponsor to demand fiduciary status be acknowledged from anyone engaged to provide comprehensive and continuous investment advice.  I also think it is a good idea to be proactive in verifying that the fiduciary process is being followed.

Q. Medical Executive Post 

Is there anything else that we should know about this topic?

A. Mr. Aikin

Yes, a further note about fi360’s standards. I wrote generically about the fiduciary standard, because there is one that is defined by multiple sources of regulation, legislation and case law.  The process defined in our handbooks, we call a Fiduciary Standard of Excellence, because it covers that minimum standard and also best practice standards that go above and beyond.  All of our Practices, which comprise that standard, are legally substantiated in our Legal Memoranda handbook, which was written by Fred Reish’s law firm, who is considered a leading ERISA attorney.

Additional resources:

Q. Medical Executive Post 

Thank you so much for your knowledge and willingness to frankly share it with the Medical-Executive-Post.

Assessment

All are invited to continue the conversation with Mr. Aikin, asynchronously online, or thru this contact information:

fi360.com
438 Division Street
Sewickley, PA 15143
412-741-8140 Phone
866-390-5080 Toll-free phone
412-741-8142 Fax

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

LEXICONS: http://www.springerpub.com/Search/marcinko
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Hospital Industry Summary

Statistical Results for 2007
Staff Writers

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In 2006, 52.4% of the 4,956 short-term, acute-care, nonfederal hospitals in the U.S. were affiliated with medical healthcare systems [MHSs], up from 51.8% of the 4,911 in 2005. Some other statistics are:

  • The average number of hospital days per 1,000 members of HMOs not owned by MHSs grew 6.6% in 2006, to 302.2 from 283.6 in 2005, the fifth consecutive annual increase.
  • In 2006, total hospital outpatient revenue was $103.6 million, up 9.9% from $94.3 million in 2005. As a consequence, the outpatient revenue percentage of total hospital revenue increased to 38.1% from 37.4% the prior year.
  • The average number of prescriptions dispensed to non-Medicare members of MHS-owned HMOs decreased slightly in 2006, to 8.5 from 8.7 the previous year.
  • Between 2005 (11,485.8) and 2006 (11,292.9), the average number of admissions fell at hospitals in MHSs that owned HMOs, the first such decline in this measure since 2001 (9,799.7).
  • Between 2005 and 2006, the ratio of FTE registered nurses (RNs) to occupied beds rose both at hospitals in MHSs that owned HMOs (to 2.08 from 2.05) and at hospitals in MHSs that did not own HMOs (to 2.02 from 2.00).
  • In 2006, total costs per occupied bed were just over $1.0 million at hospitals that were part of MHSs that owned HMOs, up 4.7% from $987,827 in 2005. Since 2001 ($821,194), these costs have risen by more than one-quarter (26.0%).
  • Non-MHS hospitals averaged 164.7 outpatient visits per day, up 5.2% from 156.6 in 2005, the fourth consecutive annual rise.
  • After rising notably between 2004 (60.2%) and 2005 (66.4%), the average intensive care unit (ICU) occupancy rate forMHS hospitals fell slightly in 2006, to 65.3%.
  • Pharmaceutical expenses per discharge at hospitals tied to government-run MHSs fell 27.9% in 2006, to $1,380 from $1,915 in 2005, reversing two straight years of double-digit growth.

*Acknowledgements

The editors and author acknowledges Verispan LLC, Yardley, Pa., as the research and reporting source for this data, reprinted with permission and based on information gathered by mail and telephone surveys gathered and effective as of December 31, 2008, unless otherwise noted.  It was commissioned, sponsored and underwritten in an arm’s length fashion by the Managed Care Digest Series of sanofi-aventis, Bridgewater, NJ, and developed and produced by Forte Information Resources, LLC, Denver, Colorado.

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

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Our Ranking System Explained

Think “Digg” for Medical Stakeholders

Staff Writers

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More than a few folks have asked about our Medical Executive-Post ranking system? So, a few words of explanation are in order. 

 

A Simple Concept

Ranking is a simple concept. Folks like you [financial advisors; HIT experts; medical professionals, accountants and practice managers; CEOs, CFOs and COOs; health law attorneys; medical clinic managers and health administrators, doctors and nurses, etc] submit articles to us which are then posted. We try to post 1-4 unique stories almost every day. Comments on the articles are accepted too, and often serve to “start the conversation.”

Rising to the Top

Then, subscribers and visitors read the posts and comments, and thereby vote them up or down depending on popularity. We make no distinction among subscribers, casual viewers or regular readers. The best stuff simply rises to the top of the rankings system.

Health Administration Niche Based

In other words, we’re much like a niche electronic newspaper, but for the healthcare administration space. Basically, all healthcare stakeholders [even patients and laymen] are invited; but we are not clinical in nature.

Eschewing Ads

Currently, we have eschewed paid advertising, as all editors, staff writers and contributors work for free. We are “unbiased and un-bought.” And, will remain so to the extent possible.  

Assessment

Well, we all do work for “exposure” and to promote our own books, white papers, dictionaries: www.HealthDictionarySeries.com, innovative ideas, online education courses: www.CertifiedMedicalPlanner.com, speeches, consulting engagements: www.MedicalBusinessAdvisors.com; and especially our 1,200 pages, 2-volume, quarterly premium-institutional subscription print journal: www.HealthcareFinancials.comho-journal

Conclusion

And so, your thoughts and comments on this Medical Executive-Post ranking system are appreciated. While we are not perfect; we do strive to be transparent and understandable thought-leaders in our space.

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

Our Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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CEO’s Annual Report for 2008

A Leadership Progress Report

By Dr. David Edward Marcinko; MBA, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™

By Ann Miller; RN, MHA

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What we’re up-to now?

We are working as medical managerial consultants, financial and economic advisors to individuals and innovative organizations seeking a unique vision and business acceleration in the Health 2.0 business space www.HealthDictionarySeries.com

Consulting Engagements

We are engaged in a project that will be unveiled shortly on this interface; great concept, great team and a great opportunity to be of service to the medical profession. We have also been contacted by a few national players about potential collaborative opportunities www.MedicalBusinessAdvisors.com

Print Guide Growing

Even while consulting, publishing and advising, we continue to evaluate, design and test new concepts which integrate our expertise and interests in healthcare administration, business development and journalism via our print guide: Healthcare Organizations [Financial Management Strategies]. It is growing nicely and represents an extension of our consulting services that may also evolve into synergistic arenas www.HealthcareFinancials.com

Online Education

Our asynchronous online educational program in health economics, for physician-focused financial advisors and fiduciary medical management consultants, has gained more notoriety and contributing didactic support than ever imagined www.CertifiedMedicalPlanner.com

Speaking

Finally, our speaking engagement schedule for 2009 is firming-up, but at a slower pace this year, probably due to the economy as well as our disclosure efforts as “unbiased and un-bought” thought leaders.

Conclusion

And so, just in case you were wondering? Let us know what’s on your mind.

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

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Domestic Economy Sickens Hospitals

AHA Reports Negative Financial-Operating News

Staff Reporters

Many hospitals are seeing the effects of the economic downturn. More than 30% of respondents to a recent American Hospital Association [AHA] survey reported a significant decline in patients seeking elective care and 40% reporting a drop in admissions overall. The majority of hospitals also noted an increase in patients unable to pay for care.

DATABANK Results

The report is based on survey results from 736 hospitals and information from DATABANK, a Web-based reporting system used in 30 states to track key hospital trends:  

  • Falling profit margins to [-] 1.6% – from [+] 6.1% year-over-year
  • Medicare and Medicaid patient care is growing
  • Reducing administrative costs (60%), staff (53%) and services (27%)
  • Borrowing for facility and technology improvements has decreased

Capital investments are also being postponed or delayed:

  • 56% delayed plans to increase capacity;
  • 45% delayed purchase of clinical technology or equipment; and
  • 39% delayed investments in new information technology.

Assessment

The report was based on data from two major sources. A survey, “The Economic Crisis: Impact on Hospitals,” provides data from 736 hospitals from late October 2008 through Nov. 10, 2008.  DATABANK figures represent early results from 557 hospitals reporting data for July through September 2007 and 2008 as of Nov. 11, 2008.

Conclusion

And so, your thoughts and comments on this Executive-Post are appreciated. How [much] has the economy affected your healthcare organization?

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

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Doctor Discontent

Physician’s Foundation Survey Results

Staff Reporters

According to the Wall Street Journal, November 18, 2008, doctors reported a variety of professional discontents in a survey conducted by the Physicians’ Foundation, to which 11,950 primary care physicians and specialists responded.

Legal Origins

The Physicians’ Foundation, began in 2003 through the settlement of a class-action lawsuit brought by doctors and medical associations against private insurers, says it seeks to “advance the work of practicing physicians and to improve the quality of health care for all Americans,” And, its most recent survey found that:

Survey Results:

  • 94 percent of respondents said the time they’ve devote to non-clinical paperwork in the past three years has increased, while 63 percent said the paperwork has meant they spend less time per patient.
  • 82 percent said their practices would be “unsustainable” if proposed Medicare pay cuts were made.
  • 78 percent believe there is a shortage of primary care docs in the U.S.
  • 49 percent said that over the next three years they plan to reduce the number of patients they see or stop practicing entirely.
  • 60 percent would not recommend medicine as a career to young people.
  • 42 percent said professional morale is either “poor” or “very low.”
  • 17 percent rated the financial position of their practices as “healthy and profitable.”

Assessment

Perhaps the most unpleasant finding was that only 06 percent described the morale of their colleagues as “positive.”

Conclusion

And so, your thoughts and comments on this Executive-Post are appreciated. Do you essentially agree, or disagree, with these results?

Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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Hospitalist Model Outcomes Study

The Human Resource Management Report

Staff Reporters

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According to a study published in Human Resource Management, hospitals that employ the hospitalist model-of-care delivered better patient outcomes.

The Study

The study explored the differences between hospitalists and traditional models of care, measuring performance outcomes in more than 6,000 cases at Newton-Wellesley Hospital in Massachusetts between July 2001 and July 2003. At the time of the study, hospitalists treated approximately one-third of the hospital’s patients, and private practice physicians treated the remaining two-thirds.

The Results

Compared to the traditional approach, researchers found that the hospitalist model:

  • Decreased the length of patient stay by about half a day and reduced costs to the hospital by $655 per patient;
  • Reduced the risk of re-admission by 41.8 percent, a key measure of quality performance in hospitals;
  • Improved coordination of care 13.2% by increasing the strength of relationships between physicians and other members of the care provider team.

Assessment

The study was reported in the Society of Hospital Medicine, on November 17, 2008

Conclusion

What do you think? As always, your thoughts and comments on this Executive-Post are appreciated.

Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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Mercer Study Says CDHPs Rising

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HSA / HRA Offerings Jump at Large Employers*

[By Staff Reporters] 

 

2005

2006

2007

2008

Very likely to offer in 2009

Small Employers (10-499 employees)

2%

5%

7%

9%

14%

Large Employers (500 or more employees)

5%

11%

14%

20%

25%

Jumbo Employers (20,000 or more employees)

22%

37%

41%

45%

45%

*Based on either a health savings account or health reimbursement arrangement.

Source: Mercer 2008 National Survey of Employer-Sponsored Health Plans.  www.mercer.com

Conclusion

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

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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Using our Monthly Events-Planner System

Are you a consulting company, or do you work in a medical office, clinic, hospital, reimbursement or pricing department in big-pharma or biotechnology, a University, a Government agency? 

Do you have a conference or a product to promote?  Use our monthly Events-Planner to cost-effectively reach your target audience.

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Medicare Benefits Report

2007 Payment Services Review

Staff Reporters

In 2007, benefit payments for the four parts of Medicare totaled $426 billion and allocated as follows:

Part A: Hospital Insurance = 41% (includes home health which is partially funded under Part B)

  • Hospital Inpatient = 30%
  • Skilled Nursing Facilities = 5%
  • Home Health = 4%
  • Hospice = 2%

Part B: Supplemental Medicare Insurance = 28%

  • Physicians and other suppliers = 20%
  • Hospital Outpatient = 4%
  • Other Part B benefits = 4%

Part C: Medicare Advantage (private health plans) = 18%

Part D: Prescription Drug Benefit = 12%

  • Payments to Drug Plans = 7%
  • Low-Income Subsidy Payments = 4%
  • Payments to Union/Employer-Sponsored Plans = 1%

Note: Does not include administrative expenses such as spending for implementation of the Medicare drug benefit and the Medicare Advantage program. Total is net of $8.1 billion in recoveries for 2007.

Data Source: Congressional Budget Office, Medicare Baseline, March 2008.

Publication: Medicare Spending and Financing Fact Sheet; September 2008. The Kaiser Family Foundation.

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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

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Copyright 2008 iMBA Inc: All rights reserved, USA, unless otherwise noted. Use is restricted to Executive-Post subscribers only. No redistribution is allowed. To avoid violation of iMBA Inc copyright restrictions and redistribution policy, please register for your own free Executive-Post membership. Detailed information and registration links are available at:

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Blue Cross – Blue Shield Administrative Survey

Cost Trends Demonstrate a Decline in 2007

By Douglas B. Sherlock; CFA

PRESS RELEASE REPORT

Gwynedd, Pennsylvania

The per-member [pm] administrative cost growth for BC/BS declined from 6.1% in 2006, to 4.3% in 2007. Adjusted to eliminate the effect of a shift in product mix, administrative expense growth declined from 6.5% in 2006 to 2.5% in 2007. Administrative expenses were 10.4% of premium equivalents in 2007. And, plans reported total administrative expenses of $25.36 PMPM. 

All cited values exclude investment and non-operating income and expense, income taxes and miscellaneous business taxes.

Sherlock Expense Evaluation Report

These results are excerpted from the Sherlock Expense Evaluation Report, a benchmarking study comprising the results of 23 Blue Cross Blue Shield Plans surveyed by the Sherlock Company. More than 90% of participants also participated in the prior year’s survey and nearly 80% have five or more years of experience participating in our benchmarks.

Benchmarks and Metrics

The Sherlock Company benchmarks include thousands of operational and financial performance metrics. Besides Blue Plans, other universes include Independent / Provider-Sponsored plans, Medicare Advantage plans, Medicaid plans and larger plans. Collectively, the 46 plans serve approximately 36 million insured Americans.

Administrative Growth

The growth in administrative expenses ranged from a high of 10.0% for Medical and Provider Services to a low of 0.2% for Corporate Services.

In fact, the Sherlock Company said that, “The increasing emphasis of these Plans on Medicare Advantage had a profound effect on their expense trends. After holding constant the product mix, corporate service costs per member declined by 6.2% and provider and medical management costs increased by 2.2%.”

Assessment

Additional information is available in the Sherlock Expense Evaluation Report. We have also published a summary in July 2008 edition of the Plan Management Navigator accessible at www.sherlockco.com/docs/navigator/navigator-08-07.pdf

Conclusion

Your thoughts and comments on the above findings are appreciated? Do they agree, or disagree, with your factual or heuristic cost impressions of this institutional space?

###

The Sherlock Company www.sherlockco.com based in Gwynedd, Pennsylvania, provides informed solutions for health plan financial management. Since its founding in 1987, Sherlock Company has been known for its impartiality and technical competence in service to its clients.

Contact: Douglas B. Sherlock; CFA for more information.

215-628-2289, sherlock@sherlockco.com or visit www.Sherlockco.com 

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Events-Planner: August 2008

AUGUST 2008

Staff Writers

“Keeping track of important health economics and financial industry meetings, conferences and summits”

August 1: Print Edition Healthcare Journalism: If you would like to “step-up-your-game” and be considered as a peer-reviewed contributor to the third edition of: The Business of Medical Practice [Advanced Profit Maximizing Techniques for Savvy Doctors]; just contact Ann at: MarcinkoAdvisors@msn.com  There are several chapter topics still available.

August 4-5: The 6th Annual World Congress Leadership Summit on Healthcare Quality; Boston, MA

August 13: Care Coordination for Managed Medicaid Health Plans, World Research Group, Chicago, Ill.

August 24-27: 7th Annual Medical Quality Colloquium, Harvard University, Cambridge, MA.

Please send in your meetings and dates for listing in the next issue of our Events-Planner: MarcinkoAdvisors@msn.com

Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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Events-Planner: July 2008

JULY 2008

Staff Writers

“Keeping track of important health economics and financial industry meetings, conferences and summits”.  

July 10-11: Health Reform & the 2008 Elections: What’s Ahead for Health Care Access, Delivery and Financing? Washington Court Hotel, Capitol Hill; Washington, DC | Phone: 800-521-4323

July 14: Medicare Advantage Special Needs Plans | Institute for International Research, Washington, DC.

July 15-17: 3rd Annual Achieving Return on Investment for Wellness; Hamilton Crowne Plaza Hotel; Washington, DC | Phone: 800-647-7600

July 15-18: Association of Medical Directors of Information Systems Symposium, Ojai Valley Inn, Ojai, CA | Phone: 530-596-4477

July 16: Medicare Marketing Compliance | Financial Research Associates, Chicago, Illinois.

July 21-22: Optimizing Managed Care Contracting for Hospitals; Boston, MA | Phone: 800-647-7600

July 21-22 Executive Forum on Rx Benefit Management for Employers and Health Plans; Las Vegas

July 22-23: The 3rd Annual World Congress Leadership Summit on the Road to Interoperability; Boston Waterfront Hotel; Boston, MA | Phone: 800-767-9499 

July 23-25: 2nd Annual Public Health Care Congress; Mandarin Oriental Hotel; Washington, DC | Phone: 800-817-8601 

July 24-26: Health Forum Leadership Summit; Manchester Grand Hyatt; San Diego, CA | Phone: 312-893-6897

July 25: SCF Arizona Medical Provider Seminars 2008; Worker’s Compensation, Sheraton Tucson Hotel | 602-631-2513 lbrott@scfaz.com  

July 29-31: Medicare Today & Tomorrow; Washington, DC | Phone: 800-647-7600

July 30-31: The 2nd Annual Leadership Summit on Process Improvement and Business Excellence in Healthcare; Hilton Suites Chicago Magnificent Mile; | Phone: 781.939.2410 

Please send in your meetings and dates for listing in the next issue of our Events-Planner: MarcinkoAdvisors@msn.com

Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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Alphabet Soup: Financial Designations & Certificates

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financial-designationsjuly

July 2008:

AUTHORS: Dr. David Edward Marcinko; MBA, CMP™ and Hope Rachel Hetico; RN, MHA, CMP™

POSITION: Publisher-in-Chief, and Managing Editor of the Executive-Post, respectively.

dem26

TOPIC: Financial Designations and Certifications [Alphabet Soup of Industry Obfuscation and Self-Promotion, or Real Gravitas – You Decide?]

EXCERPT: “Until recently, most financial advisors were regulated by the NASD, the National Association of Securities Dealers. Now the Financial Industry Regulatory Authority or FINRA is the largest non-governmental regulator for all securities firms doing business in the United States. It is a self-regulatory agency comprised of the nation’s brokerage firms. Upon completion of a required exam the FINRA will issue a variety of licenses. The most common are the Series 6, 7, and 24.

The Series 6 is essentially a license to sell packaged products, namely mutual funds. It is most commonly held by insurance agents and bank representatives. It is considered a very easy test. Holding such a license allows the holder to collect commission income through its member firm.

The Series 7 exam is a bit more difficult and includes issues relating to individual securities such as stocks, bonds and limited partnership interests. The pass rate is lower than the Series 6. The probable culprit is the extensive questioning on margin and options, topics most are unfamiliar with prior to entering the securities business.

The Series 24 covers issues of compliance and supervision and is required of Branch Managers of brokerage firms. All registered representatives (the proper name for a broker) must be supervised by someone with a Series 24, also known as a principal’s license.

Checking the background of a registered representative, a branch manager or a member firm is easily done through NASD and/or FINRA Regulation, Inc. NASDR/FINRA maintains the Central Registration Depository (CRD). The CRD can be checked for a description of a disclosed event by phone or by Internet. One should request information on an advisor’s firm as well as the individual. A reputable advisor at a disreputable firm has its own set of potentially dangerous implications.

Regardless of the above, these tests produce licenses to sell financial products. They are not educational achievements. There is virtually no academic barrier to entry for them. Stock-brokers today – hate the term – and prefer “financial advisor”; yet the term has no real meaning other than as a sales license.

Some are college graduates, and beyond; while some other experts argue that too many are not!”

Hence, the need to “raise the bar to fiduciary accountability with deep knowledge of healthcare modernity.”

For more info: http://www.CertifiedMedicalPlanner.org

READ JULY HERE: financial-designationsjuly

Conclusion

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

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Evolutionary Shifts in the Primacy of Medical Ethical Principles

Philosophic Ruminations and Personal Interviews

[By Render S. Davis; MHA, CHE]

Crawford Long Hospital at Emory University

Atlanta Georgia USA

For more than 2000 years, the principle of beneficence, the profession’s obligation to be of service to others, was the foundation of the practice of medicine.

In taking the Hippocratic Oath, physicians swore that they would “perform their art solely for the cure of patients,” and patients viewed their doctors as wise, caring, and paternalistic healers unwaveringly committed to their welfare.

Until the era of modern medicine dawned in the early Twentieth Century, sincere caring and compassionate service probably were the most effective instruments in the physician’s meager armamentarium.

Post WWII Period

World War II and the decades that followed saw an unprecedented explosion in medical knowledge and technology. As a direct consequence, physicians were called upon to become increasingly sophisticated technicians and specialists, demands that pulled them farther from the bedside and diminished the close, personal relationship with patients they once enjoyed.

This increasingly impersonal relationship, combined with the starkness and technically intimidating nature of hospitals, led to a dramatic shift in the traditional patient-physician relationship. No longer did the patient see the family doctor as the caring paternalistic figure that held his or her interests foremost.  Instead, an overwhelming array of specialists appeared before the patient to explore illness etiology or examine a particular body part – too often appearing more interested in the malady than in the person afflicted with it.

The Lost Covenant

The covenant of trust that once bonded the physician and patient was rapidly eroding and, amid the social turmoil of the 1960s, patients began to demand that physicians treat them as equal partners, both informing them of the nature of their disease and seeking their permission to initiate treatment. After all patients reasoned, they should have the final say regarding what was done to their own bodies. 

Consequently, the principle of respect for autonomy, an acknowledgment of an individual’s right to self determination, slowly took precedence over, but did not eclipse, beneficence. Physicians still cared for their patients, only now they were obligated to take extra steps to bring patients directly into the decision-making process by explaining treatment options and requesting “informed consent” on the plan of care from the patient

Impending Economic Disaster

Both principles were supported in the prevailing system of fee-for-service, private-practice medicine.  There were few constraints on physicians’ clinical autonomy and their professional judgment remained, for the most part, unquestioned. In this climate, physicians reasoned that patients would likely benefit from more tests and procedures; patients, especially the well insured, demanded almost unregulated autonomy over their health care choices. For those with the means to pay, access to nearly all that medicine had to offer was considered an unquestioned right.

This proved to be a formula for potential economic disaster. There was an explosion in new and expanded facilities and unwavering demand for the latest technological innovations, much of it supported by the government as vital to a healthy economy. Nonetheless, a fundamental problem existed because health care was being delivered in a financial vacuum, where both physicians and patients had only a vague understanding of, or interest in, the economic consequences of the services they felt either obligated to provide or entitled to receive.

Beneficence and Autonomy

Both beneficence and respect for autonomy could be invoked to support this nearly unbridled use of health care resources in the care and treatment of individual patients. 

Insurers, both private and governmental, paid “reasonable, usual and customary” charges, almost without argument; while as patients’ advocates, physicians could garner six-figure incomes from fees generated in providing virtually unlimited care.  

Inevitable Financial Fallout

Yet, the inevitable financial fallout from medicine guided by these laissez-faire rules eventually led to an unsustainable inflationary spiral in medical costs.

In the forty plus years following the passage of the Medicare Act in 1965, the health care sector of the American economy soared from 4% of Gross Domestic Product (GDP) to over 15-16% in 2008, and there is no clear end in sight to the upward rise.

Nevertheless, a growing number of Americans actually saw their access to medical care diminish due to rising costs of employer-paid insurance (when it was offered at all) and tightening restrictions in eligibility requirements for Medicaid and other government safety-net programs.  Even as the nation increased overall spending for medical care, many Americans were losing access to the system. 

This trend has continued, and even accelerated, during the recessionary period that has just begun. An especially troubling characteristic of the increasing number of Americans now without health insurance is that, for the first time, it includes expanding segments of the middle class – white collar executives, middle managers, and skilled workers who had, historically, been immune from such cutbacks. 

Today, lack of access to affordable medical care is no longer just the domain of the working poor. It is the purview of the middle class.

Sounding the Alarm

Alarm over rising health care costs began to spread in the 1970s, as both private and government payers sought any means possible to stem the hemorrhaging outflow of dollars.  President Richard Nixon tried unsuccessfully to implement wage and price controls to slow it; a few years later, President Jimmy Carter attempted to cap Medicare expenditures. Both efforts failed for two primary reasons.

First was a fundamental misunderstanding of the nature of healthcare competition. Health care providers did not compete directly for patients, but rather for physicians who held the legal authority to admit patients. As independent contractors, physicians could, for the most part choose to join the staff of institutions that provided the latest technology, the most-up-do-date facilities, and even the most luxurious amenities. Consequently, hospitals competed fiercely for doctors, a process that actually caused prices to rise, not fall.

Second, the dominant, indemnity-based, fee-for-service approach to medical care remained fundamentally intact, continuing to insulate both physicians (the consumer’s agent) and patients (consumers of care) from the true costs of the services provided. But economic concerns arising from double-digit inflation and business downturns in the late 1970s assured that fundamental and inevitable changes in the financing and practice of medicine were on the horizon. 

Cost Constraint Initiatives

The first major initiative to have a significant cost constraining effect occurred in the early 1980s with the implementation of the Medicare Prospective Payment System (PPS) and its healthcare provider payments pegged to Diagnosis Related Groups (DRGs); now Medical Severity-DRGs. This system ushered in a new era of controlled, predetermined prices for health care services. The inflationary spiral of government payments for health care slowed and soon private payers also were considering adopting alternatives to traditional insurance.  Slowly, the concept of prepaid, fixed or capitated managed health care provided by health maintenance organizations (HMOs), a concept developed by the Kaiser Foundation and other organizations on the West Coast in the 1940s (and first strongly opposed by organized medicine) began to spread nationwide as a possible answer to the country’s healthcare ills.

Enter the HMOs

By the 1990s, HMOs and other types of managed care organizations that provided integrated healthcare services and financing through insurance or other means, had gained a serious foothold and were in positions of dominance in American medical care.  The growth in the popularity of managed care signaled the next evolutionary change in the predominance of the key ethical principles.

Severing the Link 

Just as respect for autonomy super-ceded beneficence, the principle of justice, representing a new approach of balancing the health needs of an individual with the availability of finite resources for the larger population, rose to take its place as the primary principle, becoming the vanguard force driving the movement toward managed care. 

Physician-ethicist, John LaPuma M.D., in his book Managed Care Ethics, writes that managed care has gone so far as to “sever the link between autonomy and justice that once existed to support the care of individuals.”

Fairer Distribution       

Embedded within this drive toward a fairer distribution of healthcare resources was the urgent, but highly controversial desire to rein in costs. Despite years of active suppression and condemnation by health professionals and providers, the hard economic realities of American society’s love-hate (love to have it, hate to pay for it) relationship with health care had finally reached the bedside. The result has been an irrevocable sea-change in the landscape of American medicine.

***

Residents

***

Developing Healthcare Delivery Skills for Modernity

As we have seen, medical practice today is vastly different from a generation ago, and physicians need new skills to be successful.  In order to balance their obligations to both individual patients and to larger groups of plan enrollees, physicians now must become more than competent clinicians.

Traditionally, the physician was viewed as the “captain of the ship,” in charge of nearly all the medical decisions, but this changed with the new dynamics of managed care.  Now, as noted previously, the physician’s role may be more akin to the ship’s navigator – or health economist allocator – utilizing his or her clinical skills and knowledge of the health care environment to chart the patient’s course through a confusing morass of insurance requirements, care choices, and regulations to achieve the best attainable outcome.  Some of these new skills include:  

  • Negotiation – working to optimize the patient’s access to services and facilities beneficial to their treatment;
  • Team Play – working in concert with other care givers, from generalist and specialist physicians to nurses and therapists, to coordinate the delivery of care within a clinically appropriate and cost-effective framework;
  • Working within the limits of professional competence – avoiding the pitfalls of payer arrangements that may restrict access to specialty physicians and facilities, by clearly acknowledging when the symptoms or manifestations of a patient’s illness require this higher degree of service, then working on behalf of the patient to seek access to them.
  • Respecting different cultures and values – inherent in the support of the Principle of Autonomy is acceptance of values that may differ from one’s own.  As the United States becomes a more culturally heterogeneous nation, health care providers are called upon to work within and respect the socio-cultural framework of patients and their families;
  • Seeking clarity on what constitutes marginal care – within a system of finite resources, physicians will be called upon to carefully and openly communicate with patients regarding access to marginal and/or futile treatments.  Addressing the many needs of patients and families at the end of life will be an increasingly important challenge in both communications and delivery of appropriate, yet compassionate care. 
  • Exercising decision-making flexibility – treatment algorithms and clinical pathways are extremely useful tools when used within their scope, but physicians must follow the case managed patient closely and have the authority to adjust the plan if clinical circumstances warrant. 

Re-Fostering Social Responsibility

The erosion of trust expressed by the public for the health care industry may only be reversed if those charged with working within or managing the system place community and patient interests before their own.

We must foster an ethical corporate culture within health care that rewards leaders with integrity and vision; leaders who encourage and expect ethical excellence from themselves and others; and who recognize that ethics establishes the moral framework for all organizational decision making.

Healthcare Ethics

In a presentation to the Health Care Ethics Consortium of Georgia, Dr. Paul Hoffman, vice president of Provenance Health Partners, spoke of the importance of nurturing and sustaining an “ethical organizational culture” where high standards of ethics and morality govern the behavior of all participants, from senior management and physicians, to nurses and technical staff. 

In such cultures, the ethical dimensions of decisions are weighed as heavily as the financial or operational factors and actions are not taken if the outcome would conflict with the organization’s stated values and mission.

To assess the climate of an organization, Hoffman recommends conducting an “ethics audit” that would reveal real and perceived problems within the system; provide insights into ethical deficits that may exist; identify opportunities for education; and provide feedback from staff on their support for the organization’s ethical culture.

Enterprise Wide Integration

Most importantly, Hoffman stressed that ethics must be integrated into every aspect of organizational work, calling for “a systems-oriented, proactive approach to improving an institution’s health care practices, including both administrative and clinical practices.” 

He went on to say that this “integrated ethics approach anticipates and responds to recurring ethical situations and applies a continuous quality improvement philosophy. This approach unites ethics activities throughout the organization.”  

Whether your workplace is a 500-bed academic medical center or a small internal medicine practice, the purpose is the same – to foster and maintain an organization that is grounded in ethical behavior and dedicated to providing the highest quality of patient care.  

Assessment

In an article published in the Journal of the American Medical Association [JAMA], authors Ezekiel Emanual, M.D. and Nancy Dubler, L.L.B. cited what they call the “Six C’s” of the ideal physician-patient relationship: Choice, Competence, Communications, Compassion, Continuity, and [no] Conflict of interest.  Physicians who accept a seventh and eighth “C” – the Challenge and Collaboration, and are imbued with the moral sensitivity embodied in their solemn oath, have an obligation to serve as the conscience of this new system dedicated toward caring for all Americans.

Writer and ethicist Emily Friedman said it best when she wrote,  

“There are many communities in health care. 

But three to which I hope we all belong are the communities devoted to improving the health of all around us, to achieving access to care for all, and to providing our services at a price that society can afford. 

These interests are, of course, expressions of the deeper community of values that states that healing, justice, and equality must guide what we believe and do”. 

Conclusion

While the above may not solve the current philosophical and economic crisis, or provided needed answers to the domestic health insurance quagmire, we believed the problem has been reframed for further discussion and frank discourse.

And so, please add to the needed debate with your informed thoughts, opinions and comments. All are greatly appreciated?

Acknowledgements

Partial excerpt, updated from the best selling book, with permission.

The Business of Medical Practice [Profit Maximizing Skills for Savvy Physicians]

© Springer Publishing, New York, NY 2005

http://www.springerpub.com/prod.aspx?prod_id=23759

Citations:

Back to Reform: Values, Markets, and the Healthcare System.  Dougherty, Charles J., Ph.D.  Oxford University Press, New York, 1989.

“Beyond Ethics Committees,” Hoffman, Paul, Dr. P.H. Presentation at the Annual Conference of the Health Care Ethics Consortium of Georgia, April 2, 2003.

“The Doctor as Double Agent”: Angell, Marcia, M.D.  Kennedy Institute of Ethics Journal, Vol. 3, No. 3, September 1993.

“Ethical Issues in Managed Care”:  Report from the American Medical Association’s Council on Ethical and Judicial Affairs.  JAMA, Vol. 273, No. 4, January 25, 1995.

“Ethical Issues in Managed Care”: Wicclair, Mark R., Ph.D.  Remarks at Fifth Annual Retreat of the Consortium Ethics Program, October 1995.

“Ethics of Managed Care”: Philip, Donald J., FACMPE.  Medical Group Management Journal, November – December 1997.

Ethics, Trust, and the Professions: Philosophical and Cultural Aspects.  Pelligrino, Edmund D., M.D., Veatch, Robert M., Ph.D., Langan, John P., S.J.  Georgetown University Press, Washington, D.C., 1991

“The End of Health Insurance – Part II” Brody, William R., M.D., Ph.D. Crossroads: Essays on Health Care in America, Johns Hopkins University School of Medicine, June 5, 2002.

“ER’s Cut Back as Patient Loads Rise,” Kellerman, Arthur, M.D. The Atlanta Journal-Constitution, June 5, 2003.

Managed Care Ethics: Essays on the Impact of Managed Care on Traditional Medical Ethics, LaPuma, John, M.D.  Hatherleigh Press, New York, 1998.

“Managed Health Care: A Brief Glossary,” Integrated Healthcare Association, Pleasonton, CA, 1997.  Website: www.iha.org.

Medical Management Signature Series, Managed Care Resources, Inc. 1997.  Website: www.mcres.com).  Carefoote, Roberta L., R.N.:http://www.mcres.com.

Medicine At The Crossroads.  Konnor, Melvin, M.D., Vintage Books, New York, 1994.

“Poll: Health Advice Ignored,” Duffy, James A.  The Atlanta Journal-Constitution, November 20, 1998.

“Outside the Box”: Zwolak, Judith.  Tulane Medicine, September 1995.

“Preserving the Physician-Patient Relationship in the Era of Managed Care,” Emanual, Ezekiel J. M.D., Dubler, Nancy N., LL.B.  JAMA, Vol. 273, No. 4, January 25, 1995.

Principles of Biomedical Ethics:  Beauchamp, Thomas L., Ph.D., Childress, James F., Ph.D.  Oxford University Press, New York, 1989.

“Principles of Managed Healthcare”: Integrated Healthcare Association, 1997.  www.iha.org.

The Right Thing: Ten Years of Ethics Columns from The Healthcare Forum Journal.  Friedman, Emily.  Jossey-Bass Publishers, San Francisco, 1996

“Understand Guiding Principles When Mixing Business, Medicine,” LaPuma, John, M.D.  Managed Care Magazine, July 1998

“What Could Have Saved John Worthy?” The Hastings Center Report, Special Supplement, Vol. 28, No. 4, July-August 1998.

Personal Interviews:

Frank Brescia, M.D: Professor, Medical University of South Carolina, Charleston, SC.

Joseph DeGross, M.D: Professor, Mercer University School of Medicine, Macon, GA.

David DeRuyter, M.D: Pulmonologist, Atlanta, GA.

Daniel Russler, M.D: Vice President, HBOC, Inc., Atlanta, GA.

Channel Surfing the ME-P

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

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Events-Planner: June 2008

JUNE 2008

Staff Writers

“Keeping track of important health economics and financial industry meetings, conferences and summits”

June 1-3: Compliance Regulatory Affairs Conference: NAVA, Washington, DC

2-5: College for Advanced Management of Health Benefits Training, Orlando, Fla

4-6: National Medicaid Congress, Washington, DC

4-6: REITWEEK and NAREIT Conference, New York, NY

4-6: Pershing Financial Products and Services Conference, Hollywood, Fla

6-10: American Diabetes Association Annual Meeting, San Francisco, CA

9-13: Global Investors Workshop, CFA Institute, Fontainebleu, France

10-11: Hedge Fund and Structured Products Summit, New York, NY

11: Physician Quality Reporting Initiative Update, Thomas Jefferson University, Philadelphia, PA

12: Legal and Regulatory Affairs Conference, New York, NY

11-14: American Physical Therapy Association Annual Meeting, San Antonio, TX

16-19: Oxford Private Equity Program, Oxford, England

17-21: National Athletic Trainer’s Association Annual Meeting, St. Louis, MO

19-22: Western Podiatric Medical Congress, Anaheim, CA

23-25: Managed Funds Forum 2008, Chicago, Illinois.

23-26: HFMA Healthcare Finance Congress, Mandalay Bay Resort, Las Vegas, NV

27: SCF Arizona Medical Provider Seminars-Worker’s Compensation, Orange Tree Golf Resort, Scottsdale | 602-631-2513 lbrott@scfaz.com

30: American Health Lawyers Assoc. Meeting, San Francisco, CA

Please send in your meetings and dates for listing in the next issue of our Events-Planner MarcinkoAdvisors@msn.com

Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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Alternative Lifestyles and Physician-Partners

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A Top-Ten Checklist

[By Staff Writers]

The Gay and Lesbian Medical Association [GLMA] represents the interests of more than 70,000 gay, lesbian or transgender [GLBT] physicians and medical students. GLMA was founded in 1981 as a network to combat homophobia within the medical profession www.Gay.com

And, gay rights advocates had reason to celebrate on both coasts recently, with New York set to recognize same-sex marriages performed elsewhere, and California preparing to begin issuing marriage licenses to gay couples in June.

Link: http://www.msnbc.msn.com/id/24857315

Partnership Checklist

And so, the top-ten financial planning issues listed below should be discussed with all domestic partners contemplating marriage or even co-habitation.  

Moreover, the physician partner of a gay/lesbian couple should consult a financial planner, and attorney, with experience in alternative lifestyles when appropriate.

1.   Wills

A.   Is any property jointly held?

 

 

 

B.   Are there any children? If so, are the children from the domestic partnership or previous partners/spouses?

 

 

 

C.   What bank accounts and investments should be considered?

 

 

 

2.   Life insurance

A.   What type of policy or policies is appropriate for the couple?

 

 

 

B.   Does the couple own a home and have a mortgage to protect?

 

 

 

C.   Do the families of each person approve of the relationship? If not, should “crossover policies” be obtained?

 

 

 

3.   Bank accounts

A.   How are the banking and bill-paying set up?

 

 

 

B.   Are any changes needed?

 

 

 

4.   Trusts

A.   Is a trust appropriate?

 

 

 

B.   Does the couple have an estate problem?

 

 

 

C.   Are there joint assets that should be split between beneficiaries?

 

 

 

5.   Deductions

A.   Who is entitled to the itemized deductions?

 

 

 

B.   What percentage does each partner pay?

 

 

 

C.   Is one partner eligible to be the dependant of the other?

 

 

 

6.   Capital assets

A.   Were there any sales of jointly held capital assets?

 

 

 

B.   Under whose Social Security number are the gains reported?

 

 

 

C.   Is a nominee Form 1099 necessary?

 

 

 

7.   Durable powers

A.   Medical (file with all doctors)

 

 

 

B.   Financial (file with tax professional and investments)

 

 

 

8.   Pensions

A.   Who is the beneficiary?

 

 

 

9.   Asset ownership

A.   How is the title held?

 

 

 

10.  Children

A.   Dependents—who gets the deduction?

 

 

 

B.   Head of household considerations

 

 

 

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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Dental Economics Business Report

EXCLUSIVE MARCH SPECIAL REPORT!

Released February 29th, 2008biz-book

A very special report on dentists – their professional practice career and economic life cycle – by a leading national dental management corporate executive.

AUTHOR: Thomas A. Knox MBA was senior vice-president for provider partnerships at Delta Dental Plan of Minnesota, which owns a major interest in a privately held dental practice management corporation [DPMC].

POSITION: Mr. Knox held senior leadership positions in several health care organizations for more than twenty-five years. He implemented various joint ventures, partnerships and business alliances in a variety of medical organizations. He is recently retired.

TOPIC: “Practice Management and Financial Planning: It’s [NOT] for Dentist’s Only”

EXERPT: “The challenge is that for many dentists their practice is too big and too profitable to sell to new dentists who have been, traditionally, the practice buyers. Almost fifty percent of present day dentists are baby boomers pushing 50-55 years of age. And unfortunately, they cannot afford to retire at this point and still maintain the lifestyle they have created. But, the temptation is there – the thought is occurring more frequently – and it is very compelling and very frustrating.”

Don’t miss it!

REQUEST IT NOW: Complimentary by email.

https://healthcarefinancials.files.wordpress.com/2008/03/ddspracticelifecyclefinplanning.pdf

Addictive Investing Personality of Medical Professionals

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“The Addictive Investing Personality of Medical Professionals and Related Compulsions”

An exclusive white-paper report on medical professionals and their investing compulsions by one of the nation’s leading psychologists, gambling addiction and trauma specialists. 

AUTHORS:

Eugene Schmuckler PhD MBA MEd CTS [Behavioral Psychologist]

David Edward Marcinko CMP MBA MBBS

POSITION: Academic Dean: www.CertifiedMedicalPlanner.org an online certification program with fiduciary trademark logo that teaches financial professionals about contemporary health economics, physician focused financial planning, medical business management and related topics of organizational modernity.

cmp-logo16

http://www.CertifiedMedicalPlanner.org

TOPIC: The Addictive Investing Personality of Medical Professionals and Related Compulsions

EXERPT: Hard-working physicians and other medical practitioners confronted with the problems associated with managed care and healthcare reform may very well choose to direct a portion of their energies to “playing the market.” It is legal and ethical and offers the opportunity of quickly increasing one’s personal wealth – or NOT.  

Functioning virtually alone prevents others from questioning their actions. While not directly equivalent, this action is akin to the drinker who drinks alone so that no one really knows just how much is consumed – a recipe for financial and emotional disaster.”

Speaker: If you need a moderator or a speaker for an upcoming event, Dr. Gene Schmuckler is available for speaking engagements. Contact him at: MarcinkoAdvisors@msn.com

***

READ WHITE PAPER:

addictive-investing.pdf

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

***

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http://www.BusinessofMedicalPractice.com

***

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