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Update on HIPAA Administrative Simplification

Posted on November 6, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

New Enforcement Rules

Federal Register: October 30, 2009 [Volume 74, Number 209]

Rules and Regulations – Page 56123-56131

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

DOCID: fr30oc09-12

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Office of the Secretary

45 CFR Part-160 [RIN 0991-AB55]

HIPAA Administrative Simplification: Enforcement

AGENCY: Office of the Secretary, HHS.

ACTION: Interim final rule; request for comments

SUMMARY:

The Secretary of the Department of Health and Human Services (HHS) adopts this interim final rule to conform the enforcement regulations promulgated under the Health Insurance Portability and

Accountability Act of 1996 (HIPAA) to the effective statutory revisions made pursuant to the Health Information Technology for Economic and Clinical Health Act (the HITECH Act), which was enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA).

More specifically, this interim final rule amends HIPAA’s enforcement regulations, as they relate to the imposition of civil money penalties, to incorporate the HITECH Act’s categories of violations, tiered ranges of civil money penalty amounts, and revised limitations on the Secretary’s authority to impose civil money penalties for established violations of HIPAA’s Administrative Simplification rules (HIPAA rules). This interim final rule does not make amendments with respect to those enforcement provisions of the HITECH Act that are not yet effective under the applicable statutory provisions. Such amendments will be subject to forthcoming rulemaking(s).

Assessment

Link: http://edocket.access.gpo.gov/2009/E9-26203.htm

Conclusion

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Filed under: Information Technology, Practice Management | Tagged: ARRA, HHS, HIPAA, HITECH | 4 Comments »

RFID versus WiFi Hospital Inventory Tracking Systems

Posted on November 5, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Competing Wireless Technologies

By Davd Piasecki, with

Hope Hetico; RN, MHA

www.HealthcareFinancials.com

The two wireless technologies currently competing to provide hospitals with better systems for managing equipment inventories are (WiFi) and active RFID.

Wireless-Fidelity [WiFi]

WiFi is the name of the popular wireless networking technology that uses radio waves to provide wireless high-speed Internet connections. The WiFi Alliance is the non-profit organization that owns WiFi (registered trademark) and the term specifically defines WiFi as any “wireless local area network products that are based on the Institute of Electrical and Electronics Engineers’s 802.11 standards.” Yet, less than 5 percent of North American healthcare facilities are equipped with these real-time locating systems, so the market is currently up for grabs.

WiFi Pros

The advantage of WiFi-based real time locating systems (RTLSs) is that most hospitals already have WiFi networks in place, and many medical devices are equipped with WiFi functionality. Moreover, WiFi vendors such as Aeroscout, Ekahau, and PanGo market their products based on a standards-based non-proprietary functionality. The downside of WiFi systems is that hospitals will need to install additional access points to bring the needed functionality to existing networks.

RFID Pros

On the other hand, RFID vendors such as RF Code and Radianse point to the wide application of RFID for asset tracking, and to the technology’s longevity in the industry. Still, RFID tags remain suspect because their ability to efficiently track DME may not be private or secure. Increasingly, WiFi seems more ubiquitous than RFID.

Finally, of the three WiFi major vendors, only Ekahau makes a point of stressing that its inventory system is based only on WiFi and not RFID, so the issue isn’t clear cut. Perhaps it will take both technologies to deploy RTLSs for hospitals.

General Recommendations

As a general recommendation, RFID is not yet practical for most small to mid-sized healthcare entities or medical clinics looking to automate their inventory-related transactions (though it does work for other applications such as with returnable containers and asset tracking).

RFID Hype

Despite the hype over RFID, bar codes are not becoming obsolete and are still very effective at quickly and accurately identifying products, locations, and documents. Unless there exists an application where bar codes simply don’t work, or where RFID offers a significant advantage over bar codes, use bar codes. Even if an application that cries out for RFID exists, hospital material management administrators may want to consider waiting (if possible) as the cost of the technology comes down.

Both RFID and WFI Needed

According to Robert M. Wachter MD, Professor and Chief of the Division of Hospital Medicine and Associate Chairman of Department of Medicine, and Lynne and Marc Benioff Endowed Chair in Hospital Medicine, University of California at San Francisco, and Chief of the Medical Service at UCSF Medical Center [personal communication], both should be used.

Ultimately, of course, we do need both bar coding and RFIDs, and we need rigorous studies looking at what works and what doesn’t. But, you have to start somewhere. Even though the evidence continues to trail, based on what I know today, if I was a hospital ready to get into the IT game, I’d go with bar coding first.

Assessment

In the next few years, standards will be finalized, hardware prices will drop, software will become more readily available, and, more importantly, the bugs will be worked out of all these systems.

Conclusion

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Filed under: Information Technology, Practice Management | Tagged: aeroscout, David Piasecki, DME, Ekahau, hope hetico, Hospital inventory, inventory management, inventory tracking, PanGo, Radianse, RFID, Robert Wachter, RTLS, WiFi, WiFi Alliance | 5 Comments »

Doctors versus Retail Bankers

Posted on November 1, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Modern Reality

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Doctors often carry notoriously heavy debt loads. Beyond the costs of a medical education are substantial costs for equipping, launching and staffing a practice. Technology changes fast these days and capital is required frequently. And, the era of eMRs, ARRA, HI-TECH and Obama-Care is upon us!

“I‘m a Banker – I’m Here to Help”

Unfortunately, retail bankers are now very conservative by nature; and the liquidity squeeze and financial meltdown of 2008-2009 makes credit even more difficult to obtain. It may be increasingly difficult to borrow money, especially since modern bankers know that a medical degree is no longer the guarantee of a steady and high income that it once was in the past. As more than one banker has often opined to me,

“We don’t usually loan money to doctors who really need it.”

Nevertheless, the more business a physician does with a bank, the better the terms that can be obtained; even thought hey may also not have a clue about what the practitioner can do to better compete in the managed care arena.

Why Big-Banks Hate Customers

http://articles.moneycentral.msn.com/Investing/JubaksJournal/why-big-banks-hate-banking.aspx

Local Community

Some bankers do have a good concept of local community politics however, for those not familiar with a practice venue. They frequently can provide references to more focused advisors, and bankers generally do not charge a fee for their advice. But, banks selling products are doing so according to their governing regulations as “prudent experts” under ERISA, and are not necessarily held to a fiduciary standard in any broader sense.

Conclusion

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Filed under: "Doctors Only", Career Development, Practice Management | Tagged: ARRA, bankers, EMRs, ERISA, fiduciary, healthcare reform, HI-TECH, medical finance, obama, Obama care, prudent expert, retail banks | 6 Comments »

Return on Investment Calculations for [Concierge] Medical Practice Marketing Initiatives

Posted on October 30, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Calculating Tangible ROI for Intangible Activities

By DeeVee Devarakonda; MBA [Former CMO of Quaero, Inc]

By Dr. David Edward Marcinko; MBA [Publisher-in-Chief]

Gone are the days when money was freely spent on medical practice marketing activities such as the yellow pages, radio or TV advertisements. And, today’s internet based business climate is especially harsh for ethereal programs that can not present a clear Return on Investment [ROI] for their existence. Concierge and cash-based medical practice marketing is especially vulnerable in this climate unless supported with a sound ROI argument.

The Challenge

A very basic challenge all medical practices is not only pooling the resources but also allocating them wisely. ROI arguments help practices make those choices. Typically marketing budget and outlay decisions focus on operating expenses like public relations, podcasts, webcasts and internet advertising. However, marketing can also involve capital investment decisions. To be successful, medical practitioners should learn to speak the language of business and build ROI analysis to support such initiatives.

How do you calculate the ROI for internet marketing initiatives?

Here are some basic steps to help you build the ROI scenario for your marketing initiatives:

Detail the marketing costs:
Estimate the revenue impacts:

Hardware – computers, servers, accessories
Software – database, campaign management software
Implementation costs of hardware and/or software
Internal resource costs associated with the deployment of the capital improvement
Upfront investments in call centers, staff, equipment and so on.
Increase in patient response rates
Increase in patient conversion and practice acceptance rates
Increase cross-sell product and services ratios
Decreased account patient attrition rates
Increase in practice CM fees
Increase in average spend per patient/account
Increase in average number of patient transactions.

Practices can use past experiences to guesstimate the revenue impact; others like-minded colleagues.

Net Present Value

Once you calculate the revenue and cost impacts, you need to calculate the Net Present Value (NPV) of your marketing initiative. For a marketing project, if the NPV is greater than zero that means your project will make money; if it is less than zero – it will not (and you typically need a compelling business reason to implement a marketing project with an NPV less than zero).

NPV calculations include:

1) Investment – money you expend for the initiative at the beginning

2) Revenues – that accrue as a result of the initiative over a period – can be one time or a recurring revenue

3) Costs – that accrue as a result of the initiative over a period – can be one time or a recurring item

4) Discount rate – your accountant can give this rate.

5) Time Period – define the time period for which you would like to compute the NPV.

6) NPV is the cumulative differential between the revenue and cost stream discounted at the discounted rate minus the investment.

NPV=SUM ((Rt-Ct) / (1+r)t) – I

t=1

Given:

where t represents time, n represents the number of time periods, R is revenue impacts, C is cost impacts, r is the discount rate and I is the Investment.

An NPV >0 means the project will pay for itself, <0 means the project does not pay for itself and an NPV of zero will give you a break even.

Assessment

Remember NPV is simply a guideline to help quantify the marketing results to make informed investment decisions. Note: NPV calculations that include assumptions also allow room for error. Spreadsheets help calculate the NPV for any initiative. Simple software can also help develop “what-if” scenarios with various values for NPV components and marketing options. The model can be used for non-marketing, or any initiative, as well.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How do you determine ROI for any medical practice initiative? 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: "Doctors Only", Career Development, Marketing & Advertising, Practice Management, Research & Development | Tagged: concierge medicine, DeeVee Devarakonda, net present value, NPV, ROI | 6 Comments »

Take the Electronic Medical Records Survey

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

Discerning the Effects of ARRA and HI-TECH on eMR Adoption

By Ann Miller; RN, MHA

[Executive Director]

Hi Dr. Marcinko and ME-P Readers

I hope you and all readers are doing well.

As you know, this Friday marks the close of the first reporting period for Recovery Act funds. Any grants or loans awarded between February 17th (the signing of the bill) and September 30th 2009 will be reported in the survey.

Electronic Medical Records

I am eager to see the results because I want to know what effect the economic Stimulus Bill has had on eMR adoption rates. Are more doctors buying eMRs as a result of incentives? Or, has the bill simply reinvigorated research?

Take the Survey

I’m hosting a survey about this on our blog and I would love for you to participate. To be involved, just answer the question I’ve posted at:

http://www.softwareadvice.com/articles/medical/obamas-emr-stimulus-of-2009-creating-buyers-or-tire-kickers-1102709/

Assessment

I would also really appreciate your help in getting the word out about this survey. Would you mind posting a link back to the survey from your blog?

Thanks in advance for your participation!

Houston Neal
www.softwareadvice.com

Office: (512) 364-0117
Email: houston@softwareadvice.com

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About the HelloHealth.com Primary Care Business Platform

Posted on October 22, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Connecting Doctors and Patients

By Staff Reporters

Hello Health is a platform for improving the way primary care practices do business. The platform includes a significant level of support such as online access to the Hello Health practitioner community, offline and online training and continuing education.

What it is – How it works

With Hello Health, doctors can set up their own Hello Health “storefront,” and use their online web-based platform to see local patients in the office and online, communicate, document, and receive payments from them [www.HelloHealth.com].

According to its’ website, Hello Health helps primary care doctors to:

Sell professional services. Simply apply for a practice.
Be Web-Based and Mobile. Like the rest of the world— anytime, anywhere.
Keep track of a medical practice. Manage visits and appointments.
Communicate in the 21st Century. Email, IM, and video chat with patients.
Document quickly and easily. Record in-person and online interactions.
Connect with medical colleagues. Communicate, share wisdom, and collaborate.
Get paid hassle-free. Patients pay doctors with their credit card on file.

Founder by noted physician blogger Jay Parkinson MD, MPH, the Hello Health platform was built from the ground up to help doctors do what they do best— form relationships and practice real medicine [http://blog.jayparkinsonmd.com]. Jay says,

“It’s practicing medicine using today’s technology and today’s communication – and getting paid for communicating with your patients whether it’s in your office or using email, IM, or video chats within hellohealth.com.”

A companion educational service is run by L. Gordon Moore, MD of Hello Health University.

Here is a slideshow from the Feast Conference and EfficientMD.com

http://efficientmd.blogspot.com/2009/10/dr-jay-parkinsons-slides-from-feast.html

Assessment

There is also a platform for patients to help them connect with Hello Health physicians online or on-ground.

Conclusion

And so, thoughts and comments from Hello Health doctors and patients are appreciated. Give em’ a click and tell us what you think [www.HelloHealth.com]?

Channel Surfing

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

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Filed under: Career Development, Information Technology, Managed Care, Practice Management, Research & Development, Videos | Tagged: EfficientMD.com, Hello Health University, Jay Parkinson MD, L. Gordon Moore MD, primary care medicine, www.HelloHealth.com | 2 Comments »

On Physician Bonuses

Posted on October 19, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Money and Incentive Pools

By Brent A. Metfessel; MD, MS

Some Managed Care Organizations [MCOs] use medical provider profiles to allocate funds to the top-performing physicians. The MCO may give additional bonuses or preferential allocation of incentive pool funds to providers that perform well on particular cost-effectiveness and quality indices.

Incentive Pools

Incentive pools are often built based on a certain percentage or “withhold” of dollars that are taken from the providers’ usual reimbursement and placed in a pool. Top performers would be allocated the greatest percentage.

Example:

One mid-sized health plan in the Southeast paid a 20% bonus to providers with a case-mix adjusted performance ratio (actual/expected cost) of less than 1.3. Although such allocation schemes might incent providers to practice efficiently and with high quality, the MCO should attempt provider education as to the most appropriate practice patterns for the first one to two years after new profiles are introduced. This education should occur prior to introducing monetary incentives, since otherwise the relationship between providers and MCOs may ultimately become strained.

Assessment

Unfortunately, money can become a major point of contention between providers and between providers and the health plan.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How do your bonus pools work; or should work? 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, Healthcare Finance, Practice Management, Quality Initiatives | Tagged: Brent A. Metfessel, HMO, incentive risk pools, Managed Care Organizations, MCO, medical reimbursement, medical reimbursement witholds, P4P, risk pools | 1 Comment »

Goals of Medical Performance Improvement

Posted on October 18, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Best Clinical Practices

By Brent A. Metfessel; MD, MS

The major goals of medical performance improvement are twofold: First, for a particular practice pattern measure, the desire is to narrow the practice variation around the present health care mean. For instance, the spread of the distribution of a cost variance measure should decrease with process improvement. Second, clinical guideline-based “best practices” can be utilized to move the entire provider population mean toward better cost-efficiency and quality.

Best-Practices

Although best-practices may be guideline-based, they should be adapted to local considerations and evaluated periodically through actual outcomes analysis. Such outcomes measures may include:

Cost-efficiency improvement, showing a decrease in resource utilization.
An increase in the performance of preventive measures, such as childhood immunizations and various screening tests such as breast and cervical cancer screening. This may increase costs initially but will more than pay for itself through a decreased illness burden and cost in the future.
A decrease in episode length, usually implying a quicker resolution of symptoms.
A decrease in emergency room visits and unplanned hospital admissions.
A decrease in the rate of “sentinel events” such as status asthmaticus, hemorrhage during pregnancy, diabetic ketoacidosis, and ruptured appendix.

Many of these measures can be obtained using commonly available claims and administrative databases, although supplementation with clinical and functional status data will only increase the reliability and scope of outcomes analysis.

Assessment

In order to see significant performance improvement in response to quality improvement initiatives, one must be patient. Two to three years may be needed to see this improvement. Trending of measures helps analysts to determine whether such improvement is occurring. Trending of data, however, can be quite resource-intensive since there must be an adequate data set – usually requiring storage of data for several years of experience.

Conclusion

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Filed under: "Doctors Only", Career Development, Health Insurance, Managed Care, Practice Management, Quality Initiatives, Recommended Books | Tagged: Brent A. Metfessel, clinical medical guidelines, medical cost effectiveness, medical performance improvement, process improvement, sentinel events | 2 Comments »

OSHA Medical Record Keeping Standards

Posted on October 16, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

On the Recording – Reporting of Occupational Injuries and Illness [29 CFR 1904]

By Pati Trites; MPA, CHBC and CPC

In this era of eHRs, and eMRs, it is vital to understand how OSHAs Recording and Reporting of Occupational Injuries and Illnesses Standard [29 C.F.R. 1904 – also known as the Recordkeeping Standard] requires employers to record & report work-related fatalities, injuries and illnesses www.HealthcareFinancials.com

Exemptions

For example, in January 2001, OSHA provided for a partial exemption from this Standard for many industries including: Offices & Clinics of Medical Doctors, Offices and Clinics of Dentists, Offices of Osteopathic, Offices of Other Health Practitioners, Medical and Dental Laboratories, and Health and Allied Services, Not Elsewhere Classified [1].

The exemption applies as long as the above-stated employers do not have at least one of the following events occur:

any workplace incident that results in a fatality; or
the hospitalization of three or more employees (example: a malfunctioning heat exchanger on a furnace causes carbon monoxide poisoning to the employees. If three or more must be hospitalized, then the exemption is lost for the calendar year).

If either of these two events occurs then the practice must comply with the reporting requirements of this Standard. Again, each employer who is physically located in one of the 26 states that has its own OSHA must follow state requirements if they are stricter.

Fatality or Hospitalization

In the event of a workplace fatality or an incident that causes the hospitalization of three or more employees, the employer must notify OSHA’s Area Office nearest to the site of the incident either in person or by phone. Notification can also be made by calling the OSHA toll-free central telephone number, 1-800-321-OSHA (1-800-321-6742). This notification must be accomplished within eight hours of the occurrence [2].

OSHA Form 330

Although the likelihood of either of these occurrences taking place is slight, it may be prudent to maintain records that comply with the OSHA Recordkeeping Standard in the event the practice’s partial exemption is lost during a calendar year. Keeping adequate records includes maintaining an OSHA Form 300, which is a log of the following events: days away from work, restricted work or transfer to another job, medical treatment beyond first aid, loss of consciousness, and a significant injury or illness diagnosed by a physician or other licensed healthcare professional.

OSHA Form 330-A

If the practice maintains its partial exemption throughout the calendar year, nothing further needs to be done. But if the practice loses its partial exemption this form must be used to complete a second OSHA form, Form 300A, the annual summary. The employer must post a copy of Form 300A in each practice location (if there are multiple locations) in a conspicuous place or places where notices to employees are customarily posted. The employer must also ensure that the posted annual summary is not altered, defaced, or covered by other material. The Form 300A remains posted from February 1 through April 30 of the calendar year following the year of data collection [3]. In other words, for all records kept in 2005, Form 300A would be posted from February 1, 2006, through April 30, 2006, and so on.

Assessment

An additional recordkeeping requirement for healthcare entities is established in the Bloodborne Pathogen Standard, wherein the Sharps Injury Log must be maintained by any employer who must comply with the Recordkeeping Standard. If the employer loses his or her partial exemption during the year, then there is an obligation to complete and maintain the Sharps Injury Log. Again, this is a form that probably should be maintained by all healthcare organizations just in case the partial exemption is lost in any particular year.

Conclusion

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FINANCE:Financial Planning for Physicians and Advisors
INSURANCE:Risk Management and Insurance Strategies for Physicians and Advisors

1. 29 C.F.R. 1904 Subpart B Appendix A.

2. 29 C.F.R. 1904.39.

3. 29 C.F.R. 1904.32.

Filed under: "Doctors Only", Health Law & Policy, Practice Management, Professional Liability, Quality Initiatives | Tagged: 29 CFR 1904, EHRs, EMRs, OSHA, OSHA Form 330, OSHA From 330A, Pati Trites, Recording and Reporting of Occupational Injuries and Illnesses Standard, worman's compensation | 1 Comment »

Become a Published Print Author with Us

Posted on October 13, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The Business of Medical Practice [3^rd Edition]

By Hope Rachel Hetico RN, MHA, CMP™

[Managing Editor]

Dear Colleagues and ME-P Champions

As you may know, we are commencing work on the third edition of our best selling book: The Business of Medical Practice

TOC 1st: http://www.amazon.com/Business-Medical-Practice-Maximizing-Doctors/dp/0826113117/ref=sr_1_8?ie=UTF8&s=books&qid=1231111232&sr=1-8

TOC 2nd: http://www.springerpub.com/prod.aspx?prod_id=23759

Invitation to Contribute

Accordingly, we would be honored for you to consider contributing a new or revised chapter, in your area of expertise, for a low-effort but high-yield contribution. Our goal is to help physician colleagues and management executives benefit from nationally known experts, as an essential platform for their success in the healthcare industry. Many topics are still available: [health accounting; law, policy and administration; Medicare fraud and abuse; cloud computing; and finance and economics, etc].

Support Always Available

Editorial support is available, and you would enjoy increasing subject-matter notoriety, exposure and public relations in an erudite and credible fashion. As a reader, or preferably a subscriber to the ME-P, your synergy in this space may be ideal. Time line for submission of a 5,000-7,500 word chapter is ample, and in a prose writing style that is “wide, not deep.”

A Health 2.0 Initiative

And, be sure to address health 2.0 modernity. Update chapters from the second edition are also available.

Definition: https://healthcarefinancials.wordpress.com/2008/09/12/emerging-healthcare-20-initiatives

Assessment

Please contact me for more details [MarcinkoAdvisors@msn.com], if interested [770.448.0769]. A best selling-book is rare; while a third-edition volume even more so. Join us in this project. Regardless, we trust you will remain apostles of our core ME-P vision, “uniting medical mission and financial profit margin”, and promoting it whenever possible.

Front Matter Link: frontmatter1advancedbusinessmedicine

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: "Advisors Only", "Doctors Only", Book Reviews, Breaking News, Career Development, Ethics, Experts Invited, Health Economics, Health Insurance, Healthcare Finance, iMBA, Inc., Information Technology, Managed Care, Media Mentions and PR, Practice Management, Professional Liability, Quality Initiatives, Recommended Books | Tagged: acountants, american medical writers association, authors, contributors, doctors, experts, JDs, journalists, lawyers, managers, MBAs, MDs, PhDs, publishers, writers | Leave a comment »

Health Insurance Prospective Payment System [HIPPS] Grouper Software and Documentation Codes

Posted on October 13, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Enter the CMPs

Understanding Home Health Prospective Payment System (HH PPS) Case-Mix Refinement Changes

[By Staff Reporters]

A few operational changes were made to the V-Code Table in the updated version of the ICD-9-CM Official Guidelines for Coding and Reporting, including:

HH PPS grouper software and documentation (effective October 1, 2006): Contains Version 1.06 of the home health PPS case mix grouper software codes, which accommodates changes in OASIS reporting requirements effective 10/1/2006. Also includes the grouper coding logic (pseudo-code), test records, and demonstration programs.
HH Consolidated Billing Master Code List: An Excel workbook file containing complete lists of all codes ever subject to consolidated billing provision of HH PPS. A master list worksheet shows the dates each code included and excluded from consolidated billing editing on claims, with associated CMS transmittal references. The master list also associates each code with any related predecessor and successor codes. Supplemental worksheets show the list of included codes for each CMS transmittal to date.

Example:

The national unadjusted (wage index) per-visit rate payments paid per code were: [a] home health aide $44.37; [b] medical social service $153.55; [c] occupational therapy $105.44; [d] skilled nursing care $95.79 and [e] speech pathology $113.81.

Assessment

Link: http://www.cms.hhs.gov/homehealthpps/downloads/transitionepisodesqa.pdf

Link: http://www.cms.hhs.gov/HomeHealthPPS/downloads/GuidanceforHHAs_Posting_12-18-2007.pdf

Conclusion

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Filed under: "Doctors Only", Career Development, CMP Program, Health Insurance, Practice Management, Recommended Books | Tagged: CMS, HH Consolidated Billing Master Code List, HH PPS, HIPPS, Home Health Prospective Payment System, ICD-9-CM, medical billing, OASIS, V-codes | 3 Comments »

Why ADA / Intelligent Dental Marketing Failed?

Posted on October 6, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The ADA is an Incredible Dinosaur

By Darrell K. Pruitt; DDS

As a member of the ADA, I am also a part owner in any business venture the leaders of the organization enter into. I’ve observed the loss of my investment in a business deal because my employees made mistakes. As a business owner, it would be simply irresponsible for me to ignore something like this.

The Embarrassing Story

Do you know what part is missing from this embarrassing story? The ADA has not uttered a word about the ADA/IDM failure… Or, as the ADA Business Enterprise Inc. leaders call it – the ”ADA/idm” failure.

The fact that the two business entities never came to an agreement on what to even call their doomed joint venture reveals a lot about the egos that gummed up the machinery. It’s possible that pride undermined our non-profit/for-profit partnership from the very start. We just don’t know what happened because there are so many possible reasons for this business model to fail. Will loss of ADA members’ investment happen again if the cause is not recognized and eliminated? I think the chances are pretty good that even more embarrassment is on the way. Given the soft environment, it’s only natural.

Over my 27 year career as a dentist, I have met many ADA officials, both employed and elected, on all three levels of the tripartite system of governance – local, state and national. From the topmost quality of character I have witnessed in all but a few politically-empowered and proudly insensitive exceptions, I can assure you that like all major projects of the ADA, the failed ADA/IDM adventure into dental marketing was assembled with nothing but noble intentions and benevolent wishes for ADA members and dental patients – at least from the ADA side. Whether the leaders of the ADA’s new business partner, Intelligent Dental Marketing out of Utah, were dedicated to serving ADA members in a captive market is unlikely. The ADA/IDM business model is sort of like managed care dentistry. When dentists sign contracts that provide them with clients regardless of how they are treated, there is a natural tendency for dentists to become unappreciative of those who pay their bills.

Little Consumer Competition

The ADA allows Americans to experience what socialism is like in markets where there is no competition for consumers: Professionals such as dentists stop trying to please their patients, and IDM stops trying to please dentists. If IDM was a decent company before the business venture with ADA membership, the ADA ruined them with a sweetheart deal that included protecting them from competition, as well as shielding them from complaints by angry ADA members. And like dental patients with preferred provider lists, ADA members noticed the bad treatment. However, complaints were never made transparent even as more ADA members where signing contracts with ADA/IDM. That is unfair and unethical.

Just Google for Complaints

Want to see what an embarrassment in situ looks like? Just Google “CareCredit complaints.” ADA-approved CareCredit/GE has a long history of sweetheart deals like the one they made with ADA leaders. Their trail is always marked by complaints. The ADABEI is selling ADA members’ reputations. I just read ADA reporter James Berry’s article highlighting outgoing ADA President Dr. John S. Findley’s address to the House of Delegates that he gave on Friday. The article is titled, “We built our home on a foundation of science and values: Dr. Findley”

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3771

One free-standing paragraph in the article caught my attention that perhaps exposes a symptom of the pride and secrecy that surrounds the ADA/IDM disaster. In the middle of the article, James Berry offers this cryptic message that was obviously not meant for all members to understand:

“On the Association itself, the president noted that the ADA has undergone significant change in the past year and a half. As problems were discovered and defined, he said, the leadership acted to resolve them.”

Was the ADA/IDM fiasco one of the problems that was resolved? Did they resolve the problem with CareCredit/GE causing ADA members to be covered by the Red Flags Rule – and not letting members know about it? Did they resolve the problem of data breaches and how they can mean certain bankruptcy for ADA members, even if the members do the right thing?

Possibly

We just don’t know which problems were resolved, but somehow we should feel much better, now that President Findley got the message out to mid-level ADA leaders who probably know exactly what he is referring to. And, by protecting lower caste members from knowing things they don’t need to know, problems are quietly resolved and the profession’s image is preserved. “Image is everything” – ADA/IDM business slogan.

“Findley for the future”- Dr. John S. Findley’s campaign slogan.

Bingo! We have a match.

We should not forget that before IDM leaders got in way over their heads and started doing foolish things like marketing Search Engine Optimization (SEO) talents they lacked, there has not been a dues increase for a couple of years – in part because of the profits that were churned from ADA/IDM purchases ADA members made. I am certain that the ADA Business Enterprise Inc’s failure breaks the hearts of sincere and devoted leaders in the ADA who would have never recommended going outside the ADA’s Mission Statement had ADA employees been transparent with them. The officials of IDM couldn’t care less. Their part of the venture is much easier to dissolve for the Utah businessmen. They just picked up and walked away. However, the ADA officials have a fiduciary responsibility to members who trusted them. Once again, virtually all of the ADA leaders are just like you and me. Some just got in too deep on our behalf and couldn’t shut the mistake down before members got needlessly hurt.

Officials in other businesses the size of the ADA are held accountable for their mistakes and are not afforded the opportunity to filter communications with the owners because of image concerns. This kind of sweetheart deal for business executives, most of who come from Delta Dental, UnitedHealthcare or both, as in the case of the new executive director, Dr. Kathleen T. O’Loughlan, occurs only in the ADA and to a lesser extent in the US government and dental insurance industry.

Assessment

The state of the ADA is not nearly as rosy as Dr. Findley would have us believe. I think we have all seen authoritarian leaders re-write history. The ADA is an incredible dinosaur.Business can be ugly in the highly competitive land of the free. If businesses don’t take risks, we cannot move forward. For that reason, mistakes are expected. But never forget. Owners expect to be told about them.

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: Career Development, Ethics, Managed Care, Marketing & Advertising, Op-Editorials, Practice Management, Pruitt's Platform | Tagged: ADA, ADA/IDM, ADABEI, CareCredit, Darrell Pruitt, DDS, delta dental, DMD, doctoroogle.com, Dr. John S. Findley, Dr. Kathleen T. O’Loughlan, IDM, Intelligent Dental Marketing, James Berry, UnitedHealthcare | 11 Comments »

Take the MD / MBA Survey

Posted on September 24, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Seeking Collegial Input

[By Joshua T. Goldman]
MD/MBA Candidate, 2010
President & Founder, The Franklin Society
President, Associated Students of the Keck School of Medicine
University of Southern California | Marshall School of Business|Keck School of Medicine [760.409.4531]

Dr. Marcinko and ME-P Readers,

My name is Joshua Goldman and I am a 5th year MD/MBA student at the University of Southern California. The MD/MBA department at USC is conducting a study investigating the utility of the MD/MBA combined degree. People always ask, “What can you do with an MD/MBA?” We hope to better answer that question through a comprehensive look at MD/MBA graduates now working in industry. And, we would love to include and the experiences of your ME-P readership in our research.

Online Survey

We have designed a simple online survey that takes about 5-10 minutes to complete. The link to the survey is included below. If you have any colleagues or ME-P readers who have completed an MD and an MBA, it would be wonderful if you could forward them this e-mail, as well. We hope to publish our findings in a number of journals this spring and have been asked to present our results at this year’s Annual MD/MBA Conference. If you would like to receive a copy of our final manuscript, let us know and we will ensure you receive a copy in the spring jtgoldman@gmail.com

Take the Survey

Thank you for your help and support and we look forward to hearing from you!

Survey Here: MD/MBA Survey

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Alerts Sign-Up, Career Development, Managed Care, Practice Management, Research & Development, Surveys and Voting | Tagged: david marcinko, Franklin Society, Joshua Goldman, Keck School of Medicine, Marshall School of Business, MBA, MD, USC | 6 Comments »

On Healthcare Inventory Management

Posted on September 22, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Fundamental Principles

By Staff Reporters

www.HealthcareFinancials.com

According to industry inventory management expert Mr. David Piasecki, healthcare inventory is a term that describes medical items used in the delivery of healthcare services or for patient use and resale. Much like Durable Medical Equipment, a certain safety margin of stock should always be available. Inventory ranges from normal administrative office supplies to highly specialized chemicals and reagents used in the clinical laboratory. It should be distinguished from capital supplies, such as major equipment, instruments, and other items that are not used up faster than inventory or related inventory wastes.

Historical Review

Historically, asset utilization ratios provided information on how effectively the enterprise used its inventory assets to produce revenues, or deplete its cash. For example, the inventory turnover ratio (ITR) determines the total volume of inventory turnover (change) during a pre-determined accounting period (month or quarter). It is defined as cost of inventory purchased for the period, divided by average inventory (AI) at cost.

Consulting Firms

Dunn and Bradstreet, the supply chain management – consulting firm and others, do not provide exact comparatives for private healthcare ITR. Nonetheless, ITR is useful as an internal performance indicator of inventory turnover speed and cash flow enhancement. Currently however, for public hospitals, 60 – 75 days is estimated to be the average time for inventory turnover.

www.HealthcareFinancials.com

The main problem with traditional ITR, similar analyses such as AI and ICP, and the usual inventory costing methods (e.g., last-in first-out, first-in first-out, specific identification, average costs), and even just-in-time inventory costing, is that they do not embrace Supply Chain Inventory Management. This occurs because sources of profit or loss are not recognized in the traditional inventory cost accounting equation:

Assessment

Cost of goods sold = beginning inventory + net purchases – ending inventory

Conclusion

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Filed under: "Doctors Only", Glossary Terms, Practice Management | Tagged: beginning inventory, cost of goods sold, david marcinko, David Piasecki, DME, Dunn and Bradstreet, ending inventory, inventory turnover ratio, ITR, medical inventory management, www.healthcarefinancials.com, www.healthdictionaryseries.com | 3 Comments »

Understanding the Medicare Prospective Payment System

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

Origins of Diagnostic Related Groups

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

The Medicare Prospective Payment System (PPS) was introduced by the federal government in October, 1 1983, as a way to change hospital behavior through financial incentives that encourage more cost-efficient management of medical care. Under PPS, hospitals are paid a pre-determined rate for each Medicare admission. Each patient was classified into a diagnosis-related group (DRG) on the basis of clinical information. Except for certain patients with exceptionally high costs (“outliers”), the hospital is paid a flat rate for the DRG, regardless of the actual services provided.

Enter the DRGs

Each Medicare patient is classified into a DRG according to information from the medical record that appears on the bill:

principal diagnosis (why the patient was admitted);
complications and co-morbidities (other secondary diagnoses);
surgical procedures;
age and patient gender; and
discharge disposition (routine, transferred, or expired).

Medical Records Documentation

Diagnoses and procedures must be documented by the attending physician in the patient’s medical record. They are then coded by hospital personnel using ICD-9-CM nomenclature. This is a numerical coding scheme of over 13,000 diagnoses and more than 5,000 procedures. The coding process is extremely important since it essentially determines what DRG will be assigned for a patient. Coding an incorrect principal diagnosis or failing to code a significant secondary diagnosis can dramatically affect reimbursement.

DRG Categories

Originally, there were more than 490 DRG categories defined by the Centers for Medicare and Medicaid Services (CMS, formerly known as the Health Care Financing Administration [HCFA]). Each category was designed to be “clinically coherent.” In other words, all patients assigned to a DRG are deemed to have a similar clinical condition. The PPS is based on paying the average cost for treating patients in the same DRG. Each year CMS makes technical adjustments to the DRG classification system that incorporates new technologies (e.g., laparoscopic procedures) and refines its use as a payment methodology. CMS also initiates changes to the ICD-9-CM coding scheme. The DRG assignment process is computerized in a program called the “grouper” that is used by hospitals and fiscal intermediaries. It was last significantly updated by CMS in 2006.

Assessment

Each year CMS also assigns a relative weight to each DRG. These weights indicate the relative costs for treating patients during the prior year. The national average charge for each DRG is compared to the overall average. This ratio is published annually in the Federal Register for each DRG. A DRG with a weight of 2.0000, for example, means that charges were historically twice the average; a DRG with a weight of 0.5000 was half the average; and so on.

Conclusion

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Filed under: Health Economics, Health Insurance, Healthcare Finance, Practice Management | Tagged: Centers for Medicare and Medicaid Services, CMS, david marcinko, diagnosis-related group, DRG, HCFA, ICD-10-CM, ICD-9-CM, medicare, Medicare Prospective Payment System, PPS | 7 Comments »

Take the Lost Managed Care Contract Challenge!

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

Illustrative Case Model – Are You CMP™ Worthy?

By Staff Reporters

The Hope Outreach Medical Clinic (HOMC) is a private, for-profit, single specialty medical clinic in a south-eastern state. It submitted its bi-annual Request for Proposal (RFP) to continue its current managed care fixed-rate contract. Upon review of the RFP, however, Sunshine Indemnity Insurance Company, the managed care organization (MCO), denied the contract request for the upcoming year.

Seeing Economic Estimates

In shock, the clinic’s CEO asked the clinic’s administrator to work with its legal team to develop a defensible estimate of economic damages that would occur as a result of the lost contract. The clinic intended to bring suit against the MCO for breach-of-contract. However, the administrator is not an attorney and is loathe to-enter the fray. After consideration however, he decided to assist in filing the Statement of Claim (SOC) because he realized that changes in patient services (unit) volume would be a valid economic surrogate. He then requested the following information from his controller, in order to develop a change in economic profit [damages] estimate.

Change in patient visits (unit) volume

Fees (price) per patient (unit)
Marginal (incremental) cost per patient (unit)
Change in current fees (prices)
Patient volume (units) affected

Key Issues:

Fee (price) per patient (units) may be obtained from the fee schedule used by the MCO to pay HOMC.
Marginal (incremental) costs per patient (unit) are approximated using variable costs.
Higher cost payors exist because lower patient volumes raise the average cost per patient (unit) due to existing fixed costs.

Assessment

Medical management consultants, are you up to answering this challenge? We dare you to respond!

Visit: www.CertifiedMedicalPlanner.com

Conclusion

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Filed under: "Advisors Only", "Ask-an-Advisor", "Doctors Only", CMP Program, Healthcare Finance, Managed Care, Practice Management | Tagged: capitation, economic profiling, fixed rate medical reimbursement contracts, HMO, Managed Care, marginal cost, marginal profit, marginal revenue, MCO, SOC | 2 Comments »

Dr. Pruitt Invites Dr. Cohen to Discuss eDRs

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

Where is the ADA’s Representative?

By Darrell K. Pruitt; DDS

He or she should have been talking with me long ago. I have the audience and I’m giving you that opportunity I promised you, Dr. Donald Cohen.

Rest Easy

I’m aware that I possibly make you uncomfortable, considering how “unprofessionally” I’ve publicly treated lesser devoted HIPAA consultants. Rest easy! As soon as I read your article, I could tell that you’re different from your colleagues I’ve met. First of all, like me, you’re a dentist. That’s very important. Secondly, your credentials are impressive and reveal that compliancy is not a hobby for you like it is for others. Nobody can accumulate a history as impressive as yours without professional dedication. The last point, and the most important of the three, you seem honest about HIPAA compliance.

A Professional

It wasn’t lost on me that in your article you were professionally non-judgmental of the Rule. Instead of trying to justify a defenseless law, your job is to help dentists comply with the mandate as it is written or risk significant fines. Like tax-collecting, someone’s got to do the job of delivering bad news. You have a legitimate purpose to be involved in the dental industry, even if what you teach makes little difference at all if a dentist’s records are breached. I argue that following the inevitable bankruptcy from a breach, HHS fines are hardly a deterrent. And that is the issue: eDRs containing patient identifiers are too risky for the marketplace.

Electronic Dental Records

I think you would have to agree that eDRs are going nowhere until records are safe, and encryption is not going to be sufficient to protect dentists against dishonest employees. Ambitious bureaucrats in waiting, such as HIPAA consultants Travis Criswell, Sharalyn Fichtl, Kelly Mclendon and Olivia Wann – not a dentist among them – hooked their careers to the HIPAA mandate to avoid the tough sales jobs competition otherwise demands in the free market. All four share an authoritarian misconception that since it is the law, dentists will be forced to purchase their products – even if they are utterly senseless. I think we both know that they are oh so wrong. I promised earlier to give you an opportunity to publicly support truth in eDRs if you so choose. Perhaps we could rationally discuss in front of everyone how dentists can wriggle free of the approaching mess. There is no pressure here, other than this is public invitation. Since you haven’t made unrealistic claims about eDRs like others have, I am not interested in hounding you further. I simply ask you to consider responding to the article I posted in your name on PennWell titled “Dr. Donald Cohen’s opportunity.”

http://community.pennwelldentalgroup.com/forum/topics/dr-donald-cohens-opportunity

Assessment

I sincerely appreciate the respect you have shown me, and I pledge to afford you the same. Of all the consultants I have approached with my concerns about HIPAA and eDRs, you are the first to even acknowledge a problem simply by posting my concerns. I think you have the courage to face the realities of the marketplace, while others foolishly think dentists are a captive market.

Note: I submitted this to be posted following an August 28^th press release posted by HIPAA consultant Dr. Donald Cohen titled, “Dentists Should Know about New HIPAA Rules.”

http://www.dentalblogs.com/archives/administrator/dentists-should-know-about-new-hipaa-rules/comment-page-1/#comment-35672

If you are interested in discussing the topics of interoperability with fax machines, de-identified eDRs and security that surpasses paper records, in front of you is the opportunity to address your largest audience yet, Dr. Cohen. I’m self-syndicated.

Note: Do you realize that if Dr. Cohen takes me up on the offer, this will be the first time two dentists have openly discussed eDRs on the Internet? Do you think it’s about time?

Conclusion

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Filed under: Information Technology, Practice Management, Pruitt's Platform, Quality Initiatives | Tagged: ADA, American Dental Association, Darrell Pruitt, DDS, dental records, DMD, doctoroogle.com, Dr. Donald Cohen, eDRs, EHRs, ePRs, health information technology, HHS, HIPAA, HIT, IT, kelly McLendon, medical records, Olivia Wann, PennWell, Sharalyn Fichtl, Travis Criswell | 11 Comments »

Take the DME Inventory Switching Challenge!

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

Calling all Administrators and Management Consultants – Are You CMP™ Worthy?

[By Staff Reporters]

The new administrator for the ABC Medical Clinic understood that all inventory costing methods were acceptable to use in his Durable Medical Equipment [DME] department. LIFO, FIFO, specific identification, and the average cost method are all attractive methods under different circumstances in the business cycle, and companies may use the method that best fits their circumstances.

www.CertifiedMedicalPlanner.org

Reducing Taxes

For example, if ABC wished to reduce corporate income taxes in a period of inflation and rising prices, it would use LIFO. If matching DME sales revenue with the current cost of DME goods sold was desired, LIFO would also be used. Unfortunately, LIFO may charge against DME revenue the cost of DME not actually sold, and LIFO may allow the ABC Medical Clinic to manipulate net income by varying the time-periods it makes additional DME purchases. On the other hand, FIFO and specific identification method allows a more precise matching of ABC revenue with historic DME costs. However, FIFO too, can promote “paperless-phantom profits,” while specific identification can promote possible income manipulation. It is only under FIFO that net income manipulation is not possible.

CEO – 2 – CFO [Case Model]

“Let’s go with FIFO,” the new administrator said to his Chief Financial Officer, Bert. “The profits will make us look good to the home office and we can always switch back to LIFO if inflation starts back-up again, right Bert?” He mused, but he was not amused because freedom of choice does not include changing DME inventory methods every few years, especially if only to report higher income. “The switching of methods violates the basic tenet of consistency, which requires the use of the same inventory cost and accounting methods in preparing financial reports and statements,” Bert emphatically stated.

Key Issues

1) Is this sort of inventory costing and maneuvering permissible?

2) What is its justification?

3) How is it notated in financial reports?

4) Is this sort of thing ethical?

Assessment

“The switching of methods violates the basic tenet of consistency, which requires the use of the same inventory cost and accounting methods in preparing financial reports and statements,” Bert emphatically stated.

Conclusion

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Filed under: "Advisors Only", "Ask-an-Advisor", Accounting, CMP Program, Ethics, Practice Management, Taxation | Tagged: cost accounting, costing methods, DME, durable medical equipment, FIFO, inventory costing methods, inventory management, LIFO, specific identification | 7 Comments »

How Proprietary HIT Vendors May Demolish Health Reform

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

Top Five Issues from the Longman Report

By Staff Reporters

Here are the top five quotes from the Longman Report. The author, Phillip Longman, is a senior fellow at the New America Foundation and the author of: “Best Care Anywhere: Why VA Health Care Is Better than Yours as well as The Next Progressive Era: A Blueprint for Broad Prosperity.

http://www.newamerica.net/people/phillip_longman

The List

1. Twenty years after the digital revolution, only an astonishing 1.5 percent of hospitals have integrated information technology systems. Almost all experts agree that in order to begin to deal with the problems of the health care system, this has to change.

2. Done right, digitized health care could help save the nation from insolvency while improving and extending millions of lives at the same time. Done wrong, it could reconfirm Americans’ deepest suspicions of government and set back the cause of health care reform for yet another generation.

3. Thanks to the stimulus bill, $20 billion is about to be poured into buggy, expensive, proprietary software that will not bring the benefits the Obama administration hopes for. Rather, it will amount to a giant bailout of a health IT industry whose business model has never really worked.

4. The VA’s open-source software allowed a nurse in Topeka, Kansas, to adapt for her own work a bar-code scanner she saw used at a rental-car agency. Her innovation cut the number of medication-dispensing errors in half at some facilities, and saved thousands of lives.

5. While a few large institutions have managed to make meaningful use of proprietary health IT, these systems have just as often been expensive failures. In 2003, Cedars-Sinai Medical Center in Los Angeles tore out a “state-of-the-art” $34 million proprietary system after doctors rebelled and refused to use it.

Assessment

http://www.newamerica.net/publications/articles/2004/the_best_care_anywhere

Conclusion

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Filed under: Breaking News, Information Technology, Military Medicine, Practice Management, Research & Development | Tagged: digital medical records, EHRs, EMRs, health information technology, HIT, New America Foundation, Obama Administration, Philip Longman, VA, www.healthdictionaryseries.com | Leave a comment »

Take the Hospital eHR Implementation Challenge!

Posted on September 6, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Illustrative Case Model – Are You CMP™ Worthy?

By Staff Reporters

The fictitional Washington Hospital is embroiled in the healthcare reform debate and interested in implementing an electronic health record (EHR) for its major clinic areas. The flagship hospital currently utilizes a legacy-based system and several of the clinics have independently purchased software programs to provide a more inclusive electronic data base particular to that clinic.

Scenario

In addition, each of the software programs purchased in specific clinics has been modified to serve their own needs. The other satellite hospitals and clinics are not linked to the flagship hospital and have independent systems, applications and software in place. The hospital is interested in obtaining one EHR system that can be used in a standardized and uniform methodology and process throughout all of its hospitals and clinics.

Key Issues

Should the Washington Hospital?

1) Abandon the clinic’s software programs in lieu of a more centralized EHR?

2) Assess various EHR systems for healthcare providers available in the marketplace, comparing a series of hospital and clinic developed requirements against vendor capabilities?

3) Obtain an EHR product that provides interface to the existing clinic software products?

4) Assess whether the EHR vendors totally comply with HIPAA and privacy regulations as well as update their systems automatically with HIPAA changes?

5) Have the vendors assess the existing system/applications/software programs currently in use at each of the hospitals and clinics and determine the best application configuration?

6) Utilize the internal Information Technology staff to develop an interface solution?

Assessment

Medical management consultants, are you up to answering this challenge? We dare you to respond! Visit: www.CertifiedMedicalPlanner.com

Conclusion

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Filed under: "Ask-an-Advisor", CMP Program, Information Technology, Practice Management | Tagged: EHRs, EMRs, health information technology, healthcare reform, HIPAA, HIT, Obama Administration | 1 Comment »

Understanding Deviations in Medical Billing

Posted on August 21, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Appreciating Normative Comparisons

[By Patricia A. Trites; MPA, CHBC, CPC, CHCC, CHCO ]

Deviation in medical billing can be detected through utilization data that insurance companies produce on all providers that submit a claim for payment of services.

Insurance companies track utilization through a variety of parameters, including CPT codes, ICD-9-CM, or number of referrals. Different programs utilize certain benchmarks to trigger a review.

Example

For example, a physician who sees patients in the office from 8:00 a.m. until 8:00 p.m., seven days a week and has the highest billing amounts in the region can be subjected to a review. This doctor’s activities would be scrutinized. The utilization review department would probably flag this doctor’s provider number and request more information on a sampling of his or her claims, based on the volume.

Utilization Review

Some utilization review activities may occur due to the type of services that a doctor may offer. For example, if a cardiologist should suddenly start billing for a large number of incision and drainages of abscesses, this might trigger a review, since that might not be a typical scope of service for this doctor in this locality. The same could be said for a pathologist, triggering a review due to the high volume of wound care or ulcer debridement.

Audit Trigger Thresholds Vary

Thresholds vary from locale to locale regarding what triggers an audit. There are consultants who have suggested querying the local carrier for provider specific information regarding utilization activity to compare against community performance. Some Carrier Advisory Committee (CAC) representatives have indicated that this may bring undesirable attention from the Medicare program and trigger an audit. Consult professional associations. and, if possible; local CAC representatives to obtain most current information in your area.

Conclusion

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Filed under: Health Insurance, Managed Care, Practice Management, Risk Management | Tagged: billing compliance, Carrier Advisory Committee, CPT codes, fraud and aubuse, ICD-9-CM, medical audit triggers, medical billing, medical utilization review, Medicare audits, Medicare Carrier Advisory Committee, Medicare compliance, Patricia Trites | 2 Comments »

My Favorite Health 2.0 Experience from McDonalds

Posted on August 20, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Meet the Schwieterman’s

By Dr. David Edward Marcinko; MBA, CMP™

Back in 2005, we published the second edition of our popular textbook: the Business of Medical Practice. And, we are now working on the third edition. At the time however, I was fortunate to have a colleague from the Microsoft Corporation pen our Foreword, now reprinted below for your review.

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

What a Family Tradition!

My favorite story came from Dr. Thomas Schwieterman, a fourth-generation physician working in the same medical office his great grandfather established in 1896 in the town of Mariastein, Ohio. From those same historic environs, Schwieterman has used Microsoft Access to create his own physician assistant application.

The Schwieterman Family Physicians practice kept him so busy that he was wondering how he could keep up with his patient caseload. Schwieterman wanted a faster way to handle prescriptions, provide medical information, and record data for his patient records. He walked into a McDonald’s restaurant one day and had an idea.

The Epiphany

“I ordered a cheeseburger and fries and watched the person at the counter touch the screen of the cash register a few times, and realized the order was getting transferred back to the food preparation area, and that by the time I paid, my order was ready,” he said. “I thought to myself: ‘That’s what I need!’” He searched for commercially available solutions, but when he couldn’t find an exact match for his needs, and when he found prices steep for a small private practice, he decided to create his own – using Access. He also called upon a friend with a Master’s Degree in electrical engineering to help on the coding. His creation boosted his income by 20 percent – “Which was important because we pay more than $60,000 a year for malpractice insurance even though our clinic has never been sued since it was founded 107 years ago.”

Assessment

What my friends at Microsoft especially like about this story is that when Dr. Schwieterman’s colleagues tried his program, liked it, and suggested he try to sell it, he put together a PowerPoint presentation – and landed a partnership agreement with a major healthcare supply and services corporation to market his ChartScribe solution.

Conclusion

So, the pressures facing physicians are great, but so are their resources. Information technology is one resource, this book is another, but the greatest of all is the innate curiosity and drive to discover and create that seems to be so much a part of those who are drawn to this noble profession.

Ahmad Hashem; MD, PhD

Global Healthcare Productivity Manager

Microsoft’s Healthcare Industry Solutions Group

Microsoft Corporation

Redmond, Washington

Conclusion

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Filed under: Book Reviews, iMBA, Inc., Information Technology, Media Mentions and PR, Practice Management, Recommended Books | Tagged: Access, Ahmad Hashem, Business Medical Practice, ChartScribe, david marcinko, DO, eHs, EMRs, Mariastein, MD, medical records, microsoft, Ohio, PhD, PowerPoint, Schwieterman, Thomas Schwieterman | Leave a comment »

Integration of Hospital Automatic Data Collection Technologies

Posted on August 19, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Review of Automatic Data Collection Equipment

By David J. Piasecki, with
Hope Hetico; RN, MHA

While hardware costs of automatic data collection [ADC] equipment continue to come down for hospital and healthcare organizations, the cost of integration will often prove to be the project buster. Software and integration costs will often be several times the cost of the hardware, especially in smaller health system operations where only a few devices will be used. Integration of ADC technologies is also far from standardized.

www.HealthcareFinancials.com

Example:

For example, when implementing a system with portable terminals, one integrator may create a program on the terminals that will write directly to the file on the host system, another may create programs on a separate server to do this, another may write or modify a program on your host system and use terminal emulation software, and another may use a screen mapping tool to reformat an existing program to be used on the portable device. So, make sure to speak with several integrators to ensure the best solution. Also, make sure to participate heavily in equipment selection and program/process design (prompts, data input) to ensure a system that provides the highest levels of accuracy and productivity.

Real-Time Locator System

A real-time locator system (RTLS) uses RFID technology that provides the objects they are attached to the ability to transmit their current location. The system requires some type of RFID tag to be attached to each object that needs to be tracked, and RF transmitters/receivers located throughout the facility to determine the location and send information to a computerized tracking system. While it sounds like a great way to eliminate “lost” inventory, the systems are still too costly for most inventory-tracking operations and are more likely to be used to track more valuable assets.

Screen Mapping/Screen Scraping

This software provides the functionality to change the arrangement of data fields on a computer screen that accesses a mainframe computer program. Screen mapping is frequently used in combination with terminal-emulation software to “remap” data fields from a standard mainframe program to be used on the smaller screen of a portable hand-held device.

Speech-Based Technology

Speech-based technology, also known as voice technology is really composed of two technologies: (1) voice directed, which converts computer data into audible commands, and (2) speech recognition, which allows user voice input to be converted into data. Portable voice systems consist of a headset with a microphone and a wearable computer.

Terminal Emulation

Software used on desktop and portable computers is available that allows the computer to act like a terminal connected to a mainframe system. If you have a networked desktop PC and are accessing mainframe programs (green screen programs) you are using terminal emulation. Terminal emulation is also a common method used to connect portable computers (as in pharmacy bar-code ADC systems) to mainframe software.

Warehouse Management System

Computer software designed specifically for managing the movement and storage of materials throughout the healthcare system warehouse or chain of command generally controls the following three operations: (1) put-away, (2) replenishment, and (3) picking. The key to these systems is the logic to direct these operations to specific locations based on user-defined criteria. Warehouse Management Systems (WMSs) are often set up to integrate with ADC systems.

Conclusion

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Filed under: Career Development, Experts Invited, Glossary Terms, iMBA, Inc., Information Technology, Practice Management | Tagged: ADC, automatic data collection, CPOE, David Piasecki, HIT, hope hetico, hospital information technology, IT, real-time locator system, RFID, RTLS, screen mapping, Speech-Based Technology, Warehouse management systems, WMS | 1 Comment »

About Practice Fusion and Free eHRs

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

A Web Based Concept in the Clouds

By Staff Reporters

Practice Fusion is a firm that reports to address the complexities and critical needs of today’s healthcare environment by providing a free, web-based electronic Health Record (eHR) application to physicians.

America’s Fastest Growing EHR community

Practice Fusion is also a fast growing electronic Health Record community. Founded in 2005, they are rapidly expanding and adding new users regularly. Over 18,000 physicians and practice managers in 50 states currently use Practice Fusion’s electronic Health Record.

Online and Free

Practice Fusion stands out in a marketplace dominated by complicated, expensive and often inefficient eHR services. Their user-friendly eHR is reported to be activated in less than five minutes, with no downtime or extensive training; eliminating the difficult conversion process that has become an industry-standard.

Secure and Reliable

The firm understands the mission-critical nature of their application. Practice Fusion’s electronic Health Record is developed for the highest levels of security and performance with world-class data centers equipped with best-in-class technology to securely house sensitive data.

Assessment

Although Practice Fusion is a young company, they are led by a well-established team of healthcare and technology veterans. Practice Fusion is directed by a group of investors and medical practitioners who believe in the power of electronic Health Records. Investors include Band of Angels, Salesforce.com and Felicis Ventures. So, give the site a click, and tell us what you think! www.PracticeFusion.com

Conclusion

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Filed under: Information Technology, Practice Management | Tagged: CCHIT, EHRs, electronic health records, electronic medical records, EMRs, health information technology, medical records, practice fusion, www.practicefusion.com | 1 Comment »

Kelly Mclendon RHIA censors D. Kellus Pruitt DDS

Posted on August 16, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

By Darrell K. Pruitt; DDS

Dateline: 8.15.09

Dear Kelly Mclendon, Registered Health Information Administrator

You are beginning to make me feel insulted, and I will not have that. I just noticed that the last two comments I submitted to your Website, www.spacecoastmedicine.com, on August 9 and 10, are still “awaiting moderation.”

http://www.spacecoastmedicine.com/2009/08/electronic-records-for-all-patients-mandated-by-2014.html#comment-89

(For clarity, the comments which scared Mr. Mclendon are copied below)

Over five days have passed, and I want you, your readers and my readers to know that I spent a lot of time preparing those two pieces exclusively for you at your invitation for comments. You are as sincere as I am, aren’t you?

When I’ve caught others in the squeeze you might be experiencing, several have pleaded that the censorship was an innocent oversight, and did the right thing immediately by posting everything I send them (include this comment, please). And then again, there are a few slow-learning, command-and-control types who think they cam still somehow control the content of their Websites. Like you, Kelly, an anonymous dentalblogs.com editor whom I call “Nancy” by default, also informed me that my comments were awaiting indefinite moderation. What a foolish, rookie mistake that proved to be. For example, if you google “dentalblogs.com,” my article “Dentalblogs.com hates D. Kellus Pruitt DDS” is their 4^th hit. It seems to be very popular.

How’s this for the title of a comment that should make it to your first page by Monday: “Kelly Mclendon RHIA censors D. Kellus Pruitt DDS”? Please, no phone calls.

D. Kellus Pruitt; DDS

Dateline 8.9.09

I’m sure physicians’ businesses are no different than dentists’ when it comes to the liability of data breaches – especially considering the giddy, mindless momentum of HITECH-empowered HIPAA. If a computer is stolen in a burglary, compromised by a dishonest employee who sells IDs on the side, or otherwise hacked, and the dentist reports the tragedy according to the letter of the law, it inevitably means bankruptcy even before the feel-good fines are levied by HHS (HIPAA) and the FTC (Red Flags Rule) for not having required irrelevant documentation of administrative trivia in order. What were our lawmakers thinking?

I guess the HIPAA blunder proves that when politicians, insurers and healthcare IT entrepreneurs get together in vendor clubs like CCHIT, the only government-approved eHR certification authority, they can mandate damn well any law that suits their needs.

Allscripts CEO Glen Tullman, who is an influential friend of Barack Obama as well as a Trustee of CCHIT told Bloomberg.com reporter Alex Nussbaum in an interview almost a year ago that providers should make the financial commitment “to ensure that doctors have some skin in the game.”

Glen Tullman is only one reason our nation’s healthcare IT industry stinks from the top down.

D. Kellus Pruitt; DDS

Dateline: 8.10.09

Thank you, Kelly Mclendon, for providing a rare venue to possibly clear up a few items of uncertainty about eHRs in dentistry. First of all, if a technological advancement such as eDRs does not pay for itself, even with government subsidies, who pays for it? That seems like a quick way to increase the costs of dental care – and for what? How do dental patients benefit from expensive HIT solutions when the telephone, fax machine and US Mail serve us fine?

Digitalization of records offers no benefits to dental patients. Only stakeholders who would grab our patients’ money benefit from HIT. Everyone else loses. Trusting, naive dental patients lose the most.

Electronic dental records are expensive hazards. If you can think of a lame reason for them, please let me hear it. You can bet I’ve crushed it before. I’ve been down this road with others many, many times.

Within a week, the government will price computerization smooth out of dentistry. Over 90% of dentists have patient identities on their computers today. If HIPAA is enforced, with or without the Red Flags Rule, I predict that less than half of the nation’s dentists will be computerized a year from now.

As for your argument that eHRs somehow provide up-to-date and otherwise superior medical histories for dental patients, think about this: If someone changes a paper medical history, it leaves a paper trail. If an insurance thief alters allergies on a digital record to suit his or her own needs, nobody in the emergency room can tell. Whoever said “Paper kills,” lied. It is a catchy PR pitch, though.

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
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Filed under: Ethics, Health Insurance, Information Technology, Managed Care, Op-Editorials, Practice Management, Pruitt's Platform | Tagged: Alex Nussbaum, Allscripts, Bloomberg.com, CCHIT, Darrell Pruitt, DDS, dental records, Dentalblogs.com, DMD, EHRs, electronic dental records, EMRs, FTC, Glen Tullman, Health I.T., healthcare information technology, HHS, HIPAA, HITECH, IT, kelly McLendon, obama, red flag rules, Registered Health Information Administrator, RHIA, www.spacecoastmedicine.com | 12 Comments »

Borges versus Kvedar Video eHR Debate

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

The Great HIT Debate

[By Staff Reporters]

All ME-P subscribers and readers are invited to watch a debate between Dr. Alberto Borges and Dr. Joseph Kvedar. In the original broadcast, by HCPLive, both participants were asked some very interesting questions about health information technology [HIT] when posed to them. And so, if you were unable to attend the live event, it is now re-broadcasted in podcast form for your review.

About Alberto A. Borges; MD

Al Borges is Founder and CEO of the MS Office eMR Project http://www.msofficeemrproject.com He is the project author, visionary and main content developer for the independent website. As a board certified physician, he practices oncology, hematology, and internal medicine in Arlington, Virginia. He is also a clinical professor at the George Washington University Medical School. Dr. Borges is a colleague and thought-leader for the ME-P

About Joseph C. Kvedar; MD

Joe Kvedar is the Founder and Director of the Center for Connected Health http://www.connected-health.org The Center is known for applying communications technology and online resources to increase access and improve the delivery of quality medical services and patient care outside of the traditional medical setting. A division of Partners HealthCare; the Center for Connected Health works with Harvard Medical School-affiliated teaching hospitals, including Massachusetts General and Brigham and Women’s Hospitals. Dr. Kvedar is also a board-certified dermatologist and Associate Professor of Dermatology at Harvard Medical School

Podcast Link: http://www.hcplive.com/hcplive/great_debate

Assessment

Feel free to email questions, or to post follow-up comments, for all our viewers to consider and respond. The principals are asked to weigh-in, as well.

And the Winner is … ?

Conclusion

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Filed under: Information Technology, Interviews, Point-Counter Point, Practice Management, Videos, Voting Polls | Tagged: Al Borges, ARRA, Brigham and Women’s Hospitals, Center for Connected Health, EHRs, electronic medical records, EMRs, George Washington University Medical School, Harvard Medical School, health information technology, HIT, HITECH, IT, Joseph Kvedar, Massachusetts General, obama, Office eMR project, Partners Healthcare, personal medical records, protected health records | 7 Comments »

ADA President and Broken Promises

Posted on August 11, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The Future President

By Darrell K. Puritt; DDS

The election for a future ADA president occurs the first week in October in Hawaii at the 2009 annual meeting. A couple of days ago, the ADA News Online posted the ADA President-elect candidates’ statements.

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3133

All three sound like they support meaningful dialogue with membership: Candidate Dr. Raymond Gist says one of his goals is: “To protect and preserve ownership of the intellectual property of the ADA while demonstrating transparency and fostering an understanding of how our system works.” Candidate Dr. William Glecos says “My first goal will be to coordinate and improve our communication efforts within the ADA. To make sure we are engaging all our members and imparting a sense of connection and transparency.” Candidate Dr. Marie Schweinebraten says “… communication, internal and external, must be improved to respond in today’s world … barriers must be eliminated to allow member input and volunteer involvement when solving specific issues.” I’ve seen candidates use these same buzzwords before, but not mean them. Dentistry is being severely threatened right now, and I’m too young to retire. So I want to see a future leader confident enough to walk through fire with me on behalf of my patients.

Promises from ADA President-elect candidates have been very disappointing so far. Past President Dr. Mark Feldman, President Dr. John Findley and President-elect Dr. Ron Tankersley each promised “transparency.” Feldman and Findley broke their promises very early, and so far, Tankersley has done no better. Nine months ago I invited Dr. Tankersley to a conversation about the future of electronic dental records and he chose to insult me with silence rather than respond. I took it personally, Ron, and I’ll never forget it. Because all three of these presidents are simply rude people, it wouldn’t bother me to never ask any of them for friendship.

So do you think our fresh leaders are any more sincere about transparency with membership? Or are they also hoping to be safely elected. This could be an opportunity for one or more of the three to break loose and be counted as a brave leader… or not. Let me show you what Feldman, Findley and Tankersley have gotten us into. Below is a list of duties expected of dentists with NPI numbers that came out today on ANCO Online. If any of you three candidates have the courage to respond to my challenging comments about what I consider to be a perfect example of a renegade department, jump right in. Concerned members need to be warned about the courage we can count on. If you cannot defend the Department of Dental Informatics, just say so. We’ll all be better off. And on truth, we can build. What an opportunity for you! I bet one could easily gain the delegates’ attention by doing the right thing, even if it is unpopular at first to those who may have helped you to power.

Responding to this article in a respectful, professional way could be just what it takes to get a person elected to the highest position in the American Dental Association. That’s what you intensely want, isn’t it? You just have to recognize what I am spelling out for you, Raymond, William and Marie. Just look at the growing discontent with the ADA on the Internet. Whoever is the first to show sincerity and courage, will become a hero to those of us who feel betrayed by those we once trusted. Victory will never be easier. I’ve had a look around. Believe me when I tell you that things are soo bad that even I could be a contender. Don’t make me run for the job.

Here is the first issue for discussion if you are interested: For dentists who were persuaded by the ADA Department of Dental Informatics to quickly volunteer for the 10 digit identifying number, let me ask you this: If you had been told what ADA employees are paid to tell you, which you can read below, would you have applied for an NPI number? And if you were forced to apply for a number by a managed care contract with BCBSTX, Delta Dental or other discount dentistry broker, would that be considered an unfair business practice?

Let’s look at fairness: Who does the NPI number help? Dental patients or BCBSTX? Or perhaps the ADA? We were told again and again in ADA News Online articles written by Arlene Furlong that the best reason for the NPI number was convenience. She said office managers would love it because it would replace numerous identification numbers. When one reads the list of NPI obligations a dentist volunteers their office manager for, all those other numbers don’t seem so bad after all. Why was HIPAA so important that the ADA Department of Dental Informatics forced employees under its supervision to intentionally mislead membership? Does the ADA work for dentists and their patients or for CMS? There you go, Dr. Raymond Gist, Dr. William Glecos and Dr. Marie Schweinebraten. It’s your turn now. If you have the guts to step up to a challenge, it could pay off big. Besides, even if you get elected without first responding to my concerns doesn’t mean you’ll get rid of me. Oh heaven’s no.

D. Kellus Pruitt; DDS

http://anco- .blogspot.com/2009/08/asco-coa-cms-palmettoj1mac-news.html

**** CMS NEWS ****

This message is for health care providers, particularly physicians and other practitioners, who have obtained National Provider Identifiers (NPIs) and have records in the National Plan and Provider Enumeration System (NPPES). The Centers for Medicare & Medicaid Services (CMS) recommends that each health care provider, including individual physicians and non-physician practitioners: · Secure and maintain their own NPPES account information (i.e., User ID, Password, and Secret Question/Answer) for safety and accessibility purposes. Health care providers should maintain the confidentiality of their User ID, password, and Secret Question/Answer in order to protect their NPPES information from unauthorized access. Reset their NPPES passwords at least once a year.

See the NPPES Application Help page at https://nppes.cms.hhs.gov/NPPES/Help.do and select the ‘Reset Password Page’ for applicable rules. Those rules indicate the length, format, content and requirements of NPPES passwords. Review their NPPES records in order to ensure that the information reflects current and correct information. Covered health care providers are required to update their NPPES information within 30 days of the effective date of the change.

Viewing NPPES Information Health care providers, including physicians and non-physician practitioners, can view their NPPES information in one of two ways: (1) By accessing the NPPES record at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created. If the health care provider has forgotten the password, enter the User ID and click the “Reset Forgotten Password” button to navigate to the Reset Password Page. If the health care provider enters an incorrect User ID and Password combination three times, the User ID will be disabled. Please contact the NPI Enumerator at 1-800-465-3203 if the account is disabled or if the health care provider has forgotten the User ID. OR (2) By accessing the NPI Registry at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do.

The NPI Registry gives the health care provider an online view of Freedom of Information Act (FOIA)-disclosable NPPES data. The health care provider can search for its information using the name or NPI as the criterion. Information regarding NPPES data that are FOIA-disclosable can be found at http://www.cms.hhs.gov/NationalProvIdentStand/ by selecting ‘Data Dissemination’. Please note: Business Mailing Address and Business Practice location information (full address and corresponding telephone numbers) are key data elements that are FOIA-disclosable.

Health care providers should not report their residential address unless it is their Business Mailing Address or Business Practice location. The NPPES data appearing on the NPI Registry cannot be deleted; however, it can be updated or changed. Updating NPPES Information Health care providers, including physicians and non-physician practitioners, can correct, add, or delete information in their NPPES records by accessing their NPPES records at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created.

Please note: Required information cannot be deleted from an NPPES record; however, required information can be changed/updated to ensure that NPPES captures the correct information. Certain information is inaccessible via the web, thus requiring the change/update to be made via paper application. The paper NPI Application/Update Form (CMS-10114) can be downloaded and printed at http://www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf.

Deactivating the NPI Health care providers, including physicians and non-physician practitioners, can deactivate their NPIs if the NPIs are no longer required or needed. Reasons for deactivation include retirement, business dissolved, or death of the health care provider. A request for deactivation must be submitted via paper application. The paper NPI Application/Update Form (CMS-10114) can be downloaded and printed at http://www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf.

Health care providers should review the instructions located on the application regarding deactivations in order to properly complete the deactivation request. The Power of Attorney or Executor of the Will may complete the application for deactivation due to death of the health care provider.

Need More Information?

Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Visit CMS’ dedicated NPI web page at www.cms.hhs.gov/NationalProvIdentStand for additional NPI information.

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Filed under: Career Development, Ethics, Health Insurance, Health Law & Policy, Information Technology, Managed Care, Op-Editorials, Practice Management, Pruitt's Platform | Tagged: ADA, American Dental Associaion, ANCO, Arlene Furlong, BCBSTX, Darrell Pruitt, DDS, delta dental, Department of Dental Informatics, DMD, doctoroogle.com, HIPAA, john findley, Marie Schweinebraten, mark feldman, NPI, NPPES, OSHA, Raymond Gist, Ron Tankersley, William Glecos | 8 Comments »

Hospital Automated Data Collection

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

Understanding Data Capture Technologies

By David J. Piasecki, with
Hope Hetico; RN, MHA

Automated data collection (ADC), also known as automated data capture, automated identification (AutoID) or automated identification and data capture (AIDC), consists of many different technologies. Bar codes, voice systems, RFID, OCR, laser scanners, vehicle mounted and wearable computers are all part of ADC management and hospital inventory activities.

www.HealthcareFinancials.com

Six-Figure Projects

However, the fear of six-figure project costs often prevent many small to mid-sized hospitals and healthcare systems from taking advantage of these technologies. The key to implementing cost-effective ADC systems is to know what technologies are available and the amount of integration needed to implement them. Applying this processing knowledge in a healthcare organization will help in developing the scope of any project. Limiting projects to or prioritizing by those applications that have a high benefit/cost ratio allows these operational improvement technologies within a reasonable budget.

Example:

For example, adding a keyboard-wedge bar-code scanner to an existing personal computer (PC) or blade terminal in a nursing station is a very low-cost method for applying ADC to existing hospital reporting applications. This type of hardware is inexpensive and the only real programming required is to add a bar code to the proper form (work order, pick and delivery slip, etc).

Review of the ADC Technologies

Some of the current hospital data capture technologies include the following:

a. Bar Codes

b. Bar-Code Scanners

Laser or CCD

Auto-Discrimination

Keyboard-Wedge Scanners

Fixed-Position Scanners

c. Portable Computers

d. Batch versus Radio Frequency

e. Hand-Held Devices

f. Vehicle-Mounted Devices

g. Wearable Systems

h. Voice Technology

i. Optical Character Recognition

j. Light Systems

Assessment

Driven by a need for improved data capture, asset management, staff mobility and standardized medication administration to name a few benefits, hospitals are likely to invest much more heavily in ADC and Wi-Fi technologies over the next five years, according to this new research report.

Link: http://www.eweek.com/c/a/Health-Care-IT/WiFi-Healthcare-Systems-to-Hit-49B-878082/

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think. Can you think of any other hospital data capture technologies? 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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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Filed under: Experts Invited, iMBA, Inc., Information Technology, Practice Management | Tagged: ADC, AIDC, AutoID, automated identification and data capture, automatic data collection, bar codes, David Piasecki, FRID, HIT, hope hetico, Information Technology, IT, keyboard wedge scanners, laser scanners, OCR, PC, voice technology, Wi-Fi, wi-max, www.healthcarefinancials.com | 2 Comments »

OSHA and Sharp Medical Instruments

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

Understanding OSHA Requirements

By Patricia A. Trites; MPA, CHBC, CHCC, CMP™ (Hon)
Dr. Charles F. Fenton, III; JD, FACFAS
Hope Rachel Hetico; RN, MHA, CMP™

The OSHA Standard requires that contaminated needles and other contaminated sharp instruments (sharps) must not be bent, recapped, or removed.

Definition

Contaminated sharps are defined as any contaminated object that can penetrate the skin including, but not limited to: needles, scalpels, broken glass, broken capillary tubes, and exposed ends of dental wires.

Contaminated needles and other contaminated sharps must not be recapped or removed from the syringes unless the employer can demonstrate that no alternative is feasible or that such action is required by a specific medical procedure. Also, shearing or breaking of contaminated needles is prohibited. This would include those instances, such as during surgery, where recapping was necessary due to the need to give multiple injections from the same syringe. If needles are recapped, it must be through the use of a one-handed technique.

Two-Handed Recapping

Two-handed needle recapping is strictly prohibited by the Standard. Recapping of needles can be a very dangerous procedure. It is during recapping that most skin punctures occur.

Immediately, or as soon as possible after use, contaminated reusable sharps must be discarded and placed in appropriate containers until properly reprocessed. The containers must be:

puncture resistant;
labeled or color-coded; and
leak proof on the sides and bottom.

Assessment

Finally, containers must be at the site as close as feasible to the use of the sharps. This will limit the risk of injury during the time the sharp would otherwise have been transported from the site of use to the site of disposal. During use, the sharps container must be maintained upright, not be allowed to be overfilled, and replaced routinely. When moving containers of contaminated sharps from the area of use, the containers must be closed immediately prior to removal or replacement to prevent spillage or protrusion of contents during handling. The container must be placed in a secondary container if leakage is possible. Reusable containers must not be opened, emptied, or cleaned manually or in any other manner that would expose employees to the risk of percutaneous injury. Physicians can purchase turn-key sharps containers that, when full, can be shipped back to the distributor for proper disposal.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think. How has OSHA affected your practice? 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: "Doctors Only", Glossary Terms, Health Law & Policy, Practice Management, Professional Liability | Tagged: Charles Fenton, contaminated needles, contaminated sharps, hope hetico, OSHA, Patricia Trites, sharps, syringes, Two-handed needle recapping | 6 Comments »

Dictionary of Health Insurance and Managed Care

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

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Why do we need the Dictionary of Health Insurance and Managed Care, and, why do payers, providers, benefits managers, consultants, and consumers need a credible and unbiased source of explanations for their health insurance needs and managed care products?

The Answer is Clear!

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Filed under: Book Reviews, Career Development, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, iMBA, Inc., Managed Care, Practice Management, Recommended Books, Sponsors | Tagged: CPAs, david marcinko, doctors, financial advisors, health information technology, Health Insurance, healthare reform, HIT, hope hetico, INSURANCE COMPANIES, IT, Managed Care, MEDICAL PROVIDERS, nurses, obama, patients, PAYERS, physicians, www.healthdictionaryseries.com | 1 Comment »

Medical Inventory Management Methodologies

Posted on August 7, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Traditional Costing Methods

By David J. Piasecki, with
Hope Rachel Hetico; RN MHA, CMP™

A good inventory management system offers opportunities for improved efficiency in any healthcare organization. The following traditional methods of inventory cost accounting and management are useful when one is calculating the cost of supplies (as opposed to medical items for resale and DME).

a. LIFO

The last-in first-out (LIFO) inventory costing method means the last items purchased are the first to be used (at least for cost calculations if the inventory consists of identical units). In times of rising prices, a lower total cost inventory is produced with a higher cost of goods sold. The last items purchased are most often the most expensive, and used first for the calculation. This happens because LIFO increases an expense (cost of goods sold) and decreases taxable income. Given the same revenue, higher expenses mean less profit. Deflation has the opposite effect.

b. FIFO

The first-in first-out (FIFO) inventory costing method means the first items purchased are the first to be used (at least for cost calculations if the inventory consists of identical units). In times of rising prices, a higher total cost inventory is produced with a lower cost of goods sold. This happens because FIFO decreases an expense (cost of goods sold) and increases taxable income. Deflation has the opposite effect.

Note: Any switch from FIFO to LIFO does not change reality, and although a decrease in reported incomes occurs, it does not increase cash outflows. However, for a taxable healthcare entity, after-tax net cash flow does increase.

c. Specific Identification

Specific identification is used for larger pieces of equipment, as it traces actual costs to an identifiable unit of product and is usually applied with an identification tag, serial plate, or radio frequency identification device (RFID) scanner. It does not involve flow-of-cost analysis. It does, however, permit the manipulation of income because healthcare entities state their cost of goods sold, and ending inventory, at the actual cost of specific units sold.

d. Average Cost

Average costing calculates ending inventory using a weighted average unit cost. When prices are rising, cost of good sold is less than under LIFO, but more than that under FIFO, and hence income manipulation is also possible.

e. Just-in-time Management

Although technically not a costing technique, JIT inventory management means that inventory supplies like DME are delivered as soon as needed by the healthcare organization, the prescribing doctor, or the patient. In JIT, inventory is “pulled” through the flow process. This is contrasted to the “push” approach used by conventional IM. In the push system, DME is already on-site, with little regard to when it is actually needed. In the JIT “pull” system, the overriding concern is to keep a minimum cost inventory, so that means having a system in which inventory is obtained on an as-needed basis.

The key elements of JIT consist of six parts:

1. a few dependable vendors or suppliers willing to ship with little advance notice;

2. total sharing of demand information throughout the supply chain;

3. more frequent orders;

4. smaller size of individual orders;

5. improved physical plant (hospital or clinic) layout to reduce travel flow distance; and

6. use of a total quality control system to reduce flawed medical products.

Using the JIT method, inventory is delivered when needed, rather than in advance, saving handling and storage costs. The healthcare entity never needs to stockpile inventory, and cash flow is enhanced. JIT is further characterized as follows:

little or no work orders;
little or no tracing of materials;
fewer inventory accounts or accounts payables;
reduction or elimination of work-in-progress or handling activities; and
no tracing of overhead and direct labor costs

JIT requires a dependable working relationship with suppliers and the precise calculation of inventory needs, especially for the following:

sterile surgical packs;
gastro-intestinal and gastro-urinary instrumentation;
orthopedic and OB-GYN inventory;
invasive heart and lung equipment;
radio isotopes and trace radiographic materials; and
equipment for almost all pre-schedule medical interventions and procedures.

Assessment

This means that, when JIT inventory monitoring is used, healthcare managers are better prepared with the proper inputs to control and reduce inventory, including when dramatic bursts or declines occur. This means a more rapid and higher cash flow balance, rather than inventory balance. Each of these traditional methods of inventory cost accounting is adequate for most healthcare facilities, but as inventory orders and costs continue to increase, economic order quantity [EOQ] costing may be the most effective means of accounting for inventory in DME-intensive organizations.

Conclusion

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

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***

Filed under: Accounting, CMP Program, Health Economics, iMBA, Inc., Practice Management, Taxation | Tagged: acerage cost accounting, cost accounting, David Piasecki, DME, durable medical equipment, economic order quantity costing, EOQ, FIFO, GI, hope hetico, inventory management, JIT, just in time costing, just in time management, LIFO, managerial acounting, ob-gyn, RFID scanner, specific identification, www.certifiedmedicalplanner.com, www.healthcarefinancials.com, www.medicalbusinessadvisors.com | 2 Comments »

Meet Brian J. Knabe MD CFP™ CMP™

Posted on August 3, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A New ME-P Thought-Leader

By Ann Miller; RN, MHA

[Executive Director]

Brian J Knabe MD is a financial advisor with Savant Capital Management www.SavantCapital.com. He uses his experience from the medical field in his work with clients, portfolio managers, physicians and other financial advisors to develop comprehensive planning, investment, and tax strategies for professionals.

Medical and Financial Background

Brian is a magna cum laude graduate of Marquette University with an honors degree in biomedical engineering. He earned his medical degree from the University Illinois College of Medicine. Brian also attended the University of Illinois for his family practice residency, where he served as chief resident. Brian is currently pursuing his Certified Financial Planner (CFP®) designation, and he recently passed the exam.

Certified Medical Planner™

Dr. Knabe is also matriculating in the online www.CertifiedMedicalPlanner.org [CMP™] charter-designation program for financial advisors and medical management consultants, from the Institute of Medical Business Advisors, Inc.

Personal Background

As if the above were not enough to keep him busy, Brian is also a clinical assistant professor in the Department of Family Medicine with the University of Illinois. He is a member of several professional organizations, including the American Academy of Family Physicians, the American Medical Association [AMA], and the Catholic Medical Association. Brian has also served as the vice president of membership for the Blackhawk Area Council of the Boy Scouts of America.

Our Congratulations

And so, we trust all ME-P readers will give a congratulatory “shout-out” to Brian J. Knabe MD, our newest “thought-leader.” Read his position paper here:

Evidence Based Investing [A Scientific Framework for the Art of Investing]

Link: Evidence Based Investing[1][1]

We trust we will hear much more from him in the future.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think about the credentials of Dr. Knabe. Is this extreme education a new-wave of fiduciary focus for all financial advisors and planners in the healthcare space? 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: Breaking News, Career Development, CMP Program, Financial Advisor Listings, Financial Planning, Investing, Op-Editorials, Portfolio Management, Practice Management, Research & Development, Taxation | Tagged: AMA, American Academy of Family Physicians, american medical association, brian knabe, Catholic Medical Association, certified financial planner, certified medical planner, CFP, CMA, CMP www.CertifiedMedicalPlanner.com, EBM, evidence based medicine, institute of medical business advisors, Marquette University, savant capital management, University Illinois College of Medicine | 1 Comment »

Hand Washing for Healthcare Facilities

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

Understanding OSHA Standards

[By Dr. David E. Marcinko; FACFAS, MBA, CPHQ, CMP™]

[By Patricia A. Trites; MPA, CHBC, CHCC, CMP™ (Hon)]

The OSHA Standards for healthcare require that hand washing facilities be readily available to employees.

Definition

Hand washing facilities are defined as a facility providing an adequate supply of:

running potable water;
antiseptic soap; and
single-use disposable towels or hot air drying machines.

Location

The hand washing facilities must be located where the employee will have easy access. This will ensure that the employee will be likely to use the hand washing facility and will minimize the time that the contamination will remain in contact with the employee. In those instances where the provision of hand washing facilities is not feasible, either an appropriate antiseptic hand cleaner (e.g., alcohol-based rinse, antiseptic foam, or antiseptic-impregnated paper wipes) in conjunction with clean cloth or paper towels, or antiseptic towelettes, must be provided.

Soap and Running Water

When using antiseptic hand cleansers or towelettes, the hands must be washed with soap and running water as soon as feasible. Not only must the employer provide the hand washing facilities, he or she must also ensure that employees in fact do wash their hands immediately or as soon as feasible following contact with blood or other potentially infectious material [OPIM].

The employee must also wash his or her hands immediately after removal of gloves or other personal protective equipment [PPE]. It is the employer’s responsibility to ensure that hand washing occurs. OSHA states that hand washing must be strictly enforced by the employer.

***

Assessment

How has OSHA affected your hospital, medical practice or healthcare facility?

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: "Doctors Only", Career Development, Glossary Terms, Health Law & Policy, Practice Management, Quality Initiatives, Recommended Books, Risk Management | Tagged: Charles Fenton, hand washng, OPIM, OSHA, other potentially infectious material, Pati Trites, personal protective equipment, PPE | 8 Comments »

About EHRWatch.com

Posted on July 30, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A New Online Virtual Collaborative

By Staff Reporters

www.EHRWatch.com is a new online community dedicated to developments in electronic health records [eHRs], including practice, funding, product integration, standards developments and trends in implementation. The new site features blog posts, polling, commenting and a weekly e-newsletter.

A Collaborative

www.EHRWatch.com is designed to encourage community participation, interaction, collaboration and reaction. Whether you need to select and implement an EHR solution or make sure your current system meets the requirements and timeline necessary to receive the Obama Administration’s ARRA, and HITECCH, stimulus incentives, the site may offer the products, information, services and expertise to help.

Assessment

Visit www.EHRWatch.com to read the latest posts and join the virtual community. Just give em’ a click, today!

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think of this new site? 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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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Sponsors Welcomed

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Filed under: Breaking News, Information Technology, Practice Management | Tagged: ARRA, CCHIT, EHRs, electronic health records, electronic medical records, EMRs, healthcare reform, HITECH, obama | 2 Comments »

Understanding Universal Healthcare Precautions

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

The OSHA Definition for Medicine

By Patricia A. Trites; MPA, CHBC, CHCC, CMP™ (Hon)
Dr. Charles F. Fenton, III; JD, FACFAS
Hope Rachel Hetico; RN, MHA, CMP™

www.HealthcareFinancials.com

OSHA defines universal precautions (sometimes referred to as “normal precautions”) as an approach to infection control whereby all human blood and certain human body fluids are treated as if known to be infected by HIV, HBV [hepatitis], or other blood borne pathogens.

Assessment

Universal precautions must be observed to prevent contact with blood; or; Other Potentially Infectious Materials [OPIM]. Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids should be considered potentially infectious.

Conclusion

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

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Filed under: Health Law & Policy, Practice Management, Quality Initiatives, Risk Management | Tagged: blood borne pathogens, Charles F. Fenton, HBV, HIV, Hope Rachel Hetico, OPIM, OSHA, Other Potentially Infectious Materials, Patricia A. Trites, universal infection precautions | Leave a comment »

OSHA and Workplace Pathogen Control

Posted on July 26, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Engineering and Medical Work Practice Controls

By Patricia A. Trites; MPA, CHBC, CHCC, CMP™ (Hon)
Dr. Charles F. Fenton, III; JD, FACFAS
Hope Rachel Hetico; RN, MHA, CMP™

Engineering and medical practice controls are methods used to isolate or remove bloodborne pathogen hazards from the workplace. These practices should be used to eliminate or minimize employee exposure by removing the hazard or isolating the employee from the exposure. However, where occupational exposure remains after institution of these controls, personal protective equipment [PPE] must be employed, as described below.

Engineering Controls

Engineering controls can be described as those an employer purchases and makes available to protect his or her employees. Examples are sharps containers, eye-wash stations, spill-kits, and safer needle systems. It is the employer’s responsibility to implement and maintain a system for ensuring engineering that controls are used. The engineering controls must be examined and maintained or replaced on a regular schedule to ensure their effectiveness. Conducting only an annual review of the engineering controls is inappropriate under the OSHA Standard.

Healthcare Work Practice Controls

Unlike engineering controls, healthcare work practice controls depend upon the behavior of the employee to reduce exposure. Examples are hand washing, utilizing universal precautions, and wearing appropriate PPE. Even with properly implemented work practice controls, exposure can still occur. Some of the engineering and work practice controls that must be addressed (if applicable to the specific healthcare organization) within the employee control plan [ECP] include:

hand washing facilities and practices,
treatment of sharp instruments,
separation of food from contamination,
certain procedures in the treatment of contamination,
sterilization, and
care of equipment.

Assessment

These engineering controls must be examined and maintained or replaced on a regular schedule to ensure their effectiveness. Conducting only an annual review of the engineering controls is inappropriate under the OSHA Standard.

Conclusion

How has OSHA affected your practice? Or, is it so 1999?

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: "Doctors Only", Glossary Terms, Health Law & Policy, Practice Management, Quality Initiatives, Risk Management | Tagged: bloodborne pathogens, Charles Fenton, ECP, eye-wash stations, hand washing, hope hetico, OSHA, Patricia Trites, personal protective equipment, PPE, safe needle, sharps containers, spill-kits | 3 Comments »

Sign-Up for the ME-P

Posted on July 18, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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By Ann Miller; RN, MHA

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Janis Oshensky Lobbies Congress – Not Dentists

Posted on July 16, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Show Me the Math

By Darrell K. Pruitt; DDS

I have noted here far too many times how it disappoints me that Delta Dental Plans Association vice president Janis Oshensky repeatedly chooses to turn to politicians rather than discuss Delta Dental’s arguably egregious and harmful policies with me, a dentist. I intend to put a stop to such disrespect one PR expert at a time if necessary.

Long ago I warned Oshensky that if she didn’t talk to me, she should probably just shut up in order to preserve what’s left of her Internet reputation. Since by posting her Letter to the Editor on POLITICO.com today, she obviously ignored my advice, this highly critical comment will reliably join three others of mine on her first page soon enough. Her employer is sacrificing her like a pawn.

The following comment is the one I posted on POLITICO.com in response to Oshensky’s letter. It might just help the vice president to finally come to a decision on this issue one way or the other. Either way, marketplace conversation like this cannot help but lead to safer air for the community … My pleasure.

http://www.politico.com/news/stories/0709/24873.html

Dear POLITICO.com Editor:

This comment and subsequent invitation to Janis Oshensky is in response to the Delta Dental Plans Association vice president’s July 14, 2009 letter to you. Her letter is the most recent message she successfully sent Congress using a political news Website. Even though Ms. Oshensky holds the position of VP of dental relations as well as public policy, she has avoided answering this dentist’s questions about Delta Dental’s policies for months. If Ms. Oshensky is willing to do so, I would love for her to join me in discussion of Delta Dental’s taxation subsidy right here on POLITICO.com so that our lawmakers can witness a more balanced view of the issues.

Hello – It’s Me

Hello. My name is D. Kellus; Pruitt DDS, and I’m a practicing dentist in Fort Worth, Texas. It is my professional opinion that my patients are harmed by the policies of managed care dental plans like that sold by DDPA because there is no accountability to their clients or dentists. There is barely any accountability to those who select and pay for Delta’s products – dental patients’ naive bosses.

Like virtually every US citizen, your readers probably couldn’t care less about the dental industry. It is precisely because dentistry has been uninteresting for decades that make the microcosm of health care incredibly interesting to me. Let me uncover for your appreciation the event horizon in dental history. You could learn about more than just dentistry.

If left to natural forces of human nature, what happens to value when there is no accountability? For example, what do the 1975 East German Trabant and the 1979 Ford Pinto have in common? By popular vote, those products not only represent the two worst automobiles ever made, but the state shielded both manufacturers from accountability to consumers. Poor quality happens.

Oshensky argues against the taxation of managed care dental benefits like those sold to employers by Delta Dental. Let me offer that if Delta’s product were taxed like income, its value would quickly dive below the market threshold that attracts purchasers’ consideration.

Allow Me to Show-You the Math

Recently, Delta Dental of Michigan lost the accounts of thousands of GM retirees when their group dental benefits were cut in bankruptcy negotiations with UAW. Suddenly, Delta found itself forced to market their product to individuals who for once have the choice to keep their money. Faced with true competition for healthcare dollars, Delta leaders desperately cobbled together individual policies for the retirees who want to continue with their coverage. Even though Delta did everything possible to lower the cost of their coverage, the cheapest of the plans they offered still runs about $30 per person per month, and covers only 50% of everything, including preventive. So for premiums of $360 per year plus half the preferred providers’ 20% to 30% discounted fees, is this a bargain for Michigan retirees?

Free Markets

In my free-market, fee-for-service practice, if a patient comes in for two cleanings and routine x-rays during a year, 100% of my bill is $208. This is the market price in my neighborhood that is continually challenged by lively competition with other dentists for new patients who may not even have dental benefits. Those customers pay in full at the time of visit, just like most people whose bosses purchased Delta Dental Plans.

Value Comparisons

So let’s compare value of Delta Dental’s product with cash. If I were a Delta Dental preferred provider, my fee of $208, less Delta’s 25% discount would be $156. Never mind that my wife has problems with my 70% cut in pay, let’s move on.

The patient’s half of the $156 I earned is $78. $360 + $78 = $438. So for one uneventful year of discounted dental services with a dentist chosen from a list of names, a patient can expect to spend more than twice as much than if they paid the free-market price at the point of service.

Assessment

Not only is that hardly a bargain, but it is my opinion that managed care dentistry is dentistry by the lowest bidder with no quality control. That should be enough meat to get this conversation rolling. Now it’s your turn Ms. Oshensky. I think you have to admit that you’ve got holes to mend in the dental relations part of your job.

Conclusion

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Filed under: "Doctors Only", Career Development, Ethics, Health Insurance, Managed Care, Practice Management, Pruitt's Platform | Tagged: ADA, Darrell Pruitt, DDPA, DDS, delta dental, Delta Dental Michigan, dentists, DMD, GM, HMO, Janis Oshensky, managed dental care, POLITICO, PPO, UAW | 3 Comments »

Boosting Medical Practice Goodwill Value

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

Goodwill Hunting

What’s your Office Really Worth?

[By Dr. David E. Marcinko; MBA]

There are several measures a physician can take to increase the value of medical practice goodwill, which in turn will make the practice more desirable, and profitable, when selling or taking on a partner.

These are listed below for your consideration:

Keep good financial records. Know your capital purchases, and have your balance sheet, statement of cash flow and net income statement up to date.
Continually monitor key financial ratios, such as profitability, creditors, long-term debt management and medical equity value-added.
Have adequate practice insurance, including property liability coverage, plus have workers’ compensation for staff and life and disability insurance on the key doctors.
Build a brand identity for the practice rather than an individual brand identity for you as a physician. This helps in developing a business that others could assume and operate.
Have a practice continuation plan that stipulates how the practice will be sold or continued in the event of a physician’s death or disability. Specify who will buy the practice and for how much. And specify whether the purchase will include land, buildings, inventory, licenses and goodwill. Have a covenant that specifies the procedures to follow when a physician leaves the practice.
Have strong relationships with everyone who does business with your practice, including supply vendors as well as referring doctors and fellow physicians.
Be organized when it comes time to present the supporting information. Don’t accept the first valuation given. Numbers can be changed, if you can present substantive reasons.

MORE: AMA News Interviews Dr. Marcinko

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How have you reacted to the recent declines in both medical practice [business] and personal [doctor] goodwill?

Tell us what you think? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Filed under: Career Development, Glossary Terms, Health Economics, iMBA, Inc., Practice Management, Practice Worth, Research & Development | Tagged: accounting value, book value, business goodwill, david marcinko, goodwill, goodwill valuation, medical practice value, personal goodwill, practice appraisal, Practice Worth | 1 Comment »

Essay of Atul Gawande MD in the New Yorker

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

The McAllen Redux

We urge all ME-P subscribers and followers to read Atul Gawande’s piece in the New Yorker that appeared as an essay on McAllen, Texas – the little Texas town with the dubious honor of being one of the most expensive health care markets in the country, today.

Link: http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

As Dr. Gawande noted, in 2006, Medicare spent about $15,000 per enrollee there – close to twice the national average, and three thousand dollars more per person than McAllen’s per capita income of $12,000.

Commentary

Then, take at look at the comment by OMB Director Peter R. Orszag, posted on Thursday, June 4th, 2009 at 10:50 am; entitled the McAllen Redux

http://www.whitehouse.gov/omb/blog/09/06/04/McAllenRedux/

Assessment

Who says bloggers, and citizen journalists, get no respect?

Conclusion

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Filed under: Alerts Sign-Up, Breaking News, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Media Mentions and PR, Practice Management, Quality Initiatives | Tagged: Atul Gawabde, CMS, Health Insurance, McAllen Redux, McAllen Texas, medicare, New Yorker, OMB, Peter R. Orszag | 6 Comments »

Concierge Medicine and the “Zombie” Medical Practices

Posted on July 7, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Continued Growth of Boutique Medical Practices Today

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

The boutique, or direct reimbursement, or cash based medicine, or concierge medical practice business model requires an annual fee for personalized treatment that includes amenities far beyond those offered in the typical practice, or suggested by physician medical unions. Patients pay annual out-of-pocket fees for top tier service, but also use traditional health insurance to cover allowable expenses, such as inpatient hospital stays, outpatient diagnostics and care, and basic tests and physician exams. Typical annual fees can range from $1,500 to $ 5,000 per patient, to family fees that top $25,000 a year, or more. The concept, initially developed for busy corporate executives, has now made its way to others desiring such service.

A Higher Level of Care

Medical providers get to provide a much higher level of care and get to know their patients as they enjoy the incentive to spend appropriate time with them, and over time, get to know them within their unique social/cultural context as well (hence the house calls become important). Patients enjoy the access, the attentiveness, and are willing to spend cash to have the type of unhurried, contemplative time with physicians that is required to develop a trusted relationship and deliver high quality care. The financial remuneration potential is compelling as well.

Now, let us compare and contrast various parameters of traditional medical practice [third party reimbursement] with the same parameters of so-called “new-wave” concierge medicine. Then, let the next-generation of doctors decide.

Current Traditional Model

patients seen at 15-20 min increments
2,000 – 3,000 patients
Paperwork, administrative burdens, frustrations, and lack coordinated care
Impersonal experience (long waits, un-intelligible interactions with health care system)
Average Salary = $150,000-250,000

Concierge Practice Model Potential

direct relationship with patients
300-500 patients
$1,500 – $3,000 access/retainer fee
Reduced overhead, positive interactions, care coordination and increased quality
Personalized experience (reduced headaches and paperwork with transparent pricing)
24/7 access, same day appointments with multiple other amenities
Average Salary = $100,000 – $500,000

Enter the Franchisors

Concierge medical practices can be developed organically, or use a franchise business model [personal communication, Suzanne R. Dewey, Forté Partners, LLC, Williamstown, MA]. Examples of franchisors include:

Elite Health: http://elitehealth.com
Health Advocate: http://healthadvocate.com National organization with over 4,300 client relationships.
MD2 International: http://www.md2.com/home.php
MDVIP: http://www.mdvip.com
ModernMed: http://www.modernmed.com

Opponents and Pessimists

There have been plenty of opponents, within medicine and outside, to the idea of concierge practices almost from the first day. For example,

”The state of Washington’s insurance commissioner attacked the concept of practices offering all the primary care patients needed for a prepaid fee or retainer, arguing that such practices amounted to the business of underwriting health insurance. He said that the practices would have to meet all the regulatory requirements for such an insurance business, including establishing capital reserves and maintaining loss reserves for the payment of claims. It didn’t work, and besides, few concierge practices offer free traditional medical care once retainers are paid–most concierge physician’s bill insurance plans for all the services covered under their patients’ coverage. The Medicare folks chimed in and managed to drive one physician out of business, arguing that he had tried to charge Medicare patients an extra $600 a year for services already covered by Medicare, hence he was guilty of illegal “balance billing.” Rather than fight Medicare over the issue, the doctor gave up and closed his practice. [C. Davis, “Big Problems for Medicare and Concierge Medicine,” Sierra Sacramento Valley Medicine, 55:3, May/June, 2004 (www.ssvms.org)]”

Attacking ME?

Objections to concierge medicine focus on both its causes and its effects, and some critics have even attack me, personally. For example, just look what “they” said in the online journal: “Health Care Strategic Management.”

”Many critics argue that concierge medicine merely reflects physician greed and unconcern over the needs of the community. Indeed, a recent book by David Marcinko, Business of Medical Practice [Advanced Profit Maximization Techniques for Savvy Doctors], includes a chapter on “The Case for Concierge Medicine” (Ch. 24) as one of the ways ‘savvy’ physicians can maximize their profit, as if that is what medicine is all about. While the image of physicians may retain some Marcus Welby elements of their rushing to the hospital or a patient’s home in the middle of the night, most physicians would rather stay home and leave the job to someone else, it is argued”.

Nicht Schadenfreude

Just think! My mother always feared I’d be a no-body. Good publicity – bad publicity – just spell the name correctly. Schadenfreude may be defined as a “largely unanticipated delight in the suffering of another which is cognized as trivial “ and I take no delight in the slow collapse of traditional medical practice models; or the economic, professional or personal pain of colleagues. But, I also often tell my critics – and clients – that although it’s awfully nice to be altruistic; I am always mindful of the competitive business adage: “no margin-no mission.” And, in as much as this attack was written in July 2005, I can only wonder if I was prescient, or just lucky? With all due respect, I believe it was the former, rather than the later. Why so? Well, just consider how fast www.ChoiceMed.com is growing. This stuff is not rocket-science.

www.MedicalBusinessAdvisors.com

About Concierge Choice Physicians

Concierge Choice Physicians: http://choice.md is a national organization offering a hybrid business model. Physicians divide their practice between a traditional practice and a retainer practice. The retainer practice is limited to approximately 150 patients. A typical concierge practitioner may have 300-500 patients, while the norm for a traditionalist is about 2,000-3,000 patients.

Assessment – Whither the “Zombies”

I, also ruefully wonder how many “zombie” medical practices [practitioners] are out there? You know the kind – a medical practice with neither a good/bad balance sheet. One with only subsistence level operating performance; a practice that is not growing organically or thru merger activity. It is just barely existing as the doctor-in-charge slowly, agonizingly, milks it to death; or retires, whichever comes first.

Conclusion

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Filed under: Career Development, CMP Program, Ethics, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Practice Management, Professional Liability, Research & Development, Risk Management, Sponsors | Tagged: boutique medical practice, Business Medical Practice, c Davis, cash based medicine, choice.md, ChoiceMed, concierge medicine, david marcinko, direct reimbursement medicine, elite health, health advocate, Health Care Strategic Management, MD2 International, MDVIP, ModernMed, zombie medical practices | 11 Comments »

On Healthcare Intranets and Extranets

Posted on June 26, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

A Primer for Physicians and Medical Executives

By Richard J. Mata; MD, MS, CMP™ [Hon]

According to the “Dictionary of Heath Information and Technology”,

“An intranet is a private network that uses Internet Protocols, network connectivity, and possibly the public telecommunication system to securely share part of an organization’s information or operations with its employees”.

Sometimes the term refers only to the most visible service, the internal website. The same concepts and technologies of the Internet, such as clients and servers running on the Internet protocol suite, are used to build an intranet.

Uses in Healthcare

An intranet is commonly used to provide communication and application services. The advantages of using an intranet in the healthcare setting include the following:

Medical Workforce productivity: Intranets can help employees quickly find and view information and applications relevant to their roles and responsibilities. Via a simple-to-use web browser interface, users can access data held in any database the organization wants to make available, anytime and subject to security provisions — from anywhere, increasing employees’ ability to perform their jobs faster, more accurately, and with confidence that they have the right information.
Time: With intranets, healthcare organizations can make more information available to employees on a “pull” basis (i.e., employees can link to relevant information at a time that suits them) rather than being deluged indiscriminately by e-mails.
Communication: Intranets can serve as powerful tools for communication within a healthcare organization; vertically and horizontally.

Vulnerability and Security Protection

Intranets, like other IT systems, need to be protected by security systems. Any intranet is vulnerable to attack by people intent on destruction or on stealing corporate data. The open nature of the Internet and TCP/IP protocols expose a corporation to attack. Intranets require a variety of security measures, including hardware and software combinations that provide control of traffic; encryption and passwords to validate users; and software tools to prevent and cure viruses, block objectionable sites, and monitor traffic.

Multiple Lines of Defense

The first line of defense is a firewall and these are commonly set up using proxy servers, which allow system administrators to track all traffic coming in and out of an intranet. Another layer of sophistication is added by using a bastion server firewall, configured to withstand and prevent unauthorized access or services. It is typically segmented from the rest of the intranet in its own subnet or perimeter network. In this way, if the server is broken into, the rest of the intranet won’t be compromised.

Authentication Systems

Authentication systems are an important part of any intranet security scheme. They are used to ensure that anyone trying to log into the intranet or any of its resources is the person they claim to be. Authentication systems typically use user names, passwords, fingerprints and iris scans, and various encryption systems.

Protection and Monitoring

Server-based software is used to protect an intranet and its data. Virus-checking software can check every file coming into the intranet to make sure that it is virus-free, and site-blocking software can bar people on the intranet from getting objectionable material. Monitoring software tracks where people have gone and what services they have used, such as HTTP for Web access.

Filtering Systems and Routers

One way of ensuring that the wrong people or erroneous data can’t get into the intranet is to use a filtering router. This is a special kind of router that examines the IP address and header information in every packet coming into the network, and allows in only those packets that have addresses or other data, like e-mail, that the system administrator has decided should be allowed into the intranet. Increasingly, intranets are being used to deliver tools and applications, e.g., collaboration (to facilitate working in groups and for teleconferences) or sophisticated corporate directories, sales and customer relationship management (CRM) tools, project management, etc, to advance productivity. Intranets are also being used as Health 2.0 culture change platforms

Metrics

Intranet traffic, like public-facing website traffic, is better understood by using web metrics software to track overall activity, as well as through surveys of users. Intranet User experience, editorial, and technology teams work together to produce in-house sites. Most commonly, intranets are owned by the communications, HR or IT areas of large healthcare organizations, or some combination of the three.

Assessment

When part of an intranet is made accessible to customers, partners, suppliers, patients, or others outside the healthcare organization – that part becomes part of an extranet.

Conclusion

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Filed under: Career Development, iMBA, Inc., Information Technology, Practice Management, Recommended Books, Sponsors | Tagged: authentication systems, bastion server, blogs, david marcinko, EHRs, EMRs, encryption, extranet, filtering systems, firewall, health 2.0, health information systems, HIT, hope hetico, hospital information systems, HTTP, intranet, metrics, perimeter network, Richard Mata, routers, spam blocker, TCP/IP protocols, virus, virus check, websites, wikis, www.healthcarefinancials.com, www.healthdictionaryseries.com | 1 Comment »

Understanding the Need for Onsite Practice Management Visits

Posted on June 25, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Interview Information also Important

By Dr. David E. Marcinko and Staff Reporters

SPONSOR: http://www.CertifiedMedicalPlanner.org

According to Robert James Cimasi MHA, ASA, AVA, CMP™ of Health Capital Consultants, LLC, in St. Louis, MO, the following types of information specific to medical practices should be gathered by the financial executive, financial advisor or healthcare consultant when performing a practice enhancement engagement, or especially, an economic valuation and appraisal. This information may be obtained through an interview, questionnaire, or preferably a site visit:

Background Information: Include such information as the number of years the entity has operated at its current location and in the community, as well as the office hours.
Building Description: Include the location (urban/suburban), proximity to hospitals and other medical facilities, and its size, construction, electrical and computer wiring, age, access to parking, and so on.
Office Description: Approximate acquisition details and price, as well as ownership or lease details should be included. The square footage and number of rooms, and a description of different office areas should be outlined, including, where applicable: medical equipment, including all diagnostic imaging and major medical equipment; pharmacy, laboratory, examination rooms, waiting rooms, and other areas.
Management Information Systems: Document types of hardware and software and the cost, age, and suitability of all components, including their management functions, reporting capabilities, and integration between programs.
History of the Entity: Give the date founded and by whom, the number of full-time equivalent (FTE) physicians in practice by year, the physicians who have joined and left the entity, the dates they practiced at the entity, and their relationship and practice arrangement with the entity.
Staff Description: Include the number and types of non-physician positions as well as the tenure and salary of all current employees.
Competitive Analysis: Include details of hospital programs impacting practice, growth or decline in the volume of business and the reasons, association with other physicians, competitive strengths and threats, the number and volume of procedures performed, any change in the number and volume, and the corresponding fees.
Patient Base Information: Encompass income distribution and percentages from different payors, the number of new patients and total patients seen per week, the age mix of patients, the number of hours spent in patient care per week, and the number of surgeries performed.
Managed Care Environment: Details the terms and conditions of all managed care contracts including discounts and withholds, the impact on referral patterns and revenues, willingness to participate in risk sharing contracts and capitation, and the entity’s managed care reporting capabilities.
Hospital Privileges and Facilities: List all hospital privileges held by physician members of the medical practice and the requirements for acquiring privileges at the different local hospitals.
Credit Policy and Collections: Include practice policies for billing and payment, use of collection agencies, acceptance of assignments, other sources of revenues, and an aged breakdown of accounts receivable.
Financial Management: Include cash management procedures and protections, credit lines and interest, controls to improve payment of accounts payable, late payment frequency, formal or informal financial planning methods, and budgeting processes.
Operational Assessment: Include governance structure for the entity, detailing responsibilities and procedures for performance, conflicts, recruitment, outcomes measures, case management, reimbursement; income, continuing medical education (CME), credentialing, and utilization review.

Assessment

http://www.CertifiedMedicalPlanner.org

The financial advisor must also allow for discussion of overall relationships with physicians in the community, practice concerns, and needs.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Have you ever had such an onsite visit? Was it by a fiduciary financial advisor or medical management consultant; or other? What was the outcome? 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, CMP Program, Health Economics, Healthcare Finance, Managed Care, Practice Management, Practice Worth | Tagged: certified medical planner, CMP, financial advisor, financial consultant, healthcare consultant, medical consultant, medical management, medical onsite visit, medical practice appraisal, medical practice management, medical practice valuation, Robert Cimasi, www.certifiedmedicalplanner.com | 1 Comment »

On Growing Tensions in Healthcare Services Markets

Posted on June 21, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Stressors Affecting all Stakeholders

[By Robert James Cimsai; MHA, AVA, ASA, CMP™]

http://www.HealthCapital.com

The changes in reimbursement for Medicare services through the introduction of prospective payment systems and physician reimbursement cuts for professional services, as well as the increased focus on patient quality and transparency initiatives and health 2.0 collaboration have forced healthcare providers to look for more efficient ways to provide services, as well as additional sources of revenue and margin-producing business.

Additionally, with the rise of corporate healthcare provider networks and health systems, together with rising healthcare costs, competition among providers has become prevalent in the healthcare industry.

Assessment

Strict control of reimbursement costs from payers and consistent decreases in physician professional component fee reimbursement yields; reduction in traditional hospital inpatient use; and higher costs of capital have all contributed to the trend of physician investment in outpatient (and inpatient) specialty provider enterprises [ASCs, specialty hospitals and clinics, etc] , which often compete with general acute care community hospital providers.

Conclusion

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Filed under: Career Development, Health Economics, Health Insurance, Health Law & Policy, Healthcare Finance, Practice Management | Tagged: health 2.0, health 2.0 collaboration, healthcare competition, HMO, IPA, Managed Care, MC, medicare, next generation healthcare, participatory medicine, PPO, PPS, prospective payment system, Robert Cimasi, www.healthcarefinancials.com | 6 Comments »

About the MS Office® eMR Project

Posted on June 19, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Programming a Powerful eMR – or – Jumping the Shark?

By Ann Miller; RN, MHA

Recently we communicated with Al Borges MD, founder of the Office eMR Project. He is quite an innovative guy. His passion – eMRs for the physician masses – through an infra-structure already largely in place?

The Problem: You want to use a great eMR but you can’t afford to pay for it.

You have a growing medical office that is completely paper based, and wish to capture the efficiencies of an electronic medical record (eMR) system. But, many eMR systems on the market are complicated, expensive and have been known to actually slow down the typical office workflow. You have used the MS Office® suite of software products in the past and appreciate its power, but you don’t know how to use it to set up a great eMR that perfectly suits your needs.

An Alternative

Alternatively, you can purchase an inexpensive MS Office® based proprietary eMR, but you might wish to write an add-in to incorporate add certain features to this basic, but excellent eMR platform. So, what do [can] you do?

CCHIT Takes a Hit

http://www.emrupdate.com/blogs/emrinterviews/archive/2006/10/09/CCHIT-takes-a-hit-from-Washington_2C00_-D.C.-area-doctor-who-claims-new-certification-group-restrains-free-trade-in-EMR-_2800_Electronic-Medical-Record_2900_-software.aspx

https://healthcarefinancials.wordpress.com/2009/03/02/cchit-is-prejudiced-and-lacks-diversity-%e2%80%93-an-indictment/

A Solution: Open Source Programs

According to Dr. Borges, one may use his web site to get the answers to program your eMR. His site discusses these very issues. It is continuously growing, with a host of free programs, position papers and forum discussions that touch on a wide variety of topics. These include general information on the use of MS Office® in the medical office, programming the various components of MS Office®, and those political topics that affect how we use health information technology [HIT].

Two Program Versions

There are 2 major eMR programs available – the MS Word® eMR Project (MSWP) and the MS Access® eMR Project (MSAP). But, is the Office eMR Project of Alberto truly an interoperable solution – a digital solution – or something else?

Website: http://www.msofficeemrproject.com

Jumping the Shark

Jumping the Shark is a phrase coined by Jon Hein and used by TV critics to denote the point in a show where the plot veers off into absurd story lines in a desperate attempt to attract viewers. Shows that have “jumped the shark” are typically deemed to have passed their peak. On the other hand, is Dr. Borges a Cassandra at his peak … who just happens to be correct?

MSFT Discussion Groups for Al Borges, MD

http://www.microsoft.com/office/community/en-us/default.mspx?query=alborg&dg=&cat=en-us-office&lang=en&cr=US&pt=3a4e9862-cdce-4bdc-8664-91038e3eb1e9&catlist=&dglist=&ptlist=&exp=&sloc=en-us

Making eHRs Illegal?

For example, did you know that the democrats want to make use of non certified eHRs illegal in NJ? The bill allegedly provides specifically as follows:

“On or after January 1, 2011, no person or entity is permitted to sell, offer for sale, give, furnish, or otherwise distribute to any person or entity in this State a health information technology product that has not been certified by CCHIT. A person or entity that violates this provision is liable to a civil penalty of not less than $1,000 for the first violation, not less than $2,500 for the second violation, and $5,000 for the third and each subsequent violation, to be collected pursuant to the “Penalty Enforcement Law of 1999,” P.L.1999, c.274 (C.2A:58-10 et seq.).”

Link: http://www.njleg.state.nj.us/2008/Bills/A4000/3934_I1.HTM

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is the Office eMR Project a panacea to the eMR conundrum, or a hybrid? What about CCHIT; is it certified – does it have to be? Users and early-adopters, we need your opinions! Has the “shark been jumped” here; or not? Tell us what you think. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Filed under: "Doctors Only", Career Development, Information Technology, Interviews, Op-Editorials, Practice Management, Research & Development | Tagged: Al Borges, Alberto Borges MD, CCHIT, EHRs, EMRs, health information technology, HIT, MS Office eMR Project, MS Office® suite, MSAP, MSWP, Office eMR project, open source eHRs, open source eMRs, PHI | 4 Comments »

GM Bankruptcy Hits Delta Dental Hard

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

United Auto Workers Retirees Lose Benefits

[By Darrell K. Pruitt; DDS]

It’s no longer just the recent rash of bad PR on the Internet that has some Delta Dental employees worried about losing their jobs. Okemos, Michigan, home to Delta Dental of Michigan is downstream from GM. If Delta employees are laid off because of decreased sales of benefits packages, Okemos will lose even more of its disappearing tax base. And, this week we learn that United Auto Workers [UAW] retirees will lose their Delta dental benefits in GM’s bankruptcy.

The Michigan Messenger

I discovered a short article today on the Michigan Messenger Website, written by Ed Brayton, titled “GM’s UAW retirees to lose Delta Dental coverage.” Brayton closes with a sad lament: “It was only last November that Tim Daman, a Lansing Regional Chamber of Commerce vice president, declared that with the office expansion, 2008 was ‘really Delta’s year.’ It appears that 2009 will not be.” Less than a year before Daman’s optimistic comment, Delta Dental announced that it was expanding its existing office space by 25,000 square-feet including 20,000 for a new data center. It’s unfortunate that the squandered money wasn’t spent on GM retirees’ teeth before they lost their dental insurance. Is it any wonder that Americans pay so much for so little healthcare?

Eyeing the Situation

And, what was Delta planning to do with that much data space anyway? Are Delta’s computers that huge, or was someone anticipating that future claims processing will require lots of soon to be unemployed Okemos citizens? I think if Colombo, a detective played by Peter Falk in a TV show long ago, were to cast his good eye on this situation with Delta Dental, he would see something odd about risking so much healthcare money on “data” rather than rewarding bonuses to executives who managed to save those huge amounts of money on payments to dentists. He’d scratch his head with the same hand holding a cigar, and say something like, “If Delta was willing to invest that much into say, a data mining project; they must have been planning on saving even more money on dental care for GM retirees somehow. Where was that money going to come from?

Public Relations Perspective

Ari Adler, the same Delta PR employee who a few months ago publicly announced that Delta Dental guarantees its dentistry, offered prepared statements about the bad news for Delta, but would not comment on how this enormous loss in business might ultimately change the company’s plans. He was only allowed to offer that the company is “studying the impact of this situation on the organization.” He assured Brayton that the building is going up as planned. I hope Delta doesn’t back out of its guarantees on fillings. That would be especially cruel to GM retirees.

More: GM’s UAW Retirees to Lose Delta Dental Coverage

Dental provider plans to offer special options for retirees, whose coverage could end as early as next month

By Ed Brayton 6/8/09 12:11 PM

http://michiganmessenger.com/20507/gms-uaw-retirees-to-lose-delta-dental-coverage

Assessment

It’s a real puzzler, Columbo. But, I’d bet you could figure it out by the end of the show. Peter Falk and family, I wish you the best.

Managing Editor’s Note: Dr. Dave Marcinko our publisher will be on a book and speaking tour in Michigan, and the Upper Peninsula later this month. He will be “signing and opining” – “preaching and teaching” to all ME-P advocates and others who attend. So, be sure to stop by any venue, and say hello. And, we will report back on his trip later this summer.

Link: https://healthcarefinancials.wordpress.com/dr-david-marcinko%e2%80%99s-bookings/

Conclusion

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

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Filed under: Alerts Sign-Up, Breaking News, Career Development, Events-Planner, Health Insurance, Interviews, Managed Care, Marketing & Advertising, Media Mentions and PR, Practice Management, Research & Development, Sponsors | Tagged: Ari Adler, book tour, Darrell Pruitt, david marcinko, Delta Dental Michigan, dental insurance, Ed Brayton, General Motors, GM, GM bankruptcy, healthcare benefits, Lansing, Michigan Messenger, Okemos, Tim Daman, UAW, United Auto Workers | 8 Comments »

Medical Accounts Receivable and Related Formulae

Posted on June 16, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Understanding Rationale and Formulae

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

[By Dr. Gary L. Bode; CPA, MSA, CMP™]

Medical practices, clinics and hospitals generate a patient account or an account receivable (AR) at the same time as they send the patient a bill or the insurance company a claim. ARs are treated as current assets (cash equivalents) on the healthcare entity balance sheet, and usually with a percentage mark-down to reflect historic collection rates.

The Balance Sheet

The balance sheet is a snapshot of a medical practice or healthcare entity at a specific point in time. This contrasts with the income statement (profit and loss), which shows accounting data across a period of time. The balance sheet uses the accounting formula:

Assets (what the entity owns) = Liabilities (what the entity owes) + Entity Equity (left over).

AR Aging Schedules

According to the Dictionary of Health Economics and Finance, an AR aging schedule is a periodic report (30, 60, 90, 180, or 360 days) showing all outstanding ARs identified by patient or payor, and month due. The average duration of an AR is equal to total claims, divided by accounts receivable. Faster is better, of course, but it is not unusual for a hospital to wait six, nine, twelve months, or more for payment. Each of these measures seeks to answer two questions:

1) How many days of revenue are tied up in ARs?

2) How long does it take to collect ARs?

More Formulae

An important measure in the analysis of accounts receivable is the AR Ratio, AR Turnover Rate, and Average Days Receivables, expressed by these formulae:

1. AR Ratio = Current AR Balance / Average Monthly Gross Production
(suggested between 1 and 3 for hospitals)

2. AR Turnover Rate = AR Balance / Average Monthly Receipts

3. Average Days Receivable = AR Balance / Daily Average Charges
(suggested < 90 days for medical practices)

And Even More Measures

Other significant measures include:

1. Collection Period = ARs / Net Patient Revenue / 365 days

2. Gross Collection Percentage = Clinic Collections / Clinic Production
(suggested > 40-80% for hospitals)

3. Net Collection Percentage = Clinic Collections / Clinic Production – (minus) Contractual Adjustments (suggested > 80-90% for medical practices)

4. Contractual Percentage = Contractual adjustments / Gross production
(suggested < 40-50% for hospitals).

Assessment

Often, older ARs are often written off, or charged back as bad debt expenses and never collected at all.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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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

[HEALTH INSURANCE, MANAGED CARE, ECONOMICS, FINANCE AND HEALTH INFORMATION TECHNOLOGY COMPANION DICTIONARY SET]

***

Filed under: Accounting, Book Reviews, Financial Planning, Healthcare Finance, Practice Management, Recommended Books | Tagged: accounts payable, accounts receivable, AR aging schedule, ARs, bad debt, bad debt expenses, balance shet, cash equivalents, current assets, current ratio, david marcinko, Gary Bode, income statement, medical billing, medical collections, turnover ratio, www.healthcarefinancials.com, www.healthdictionaryseries.com | 2 Comments »

Sample Medical Practice Sales Non-Disclosure Agreement

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

Customizable Medical Practice Valuation Example

[By Staff Reporters]

The undersigned acknowledges that Hamilton Family Clinic (HFC) has furnished to the undersigned potential Investor (“Investor”) certain proprietary data (“Confidential Information”) relating to the business affairs and operations of Hamilton Family Clinic (HFC) for study and evaluation by Investor for possibly investing in Hamilton Family Clinic (HFC).

It is acknowledged by Investor that the information provided by Hamilton Family Clinic (HFC) is confidential; therefore, Investor agrees not to disclose it and not to disclose that any discussions or contracts with Hamilton Family Clinic (HFC) have occurred or are intended, other than as provided for in the following paragraph.

It is acknowledged by Investor that information to be furnished is in all respects confidential in nature, other than information which is in the public domain through other means and that any disclosure or use of same by Investor, except as provided in this agreement, may cause serious harm or damage to Hamilton Family Clinic (HFC), and its owners and officers.

Therefore, Investor agrees that Investor will not use the information furnished for any purpose other than as stated above, and agrees that Investor will not either directly or indirectly by agent, employee, or representative, disclose this information, either in whole or in part, to any third party; provided, however that (a) information furnished may be disclosed only to those directors, officers and employees of Investor and to Investor’s advisors or their representatives who need such information for the purpose of evaluating any possible transaction (it being understood that those directors, officers, employees, advisors and representatives shall be informed by Investor of the confidential nature of such information and shall be directed by Investor to treat such information confidentially), and (b) any disclosure of information may be made to which Hamilton Family Clinic (HFC) consents in writing. At the close of negotiations, Investor will return to Hamilton Family Clinic (HFC) all records, reports, documents, and memoranda furnished and will not make or retain any copy thereof.

__________________

Signature – and – Date

LINK: Sample

Assessment

No intent to practice law; sample customizable template only. Always consult an attorney or competent consultant familiar with your individual circumstances before use.

Conclusion

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Filed under: Book Reviews, Career Development, Practice Management, Professional Liability, Recommended Books, Risk Management | 2 Comments »

Meet Richard A. Berning MD

Posted on June 13, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Our Newest “Thought-Leader”

By Ann Miller; RN, MHA

The Medical Executive-Post is proud to introduce Richard Berning MD as our newest thought-leader for medical practice management modernity.

About Dr. Berning

Dr. Richard A. Berning attended the University of Cincinnati – College of Medicine. He is a pediatric cardiologist and Assistant Clinical Professor of Pediatrics who practices in Hartford, CT. His patients call him “DrRichB.”

PrivatePractice.MD [An Emerging Network]

PrivatePractice.MD (pronounced “Private Practice dot MD”) is an emerging Health 2.0 community of experienced physicians in private practice, and the supporting experts and advisors who help them start and manage private medical practices. It is the brain-child of Dr. Berning who believes that a well-run medical practice results in better patient care, physician income and quality of life. Health care is rapidly changing and is destined to change at an even faster pace in the future.

The Website

According to the website, experienced doctors can discuss business decisions with other experienced experts in each of the listed aspects of managing the business side of medical practice. Questions about practice structure, partnership issues, medical billing, electronic medical records, quality control, staff and other medical office management issues are addressed; and others are in development. Physician-specific issues such as credentialing, medical malpractice, and insurance, investing, pensions and retirement planning are also discussed. A job board will soon list opportunities, and a classified ad section will list new and used equipment and real estate for sale, trade or barter. The goal for PrivatePractice.MD is to be a deep resource for all medical providers in private practice today.

Assessment

We are in luck, too! Rich has promised to publish his most exciting ideas and innovative works on our blog. He is also available through PrivatePractice.MD. So, let’s give a warm ME-P “shout-out” to Dr. Richard A. Berning, our newest “thought-leader.”

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Feel free to send in your comments whenever Rich posts. Visit his site, sign-up for his newsletter, and let the discussions begin.

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: "Ask-an-Advisor", "Doctors Only", Breaking News, Career Development, Managed Care, Practice Management | Tagged: cardiologist, DrRichB, pediatric cardiology, pediatrics, PrivatePratice.MD, richard berning | 1 Comment »

Healthcare Organizations – The eJournal on CD

Posted on June 11, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Journal of Financial Management Strategies **

Beginning in August 2009, we are pleased to inform you of two new milestones reached by Healthcare Organizations [e-Journal of Financial Management Strategies].

First, we have achieved journal status with our periodical publication. From a nomenclature perspective, we will no longer be known as a guide, but more rightly as the comprehensive journal we envisioned at inception.

Second, we have ceased our print-only existence and migrated to a CD-ROM format, via Adobe Reader, with quarterly email updates. This transition illustrates our collaborative philosophy in the modern health 2.0 participatory era. Of course, all chapter files are still printable at your own discretion.

“Bridging the Intersection of Medical Mission and Profit Margin”

All hospitals, healthcare systems and organizations use a variety of teaching, educational and didactic techniques to bring value to patients, payers, providers, governments and third-party intermediaries. This Intellectual Capital is the sum total of all knowledge and expertise used to serve society and stakeholders. Leaders, CXOs and employees provide almost all of this Intellectual Capital.

We believe that Healthcare Organizations [e-Journal of Financial Management Strategies] adds to this Intellectual Capital by guiding you, empowering your organization, and creating value for your patients, employees, investors and clients by bridging the intersection of medical mission and profit margin.

* Unlimited non-transferabl license; not for redistribution or resale.

** Embossable binder available at slight surcharge

Letter: Publisher’s Letter

Conclusion

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Health Administration Terms: www.HealthDictionarySeries.com

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Sponsors Welcomed

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Filed under: Alerts Sign-Up, Breaking News, Career Development, iMBA, Inc., Marketing & Advertising, Practice Management | Tagged: ASCs, CD-ROM, clinics, david marcinko, DC, DDS, DMD, DO, DPM, economc journal, financial journal, health 2.0, Healthcare Organizations, hope hetico, hospitlas, MD, medical clinics, medical offices, medical practices, OD, www.healthcarefinancials.com, www.medicalbusinessadvisors.com | Leave a comment »

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