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Coordination, Switching Costs and the Division of Labor in General Medicine

Posted on June 13, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

An Economic Explanation for the Emergence of Hospitalists in the United States

Submitted by Hope Rachel Hetico RN, MHA

[Managing Editor]

From a white paper by David O. Meltzer, Jeanette W. Chung

NBER Working Paper No. 16040
Issued in May 2010

General medical care in the United States has historically been provided by physicians who care for their patients in both ambulatory and hospital settings. Care is now increasingly divided between physicians specializing in hospital care (hospitalists) and ambulatory-based care primary care physicians. We develop and find strong empirical support for a theoretical model of the division of labor in general medicine that views the use of hospitalists as balancing the costs of coordinating care across physicians in the hospitalist model against physicians costs switching between ambulatory and hospital settings in the traditional model.

Assessment

These findings suggest opportunities to improve care.

Link: http://papers.nber.org/papers/w16040

Conclusion

All ME-P readers are invited to opine.

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Filed under: Health Economics, Managed Care, Practice Management | Tagged: David O. Meltzer, hospital based physicians, hospitalists, Jeanette W. Chung | 1 Comment »

Building a Meaningful Medical Practice Marketing Campaign

Posted on June 9, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

What it Is – How it Works

[By Dr. David Edward Marcinko MBA, CMP™]

[By DeeVee Devarakonda MBA]

The success of a knowledge driven healthcare organization depends on not only how data can be converted to information – and information into marketing insight – but also by acting upon and converting those insights into building meaningful patient acquisition campaigns.

Definition of Patient Recruitment

Patient recruitment or campaign managementis the process of designing, executing, and measuring marketing campaigns through the use of applications that help to:

Select and segment patients
Design campaigns and execute the campaigns to contact patients
Track the contacts made with patients
Measure the results of those contacts
Learn from these results to more efficiently target patients in the future.

Key Queries

Some key questions to ask while you build campaigns:

Do you have a Customer [Patient] Relations Management roadmap that fits in with your overall patient vision and strategies and outlines the course of action for campaign management?
What is your privacy policy and strategy? – It is imperative for healthcare organizations to be proactive and self-regulate with a coherent privacy policy and design their systems to comply with this strategy. This may affect the way you design and execute campaigns.
What tools should you use? – There are several campaign management tools available today but no one tool may solve all business problems. You need to decide: what works best for my technical/ business environment? Is any integration effort required, if yes, how much will it cost me? How user-friendly are the tools? How much should I invest in training?

Important Campaign Components

Critical components of campaign management include the following activities:

Patient Segmentation: Process of identifying groups of patients for better targeting marketing and communications efforts. Segmentation is critical for effective and intelligent one on one communications with your patient.

Ensure your data quality is excellent which can give you meaningful segmentation.
Consistency of treatments and processes are of paramount importance.
Buying a software tool is not enough for effective segmentation. You also need to understand what the software tool does in the backend. Watch out for anomalies and take steps to make reparations.
Make sure you administer the initiative to a small sample and the business rules are in place before you roll out your campaign to the larger group.

Personalization: Ability to customize your product/service to each patient:

Good personalization is possible especially when you have a good patient past history.
You also need to have all business rules in place for effective personalization.
Ensure your patient data is of high quality (e.g. addressing a female patient as a Mr. or sending mails to sign up for your service to a person who is already your patient can defeat the purpose of personalization)
If you model data before personalization, you can target more effectively and personalize.
It pays to have a clear privacy policy and ensure your personalization philosophies are in tune with that policy.

Execution – Actual implementation of your marketing programs and messages

Before you execute, ensure you are equipped to fulfill promises you are making in the campaigns (e.g. If you are printing a toll free phone number in your direct mail piece for your patients to use, that toll free telephone number should work)
Make sure your sales and service channels are aware of the campaigns and publish a general calendar for the whole company
Develop business rules and strategies for follow-up campaigns.

Learn more: http://www.CertifiedMedicalPlanner.org

The Mindset

Successful patient marketing campaigns begin with the proper mindset and practice culture. There is no technology silver bullet to any P[C]RM campaign. And today, patient privacy is the key element of loyalty with a commitment to build long lasting and profitable campaigns through mutual trust and engaging cross-functional teams that can pick and deploy the elements mentioned above, across the entire enterprise and IT network, as needed.

Assessment

Healthcare organizations should keep privacy and the above components as their laundry list of action items when considering a C(P)RM plan.

Conclusion

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Filed under: Career Development, CMP Program, Glossary Terms, Marketing & Advertising, Practice Management | Tagged: CRM, DeeVee Devarakonda, healthcare marketing campaigns, Medical CRM, medical marketing, www.certifiedmedicalplanner.com, www.HealthDictionaySeries.com, www.medicalbusinessadvisors.com | 2 Comments »

Some Dental Consultants Say the Most Incredible Things

Posted on June 7, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Are Dentists like … Rodney Dangerfield?

By Darrell Kellus Pruitt; DDS

“Let’s face it — in our world dentists do not get the respect they deserve. They are not perceived to be ‘real’ doctors … Perhaps the lack of sex appeal in dentistry is part of why dental coverage for everyone is an afterthought in the national health care conversation.”

Gary Kadi DDS, DentistryiQ

http://www.dentaleconomics.com/index/display/article-display/4196579430/articles/dental-economics/volume-100/issue-5/features/the-cavity_in_the.html

Even if Dr. Kadi is correct, and the barrier between a 12 year old and his toothbrush is a world-wide lack of respect of dentistry, that hardly means that electronic dental records (eDR) are going to make the kid brush any better. Experience tells me that if mom’s nagging won’t motivate the stinker, the computer won’t either.

eDR Rationalization?

For those who read the article, did you notice how Dr. Kadi, a dental practice consultant, attempts to subtly insert a fat rationalization for adopting eDRs into the middle of a comment lamenting dentistry’s lack of respect? Tricks like Kadi’s make stakeholders look silly at times, and it bothers me that hardly anyone notices and appreciates the humor that these pros bring to marketplace conversation. That’s why I like to point out mistakes like Kadi’s when I come across them. It’s getting harder to find these kinds of articles about eDRs. My pleasure!

Working Both Sides of the Consulting Fence

As far as I can tell, all but a few dental consultants work both sides of the fence in order to please vendors who give them good deals, as well as dentists who pay for unbiased help. Sponsorship by vendors is the bottom level of a consultant career if one chooses to make a living at selling advice. In this way, the dental consultant business is a lot like the financial advice business. Some advisors push their favorite investments that serve them well no matter what happens to their clients’ money. If a client wants advice, but prefers not to pay full price, interested vendors can be counted on to quietly chip in on an advisor’s bill. And that is why the customer must always be cynical. What’s more, it is arguably one’s community obligation to publicly challenge such artists by luring them out into the open to explain further what they meant to say to naïve people. Dr. Kadi begins:

“The national health-care debate cannot be complete unless we include dental care as part of the discourse.”

He then presents oft-repeated, convincing findings which support the widely held conclusion that one’s overall health is dependent on one’s oral health. Even though this chunk of common sense has recently been supported with well-respected research, the news isn’t a revelation. Other stakeholders have proclaimed the findings as an example of ultra-modern “Evidence-Based Dentistry,” and proof of the need for thousands of their dental products. However, let’s not kid ourselves. A healthy mouth has less to do with computerization than the proper application of a low-tech toothbrush. 10,000 years ago, even buzzards recognized that bad breath from advanced gum disease smells like imminent death from a long way off if the wind is right. The results Dr. Kadi leans his reasons against only confirm traditional Evidence-Based Superstition.

eDR Lobbying

By half-way through the article Dr. Kadi turned “The cavity in the health-care debate” into a PR piece for eDRs. He’s in so deep that he cannot recognize that his misplaced concerns about image have nothing to do with dental patients’ oral health. Image is only cosmetic.

“A validation [of bringing “sex appeal” to the profession] is the inclusion of dentistry in the recently mandated National Healthcare Information Infrastructure (NHII). The purpose of the NHII is to create an information network to facilitate the creation of an electric health record [eHR] for all aspects of health care. The primary impetus is to achieve interoperability of health information technologies used in the mainstream delivery of health care.”

Note: Dr. Kadi admits that the goal is HIT, and sharing health information is the tool – not the other way around. As anyone can see, that kind of nonsense will never work out well in the US. Why that would be as foolish as stuffing a certifying commission for eHRs with industry, government and academic leaders rather than providers – and then tossing billions of dollars that could otherwise be used for treating disease out in the street for the biggest and fastest stakeholders who grab the most. That would be simply ridiculous.

Dr. Kadi bravely continues: “This will enable an individual’s health care information to be shared by all the necessary health care parties in a secure manner, including dentistry. It will improve patient care and reduce the number of patients, currently 100,000 plus, who die each year due to a lack of accurate, complete, or timely information. The federal government estimates a cost savings of $85 billion to $100 billion per year with electronic health records [eHR].”

Is HIT – Or any IT – Really Secure?

In a secure manner – really? There are so many other misleading statements in this paragraph as well. First of all, how can an eDR improve a dentist’s chance of successfully extracting a molar in one piece? It can’t. Secondly, how many of the alleged 100,000 victims died because of lack of electronic DENTAL records? Third, how many patients will die because of faulty information in interoperable records that would not have occurred if the records were paper? Fourth, to insinuate that patient information can only be shared over the Internet is plain silly. Telephone, fax and the US mail have been sufficient for dentistry for decades, and none involve HIPAA. Finally, the $85 to $100 billion in savings Dr. Kadi casually throws out is based on a five year old Rand study that’s been widely trashed for being biased in favor of the stakeholders who funded the research. That happens. It just amazes me that anyone in the healthcare industry who knows anything about HIT is foolish enough to still shop discarded garbage. And once again, regardless of the success of electronic medical records, how will eDRs save even $10 in dentistry? It’s impossible without re-defining “savings.”

Cost Savings

“Dentists and hygienists will play a vital role in this cost savings because people who go for regular cleanings will have their medical history updated in the shared system during each visit. In some cases, dental cleanings may be the only medical attention a person receives yearly.”

“Cost savings”? Where have I heard that term? And why didn’t Dr. Kadi simply say “savings”?

Now I remember. It was Dr. Robert Ahlstrom, the ADA’s eDR expert, who coined the handy buzzword in his testimony describing the benefits of paperless dental practices for the US Department of Health and Human Services in July of 2007. “Cost savings to providers and plans will translate in less costly health care for consumers. Premiums and charges will be lowered.” That would be the seventh of his 11 reasons that are each one so lame that other than Dr. Kadi, stakeholders never borrow them. Although it is undeniable that electronic records benefit insurers and the government more than the patient, if Ahlstrom hadn’t been coy, and had clearly stated that eDRs will save money in dentistry, his testimony would have been false. By calling it a “cost savings,” Ahlstrom technically concedes that using eDRs will indeed require an increase in cost of overhead – which dental patients will ultimately have to pay to obtain dental care. The saving part comes from “what could have been.” Whatever that could possibly mean, HHS Secretary Michael Leavitt bought it.

The PennWell Article

Because of a situation beyond my control, I am unable to provide a link, but to find more of my opinion of Ahlstrom’s testimony that is still used by lawmakers to establish national policy, simply google “Dr. Robert Ahlstrom.” My PennWell article from a year ago or so, “Dr. Robert H. Ahlstrom’s controversial HIPAA testimony,” is probably still his first hit. It could be on his first page the rest of his life.

Assessment

If necessary, I’ll make a few more examples of insensitive HIT stakeholders who know better than to offer such crap to the nation’s lawmakers as well as providers who are too busy to pay attention to the welfare of their profession. The ADA should reassure the nation that there are cheap, effective low-tech ways dental patients can stay healthy that don’t risk their identities and won’t bankrupt a dental practice because of a stolen computer. But; they won’t do it.

Conclusion

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Filed under: Op-Editorials, Practice Management, Pruitt's Platform, Quality Initiatives | Tagged: ADA, Darrell Pruitt, DDS, dental consultants, dental economics, dentistry, DentistryiQ, DMD, Dr. Robert Ahlstrom, eDRs, EHRs, EMRs, Gary Kadi DDS, HIPPA, HIT, NHII, PennWell | 37 Comments »

2010 Physician Sentiment Index™

Posted on June 2, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Taking the Pulse of the Physician Community

By Ann Miller RN, MHA

[Executive Director]

From time to time, our readers send in e-books, files or e-chapters, pamphlets or other material they have created for client, educational or marketing use. Some of it may be worthwhile; some not so. Nevertheless, these publications are often a good place to start the conversation, or thought-process on related topics.

They will be occasionally offered as a complimentary membership feature of the Medical Executive-Post.

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February 2010 Physician Sentiment Index™

By athenahealth

By Sermo

Link: Sermo

Disclaimer

No advice is offered. We make no copyright claim to these works. Veracity should be checked and information should be considered time sensitive. Please contact a professional for your situation.

Assessment

Feel free to send in your own material for the benefit of all Medical Executive-Post readers and subscribers.

Conclusion

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Filed under: "Doctors Only", Career Development, Practice Management, Research & Development, Surveys and Voting | Tagged: 2010 Physician Sentiment Index™, AthenaHealth, medical practice management, sermo | Leave a comment »

Doctors – Are You Using Health 2.0 Tools?

Posted on May 31, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

A New ME-P Survey

By Ann Miller RN, MHA

[Executive Director]

Web, or more specifically health 2.0, tools have made medical practice more interactive and collaborative for all stakeholders; doctors, patients, payers, hospitals, employers and third party insurance companies.

But, what actually is Health 2.0? Do you embrace or fear it?

A Definition

Link: https://medicalexecutivepost.com/2010/02/19/health-2-0-empowers-patients/

Link: www.HealthDictionarySeries.com

Survey:

Now, it’s your turn.

Doctors, do you use Health 2.0 tools in your own medical practice [all specialties and degree designations are invited to opine]; either in the cloud [SaaS] or thru on-site programs? Please tell us why or why not! What tools do you use, the risks, benefits, results, costs, etc?

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Filed under: "Doctors Only", Information Technology, Practice Management, Surveys and Voting | Tagged: health 2.0, managed care 2.0, www.HealthDictionaySeries.com | 3 Comments »

About ReachMD Media

Posted on May 28, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

The Center of New Media in Healthcare?

By Staff Reporters

ReachMD is an innovative communications company that provides thought-provoking medical news and information to healthcare practitioners. Established to help increasingly time-constrained medical providers stay abreast of new research, treatment protocols and continuing education requirements, ReachMD delivers innovative and informative radio programming via XM Satellite Radio Channel 160 and online streaming developed by doctors for doctors.

The Founder

Founded by Dr. David Preskill, a well-known OB/GYN, ReachMD is a communication and education platform that even the busiest clinician can use.

For example, ReachMD’s first innovation was to allow healthcare providers a method to receive education in 15-minute segments on demand by cell phone. Clinicians can call in anytime from any phone to listen to relevant content, answer a few short voice-activated questions and receive CME credit in a completely paperless transaction.

Launch

In April 2007 ReachMD launched the first-ever national radio channel for medical professionals: a platform for clinical discussion, news and education. This content is broadcast 24/7 on XM Satellite Radio channel 160.

In October 2007, ReachMD launched new online streaming access to all programming and CME content and continues to expand the listening audience and deliver on its’ mission of providing the best communication, education and information to America’s medical professionals.

Assessment

ReachMD strives to provide compelling information to the healthcare community in the most convenient formats. So, give em’ a click, and tell us what you think?

http://www.reachmd.com

Conclusion

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Sponsors Welcomed

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Filed under: "Doctors Only", Practice Management, Research & Development | Tagged: Dr. David Preskill, new medical media, ReachMD, XM Satellite Radio Channel 160 | Leave a comment »

What is the Medical Executive-Post?

Posted on May 22, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

What is our Blog – How does it Work?

By Ann Miller; RN, MHA

[Executive-Director]

The Medical Executive-Post is an independent information sharing portal for the integrated healthcare industrial complex, medical practice management and financial planning and advisory communities. We have a search engine to help find essays and follow the breaking news that interests you for this space.

Our articles, gossip, videos, books, journals, dictionaries, alerts and related essays and information are continuously updated and ranked by users thru more than 50 topical channels. And, we are sponsored by the www.MedicalBusinessAdvisors.com

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Assessment

Of course, this means he ME-P is a participatory service: you can publish an article directly on the site or comment on an existing item. Or, we can edit, re-write and proof-read for you. You can also vote for an article or a group that captures your interest in order to increase its visibility on the site. And, you may virtually matriculate online at www.CertifiedMedicalPlanner.com

Each ME-P page also offers an RSS feed that allows you to subscribe to receive the information that appears there in the reader of your choice. But, you must subscribe for full functionality.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. How can we make the ME-P better and more useful to you? What new features would you like to see?

Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.

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Sponsors Welcomed

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Filed under: Alerts Sign-Up, Career Development, CMP Program, Financial Planning, Health Economics, iMBA, Inc., Investing, Managed Care, Marketing & Advertising, Practice Management, Sponsors | Tagged: ann miller, david marcinko, healthcare blogs, hope hetico, medical executive post, www.CertifiedMedicalPlanner, www.healthcarefinancials.com, www.HealthDictionaySeries.com, www.medicalbusinessadvisors.com | Leave a comment »

CRM Considerations for a Health 2.0 Medical Practice

Posted on May 21, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

The Build vs. Buy vs. Outsource Conundrum

By DeeVee Devarakonda MBA

There are several options to build, buy or outsource a medical practice Customer Resource Management infrastructure. And, there are advantages and disadvantages to all three options. I will review all three for our ME-P readers.

Build:

Rapid technology advances are transforming the business landscape. This makes it very challenging for healthcare organizations to keep abreast of the technologies, to train and manage resources on tools, to grapple with cross-functional, cross-departmental dynamics and build the CRM application. In addition mergers/ acquisitions and other market realities can make CRM operations complex and distract healthcare organizations from delivering excellent patient experience.

It is very tempting for small healthcare organizations to think they can develop what they need in-house themselves. May be May be not. It is very essential to stay focused on your main business and see if the solution is available elsewhere. Figure out if you are in the business of whatever you are doing or let us say in the business to develop patient survey tool or a low-end database. It is best to get outside help wherever you are dealing with an initiative/ task that is not your core competence or where it is to your strategic advantage- be it time-to-value or cost savings.

Buy:

Depending on your business needs you can either buy CRM package solution and implement or build best of breed solutions that are suited to your business needs. You need to pay very close attention to what the software vendors are promising. Naturally they will be more interested in making the sale, than advising on whether it integrates well with your existing technologies, so the onus is on you as a buyer to ask the right questions and make appropriate purchases.

Outsource:

Especially for very young healthcare organizations today, outsourcing can be an option worth exploring to de-risk technology decisions. Outsourcing de-risks marketing program – avoids unnecessary, upfront, massive capital investment and will also equip the marketers with the flexibility to ramp up or down as situation demands. Outsourcing does not mean healthcare organizations can wash their hands off the CRM function. Still it is the business that will have to provide the strategic direction and control the CRM process and outcome. There are also Application Service Provider (ASP) solutions which de-risk technology decisions.

Assessment

One of the attractions of going the hosted route becomes very clear when you have a two doctor practice marketing medical services that require 24×7 availability of information, transaction and service. They have attractive pricing that encourage “pay as you go” paradigm which is of enormous help to young businesses. However, the disadvantages of an ASP [SaaS] are: 1) you can’t integrate with your other enterprise systems for patient 360-degree view 2) you can’t customize to reflect your exact needs 3) you can’t work offline, which can be a disadvantage if you are a mobile “new-wave” medical practice.

MORE: CRM Marketing

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Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
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ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

Filed under: "Doctors Only", Career Development, Experts Invited, Information Technology, Practice Management | Tagged: CRM, CRM applications, Customer Resource Management, DeeVee Devarakonda | 4 Comments »

About the Institute for Interactive Patient Care [IIPC]

Posted on May 16, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Advancing the role and prevalence of patient and family engagement in the healthcare 2.0 era

By Staff Reporters

The Institute for Interactive Patient Care (IIPC) is a healthcare organization dedicated to empowering patients and improving health outcomes through direct patient engagement. Their mission is to foster widespread adoption of patient and family/caregiver engagement strategies, which are proven to optimize patient care outcomes.

[picapp align=”none” wrap=”false” link=”term=medical+care&iid=299749″ src=”0296/b744a919-026d-4cb2-8a9a-5edd2a9ce15d.jpg?adImageId=12868513&imageId=299749″ width=”317″ height=”480″ /]

Vision

The vision of IIPC and its’ national board of advisors is to create a forum through which healthcare leaders worldwide learn about and adopt best practices in patient engagement as a principle means of improving healthcare outcomes. To achieve its mission, the IIPC engages in high quality research and advocates for advances in policy, standards and payment reform, all consistent with the mission of IIPC. The IIPC is governed by an independent National Advisory Board comprised of prominent leaders in healthcare.

Responsibilities

Among its primary responsibilities, advisory members help oversee and validate research projects, as well as to guide the use and dissemination of information and findings from the research in order to promote establishment of patient engagement standards for all care providers. IIPC fills a unique role in healthcare by serving as a reliable source of information and evidence-based data on the impact and efficacy of patient and family/caregiver engagement.

Assessment

IIPC is a not for profit 501(3)(c) organization.

Link: http://www.instituteipc.org/research/

Conclusion

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Health Administration Terms: www.HealthDictionarySeries.com

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Sponsors Welcomed

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Filed under: Career Development, Information Technology, Practice Management, Research & Development | 1 Comment »

25 or so – Unintended Consequences of Healthcare Reform

Posted on May 14, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Protean, Pervasive, Prolonged and Painful

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Definition of the Term

Much like the physical laws of nature, action begets consequences, which are usually known, unknown or disregarded by human foibles.

According to Robert Norton, the law of unintended consequences, often cited but rarely defined, is that actions of people—and especially of government—always have effects that are unanticipated or unintended. Economists and other social scientists have heeded its power for centuries; for just as long, politicians and popular opinion have largely ignored it.

My List

And so, regardless of your political affiliation or opinion on healthcare reform in America, passed on March 21 2010 [Patient Protection and Affordable Care Act], there is a plethora of unintended consequences with the [any] new law. So, please indulge me in a bit of healthcare administration prescience:

Healthcare costs will be shifted to doctors in the form of lower reimbursement with higher practice overhead costs for private physicians, and with fewer office employees and more ancillary business and service line extensions.
Hospital based physicians like pathologists, radiologists, anesthesiologists, emergency department doctors and hospitalists will demand, and receive, higher salaries.
Fewer [under populated] primary care physicians with more [over populated] PAs, nurse practitioners and DNPs; with a blunted medical establishment oligopoly.
Higher health insurance costs for employers and most patients, especially young adults without a commensurate increase in aggregate risk.
Medical care access impediments for most Americans, but improvements for those previously uninsured.
Health 2.0 electronic connectivity for the masses with medical data “internet-neutrality”.
Continued rise of evidence based medicine and crowd-sourced healthcare information.
Higher costs for DME, instruments and drugs; particularly in the filed of human genomics and personalized pharmaceuticals.
Increased acceptance of MSAs, HSAs, concierge medicine, private-pay and other direct cash payment methods for medical care.
Realization that eMRs do not improve patient care or reduce costs as “meaningful use” is diluted.
An enterprise wide health data breach of epic proportions, with in-numerable smaller security breaches despite the HIPAA laws.
Long term macro-economically induced national inflation with weakness in the US dollar
Poor quality digital manipulation of medical information with eMR specific inflation due to ARRA and HI-TECH.
Increased national unemployment with widespread underemployment for some Americans.
Modified value added taxation in addition to increased federal tax brackets, rates and related others.
Promotion of outcomes reimbursement models, values based healthcare [episodes of care] and various micro-capitation derivatives.
Many more community hospitals, which lost 12 cents/dollar spent on Medicare and 35 cents/dollar on Medicaid patients last year, will close.
Medicare will become the defacto health insurance, much like public housing, food stamps, the USPS and public transportation.
There will be fewer viable alternatives to commercial health insurance, other than Medicare and Medicaid, since the antitrust exemption for health insurers was not repealed.
The impact of changing to ICD-10 for medical records coding and billing, will be as significant across the industry, as was Y2K and will push many other HIT projects to lower priority.
New HIPAA 5010 requirements will present substantial changes in the content of the data submitted with claims as well as the data available in response to electronic inquiries.
The Obama health insurance “police” program will be a policy failure, but a job creator.
Medical practices, often a doctor’s largest financial asset, will go down in value jeopardizing personal retirement plans.
Medicine’s lost professional status will become complete as healthcare becomes commoditized and future grass-roots caregivers are neutered.
Your 2 cents here.

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Assessment

In order to be politically correct – not a known trait for me – I will adopt a scientist’s perspective and omit any value judgment regarding the above [positive or negative] unintended consequences.

www.BusinessofMedicalPractice.com

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. 25 consequences not listed? Add your 2 cents. What else can you think of? Am I correct, or not, and how do you feel about the above?

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Filed under: Career Development, Health Economics, Health Insurance, Healthcare Finance, Op-Editorials, Practice Management, Research & Development | 7 Comments »

More On Meaningful Use for eMRs

Posted on April 30, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

The Economic Sticks

By MedeAnalytics

The HITECH Act specifies both economic carrots and sticks in future years to motivate hospitals to meaningfully use electronic health records (EHRs).

The Sticks

Economic sticks are negative adjustments to Medicare’s market basket update to the Inpatient Prospective Payment System (IPPS), with adjustments pertaining to meaningful use of EHRs and quality measure reporting and constitute a major financial downside risk for hospitals.

Assessment

Read this whitepaper to find out how your organization may be effected by these economic sticks and to prepare for the scheduled adjustments to these incentives and penalties.

Meaningful Use

Conclusion

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Speakers: 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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Filed under: Alerts Sign-Up, Health Law & Policy, Information Technology, Practice Management | Tagged: ARRA, EHRs, EMRs, HITECH, IPPS, Ken Perez, meaningful use | 10 Comments »

How to Evaluate a Managed Care Contract Proposal?

Posted on April 27, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ASK AN ADVISOR

To Join -or- Not to Join is the Question

By Staff Reporters

www.HealthcareFinancials.com

A new-wave West-Coast managed care organization (MCO) wanted a multi-specialty medical group to contract with them to provide medical services to all subscribers. Compensation would be in the form of a fixed-rate capitated payment system, a.k.a. per member / per month (PM/PM).

Ask an Advisor

The medical group practice administrator reviewed their request for proposal (RFP) very carefully, but is still not sure what to do. So, allow us to “crowd-source” as we ask ME-P readers, advisors and management consultants for a solution.

Key Issues

Facts to know for an informed PM/PM capitated reimbursement decision:

annual frequency or service-rate per 1,000 patients
unit cost of medical services per unit-patient
co-payment dollar amount per patient
co-payment frequency rate per 1,000 patients
variable cost per patient
under-capacity medical group office utilization rates, and
fixed overhead office-cost coverage [+/-].

Assessment

Visit: www.CertifiedMedicalPlanner.com

More case models: https://medicalexecutivepost.com/2010/03/12/healthcare-case-models-cd-rom/

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. What is your solution; accept or reject the contract proposal? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe. It is fast, free and secure.

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Filed under: "Advisors Only", "Ask-an-Advisor", Managed Care, Practice Management | Tagged: capitation, fixed rate medical reimbursement, HMO, Managed Care, MCO, medical contracting | 2 Comments »

Overhauling Health Care Oversight

Posted on April 26, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Union Pressure Exacts a Toll on California Bill

By Charles Ornstein and Tracy Weber, ProPublica – April 20, 2010 11:19 am EDT

A California Senate committee postponed a vote last Monday on legislation [1] to speed up the investigation and discipline of health professionals accused of misconduct, even as the bill’s author removed some provisions opposed by labor unions.

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Two Bills Advance

Separately, the committee advanced two other bills to address problems raised in articles last year [2] by ProPublica and the Los Angeles Times. One bill [3] would require that temporary staffing firms perform certain checks before sending nurses to hospitals; the second [4] would mandate that substance-abusing health workers be barred from practice if they test positive for drugs while participating in a treatment program. The bill to overhaul the disciplinary process for California’s nearly 1 million health professionals is the most contentious. It would require that employers report workers who are fired or suspended for serious wrongdoing, a mandate in place in 36 states already. Some California licensing boards already require this, but the Board of Registered Nursing [5], which oversees more than 350,000 nurses, does not.

A Controversial Provision

Another controversial provision could result in closure of state-run recovery programs for substance-abusing health professionals. The Senate Business, Professions and Economic Development Committee heard testimony—including objections from unions and professional trade associations—during a hearing Monday but postponed a vote until Thursday. Even if the legislation clears the committee, it still must get through several others and the full Assembly and Senate.

Critical Response

In response to critics, the bill’s author, Democratic Sen. Gloria Negrete McLeod [6], agreed to remove a provision that would have allowed the director of the state Department of Consumer Affairs to quickly suspend the license of a practitioner who is believed to pose an imminent risk to the public.

She also stripped language to allow licensing boards to deny a license based on a mental or physical disability.

Negrete McLeod

Negrete McLeod said the bill is urgently needed to keep dangerous and incompetent nurses from being able to continue practicing, sometimes for years, regardless of misconduct allegations. “There was enough blame to go around that we could all get painted with the same brush,” she said. Critics said the changes made the bill better, but the still oppose major elements. It is unclear whether the measure has the votes to pass.

Leland Yee

Democratic Sen. Leland Yee said the bill may have an “overemphasis” on consumers at the expense of the rights of professionals. “Some people may say we can throw away” the due process rights of professionals, Yee said. “But that’s not the way we do things in this country.”

Assessment

Finally, Negrete McLeod said she found arguments against the bill “ironic.” Each of the representatives of the various professional groups had “averred that only 1 percent” of their members were getting into trouble. If that is true, she asked, why was there such a “hue and cry” over the proposed reforms?

Conclusion

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Filed under: Alerts Sign-Up, Career Development, Health Law & Policy, Practice Management | Tagged: Board of Registered Nursing, Charles Ornstein, discipline health professionals, Gloria Negrete McLeod, health professional misconduct, Leland Yee, Professions and Economic Development Committee, ProPublica, Senate Business, Tracy Weber | 1 Comment »

About URAC

Posted on April 24, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Accrediting Healthcare Organizations

By Staff Reporters

URAC, formerly known as the Utilization Review Accreditation Commission, promotes healthcare quality by accrediting healthcare organizations.

An Independent Nonprofit

URAC, an independent, nonprofit organization is well known as a leader in promoting healthcare quality through its accreditation, education, and measurement programs. URAC offers a wide range of quality benchmarking programs and services that keep pace with the rapid changes in the healthcare system, and provide a symbol of excellence for organizations to validate their commitment to quality and accountability.

Mission

URAC’s mission is to promote continuous improvement in the quality and efficiency of health care management through processes of accreditation and education.

Assessment

Through its broad-based governance structure and an inclusive standards development process, URAC ensures that all stakeholders are represented in establishing meaningful quality measures for the entire healthcare industry.

For more information, visit www.urac.org.

Conclusion

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Filed under: "Doctors Only", Practice Management, Quality Initiatives, Risk Management | Tagged: accrediting healthcare organizations, URAC, Utilization Review Accreditation Commission, www.urac.org | 3 Comments »

Internet Marketing for Physicians

Posted on April 22, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ADVERTISEMENT

Vital Checklist for Website Re-Design

By Theo Bennett

Dear Dr. Marcinko

MoreVisibility has been developing and implementing successful online marketing programs since 1999.

So, please accept this whitepaper on modern web re-design at no cost or obligation to your readers.

Link: Website-Redesign-Checklist

Assessment

Those interested in learning more may contact me at the address below.

Client Strategist
MoreVisibility
925 South Federal Highway
Suite 750
Boca Raton, FL 33432
800.787.0497
tbennett@morevisibility.com

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Filed under: Career Development, Information Technology, Marketing & Advertising, Practice Management | Tagged: MoreVisability, Theo Bennett, web design | 2 Comments »

Understanding Efforts to Promote Lower-Cost Physicians

Posted on March 31, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

May Be Based on Misleading Profiles – According to Rand Study

By Staff Reporters

It is increasingly common for insurance plans to encourage patients to receive care from physicians who keep medical costs lower. However, this ethos may be based on unreliable estimates of doctor performance and may not achieve the intended savings, according to a new RAND Corporation press release and study.

PR Link: http://www.rand.org/news/press/2010/03/17/?ref=homepage&key=t_doctor_cash

About the Study

Funding for the study was provided by the U.S. Department of Labor. Other authors of the study are Elizabeth A. McGlynn PhD of RAND, Dr. Ateev Mehrotra of RAND and the University of Pittsburgh School of Medicine, and J. William Thomas of the University of Southern Maine.

About Rand Health

RAND Health, a division of the RAND Corporation, is the nation’s largest independent health policy research program, with a broad research portfolio that focuses on quality, costs and health services delivery, among other topics. RAND Health is the developer of COMPARE (Comprehensive Assessment of Reform Efforts), a one-of-a-kind online resource that provides objective analysis about national health care reform proposals. Visit www.randcompare.org to learn more.

Conclusion

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Filed under: "Doctors Only", Career Development, Health Economics, Managed Care, Practice Management | Tagged: DOM, Dr. Ateev Mehrotra, Elizabeth McGlynn, Health Economics, J. William Thomas, Rand, USDOL | 2 Comments »

About the Covestor Mutual Fund Portfolio Sharing Service

Posted on March 29, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

What it is – How it works

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Covestor, with offices in New York and London, is a web platform started by entrepreneurs Perry Blancher, Richard Tachta and Simon Veingard http://www.covestor.com. Their belief was that salaried mutual fund managers have no monopoly on investment talent and shouldn’t have a lock on the rewards that come with investment success. As financial services, and online netizens, they also believed in democratizing the investment management industry and helping proven self-investors compete with the large institutions. This is known as the power of “crowd-sourcing.” All core philosophies seem to be shared by this ME-P.

What it is

According to their website, Covestor is both a portfolio sharing service for proven self-investors and for those wishing to track them; where data is private, secure and anonymous. With Covestor, one can coat-tail successful investors and follow their real trade activity. Or, have their moves auto-traded for you by Covestor Investment Management. Members can also keep track of their investments andBuild a free track record comparable to professional mutual funds. Members earn fees for their hard work, and Manage a model that their clients can mirror thru shared management fees.

Profit Sharing Investors

Covestor investors sharing portfolios include professionals, full time amateurs and industry specialists. They are a serious bunch with an average reported portfolio size of over $200,000 (excluding cash). Positions are typically held in over 5,000 different equities; are based in 50 countries and span the full range of ages, backgrounds and styles.

Issues

As a doctor-investor, health economist and former certified financial planner, there are at least three issues needed to be raised about this firm.

The first is SEC/NASD/FINRA rules and applicable SRO and state regulations for brokers, RIAs, FAs and related others? The status of suitability versus fiduciary accountability for ERISA regulated plans is also questioned. The third [and least important] is the potential negative impact on traditional financial services “professionals.”

In other words, is this another example of how technology will flatten the “intermediary curve” and reduce the profit of middle sales-men and sales-women? Oh! What about medical specificity for our target audience?

www.CertifiedMedicalPlanner.org

Assessment

I am sure there are other issues as well. Your thoughts and comments on this ME-Pare appreciated; especially from financial services “professionals”, lawyers and FAs, etc, Give em’ a click and tell us what you think http://www.covestor.com?

Conclusion

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Filed under: "Ask-an-Advisor", Breaking News, Career Development, CMP Program, Ethics, Information Technology, Investing, Practice Management | Tagged: certified financial planner, CFP, CMP, covestor, Covestor Investment Management, ERISA, FINRA, NASD, Perry Blancher, RIA, Richard Tachta, SEC, Simon Veingard, www.CertifiedMedicalPlanner | 4 Comments »

Need a New Career in Dentistry – Become a Consultant

Posted on March 26, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Or – Maybe Just a Hobby

By Darrell K. Pruitt; DDS

One might ask how much knowledge of dentistry is required before a person is qualified to call oneself a “dental practice management consultant” – beyond maybe being able to spell HIPAA with only one P, and Hippocrates with two.

Meet Jill Coon, Inc

An anonymous management consultant who works for Jill Coon, Inc of Florida posted this brave suggestion on the company Facebook today:

“Why not take 3 max anterior PA’s and 1 mandibular PA once a year with bitewings to check for caries in front teeth? We actually bill insurance for 3 PA’s not 4. Hygiene production just increased!”

My Translation

Here is a translation of her question from dental-speak to English:

“Why don’t dentists take routine x-rays of front teeth like they do for back teeth, when doing so increases hygiene production and payments from the insurance companies?”

[Dental team members, please sit on your hands for this one].

Bonus Round

Bonus question: Can anyone think of any reason why one might not want additional routine x-rays – even if insurance pays for it at 100% (of usual and customary fees)?

Hint: It can be trickier to avoid irradiating the thyroid when taking anterior x-rays than while taking routine bitewing x-rays.

Assessment

I’ll be back soon with the tricky opinion I will have posted on Jill Coon, Inc Facebook. It will be her first if nobody beats me to it.

http://www.facebook.com/home.php#!/pages/West-Palm-Beach-FL/Jill-Coon-Inc/125510596754?v=wall&ref=mf

Conclusion

Is there anyone out there with almost no knowledge of dental care who wants to match wits with a sales rep for a consulting company that “specializes in dental insurance billing and treatment planning for dental practices”?

Industry Indignation Index: 47

How about it – HHS Secretary Kathleen Sebelius, JD?

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Filed under: Career Development, Ethics, Health Insurance, Industry Indignation Index, Practice Management, Pruitt's Platform | Tagged: ADA, bitewing X rays, Darrell Pruitt, DDS, dental consultants, dentist, dentistry, HIPAA, ionizing radiation, Jill Coon Inc, Kathy Sebelius, thyroid gland | 5 Comments »

On Disruptive Healthcare Innovators and Financial Industry Change Agents

Posted on March 22, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Calling all Young Doctors, FAs and Medical Executives with “FLY”

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

In my real-job travels as a medical management consultant, speaker and physician focused financial advisor, my clients and their healthcare practices / financial services business models run the gamut from the sublime to the ridiculous; from pegboards to eMRs and clinical groupware; from cash/bond holders to hedge fund devotees and IPO junkies.

And, from broker-sharks and commissioned sales agents, to fee-only financial advisors and fiduciary RIAs. Fortunately, we see much more of what’s in-between than the latter [www.MedicalBusinessAdvisors.com and www.CertifiedMedicalPlanner.org

Business Analogy

Nevertheless, I am always struck by the fact that change and disruptive innovation [both positive and negative] seems to be within the realm of the young, rather than the more “mature” [sic].

Why? Younger folks just don’t seem to have the mental baggage and fear of failure that older counterparts seem to harbor. THINK: Janis Joplin: Freedom is just another word for nothing left to loose.

For example, Microsoft, Dell, Google, Yahoo, Facebook, Apple and Twitter, etc. No one told these young founders that “it can’t be done” – or – “we don’t do it that way around here.” Or, they did not listen to such talk. Unfortunately, this hubris [confidence or elan] is often just lost with age in the guise of political correctness.

Nevertheless, although started by folks in their youth, the professional management that most successful companies in the public domain ultimately require is from “older” folks.

Healthcare / Financial Services Analogy

Still, it is not surprising to learn that even some hospitals that house the most accomplished authorities in the fields of IT and quality care do not always follow their own advice when it comes to making improvements in the delivery of healthcare, or in their operational and delivery activities. THINK: Robert Wachter, MD.

And, it is not unusual for industries like the financial services and banking sectors, facing deep structural change, to be slow moving. THINK: Harry Markopolis.

Also, consider the auto industry – public education and labor unions – before the fall. Why – because the leaders of such sectors are typically promoted within, and because of past success, and not any ability to change the current environment?

IOW: They were hired for their ability to maintain the status quo, rather than for their ability to make constructive changes.

Assessment

Do we call this need for young blood, the “theory of business evolution?” The dinosaur is dead … long live the dinosaur!

Moral: We can’t help getting physiologically old – but we can help getting cognitively old to the extent possible. Be disruptive – champion change – don’t settle and raise a little hell in the dual industries we love and serve!

Conclusion

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Filed under: Career Development, CMP Program, iMBA, Inc., Op-Editorials, Practice Management | Tagged: change agents, disruptive innovation, EMRs, www.certifiedmedicalplanner.com, www.medicalbusinessadvisors.com | 9 Comments »

A New Survey on Dental Insurance

Posted on March 22, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Come on out Kim E. Volk – CEO of Delta Dental

By Darrell K. Pruitt; DDS

Today, Julie Frey posted “Dentist & Dental Insurance: No Love Lost” on Jim Du Molin’s Blog.

http://www.thewealthydentist.com/blog/1186/dentist-dental-insurance/

Frey hosts dentists’ frank criticism of dental insurance – their harsh sentiments backed up with fresh results from yet another of the blog’s timely studies that nobody else can compete with. Frey writes “Half of dentists have mostly or completely stopped accepting dental insurances, according to this survey.” One dentist captured the mood of the dentists with the statement, “Do the math … somebody is making hell of a lot of money on these plans, and it is not the dentist!” I smelled blood and posted the following comment.

Bloody Sunday

Anonymous members of the obscure National Association of Dental Plans (NADP) are losing the fat, collective thumb they once oppressed us with – even using our own ADA News to present their non-negotiable terms. Apart from common sense appearing in the marketplace about the same time as transparency, multiple other interconnected factors are causing dental insurance companies to lose business. The bad economy, corporate greed and pride are a few of their more serious handicaps that come to mind. Wasteful, deceptive insurance practices have aggravated my patients and me for decades before modern networked recourse became available on the Internet through progressive Websites like Jim Du Molin’s Blog. I’ll go out on a limb and say it is not unprofessional for us to enjoy protecting those we serve by showing no mercy to unfair stakeholders like the NADP.

There. I said it. In fact, as US citizens and taxpayers I think blowing the whistle on unneeded expense and danger in the nation’s healthcare delivery is the least we can do for meaningful healthcare reform. I say do your part. Make an insurance CEO like Delta Dental Plans Association’s Kim E. Volk feel discomfort on the Internet. Do you know that Kim E. Volk is the only person who has ever refused to accept me as a friend on Facebook?

http://www.jbpub.com/catalog/9780763733421/

Assessment

We really don’t want to allow Delta Dental, UnitedHealthcare, United Concordia and others to dictate fees for non-covered dental services, do we? I also don’t think they deserve continued protection from FTC anti-trust litigation. I say we punish the NADP hard every chance we get until the repeal of the McCarran-Ferguson Act and finally make such in-your-face collusion illegal for crying out loud.

Conclusion

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Filed under: Career Development, Ethics, Health Insurance, Practice Management, Pruitt's Platform | Tagged: ADA, Darrell Pruitt DDS, DDS, delta dental, dental insurance, eDRs, FTC, Julie Frey. Jim Du Molin, Kim E. Volk, McCarran-Ferguson Act, NADP, National Association of Dental Plans, United Concordia, UnitedHealthcare | 13 Comments »

eHRs and Clinical Trials

Posted on March 20, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

An Oft Neglected Topic

By Chris Thorman

I wanted to give the ME-P a heads up on an article I just finished about a neglected topic in the eHR debate concerning clinical trial participation.

It’s called: Electronic Health Records and Clinical Trials: An Incentive to Integrate.

The Argument

In the article, I make the argument that clinical trials should play a bigger role in whether or not to purchase eHR software because:

The potential profit from participating in clinical trials is so large that it dwarfs the HITECH Act incentives;
eHRs make clinical trial participation much easier than in the past; and,
eHR software has the potential to solve many of the problems that clinical trials face.

Editors Note: So, let’s try to spark some discussion on this oft-ignored topic. And, feel free to contact the author.

Chris Thorman
Senior Marketing Manager
Software Advice
(512) 364-0118
chris@softwareadvice.com

Conclusion

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Filed under: Information Technology, Practice Management, Research & Development | Tagged: ARRA, chris thorman, clinical trials, EHRs, EMRs, HIPAA, HITECH, Software Advice | 2 Comments »

On Employer Based Health Insurance Premium Costs

Posted on March 15, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

One Client’s Comparative Expense Analysis Experience

By Dr. David Edward Marcinko; MBA

[Publisher-in-Chief]

A colleague posted an interesting essay recently on his blog The Incidental Economist. Austin Frakt PhD is a health economist with an educational background in physics and engineering. After receiving a PhD in statistical and applied mathematics, he spent four years at a research and consulting firm conducting policy evaluations for various federal health agencies. Here is the post.

Link: http://theincidentaleconomist.com/index.php?s=Kaiser%2FHRET+

The Survey

In his essay, Austin reported these figures from a cited survey:

“The 2009 Kaiser/HRET employer health benefits survey found that employees pay 17% of the $4,824 annual premium for single coverage and 27% of the $13,375 annual premium for family coverage (all average figures)”.

Case Report Model

So, if the survey is correct, it got me thinking about how much a long-time client paid as a doctor-employer, when she last practiced in a certain medical group back in 2000. And, especially about how much she would be paying today if still in business with the same group. This brief case-report with comparative expense analysis [CEA} is the up-shot.

My Client’s Story

Her health insurance premium costs including doctor-partners, was about $13,500 annually, per employee. This was a sunk cost, but an above the AGI line deductible business expense to the practice and entirely employer paid as a fringe benefit [all valid corporate expenses are deductible as there is no AGI line on a business tax return]. She and her three partners were both very magnanimous to their employees, and naïve. They became virtually insolvent a few years later and were bought out by a larger medical group for a pittance. Today, they are grunt employee doctors in a 25 plus physician group practice.

My Numbers

Now, if I crunched the numbers correctly as an citizen economist, on my HP12-C calculator, using health insurance inflation rates of 3%, 5% and 7% respectively for a decade [low], she would be now be paying somewhere between $18,143 and $21,990 and $26,556 in 2010 [dangerously assuming linear economics]. Each of her 15-18 employees at the time was a female, head of household, with 1-4 dependents of their own; no singles. Her own family unit included a professional husband and young daughter in private elementary school. They were the most health conscious of the bunch.

Her Situation

So, she left the group in 2000, and we transitioned her to solo private practice with a HD-HCP indemnity-styled [better] plan that pays 100% after her $5,000, and later $10,000, deductible. She has 100% prescription drug coverage, no OB coverage and no networks, second opinions or pre-certification requirements. Today, she has more than $50-K in the savings portion [cash account earning 3.5%, tax deferred].

Her Reaction

As she just turned age 55, there as was significant jump in her family coverage premiums from about $1,350/quarter to $1,650/quarter! Of course, her carrier offered a ten percent discount to $1,485 quarter, when she pitched a fit, and completed a health and wellness survey which “they” verified.

My Intervention

So, I used my “insider” knowledge as a doctor, financial advisor and insurance agent and went back to the open market place for coverage. Her new direct halth insurance coverage [she used a non-fiduciary insurance agent intermediary previously] is better, and her premium is only $1,248/quarter or about $5,000 annually to age 58. Bye, bye insurance agent. Link: www.CertifiedMedicalPlanner.com

Now, if we use the non-inflated [a conservative unlikely scenario] 27% employee premium contribution for the present value projections of $18,143 and $21,990 and $26,556 today – each employee would be responsible for about $4,898, $5,937 and $7,170 respectively [please again recall both our conservative nature and the repeat danger of linear economic assumptions].

Where Did the Money Go?

So, under the 3-5% health insurance inflation scenario, my client would have been contributing about $5,417 for her heath insurance. This is very close to what she is annually paying now! So, where did the much larger employer’s contribution portion of the money go? Probably to overhead costs, marketing, advertising, sales and commissions, HR, high-risk pool premiums, ie … down the drain?

What did my client do with the monetary difference? Well, she paid all family doctor and drug bills that were under the high-deductible threshold; some went to her annual family health club membership dues, covered extras and various “wants and nice-to-haves”, and the remainder of course, went into her savings account portion. In other words … not down the drain.

There is an additional $1.000 “catch up” savings provision for those over age 55. She paid it – to herself.

The Road Ahead – More Expensive

I informed my colleague-client that there likely will be another big premium jump when she turns 58, 60 and age 62 respectively. We will report back to ME-P readers on market competition and related health insurance pricing at that time, ceteris paribus.

Assessment

Does the competitive open marketplace find a way to reduce HI costs– sooner or later? High Deductible HealthCare Plans were launched as a temporary pilot project in 1997 and initially sold poorly. In the past few years however, there has been a boom in HD-HCPs and the pilot project was made permanent. What other HI innovations may be in the future?

Of course, President Obama was against them in his original healthcare reform plan. But, now in his weakened political position, they seem acceptable to him. So, go figure. Utility depends on political winds, not economic efficacy, I suppose.

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: CMP Program, Health Insurance, iMBA, Investing, Practice Management | Tagged: AGI, Austin Frakt, CMP, CMP Program, CMP www.CertifiedMedicalPlanner.com, david marcinko, fiduciary, HD-HCPs, Health Insurance, high deductible health care plans, HSAs, incidental economist, insurance agents, Kaiser/HRET, MSAs | 7 Comments »

Why eMRs Won’t Improve Patient Care or Reduce Costs

Posted on March 13, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Deus Ex Machina – NOT

By Staff Reporters

Question

Have electronic medical records made a difference in patient care?

Answer

According to a new study looking at the digital medical record adoption of 3,000 hospitals, electronic records have made little difference in healthcare costs or the quality of medical care.

Assessment

That’s discouraging, considering that the government is investing billions of dollars into the technology.

Related posts from Kevin Pho MD:

Conclusion

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Healthcare Case Models CD-ROM

Posted on March 12, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

ADVERTISEMENT

Office Case Models in Healthcare Business

[A Practice Improvement Compendium]

In Medical Practice? – Buy this CD-ROM

Regardless of specialty, most doctors quickly realize there are few case model guidelines available to steer them through the day-to-day management maze. One solution is to discuss best-of-breed practices with leading practitioners in order to discern what successful doctors are doing [mentoring concept].

The Problem

Of course, this is a costly and time consuming process with no criteria for success. Today, mentors are even loath to assist as competitive advantage can be lost.

A Solution

A better solution may be to use our Case Models in Healthcare [A Practice Improvement Compendium] to appreciate real-world practice situations and develop personalized approaches for an appropriate course of action. These techniques are so powerful that many business schools center their teaching on them. Case studies have been used for one hundred years because of their practical descriptions of actual situations.

Typically, information is presented about a practice’s patients, markets, competition, financial structure, service volumes, management, employees and other factors affecting success. The length of a case study may range from a few pages to 30, or more. And, our Case Models in Healthcare [A Practice Improvement Compendium] is suitable for medical practices, clinics, hospitals and other emerging healthcare entities.

We use three different methods to enhance your knowledge and launch your practice’s success:

Prepared case-specific questions, with detailed answers, to illustrate underlying practice management concepts.
Problem-solving analysis, styled after Harvard Business School, to learn intuitive skills for resolving various practice issues.
A “no-answer” strategic planning approach to develop your ability to analyze a complex situation, generate a variety of possible strategies, and select the “best” from multiple self-generated solutions.

Case Model Topics

We give you more than 25 healthcare administration cases, covering the enterprise wide practice management ecosystem, to champion your financial success:

Market Competition
Operations Management
Capital Formation
Cash Flow Management
Revenue Analysis
Hybrid Costing
OSHA Model
Economic Order Quantity Costing
USA Patriot Act
Mixed Costing
Managerial Accounting
Cost Volume Profit Analysis
Insurance Contract Analysis
Incurred but Not Reported Claims
Accounts Receivable
Cost Accounting
Medical Contract Negotiations
Workplace Violence
HIPAA
Sarbanes-Oxley Act
Medicare Compliance
Health Information Technology
IRS Form 990
Hospital Valuations
HIT Security
Medical Endowment Funds; and others.

Bonus Features

We also include at no additional charge:

1. Glossary of Insurance and Managed Care

2. Glossary of Health Economics and Finance

3. Glossary of Health IT and Security

To help avoid administrative worries, you need Case Models in Healthcare [A Practice Improvement Compendium].

Sample Case Model: WV 1

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TO ORDER: Please send your check or money order [for the CD] to: iMBA Inc, Suite #5901 Wilbanks Drive, Norcross, GA 30092-1141 [770.448.0769] or MarcinkoAdvisors@msn.com

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Only: $ 99.00 USD [includes SPH & tax].

Filed under: Book Reviews, Career Development, iMBA, Inc., Practice Management, Recommended Books, Sponsors | 3 Comments »

About Microsoft HealthVault Community Connect

Posted on March 11, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Connecting Hospitals with Patients and Referring Physicians

[By Staff Reporters]

At the recent 2010 Annual Healthcare Information and Management Systems Society (HIMSS) Conference & Exhibition here in Atlanta, Microsoft announced Microsoft HealthVault Community Connect, a new software solution for hospitals designed to help them improve care coordination and engage patients and their families in managing their own health.

Improving Coordination of Care

HealthVault Community Connect reports to enable hospitals to give patients and referring physician’s access, after discharge, to electronic copies of the patient’s personal health data generated at the hospital. The product also lets patients pre-register for hospital appointments online using their electronic personal health information to populate hospital forms in advance.

Assessment

Microsoft HealthVault Community Connect lets hospitals exchange electronic patient health information with patients and referring doctors. The new solution is scheduled to be available in the third quarter of 2010.

http://www.microsoft.com/presspass/press/2010/mar10/03-01MSMiamiPR.mspx

Conclusion

So, give em’ a click and tell us what you think.

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FINANCE: Financial Planning for Physicians and Advisors
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Filed under: Information Technology, Practice Management | Tagged: Community Connect, EHRs, EMRs, Healthcare Information and Management Systems Society, healthvault, HIMSS, microsoft, Microsoft HealthVault Community Connect | 9 Comments »

Risk Assessment of Medical Coding Services

Posted on March 3, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Office of Inspector General

By Pati Trites MPA CHBC, with Staff Reporters

Any readers considering enrolling in a medical coding school should read this ME-P.

Why? Because the written policies and procedures concerning proper health insurance and Medicare coding should reflect the current reimbursement principles set forth in applicable statutes, regulations and Federal, State or private payer health care program requirements, and should be developed in tandem with organizational standards.

Furthermore, written policies and procedures should ensure that coding and billing are based on medical record documentation; which is now the “reality” rather than just a “reflection” of the reality.

Focus on the Codes

Particular attention should be paid to issues of appropriate diagnosis codes, CPT, DRG and MS-DRG coding, individual Medicare Part A and B claims (including documentation guidelines for evaluation and management services) and the use of patient discharge codes. The billing company should also institute a policy that all rejected claims pertaining to diagnosis and procedure codes be reviewed by the coder or the coding department. This should facilitate a reduction in similar errors.

Problem Areas

Among the risk areas that some billing companies who provide coding services should address are:

Internal coding practices;
“Assumption” coding;
Upcoding and Downcoding;
Alteration of medical records and documentation;
Coding without proper documentation of all physician and other professional services;
Billing for services provided by unqualified or unlicensed clinical personnel;
Availability of all necessary documentation at the time of coding; and
Employment of sanctioned individuals.

Assessment

Billing companies that provide coding services should maintain an up-to-date user-friendly index for coding policies and procedures to ensure that specific information can be readily located.

Similarly, for billing companies which provide coding services, the physician-executive and billing company should assure that essential coding materials are readily accessible to all coding staff.

Finally, billing companies should emphasize in their standards the importance of safeguarding the confidentiality of medical, financial and other personal information in their possession.

Channel Surfing the ME-P

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Accounting, Health Insurance, Health Law & Policy, Practice Management | 3 Comments »

The FDA and eMR Regulation?

Posted on March 1, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

One HIT Futurist’s Opinion

By Staff Reporters

A few years ago, Shahid N. Shah wrote that the FDA should be paying closer attention to healthcare IT systems and consider regulating those systems; in other words – regulating them the same as any other drug, medical device or foodstuff.

After all, some healthcare IT systems can kill just as easily as inappropriate medical care.

Link: http://www.healthcareguy.com/2010/02/24/thank-goodness-the-fda-could-start-regulating-healthcare-it-systems/

Our View

We agree that hospital IT systems and eMRs can, do, and will kill when not used or implemented properly.

And, it’s a shame that we may need the government to improve quality; but perhaps the fear of regulation will do the trick. In fact, we’ve also warned of similar adverse unintended consequences of eMRs and related HIT systems, previously on this ME-P.

Link: https://healthcarefinancials.wordpress.com/2009/12/23/will-electronic-records-raise-the-legal-standard-of-care-and-increase-malpractice-risk/#comments

About Shahid Shah

Shahid is CEO of Netspective, a Java/.NET consultancy that specializes in healthcare IT with an emphasis on e-health, EMRs, data integration, and legacy modernization. He is also a valued thought-leader for the ME-P, who will be contributing the HIT chapter for the third edition of our best selling book: www.BusinessofMedicalPractice.com to be released later this Spring.

Conclusion

And so, your thoughts and comments on this ME-Pare appreciated. Should eMRs be regulated by the FDA? Does the FDA need to put even more on its plate and has it done a good job until now? Do we really need more governmental intervention in healthcare?

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BLOG: www.MedicalExecutivePost.com
FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: "Doctors Only", Health Law & Policy, Information Technology, Op-Editorials, Practice Management | Tagged: david marcinko, EHRs, EMRs, FDA, healthcare information technology, HIT, Shahid Shaw, www.BusinesofMedicalPractice | 18 Comments »

Are You Prepared for a HIPAA Dental Audit?

Posted on February 26, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Why – or Why Not?

By D. Kellus Pruitt; DDS

If you are a dentist and pay ADA dues year after year to be kept better informed about protecting your patients as well as your practice, your ignorance of HIPAA is not entirely your fault. The ADA clearly dropped the ball. Nevertheless, you could still suffer fines as high as $1.5 million for what our leaders failed to emphasize.

It’s time members accept the shameful truth about the ADA Department of Dental Informatics, headed by Ms. Jean Narcisi. Narcisi, working under the direction of ADA Sr. Vice President Dr. John Luther, has been abysmally negligent in preparing members for HITECH HIPAA, and now the compliance deadline is only days away. It’s been months since any information about HIPAA has been published in any ADA publications. Why?

HIPAA Avoidance

Why do ADA leaders avoid discussing HIPAA? They are ashamed, not unlike embarrassed scam victims. About six years ago, Newt Gingrich visited ADA Headquarters and “lied” to ADA Delegates about the future of eHRs in the US. Then he bribed the ambitious career bureaucrats in the crowd with millions of dollars in federal grants to play along with the scam. I can only imagine that the Delegates must have been star-struck by the former Speaker of the House, because nobody dared asked the tough questions.

Newt’s Slick

So here I am, Ms. Jean Narcisi. I’m again doing your job because your mistakes I pointed out years ago now have you frozen in shame. If you disagree, and consider self-respect as something worth defending, let’s discuss your innocence in front of everyone – including the ADA members who pay your salary. Or, you can continue to hide from your responsibilities. This crap will catch up with you soon enough, Ms. Narcisi, and Dr. Luther no longer has the courage to stick his neck out to protect you. He’s also scared of me. You are alone.

Newsletters

Dom Nicastro, senior managing editor at HCPro, edits the Briefings on HIPAA and Health Information Compliance Insider newsletters. He posted an informative article on HealthLeadersMedia.com today titled “HIPAA Compliance Questions to Ask as HITECH Date Nears.”

http://www.healthleadersmedia.com/page-1/TEC-246514/HIPAA-Compliance-Questions-to-Ask-as-HITECH-Date-Nears

The article features Chris Apgar, CISSP, president, Apgar & Associates, LLC, in Portland, Oregon. Mr. Apgar notes that “many covered entities and business associates have consistently failed to comply with the HIPAA Security Rule.” Apgar adds, “I find this over and over when conducting compliance audits.”

The lack of compliance described by Apgar is consistent with the results from my study in 2008, “HIPAA Rules and Dentistry.”

https://medicalexecutivepost.com/wp-content/uploads/2008/08/hipaa-survey-dentists4.pdf

Study Abstract

A survey of 18 dentists was performed using the Internet as a platform. The volunteer dentists’ anonymity was guaranteed. The dentists were presented with ten HIPAA compliancy requirements followed by a series of questions concerning their compliancy as well as the importance of the requirements in dental practices.

The range of compliancy was found to be from 0% for the requirement of a written workstation policy to 88% for that of password security. The average was 49%, meaning that less than half of the requirements are being respected by the dentists in this sample.

Frustrated at Mandates

Frustration with the tenets of the mandate, as well as open defiance is evident by the written responses. In addition, it appears that a dentist’s likelihood of satisfying a requirement is related to the dentist’s perceived importance of the requirement. Even though this is a limited pilot study, there is convincing evidence that more thorough investigation concerning the cost and benefits of the requirements need to be performed before enforcement of the HIPAA mandate is considered for the nation’s dental practices.

Questions to Consider

Apgar says that the security rule requires covered entities to consider these questions:

Has a risk analysis been conducted lately? Was it properly documented? Were damages mitigated and were the risks acceptable?
Is privacy/security training current? Have new workforce members who will have access to personal health information (PHI) been adequately trained? Has refresher training for all staff been accomplished? Have security reminders been provided?
Are the office policies and procedures complete, current and enforceable? Are workforce members trained on the policies and procedures they are required to respect?
Has a comprehensive audit program been implemented? (The security rule requires three periodic audits and an “evaluation” or compliance audit). Are evaluations current? Have audit findings been addressed and documented?
Have up to date disaster recovery and emergency mode operations plans been communicated and recently tested?
Are CMS’ remote access guidelines being followed? (These are not part of the rule, but CMS earlier indicated remote access management would be included as audit criteria).
Are data in transit and data at rest encrypted? Are non-electronic PHI being protected?

Office of Civil Rights

Mr. Apgar adds that even though the Office of Civil Rights isn’t saying when audits will start, if a complaint is filed with OCR alleging ”willful neglect,” OCR is mandated by statute to investigate. The fines for “willful neglect” are much more devastating than fines for simple carelessness. And “willful neglect” is a subjective judgment call made by inspectors … who work on commission.

Assessment

Unfortunately for the nation’s dentists, the statute invites disgruntled patients and employees to celebrate revenge via federal inspectors. And, the more dentists are fined, the more the inspectors make. That can’t end well. Where are you hiding, Jean Narcisi? You’ve been silent far too long. Let’s talk. Don’t make me come get you.

Editor’s Note: The applicability of this post to all medical specialties is obvious.

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Filed under: Health Law & Policy, Information Technology, Practice Management | Tagged: ADA, Apgar & Associates, Chris Apgar, CISSP, CMS, Darrell Pruitt, Department of Dental Informatics, Dom Nicastro, Dr. Luther, EHRs, EMRs, HIPAA, HITECH, Jean Narcisi. Narcisi, Newt Gingrich, OCR, Office of Civil Rights, PHI, president | 14 Comments »

Dr. Mark Leavitt says “Trust me”

Posted on February 24, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

On eMRs – Just Go for IT

By Darrell K. Pruitt; DDS

Neil Versel, a frequent contributor to FierceEMR, posted an article titled “CCHIT’s Leavitt: Don’t wait for final rules to proceed with EHR.”

http://www.fierceemr.com/story/cchits-leavitt-dont-wait-final-rules-proceed-ehr/2010-02-18#comment-778

Half-Baked Ideas

Even though many states are spending eHR stimulus bucks as fast as they can on half-baked, expensive ideas that enrich HIT stakeholders, most physicians and most all dentists are delaying investing tens of thousands of dollars in HIT fantasy until HHS Secretary Kathleen Sebelius gets her act together. Sebelius is in way over her head. She hasn’t even settled on the definition of “meaningful use” for crying out loud.

Soon to Be Former CCHIT Leader

Foot-dragging upsets the soon to be former head of CCHIT Dr. Mark Leavitt. He says doctors should put caution aside and just go for it.

“We believe that it’s risky for providers to wait until all the federal rules are final. If you wait to purchase an eHR until the rules are final and the accreditation process for certifying bodies is complete, I will put my reputation on the line and say that you will not achieve meaningful use in 2011.”

Assessment

So, Dr. Leavitt, even as you are no longer wanted at CCHIT and are leaving in less than six weeks, you promise American doctors that your reputation is like (stimulus) money in the bank. Will you co-sign loan agreements? Talk is cheap, Dude.

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Filed under: Health Law & Policy, Information Technology, Practice Management | Tagged: CCHIT, Darrell Pruitt, EHRs, EMRs, FierceEMR, IT, Kathleen Sebelius, Mark Leavitt, Neil Versel | 6 Comments »

About PatientTrak

Posted on February 22, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

The Solution – Tomorrow’s Technology Today

By Staff Reporters

www.patienttrak.net was created in order to easily and affordably allow emergency departments and healthcare organizations track and monitor patients with a simple web browser. The design of PatientTrak.net makes registration and flow management user-configurable options suitable for most any healthcare department or organization.

Dry Erase Boards

With many healthcare organizations using “dry erase” boards, or no tracking system at all, a computerized patient tracking system provides a more accurate and complete picture of the organization’s patient flow. Some other tracking systems require large upfront investments, involvement of several IT personnel, and significant training needs. PatientTrak.net was designed to be a simple, inexpensive solution that serves the needs of the healthcare department.

A Vision of Simplicity

In the twenty-first century, healthcare organizations can no longer operate in an environment where the expected pay-pack period for IT projects is measured in years (elapsed period of time before the project’s benefits outweighs the costs). With changes in technology must come changes in the expected return-on-investment. The founder of PatientTrak.net believes that improvements in technology should make it easier and more cost effective to implement new systems, as shown in their Cost Comparison Report. These cost improvements should be recognized in all areas of the IT project, including contract negotiations, installation, system configuration, training, and period-end data analysis. This is the vision of PatientTrak.net.

The Inventor

Michael Buist MD, inventor of PatientTrack, experienced not one, but two near-death experiences due to medical errors. An internist in Australia, he went on to invent Patientrack, a program that reportedly improves the timeliness of doctors attending to their hospitalized patients.

Link: http://www.smh.com.au/articles/2002/04/21/1019233296613.html

Assessment

PatientTrak.net is reported to provide a high-level of product features, while still maintaining the simplicity that is fundamental in the initial design of the product. In addition to the hosted service provided by PatientTrak.net, the system can also be implemented on an in-house server for those who desire an internally hosted application.

Microsoft Health Tech

And so, we are pleased to be able to share information about Mike and PatientTrak on the newest episode of Microsoft Health Tech Today, the on-line video series at the intersection of health and information technology. The March program premiers on February 25^th 2010, and is hosted by Microsoft’s worldwide health senior director Bill Crounse MD.

Link: http://blogs.msdn.com/healthblog

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Filed under: Alerts Sign-Up, Career Development, Information Technology, Practice Management | Tagged: Bill Crounse, Health I.T., Michael Buist MD, Microsoft Health Tech Today, Microsogt, www.patienttrak.net | Leave a comment »

Sales of Dental Equipment and eDRs Down

Posted on February 20, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Peterson Dental Supply Reveals a Decline

By Darrell K. Pruitt; DDS

Yesterday, Kevin Henry posted “Dental news of the day for Thursday, Feb. 18” on the DentistryiQ Blog.

The source for the day’s dental news was a sales report provided by Patterson Dental Supply.

http://community.pennwelldentalgroup.com/profiles/blogs/dental-news-of-the-day-for

Soft Sales

“Sales of dental equipment and software declined 10% from the year-earlier level, which was consistent with Patterson’s forecast for this period.”

If one remembers the economy at the last of 2008, it is not difficult to understand why Patterson’s analysts forecast that sales of dental equipment would drop. But, how did they know that sales of Patterson EagleSoft, their clinical and practice management software would also fall by 10%? I find it interesting that their accurate prediction was made shortly after Patterson announced the release of EagleSoft Version 15.00 on October 10, 2008. That must have been discouraging to EagleSoft employees.

When is the last time you’ve heard of a company roll-out of a new version of software – expecting it to be even less successful the previous version? That’s interesting.

Health Policy and Politics

What makes Patterson’s valiant prediction of a decline in software sales even more remarkable is that a year ago, President-elect Barack Obama was giddy enthusiastic for digital health records, which includes Patterson’s EagleSoft. Not to say I told you so [maybe-a-little], but Patterson’s analysts obviously recognized what I did long before: Digital dental records are losing popularity among dentists. What’s more, none of my patients have ever said that they wish I had digital dental records. Dental patients simply do not desire them.

As a matter of fact, some have expressed relief that my paper records are more secure than anyone’s digital records. They also like not having to sign HIPAA forms – a meaningless waste of trees and appointment time.

Assessment

A year after Patterson privately admitted doubt about paperless dental practices, the slow-moving ADA House of Delegates met in Hawaii in October ‘09 and officially encouraged ADA members to adopt eDRs. Why doesn’t the American Dental Association know at least as much about dentistry as Patterson Dental?

This is an intriguing time in dental history. I can’t wait until the ADA opens up about their mistakes in dental informatics. One of these days we’ll all have a good laugh about their lame, expensive shenanigans.

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Filed under: Information Technology, Practice Management, Pruitt's Platform | Tagged: ADA, ADA Department of Dental Informatics, DDS, dental records, DentistryiQ Blog, EagleSoft, eDRs, EMRs, healthcare reform, HIPAA, Kevin Henry, obama, Patterson Dental Supply | 7 Comments »

Health 2.0 Empowers Patients – Worries Doctors

Posted on February 19, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Patient 2.0 Collaborative Care Worries Doctors

By Staff Reporters

Writing for Time, Bonnie Rochman digs into the ramifications of patients sharing information and tips online, an “empowerment movement” she calls “Patient 2.0.”

Society of Participatory Medicine

In the piece, she profiles the newly created Society for Participatory Medicine, which “encourages patients to learn as much as they can about their health and also helps doctors support patients on this data-intensive quest,” as well as PatientsLikeMe.com, a free service which makes its money by selling anonymized patient information.

Assessment

Link: http://www.healthjournalism.org/blog/2010/02/patient-20-empowers-patients-worries-doctors/

Our New Book

For more information, please visit our new companion blog for the: Business of Medical Practice [Transformational Health 2.0 Profit Maximizing Skills for Savvy Doctors] – third edition.

Link: www.BusinessofMedicalPractice.com

Conclusion

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Filed under: "Doctors Only", Ethics, Practice Management, Recommended Books | Tagged: Bonnie Rochman, Business of Medical Practice, collaborative care, health 2.0, patient 2.0, Society of Participatory Medicine | 6 Comments »

HealthyMagination and Direct to Consumer [D2C] eMRs?

Posted on February 17, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

About HealthyMagination.com from GE

By Staff Reporters

Just imagine … the broadcast TV or radio commercial fades in, as the announcer says:

“Almost everyone wants to make healthier choices, but they don’t always know how. The amount of information available on wellness, nutrition and exercise is overwhelming, to say the least. Even when we do know how to improve our health, we often try to make sweeping changes or set goals that seem too daunting to reach.”

What it is

Healthymagination, from General Electric, is a consumer directed internet site, with new D2C TV commercial about becoming healthier, through the sharing of imaginative ideas and proven solutions. It goes beyond innovations in the fields of technology and medicine, celebrating the people behind these advancements.

Seeking to build stronger relationships between patients and doctors, GE created healthymagination to gather, share and discuss healthy ideas and illustrative stories.

Story link: http://www.healthymagination.com/stories/

Participatory Projects for Patients

Because healthymagination is about becoming healthier together, it takes the form of multiple projects that patients can participate in, whether they are looking to change a lifestyle or fine-tune an approach to health.

According to GE, making healthy decisions should be easy … and fun.

Link: http://www.healthymagination.com/projects/

Info and Video for Doctors

There is also a portal for medical professionals, promoting GE eMRs, of course.

Link: http://www.ge.com/innovation/emr/index.html

Due Diligence RFP

And, good preliminary questions for all physicians to ask any eMR vendor are:

What is the cost per physician license?
Do you have any existing clients in our specialty?
Does your system come pre-loaded with templates for my specialty?
Is your company the developers of the software or is it re-branded from another vendor?
Is your system client/server based or ASP based?
Does your system include practice management software?
How many clients does your company have?
Is your system HL7 compliant?
How long has your company been in business?
Is your development done overseas?
Is support done overseas?
Is your software CCHIT certified? If not, why?
How often is the software updated?

Assessment

Let us hope that the health 2.0 participatory patient of the future doesn’t select a physician based on the proprietary eMRs s/he uses, as seen on a television commercial, much like the D2C [direct-to-consumer] pharmaceutical industry of today.

IOW: Will that be Allscripts, Cerner or GE, etc? Or, listen to narrator and actor Morgan Freeman intone on a TV spot: “Ask your doctor if XYZ electronic medical records are right for you.”

Conclusion

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Filed under: Drugs and Pharma, Information Technology, Practice Management | Tagged: Allscripts, ASP, CCHIT, Cerner, D2C, DTC, EHRs, EMRs, GE, health 2.0, HL7, www.HealthyMagination.com | 4 Comments »

Seeking your Medical Practice Management [Horror] Story

Posted on February 11, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Help us Find a Case Report Learning Experience

By Ann Miller; RN, MHA

We at the ME-P have been reporting for the past four years on the troubles in which medical professionals often find themselves while running a private medical practice. It’s difficult for doctors to stay abreast of the healthcare industrial complex, or always select the right consultants. And, it’s often more difficult – once consultants are retained – to have expectations met or exceeded.

Often, it is a matter of not knowing, what you don’t know.

Difficult Doctor Clients

And, it is true that doctors make difficult clients in some instances. This occurs because some are desperate for practice enhancement solutions, but don’t know where to turn for help? Others, may have had a prior negative experienced with a business consultant, or management guru, more interested in their bottom line than the doctor’s success?

Assessment

Read this Federal Government report to learn what can happen when your consultant is not an informed medical management practitioner. Although almost a decade old, its’ premise is still fresh today [ie., buyer beware]!

Full Article: http://oig.hhs.gov/fraud/docs/alertsandbulletins/consultants.pdf

Call to Action

To illustrate the problem, we’re looking to shine a light on the [un] lucky doctor who has dealt with poor managerial advice from a consultant, or had a bad experience with one. Give us the gory details and journalistic 5Ws of your ordeal so that others may learn. You may be named, or remain anonymous, as you wish.

Submissions

Please submit your best [worst] case study exprience to me at: MarcinkoAdvisors@msn.com If appropriate, we will publish in an upcoming edition of the ME-P, so that we might all humbly learn from you.

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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Filed under: "Doctors Only", Career Development, Practice Management, Research & Development | Tagged: david marcinko, medical management consultants, medical practice management, Practice Management, www.certifiedmedicalplanner.com | Leave a comment »

About Medical Clinical IT Groupware

Posted on February 9, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

What it is – how it works

By Staff Reporters

According to Bill Crounse MD of Microsoft,

clinical medical groupware is a new and evolving model for the development and deployment of health IT platforms and applications, the characteristics of which include use of the Internet and the Web as a platform, explicit design for health data exchange and online communication among providers and patients/consumers, a modular or component architecture upon which applications can be aggregated to meet specific clinical and workflow tasks; while allowing interface standards and protocols for data exchange to emerge in a market-driven manner.

Distribution Platforms

Clinical medical groupware applications can be distributed as software-as-as-service, and are intended to support today’s mobile health care environment by supplying the right information, at the right time and the right place.

Link: http://blogs.msdn.com/healthblog/archive/2009/09/14/learn-more-about-clinical-groupware.aspx

Assessments

Advocates of the clinical medical groupware approach are not limited to software developers and technologists, but also include practicing physicians, executives and managers from health care provider organizations and care management companies, patient advocates, and leaders in life sciences, home monitoring, and medical device manufacturing firms.

Conclusion

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Filed under: Information Technology, Op-Editorials, Practice Management | Tagged: ARRA, Bill Crounse, clinical medical groupware, Health I.T., HI-TECH, HIT, SaaS | Leave a comment »

On the Elimination of Medicare Consultation Codes

Posted on February 8, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Is it Budget Neutral?

By Brian J. Knabe MD, CFP, CMP

http://www.CertifiedMedicalPlanner.org

The New Year 2010 has brought some changes in the Medicare Physicians Fee Schedule. For many specialists, the most significant change is the elimination of consultation codes, 99241-99245 in the outpatient setting and 99251-99255 for inpatient care. Physicians can still provide consultations and bill for these services – using codes for routine new or established patient visits (99201-99205 and 99211-99215).

Reported Revenue Neutrality

It has been reported that this change has been made in a revenue neutral manner. Reimbursement for all E/M codes has been increased in order to make up for the removal of consultation codes. The increase is approximately 6% in the outpatient setting and about 2% for inpatient codes.

Of Averages and Outliers

The result of these changes might be revenue neutral overall, but the outlier effect on many specialties and individual physicians can be significant. Specialists who obtain most of their income from procedures will see less of an effect on their income. This includes dermatologists, surgeons, and gastroenterologists. Less procedurally-oriented specialists, particularly those who rely upon Medicare as a primary payor, are seeing the most significant effect. For example, neurologists and hematologists will likely see double-digit declines in revenue.

Private Payers

While private payers have not yet adopted these changes, billing codes must be adjusted when filing a claim with a commercial insurer when Medicare is the secondary insurer. If a consultation code is used in these instances, the primary payer will pay their portion of the bill, but Medicare will deny secondary coverage. There is no indication yet that commercial insurers are dropping the consultation codes altogether, but if history is any indication, they will likely eventually follow the lead of Medicare.

Assessment

Physicians can take certain measures to decrease the impact of these changes on their revenue stream. It is increasingly important to understand how the complexity of a patient visit affects the appropriate level to be billed. Prolonged service codes are also available (99356 and 99357) to enable physicians to bill appropriately for more complex and time-consuming evaluations.

Conclusion

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Dictionary of Health Economics and Finance
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Dictionary of Health Insurance and Managed Care

Product Details

Filed under: Health Insurance, Health Law & Policy, Practice Management | Tagged: brian knabe, CPT codes, EM codes, medical billing codes, medicare, physician fee schedules | 5 Comments »

Access Management in the Hospital Check-In and Admissions Setting

Posted on February 5, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

The Role of Operational Activity Based Cost Management

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

www.HealthcareFinancials.com

In order to be paid and maintain cash flow, hospitals and clinics set up levels of specialization. The result is usually more handoffs, delays, eroding financial positions, and a frustrated set of patients and physicians. Much seems out of control. When you factor in the maze of Health Insurance Portability and Accountability Act (HIPAA) technologies, it becomes overwhelming. Now, consider these operational inefficiencies in light of Obama Care?

Access Management

At the hub of the patient hospital or clinic experience is admitting or registration. This department collects information for clinicians treating the patient, meets Joint Commission standards and other requirements, facilitates medical record documentation, patient flow, revenue capture, billing and collections, and ultimately begins to settle accounts. The access management area has numerous customers in addition to the doctor, patient, or family member sitting across from them.

Increasing HR Complexity

Without the benefit of relevant information, managers attempt to staff access management departments based on past history — namely, if patient and physician complaints are not too high, there is probably enough staff. However, staffing in access management has not kept up with the increased demands and complexity of the process, and other hospital areas often suffer. Clinicians and medical records personnel must often deal with incomplete or incorrect information, and take up the slack.

Beware Un-Happy Stakeholders

All of these deficits make for an unhappy set of customers (physicians and patients) as they continually live with the repercussions of inaccurate and incomplete information. This does not go unnoticed by patients and physicians, as these situations erode confidence in the hospital’s ability to get things done correctly.

Emotional Touch Points

Access Management is the clinic or hospital’s first chance to create an “emotional contract” with the customer. It is here that the tone is set for the patient on the issues with respect to his or her hospitalization. And it is here that the provider has the chance to begin working on the patient’s behalf so that clinical outcomes are appropriate. All of this must happen in an environment that minimizes the likelihood of an unfavorable occurrence, and outside the realm of the complex legal requirements established by state and federal officials.

Tips from the Manufacturing Sector

So why are there unresolved issues in the access management area? In a manufacturing environment, if there are problems on the front-end design, huge problems ripple downstream in terms of recalls, warranty-related expenses, lawsuits, and customers that abandon the company’s products. world -class manufacturers dealt with these issues with their ISO-9000, Total Quality Management (TQM), and Six Sigma programs during the ’80s and ’90s. Hospitals, however, have allowed issues in their access management process to fester and create huge and costly problems in the downstream process.

Assessment

In an effort to help solve access management issues, every provider must take a proactive role in dealing with the trend. The first step in this journey is healthcare administrator and physician-executive assessment.

This assessment is not a management engineering set of time studies aimed at micro-costing every second of work. The critical path information needed for this plan is reasonable and collected in a few days by talking to the people performing the work. Estimates are gathered based on workers’ views about how they spend their time. This information is combined with available workload measures and general ledger cost information, and activity-based reports are produced.

Conclusion

Going forward, ABCM it is an exercise in operational planning. Activity-based information is used to look at areas where work can be restructured so errors and rework can be eliminated. New technologies that target problematic activities are selected and implemented. Outside companies that can perform complex activities more economically can be used (e.g., www.ICMS.net).

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Filed under: CMP Program, iMBA, Inc., Practice Management | Tagged: ABC, access management, Dr. Marcinko, HIPAA, hospital admissions, HR, ISO, Joint Commission, Six Sigma, TQM, www.healthcarefinancials.com, www.medicalbusinessadvisors.com | 2 Comments »

Off Road Touring in Boston with Dr. Marcinko

Posted on December 31, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

How Doctors Get Paid

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Just before the Christmas Holidays, I flew up to Boston at the invitation of a pharmaceutical company to lead a managerial workshop entitled: “How Doctors Get Paid” [Treatment is only the beginning in the Changing Billing and Medical Reimbursement Climate].

Our goal was to inform drug representatives, and their regional managers, what value added information physician offices might expect from the pharmaceutical industry of the future.

Topics of Discussion

The two hour interactive workshop included team projects, flip chart exercises, a mock role-playing session and the customary [hopefully energetic] ppt presentation. Other topics of discussion included:

Health insurance payment evolution
Collapse of Medicare
Rise of managed care
Medical records documentation
ICD-9 and 10, HCPCS, DRGs and CPT® coding
ABNs, super-bills and HCFA 150 forms
Billing methodologies
Healthcare fraud, abuse and related policies
Capitation, HSAs, concierge medicine and RACs
Futuristic health 2.0 payment mechanisms, and more.

Assessment

Rest assured; these folks were a very knowledgeable and aggressive group; not like your father’s “detail men” of yore! They seek to … talk the talk, and walk the walk, of the Health 2.0 era.

Many thanks again to Helen, and Jon D, for the invite.

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Filed under: "Doctors Only", Drugs and Pharma, Health Economics, Managed Care, Media Mentions and PR, Practice Management, Sponsors, Touring with Marcinko | Tagged: ABNs, concierge medicine, CPT codes, HCFA 1500, health abuse, health fraud, HSA, ICD-10, ICD-9, Managed Care, medicare, super bill | 3 Comments »

Defining “Provider” for Medicare Incentive Payments?

Posted on December 29, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Ask a Medical Practice Management Advisor

Staff Reporters

HR 1 of ARRA states:

“The term ‘health care provider’ includes a hospital, skilled nursing facility, nursing facility, home health entity or other long term care facility, health care clinic, community mental health center (as defined in section 1913(b)(1)), renal dialysis facility, blood center, ambulatory surgical center described in section 1833(i) of the Social Security Act, emergency medical services provider, Federally qualified health center, group practice, a pharmacist, a pharmacy, a laboratory, a physician (as defined in section 1861(r) of the Social Security Act), a practitioner (as described in section 1842(b)(18)(C) of the Social Security Act).”

For Ambulatory Surgery Center’s

HR 1 of ARRA includes ASCs in the definition of “provider” (see above), but the CMS seems to indicate otherwise CMS’s site.

For Pharmacists

HR 1 of ARRA includes pharmacists and pharmacies as “providers.” New information on phamacists’ eligibility for IT loans was recently announced – see the Healthcare IT News coverage on this.

Assessment

What was missed; please advise?

Conclusion

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Filed under: "Ask-an-Advisor", Health Law & Policy, Information Technology, Practice Management | Tagged: ARRA, HITECH, MC, medicare, Social security act | 1 Comment »

To Par or Not to Par? [The Critical Question for 2010]

Posted on December 15, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

About the Medicare HIT 1115 Project

By Ann Miller; RN, MHA

[Executive-Director]

At least one iconoclastic physician, ME-P thought-leader Al Borges MD, has asked that all doctors unite and participate in this year’s Medicare “HIT 1115 Project”; now in-process.

The November 15, 2009 Project

November 15, 2009 began the 6-week time period during which all medical providers can switch Medicare participation. If all physicians become “non-participating” or simply “opt-out,” then lawmakers and their lobbyists may take notice that doctors are fed-up with government intrusion into physician affairs!

Assessment

More: http://www.hcplive.com/technology/blogs/The_HIT_Realist/1269/HIT_1115_project

Cast Your Ballot – Send a Messsage

After reading the above op-ed piece, and a month into the project, please cast your VOTE:

About Dr. Borges

Alberto Borges, MD, is in private practice and is an assistant clinical professor of medicine at The George Washington University School of Medicine and Health Sciences in Washington, DC.

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Filed under: Breaking News, Career Development, Information Technology, Practice Management, Surveys and Voting, Voting Polls | Tagged: Alberto Borges MD, medicare, Non-Par, Par | 2 Comments »

Should Specialists Staff Medical Homes, etc?

Posted on December 14, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Are they Even Needed?

[By Staff Reporters]

In an op-ed piece originally published in HCPLive.com, by Alan Berkenwald MD, the approaching fire storm over the “patient-centered medical home” model reminds us of the destructive powers seen with some early restrictive HMO models.

Enter – Exit – ReEnter the Gatekeepers

Once seemingly destined to revolutionize organized medicine, and empower patients and primary care physicians, the HMO model of “gatekeepers” nearly destroyed it.

Assessment

And so, can we learn from past failures with this new medical home model? Or, are they even needed?

Related posts from Kevin Pho MD:

Conclusion

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Filed under: "Doctors Only", Career Development, Managed Care, Op-Editorials, Practice Management | Tagged: David Kibbe, medical homes | 8 Comments »

Understanding Medical Billing Methodologies

Posted on December 10, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The Cash Conversion Cycle

[By Staff Reporters]

Most patients and financial advisors don’t have a clue about how doctor’s get paid in our current system; but it’s not by magic. Yet, a number of different steps occur during the processing of a medical claim that can be seen in a flow chart. Each step in the process can be mapped out and each is subject to claim payment-or-claim rejection. A payment time line for a typical FFS or PPO can also be subjected to a number of variables, depending on different factors including staff competency, time, outside vendors, information management, management decisions in general, or regulatory requirements. The total transit times may take weeks for electronic claims or up to two-years for some paper based claims.

First Make the Diagnosis

• ICD-9 alpha numeric code for disease classes, not billing.

• HHS offers ICD-9 [CM] for MDs and facilities.

• WHO-1900, updated every 3-10 years, e-ICD-10 [2013].

• Diagnostic Statistical Manual Mental Disorders, 4th Edition [DSM-IV].

Then Select the Current Procedure Terminology® Code

Medical, surgical and diagnostic task & service billing code numbers [5-digit] of AMA used by payers:

• Thousands updated annually

• Secretive with registered mark ®

• Office Visits: [brief, inter, extended, etc]

• # 99214 physical exam

• # 90658 H1N1 flu shot

• # 12002 one-inch laceration suture

• CDT® and HCPCS codes, too!

Document the Visit in Patient Progress Notes

Subjective:

“I was gardening and noticed my wrist was swollen and itched like crazy”

Objective:

A 4 inch linear red rash with circular oozing papules and swollen skin is present. Patient is wearing a small tennis bracelet which was tight.

Assessment:

Rule out rues dermatitidis versus nickel allergy.

Plan:

Soap soaks, with OTC calamine lotion with Rx oral diphenhydramine or [benadryl].

Submit the “Super Bill”

Not a “big bill” or expensive medical invoice; just an invoice

• Official standard billing form used by doctors submitting MC/MD claims.

• Also used by some private insurers and managed care plans.

• Contains patient demographics, diagnostic codes, CPT®, HCPC codes, etc.

• Generic billing form, like the generic HCFA 1500 claim form.

Conclusion

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Filed under: Accounting, Health Economics, Practice Management | Tagged: AMA, CDT, CMS, CPT, HCFA 1500, HCPCS, HHS, ICD-9, medical billing, medical coding, WHO | 4 Comments »

Physicians Seeking Financial Support from Hospitals

Posted on December 9, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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

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Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Health Economics, Monthly Reports, Practice Management | Tagged: AHA, American Hospital Association | 2 Comments »

Diagnostic and Statistical Manual of Mental Disorders

Posted on November 29, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Coding Classification

By Staff Reporters

The classification and coding systems used by mental health insurers both diagnosis-related groups (DRGs) and current procedural terminology (CPT®) are still being defined through historical methodologies and are vague compared to the medical classification coding structure.

As an example, mental health insurers classify Tourette Syndrome (TS) as a “mental disorder.” In fact, TS is an inherited, neurobiological disorder, and both neurologists and psychiatrists treat TS with the same medications. If TS were reclassified under the medical coding structure, TS would not only receive potentially a better reimbursement but public perception of TS as a “mental disorder” would be changed.

The DSM-IV

The Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision), also known as the DSM-IV-TR, is a manual published by the American Psychiatric Association (APA) that includes all currently recognized mental health disorders. The coding system utilized by the DSM-IV is designed to correspond with codes from the International Classification of Diseases, commonly referred to as the ICD. Since early versions of the DSM did not correspond with ICD codes and updates of the publications for the ICD and the DSM are not simultaneous, some distinctions in the coding systems may still be present.

Assessment

For this reason, it is recommended that users of these manuals consult the appropriate reference when accessing diagnostic codes. For more information, contact the APA at (800) 368-5777.

Link: www.HealthcareFinancials.com

Conclusion

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Filed under: Career Development, Health Insurance, Healthcare Finance, Information Technology, Practice Management | Tagged: American Psychiatric Association, APA, billing codes, CPT, Diagnostic and Statistical Manual of Mental Disorders, DRG, DSM, DSM-IV, ICD, mental disorders, mental health | 1 Comment »

Recovery Asset Contractor Survey Poll

Posted on November 17, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

RAC RESULTS TO-DATE [Beta]

By Staff Reporters

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:

Connolly Consulting
PRG-Schultz
HealthDataInsights
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

Filed under: Ethics, Health Economics, Monthly Reports, Practice Management, Professional Liability, Quality Initiatives, Surveys and Voting | Tagged: CMS, CMS over-payments, CMS under-payments, Connolly, HealthDataINsights, PRG-Schulz, RAC, Recovery Asset Contractor | 19 Comments »

About the PriceDoc Patient Opportunity

Posted on November 17, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Increasing Health 2.0 Financial Transparency

By Staff Reporters

www.PriceDoc.com is a free online service that empowers consumers to take control of their healthcare costs. PriceDoc allows patients to search for medical providers in their local area and compare fee schedules for specific procedures.

Assessment

With PriceDoc, healthcare providers are able to post their discounts in exchange for cash or credit card payment. The result is access to affordable healthcare for those with no insurance, high deductibles health plans or those seeking elective procedures.

Conclusion

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Filed under: Career Development, Healthcare Finance, Information Technology, Practice Management | Tagged: cash based medicine, fee schedules, HDHCP, healthcare pricing, high deductible health plans, PriceDoc.com, private pay | 2 Comments »

Don’t Hide a Security Breach if You Can’t Do the Time

Posted on November 15, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

When Will Costs Outweigh Health Information Technololgy?

[By Darrell K. Pruitt; DDS]

At what point will security data breaches become so costly that dentists will abandon computerization and return to pegboards and ledger cards?

Senate Judiciary Committee

A week ago, the Senate Judiciary Committee approved two separate bills which would mandate that dentists who store digital PHI notify patients if their data is breached. Of course, that would be the ethical thing to do anyway, wouldn’t it?

Senate Bill 139, also known as the Data Breach Notification Act, was introduced by Dianne Feinstein of California and is similar to existing state notification bills – including California’s own landmark Bill 1386 which set the standard 7 years ago.

Two Hundred Ten Dollars Cost – Per Record – for Notification

Considering that in October, the Ponemon Institute reported that it costs an estimated $210 per record to notify patients of a breach, there are a lot of angry lawmakers who are missing the point. Mandated fines for a breach are meaningless. Simply notifying thousands of patients of a breach will bankrupt any dental practice, even if it is an insurance company employee who loses a laptop computer containing a dentists’ patients’ personal data – like a BCBS employee did recently with over 800,000 physicians’ personal information.

Personal Data Privacy and Security Act

Even now, a dentist whose practice is a victim of a breach, whether it is from stolen computer, hacker or dishonest employee, might take a quick look at the notification path to certain bankruptcy and gamble that patients’ data won’t be used before hiding the incident. That is why Senator Patrick Leahy of Vermont has sponsored the other breach bill which reflects the prevailing attitude of frustrated constituents throughout the nation. It is known as the Personal Data Privacy and Security Act.

Leahy is more concerned with punishment than with breaches themselves. In addition to a fine, he would establish a jail term of up to five years for failing to disclose a breach when required.

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:s1490is.txt.pdf

§ 1041. Concealment of security breaches involving sensitive personally identifiable information

‘‘Whoever, having knowledge of a security breach and of the obligation to provide notice of such breach to individuals under title III of the Personal Data Privacy and Security Act of 2009, and having not otherwise qualified for an exemption from providing notice under section 312 of such Act, intentionally and willfully conceals the fact of such security breach and which breach causes economic damage to 1 or more persons, shall be fined under this title or imprisoned not more than 5 years, or both.”

If dentists want to continue to use computers in their practices, Leahy would have them put serious skin into the game. The bill was read twice and referred to the Committee on the Judiciary.

On the ADA Advocacy page, dental leaders still maintain that electronic dental records will lower the cost of dentistry. And as recently as last month, the ADA House of Delegates again publicly endorsed the adoption of eDRs, yet still neglect to adequately warn ADA members of their dangers, now including possible imprisonment.

Assessment

ADA President Dr. Ron Tankersley is already irrelevant.

Conclusion

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Filed under: Health Law & Policy, Information Technology, Practice Management, Pruitt's Platform | Tagged: ADA, Darrell Pruitt, Data Breach Notification Act, dentists, Dianne Feinstein, EHRs, EMRs, HIPAA, Patrick Leahy, Personal Data Privacy and Security Act, PHI, Ponemon Institute, Ron Tankersley, Senate Bill 139 | 13 Comments »

Don’t Tread on Me – Obama

Posted on November 12, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Bite Me – CMS

[By D. Kellus Pruitt; DDS]

Shy but proud Texas Dental Association leaders still direct employees to encourage members to volunteer for permanent, mandated National Provider Identifier numbers. Why? “Just ‘cause.”

As part of an agreement the TDA made with the state to help politicians out of a lawsuit they brought upon themselves for not providing adequate dental care for the poor in the state, TDA leaders followed someone’s bad advice to encourage Texas dentists to accept CHIP (Medicaid) – which requires dentists to have arbitrary 10 digit NPI numbers to participate.

Don’t get me wrong. I have the highest respect for dentists who treat the poor for pay that doesn’t even cover overhead. That is compassion to a fault – even before CMS investigators arrive with subpoenas based on vague, nuisance complaints from disappointed patients, disgruntled employees and hungry competitors. Getting even with rich, greedy, or otherwise mouthy dentists has never been easier because I’ve heard that CMS intends to investigate all complaints.

Yes, low pay is only part of the nasty package that TDA officials are officially discouraged from discussing with membership – even as they beg for us to sign up for CHIP and “do our part to return our debt to society by helping those who cannot care for themselves.” So who would dare question the reason for the faux sentiment expressed by a long string of TDA Presidents? That would be me.

There are simply so many other charitable ways of publicly and privately returning help to the community that don’t add to the risk of donating one’s skill. Even if one does not help local free clinics, how hard can it be to quietly give away care, Doc, in these hard times? It’s just between you and God anyway, isn’t it? One simply enters N/C in the fee column. Confidentially I sometimes get hugs that so far can be neither controlled nor taxed.

It appears to me that CMS is arguably more influential with TDA leaders than common TDA members like me. If I am correct, this means that dentistry is at risk of being overrun by authoritarian bureaucrats hired by ambitious politicians who often promise more than they can deliver before ducking accountability for earthly bad decisions. The business model even reminds me of the TDA’s.

So now that the TDA played its hand with regard to its fondness for BCBSTX and the NPI number, what does it mean for Texas dentists if Obama’s imminent “Public Plan Option” turns into “Medicaid for All” – as some naively hope and others justifiably fear? This week, the AMA gave its support to the Public Option. Will the ADA be next?

Dentistry unhurried is value-added service. One cannot get rich at it, but it’s an honorable living.

Regardless of whether you approve of my tactless vitriol or not, I have to say that when it comes down to feeding my family, even this special bastard could be silenced if there is no longer a market on the east side of Fort Worth for dentistry unhurried. Especially if it meant a monthly visit by CMS inspectors like Dr. Annie Bukacek is going through right now. Like me, she also gives her patients the time they deserve. But unlike me, she doesn’t have time to pick fights with shy bullies who hide behind employees.

I’ll get to the physician’s story in a moment. But first, just how important are secrets to the leaders of the nation’s preeminent non-profit dental organization? It’s important enough that many in the ADA House of Delegates want the power to mete out punishment to fellow officers who cannot keep their mouths shut. Some of those we elected even want to make the sanctions retroactive to deal with colleagues who have already broken the traditional unwritten good ol’ boy code of stoic conduct. At the same time, the TDA is begging dentists in the state to run for ADA office – starting on the local level. Why do you think dentists in Texas don’t want to get involved? Nobody accepts delivery from the cluetrain in Austin. It probably stops there at least a couple of times each week day.

I copied below three of the ADA Delegates’ referred resolutions from Judy Jakush’s November 2 ADANews article, “Delegates vote on Association business matters,”

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3821

1] Res. 70 states that if any member of the ADA, including delegation member, council, committee or task force member, or Board of Trustees member has been acknowledged as breaking the attorney-client privilege or executive session, that member is, at a minimum, barred from ever again participating in an attorney-client or executive session within the ADA. This shall include such acts which have been acknowledged as occurring prior to the enactment of this resolution.

2] Res. 67 would specify that candidates for elective or appointive officers may not have had any sanctions bestowed upon them by the Association. Also referred was Res. 67RC, which would direct that anyone found by the Committee on Credentials, Rules and Order to have violated his or her duties to the Association would be disqualified from holding elective or appointive office.

3] Res. 68 was referred to the Council on Ethics, Bylaws and Judicial Affairs for report to the 2010 House with recommendations for Bylaws changes. The proposal calls for CEBJA to review the Bylaws and craft language that would define the mechanism for sanctions up to and including removal from office of a delegation member or Board of Trustee member if there is found to be cause for removal as shall be defined. That cause, at a minimum, should include those causes as delineated currently for council members. Res. 68 also calls for a method for fair and impartial hearings to be recommended and the establishment of an authorized House committee that can be held on an ad interim basis between annual sessions of the House of Delegates with authority to determine and impose any such sanctions deemed appropriate.

Remember, the ADA is a non-profit, professional organization whose only purpose for existence is to serve dental patients through dentist members who support it with dues. When one reads these and other resolutions in Jakush’s article, it looks like ADA President Dr. Ron Tankersley is running the Pentagon. We’re only dentists for crying out loud!

Dr. Annie Bukacek’s 6-month battle with CMS

This morning I read what has turned out to be a popular article titled “Investigators descend on doctor,” written by Candace Chase, writing for the Daily Inter Lake which serves northwest Montana.

http://www.dailyinterlake.com/news/local_montana/article_d8cde54e-cc2d-11de-9ddd-001cc4c03286.html

“Dr. Annie Bukacek of Hosanna Health Care in Kalispell was surprised when a 30- to 40-foot-long command-post vehicle pulled up unannounced last week, along with a posse of state and federal health-care fraud investigators.”

“Bukacek points out that anyone – a disgruntled ex-employee or patient or someone who doesn’t like a physician’s looks or politics – could trigger an investigation and cost a physician as well as the government thousands of dollars.”

I wonder what would happen if a dentist openly taunts CMS leaders? As I previously mentioned, it is Dr. Bukacek who claims, “They said they have to followup every allegation made.”

When all American dentists are required to volunteer for NPI numbers and can no longer be legally paid in cash at the time of service, we’ll all be hung by an ADA-approved mistake of historic proportions. I suggest that ADA members take time right now to jot down names so that when judgment day inevitably arrives, one will be prepared to hold accountable the ADA employees who recommended the numbers. After reading how ADA leaders are hunkering down, it looks like going through employees will probably be the only way to touch the bosses they bravely try to shield.

Oh yeah. I posted the 5^th of almost 30 comments that so far follow Candace Chase’s provocative article:

“Dr. Annie Bukacek’s experience is why as a US citizen in the land of the free, I simply refuse to do business with the US government. Bite me, CMS. Did you hear me? I said bite me!”

Assessment

It’s not likely that I’ll regret those words because I am powerless to stop myself from typing them anyway.

Conclusion

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HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
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FINANCE:Financial Planning for Physicians and Advisors
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Filed under: "Doctors Only", Career Development, Health Insurance, Managed Care, Practice Management, Pruitt's Platform | Tagged: ADA, AMA, Annie Bukacek, BCBSTX, Candace Chase, CEBJA, CHIP, CMS, Darrell Pruitt, Hosanna Health Care Kalispell, Judy Jakush, National Provider Identification number, NPI, Ron Tankersley, Texas Dental Association | 2 Comments »

About Carena In-Home Medical Care

Posted on November 10, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

In-Home Medical Care Services for the Modern Era

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

We have written about the high cost, questionable quality and scheduling burden of emergency room visits on the Medical Executive-Post before. And, for some non-emergency or after-hours needs, the ER may possibly be one of the worst places to deliver medical care.

Enter Carena, Inc

Seattle-based Carena Inc. was founded in 2000 on the principle that expanding access to medical care improves outcomes and reduces costs. By providing around-the-clock medical care and education at a patient-identified time of need, Carena patients, clients and health plans are reported to experience lower costs while patients receive the right care – at the right time [www.CarenaMD.com].

A New [Old] Business Model

Carena is not an emergency room, not an urgent care center and not someplace patients go. This medical group delivers 24/7 house-calls both to render care and provide education for urgent medical needs.

House calls last as long as needed—often an hour—to make sure patients have the care and education needed to take control of their health.

The Carena model also offers medical care at the workplace enabling corporate clients to offer on-site care without the cost and space requirements of a typical employer-sponsored health clinic.

Home Visits in the Modern Era

Carena medical group physicians treat a wide range of urgent concerns. They carry an updated version of the traditional “doctor bag” filled with state-of-the art and portable instruments. For example, physicians have the equipment to suture minor cuts, deliver nebulizer treatments for asthma, or obtain lab samples. They run in-home rapid diagnostic tests for influenza, strep throat, and other medical issues. If X-rays or tests are needed, physicians coordinate scheduling and share results with patient PCPs. Electronic medical records are used throughout.

Always Open 24/7

Carena is always open. No waiting in the ER while doctors treat true emergencies. No wondering if other waiting patients are contagious.

Reduced Financial Shock.

Carena house calls are reported to costs about 30-35 percent less than a typical emergency room visit of about $1,500.

Another New Term

With apologies to my esteemed colleague Robert M. Wachter MD, the hospitalist guru at UCFS, Carena doctors are often called “housepitlists.”

Assessment

Carena is a medical company that provides a new model of health care delivery for innovative, self-insured companies. Internist Frances Gough MD is the Vice President of Product Development at Carena, Ted Conklin MD is the founder and Ralph C. Derrickson is President and CEO. Corporate clients for both Carena business models are Costco and the Microsoft Corporation of Redmond, WA.

Disclaimer

I own shares of MSFT common stock and am a professional member of MS-HUG.

Conclusion

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

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Filed under: Career Development, Health Economics, Health Insurance, Managed Care, Practice Management, Research & Development | Tagged: Carena, Dr. Marcinko, emergency room, ER, house calls, housepitalist, in home medical care, PCP, Robert Wachter | 1 Comment »

A New Remote Patient Monitoring Device

Posted on November 8, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The Next Step in RPM Solutions

[By Staff Reporters]

Long-term medical conditions create many challenges—for patients who have them, as well as for their attending physicians. This gadget reports to address those challenges

What it Is

The Intel® Health Guide is a comprehensive, next-generation remote patient monitoring (RPM) solution that combines an in-home patient device [the Intel Health Guide PHS6000] with the Intel® Health Care Management Suite; an online interface that allows clinicians to monitor patients and remotely manage care.

Reported Benefits

The benefits of the Intel Health Guide include patients who feel empowered to take a more active and positive role in their own care. For doctors, it enables more informed and personalized care—which may lead to better patient satisfaction. And it helps healthcare organizations to face the challenges of chronic care, increase efficiency, and achieve organizational objectives.

Assessment

In short, Intel® technology hopes to fulfill the promise of RPM, where interactive, data-rich telehealth helps to create timely, personalized and cost-effective care.

Disclaimer

The Intel® Health Guide requires an internet connection to enable communications with the patient’s care team and back-end data hosting. The Intel Health Guide is intended for use by patients under the guidance of a healthcare professional and is not intended for emergency medical communications or real-time patient monitoring.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

***

Filed under: "Doctors Only", Health Economics, Information Technology, Practice Management | Tagged: Intel, Intel Health Guide, remote patient monitoring | 1 Comment »

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