OUTCOMES: In-Person and Tele-Health Encounters During COVID-19

By Staff Reporters and MCOL

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Outcomes of In-Person and Tele-Health Encounters During COVID-19

 •  Ambulatory encounters decreased by 1.0% and the number of in-person encounters per enrollee decreased by 17.0% from 2019 to 2020.
 •  For members with an initial telehealth encounter for a new acute condition, the adjusted odds ratio was 1.44 for all follow-ups combined and 1.11 for an emergency department encounter.
 •  For members with an initial telehealth encounter for a new chronic condition, the adjusted odds ratios were 0.94 for all follow-ups combined and 0.94 for in-patient admissions.

Source: JAMA Network, April 26, 2022

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What Is Integrative Medicine?

By Staff Reporters

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The term integrative medicine was born from combining the practice of so-called “conventional” medicine and “complementary medicine.” Conventional medicine is what most doctors practice. This is also called “traditional Western medicine.”

Adding “outside-the-box” treatments such as chiropractic care, acupuncture, and other lifestyle recommendations like improving diet, supplements, herbs, exercise, stress management, and functional specialty labs results in the actual integration of the two disciplines. And we need both.

READ: https://www.msn.com/en-us/health/medical/the-one-doctor-you-dont-have-but-likely-need/ar-AAXagMw?li=BBnb7Kz\

Complimentary Medicine: https://medicalexecutivepost.com/2007/12/16/complimentary-medicine/

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PODCASTS: The GREAT ECONOMIC MODERATION / RESIGNATION in Medicine?

A HISTORICAL REVIEW WITH UPDATE

Dr. David Edward Marcinko | The Leading Business Education Network for  Doctors, Financial Advisors and Health Industry Consultants

By Dr. David E. Marcinko MBA CMP®

CMP logo

SPONSOR: http://www.CertifiedMedicalPlanner.org

What was the Great Economic Moderation?

The Great Moderation is the name given to the period of decreased macroeconomic volatility experienced in the United States starting in the 1980s.

CITE: https://www.r2library.com/Resource/Title/0826102549

During this period, the standard deviation of quarterly real gross domestic product (GDP) declined by half and the standard deviation of inflation declined by two-thirds, according to figures reported by former U.S. Federal Reserve Chair Ben Bernanke. The Great Moderation can be summed up as a multi-decade period of low inflation and positive economic growth.

But, what about health economics, writ large? And, the actual practice of medicine by physicians in the trenches. Consider this historical review.

GOLDEN AGE OF MEDICINE

The ‘golden age of medicine’ – the first half of the 20th century, reaching its zenith with Jonas Salk’s 1955 polio vaccine – was a time of profound advances in surgical techniques, immunization, drug discovery, and the control of infectious disease; however, when the burden of disease shifted to lifestyle-driven, chronic, non-communicable diseases, the golden era slipped away. Although modifiable lifestyle practices now account for some 80% of premature mortality, medicine remains loathe to embrace lifestyle interventions as medicine Here, we argue that a 21st century golden age of medicine can be realized; the path to this era requires a transformation of medical school recruitment and training in ways that prioritize a broad view of lifestyle medicine. Moving beyond the basic principles of modifiable lifestyle practices as therapeutic interventions, each person/community should be viewed as a biological manifestation of accumulated experiences (and choices) made within the dynamic social, political, economic and cultural ecosystems that comprise their total life history. This requires an understanding that powerful forces operate within these ecosystems; marketing and neoliberal forces push an exclusive ‘personal responsibility’ view of health – blaming the individual, and deflecting from the large-scale influences that maintain health inequalities and threaten planetary health. The latter term denotes the interconnections between the sustainable vitality of person and place at all scales. We emphasize that barriers to planetary health and the clinical application of lifestyle medicine – including authoritarianism and social dominance orientation – are maintaining an unhealthy status quo.

NOTE: https://pubmed.ncbi.nlm.nih.gov/31828026/

GOLDEN AGE OF MEDICAL PRACTICE

To listen to all those desperate to reform health care, you get the impression that physicians are pretty horrible people. We are all sexist, greedy, money grubbing tyrants who will perform unnecessary tests and procedures just to make money. We don’t care about quality or cost. We are killing off 250,000 patients every year with our ignored “errors.”

We purposely keep our patients in pain, or we addict them to narcotics just to shut them up. We are constantly told by lawyers that lawsuits are necessary to protect patients from doctors. We provide unsafe drugs just because the drug reps give us free pens and coffee cups. The government must step in to clean up the mess.

PODCAST: https://www.kevinmd.com/blog/2017/08/9-reasons-golden-age-medicine-golden.html

GOLDEN AGE OF PATIENT TRUST

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THE GREAT PHYSICIAN RETIREMENT AND RESIGNATION: https://medicalexecutivepost.com/2021/11/09/healthcare-industry-hit-with-the-great-resignation-retirement/

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

RETIREMENT PLANNING: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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INTERVIEW: A Solution for Healthcare Financing?

HEALTHCARE FINANCING

Former: CEO and Founder
Superior Consultant Company, Inc.
[SUPC-NASD]

EDITOR’S NOTE: I first met Rich in B-school, when I was a student, back in the day. He was the Founder and CEO of Superior Consultant Holdings Corp. Rich graciously wrote the Foreword to one of my first textbooks on financial planning for physicians and healthcare professionals. Today, Rich is a successful entrepreneur in the technology, health and finance space.

-Dr. David E. Marcinko MBA CMP®

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Staff & Contributors - CHAMPIONS OF WAYNE

By Richard Helppie

Today for your consideration – How to fix the healthcare financing methods in the United States?

I use the term “methods” because calling what we do now a “system” is inaccurate. I also focus on healthcare financing, because in terms of healthcare delivery, there is no better place in the world than the USA in terms of supply and innovation for medical diagnosis and treatment. Similarly, I use the term healthcare financing to differentiate from healthcare insurance – because insurance without supply is an empty promise.

This is a straightforward, 4-part plan. It is uniquely American and will at last extend coverage to every US citizen while not hampering the innovation and robust supply that we have today. As this is about a Common Bridge and not about ideology or dogma, there will no doubt be aspects of this proposal that every individual will have difficulty with. However, on balance, I believe it is the most fair and equitable way to resolve the impasse on healthcare funding . . . .

CITE: https://www.r2library.com/Resource/Title/0826102549

Let me start in an area sure to raise the ire of a few. And that is, we have to start with eliminating the methods that are in place today. The first is the outdated notion that healthcare insurance is tied to one’s work, and the second is that there are overlapping and competing tax-supported bureaucracies to administer that area of healthcare finance.

Step 1 is to break the link between employment and health insurance. Fastest way to do that is simply tax the cost of benefits for the compensation that it is. This is how company cars, big life insurance policies and other fringe benefits were trimmed. Eliminating the tax-favored treatment of employer-provided healthcare is the single most important change that should be made.

Yes, you will hear arguments that this is an efficient market with satisfied customers. However, upon examination, it is highly risky, unfair, and frankly out of step with today’s job market.

Employer provided health insurance is an artifact from the 1940’s as an answer to wage freezes – an employer could not give a wage increase, but could offer benefits that weren’t taxed. It makes no sense today for a variety of reasons. Here are a few:

1. Its patently unfair. Two people living in the same apartment building, each making the same income and each have employer provided health insurance. Chris in unit 21 has a generous health plan that would be worth $25,000 each year. Pays zero tax on that compensation. Pat, in unit 42 has a skimpy plan with a narrow network, big deductibles and hefty co-pays. The play is worth $9,000 each year. Pat pays zero tax.

3. The insurance pools kick out the aged. Once one becomes too old to work, they are out of the employer plan and on to the retirement plan or over to the taxpayers (Medicare).

4. The structure is a bad fit. Health insurance and healthy living are longitudinal needs over a long period of time. In a time when people change careers and jobs frequently, or are in the gig economy, they are not any one place long enough for the insurance to work like insurance.

5. Creates perverse incentives. The incentives are weighted to have employers not have their work force meet the standards of employees so they don’t have to pay for the health insurance. Witness latest news in California with Uber and Lyft.

6. Incentives to deny claims abound. There is little incentive to serve the subscriber/patient since the likelihood the employer will shop the plan or the employee will change jobs means that stringing out a claim approval is a profitable exercise.

7. Employers have difficulty as purchasers. An employer large enough to supply health insurance has a diverse set of health insurance needs in their work force. They pay a lot of money and their work force is still not 100% happy.

Net of it, health insurance tied to work has outlived its usefulness. Time to end the tax-favored treatment of employer-based insurance. If an employer wants to provide health insurance, they can do it, but the value of that insurance is reflected in the taxable W-2 wages – now Pat and Chris will be treated equally.

Step 2 is to consolidate the multiple tax-supported bureaus that supply healthcare. Relieve the citizens from having to prove they are old enough, disabled enough, impoverished enough, young enough. Combine Medicare, Medicaid, CHIP, Tricare and even possibly the VA into a single bureaucracy. Every American Citizen gets this broad coverage at some level. Everyone pays something into the system – start at $20 a year, and then perhaps an income-adjusted escalator that would charge the most wealthy up to $75,000. Collect the money with a line on Form 1040.

I have not done the exact math. However, removing the process to prove eligibility and having one versus many bureaucracies has to generate savings. Are you a US Citizen? Yes, then here is your base insurance. Like every other nationalized system, one can expect longer waits, fewer referrals to a specialist, and less innovation. These centralized systems all squeeze supply of healthcare services to keep their spend down. The reports extolling their efficiencies come from the people whose livelihoods depend on the centralized system. However, at least everyone gets something. And, for life threatening health conditions, by and large the centralized systems do a decent job. With everyone covered, the fear of medical bankruptcy evaporates. The fear of being out of work and losing healthcare when one needs it most is gone.

So if you are a free market absolutist, then the reduction of vast bureaucracies should be attractive – no need for eligibility requirements (old enough, etc.) and a single administration which is both more efficient, more equitable (everyone gets the same thing). And there remains a private market (more on this in step 3) For those who detest private insurance companies a portion of that market just went away. There is less incentive to purchase a private plan. And for everyone’s sense of fairness, the national plan is funded on ability to pay. Bearing in mind that everyone has to pay something. Less bureaucracies. Everyone in it together. Funded on ability to pay.

Step 3 is to allow and even encourage a robust market for health insurance above and beyond the national plan – If people want to purchase more health insurance, then they have the ability to do so. Which increases supply, relieves burden on the tax-supported system, aligns the US with other countries, provides an alternative to medical tourism (and the associated health spend in our country) and offers a bit of competition to the otherwise monopolistic government plan.

Its not a new concept, in many respects it is like the widely popular Medigap plans that supplement what Medicare does not cover.

No one is forced to make that purchase. Other counties’ experience shows that those who choose to purchase private coverage over and above a national plan often cite faster access, more choice, innovation, or services outside the universal system, e.g., a woman who chooses to have mammography at an early age or with more frequency than the national plan might allow.  If the insurance provider can offer a good value to the price, then they will sell insurance. If they can deliver that value for more than their costs, then they create a profit. Owners of the company, who risk their capital in creating the business may earn a return.

For those of you who favor a free market, the choices are available. There will be necessary regulation to prevent discrimination on genetics, pre-existing conditions, and the like. Buy the type of plan that makes you feel secure – just as one purchases automobile and life insurance.For those who are supremely confident in the absolute performance of a centralized system to support 300+ million Americans in the way each would want, they should like this plan as well – because if the national plan is meeting all needs and no one wants perhaps faster services, then few will purchase the private insurance and the issuers will not have a business. Free choice. More health insurance for those who want it. Competition keeps both national and private plans seeking to better themselves.

Step 4 would be to Permit Access to Medicare Part D to every US Citizen, Immediately

One of the bright spots in the US Healthcare Financing Method is Medicare Part D, which provides prescription drug coverage to seniors. It is running at 95% subscriber satisfaction and about 40% below cost projections.

Subscribers choose from a wide variety of plans offered by private insurance companies. There are differences in formularies, co-pays, deductibles and premiums.

So there you have it, a four part plan that would maintain or increase the supply of healthcare services, universal insurance coverage, market competition, and lower costs. Its not perfect but I believe a vast improvement over what exists today. To recap:

1. Break the link between employment and healthcare insurance coverage, by taxing the benefits as the compensation they are.

2. Establish a single, universal plan that covers all US citizens paid for via personal income taxes on an ability-to-pay basis.  Eliminate all the other tax-funded plans in favor of this new one.

3. For those who want it, private, supplemental insurance to the national system, ala major industrialized nations.

4. Open Medicare Part D (prescription drugs) to every US citizen. Today.

YOUR THOUGHTS ARE APPRECIATED.

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What is Your Academic Teaching Philosophy?

 Here is My Teaching Philosophy

[By Dr. David Edward Marcinko MBA]

Although any learner-centered teaching philosophy, or Boyer Model of scholarship, is constantly in flux, the mission of a public or private educator is: [1] to promote positive learning; [2] to motivate students, staff and graduates; [3] to provide a strong foundation for lifelong learning; and in modernity [4] to enhance career and life-work opportunities; to [5] improve bottom-line financial metrics, and [6] to collaborate on a national and global basis.

However, because we are specifically operating in the rapidly changing healthcare, business management, investing, finance, economics and education milieu, even deeper experiential insight is needed.

Developing NEW Teaching AND Education Skills FOR Business and Healthcare 2.0

Medicine and healthcare business today is different than a generation ago, and all educators and healthcare professionals need new skills to be successful.

Traditionally, the physician – like the classroom professor – was viewed as the “captain of the ship”. Today, their role may be more akin to a ship’s navigator, utilizing clinical, teaching skills and knowledge to chart the patient’s, or student’s, course through a confusing morass of requirements, choices, rules and regulations to achieve the best attainable clinical or didactic outcomes.

This new teaching paradigm includes many classic business school principles, now modified to fit the PP-ACA, the era of health reform, and modern technical connectivity. Thus, a Professor, Chair or Dean must be a subtle guide on the side; not bombastic sage on the stage.

These, newer teaching philosophies must include:

  • Negotiation – working to optimize appropriate curricula, services and materials;
  • Team play – working in concert with others to coordinate education delivery within a clinically appropriate and cost-effective framework;
  • Working within the limits of competence – avoiding the pitfalls of the generalist teacher versus the subject matter expert that may restrict access to professors, texts and facilities by clearly acknowledging when a higher degree of didactic service is needed on behalf of the student;
  • Respecting different cultures and values – inherent in the support of the academic Principle of Autonomy is the acceptance of values that may differ from one’s own. As the US becomes more culturally heterogeneous, educators and medical providers are called upon to work within, and respect, the socio-cultural and/or spiritual framework of patients, students and their families; 
  • Seeking clarity on what constitutes marginal education – within a system of finite resources; providers and professors are called upon to openly communicate with students and patients regarding access to marginal education and/or treatments.
  • Supporting evidence-based practice – educators, like healthcare providers, should utilize outcomes data to reduce variation in treatments and curriculum to achieve higher academic efficiencies and improved care delivery;
  • Fostering transparency and openness in communications – teachers and healthcare professionals should be willing, and prepared, to discuss all aspects of care and academic andragogy; especially when disclosing problems or issues that arise;
  • Exercising decision-making flexibility – treatment algorithms, templates and teaching pathways are useful tools when used within their scope; but providers and professors must have the authority to adjust the plan if circumstances warrant;
  • Becoming skilled in the art of listening and interpretingIn her ground-breaking book, Narrative Ethics: Honoring the Stories of Illness, Rita Charon, MD PhD, a professor at Columbia University, writes of the extraordinary value of using the patient’s personal story in the treatment plan. She notes that, “medicine practiced with narrative competence will more ably recognize patients and diseases; convey knowledge and regard, join humbly with colleagues, and accompany patients and their families through ordeals of illness.” In many ways, attention to narrative returns medicine full circle to the compassionate and caring foundations of the patient-physician relationship. The educational analog to this book is, The Ethics of Teaching [A Casebook], co-edited by my teacher and colleague Deborah Ware Balogh PhD of the University of Indianapolis.

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The Ohio State University
 Photo by Kevin Fitzsimons

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Assessment

Finally, these thoughts represent only a handful of examples to illustrate the myriad of new skills that tomorrow’s healthcare professionals, and modern educators, must master in order to meet their timeless professional obligations of compassionate patient care and contemporary teaching effectiveness.

Dr. Marcinko Teaching Philosophy

CHAIR: Chair 3.0 Philosophy Dr. Marcinko

Conclusion

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

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

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

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DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

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PODCAST: 50% of Medical Treatments Have Unknown Effectiveness

By Eric Bricker MD

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ORDER: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PODCAST: The Dartmouth Atlas of Healthcare

Geographic Variation in Spine Surgery

By Dr. Eric Bricker MD

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MORE: https://www.dartmouthatlas.org/

John Wennberg MD: https://tdi.dartmouth.edu/about/our-people/directory/john-e-wennberg-md-mph

CHECKLISTS: https://medicalexecutivepost.com/2009/01/20/a-homer-simpson-moment-of-clarity-on-medical-quality/

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Primary Care in High-Income Countries [How the United States Compares?]

By Staff Reporters

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Commonwealth Fund: % of Adults Who Have Regular Doctors

 •  Norway: 100%
 •  Netherlands: 99%
 •  U.K.: 97%
 •  New Zealand: 96%
 •  Germany: 96%
 •  France: 95%
 •  Australia: 93%
 •  Switzerland: 93%
 •  Canada: 90%
 •  U.S.: 89%
 •  Sweden: 87%

Source: The Commonwealth Fund, “Primary Care in High-Income Countries: How the United States Compares,” March 15, 2022

Citation: https://www.r2library.com/Resource/Title/0826102549

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Types of Care Medical Providers Deliver Via Tele-Health

By Staff Reporters

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1
.   Conduct primary care visits (75%)
2.  
Conduct chronic care visits (72%)
3.   Order prescription refills (64%)
4.   Conduct COVID-19 screenings (39%)
5.   Conduct urgent care visits (38%)
6.  
Address mental health concerns (36%)
7.   Conduct follow-up after a procedure or surgery care (28%)

Source: Optum Via UnitedHealth Group, March 15, 2022

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30% of Adults Surveyed Would Give Up Their Current PCP

By Staff Reporters

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Primary Care Providers

A survey was recently conducted by Centivo of 805 US adults ages 18-64 with employer-sponsored private health insurance. The survey found that respondents were willing to accept the following conditions in exchange for significant cost savings:

 •  50% would accept referrals for specialists as a requirement.
 •  47% would select a primary care physician (PCP) from a defined list.
 •  30% would give up their current PCP.
 •  28% would stop seeing a current specialist.

Source: Centivo Via PR Newswire, March 16, 2022

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Primary Care Physician Estimated Career Turn-Over Per Year

By Staff Reporters

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 •  General internal medicine: 4370 (4% of this workforce)
 •  Family medicine: 3624 (3% of this workforce)
 •  General pediatrics: 1320 (2% of this workforce)
 •  Obstetrics/gynecology: 1563 (4% of this workforce)
 •  Geriatrics: 149 (3% of this workforce)
 •  Preventive medicine: 93 (2% of this workforce)

Source: Mayo Clinic Proceedings, “Health Care Expenditures Attributable to Primary Care Physician Overall and Burnout-Related Turnover: A Cross-sectional Analysis,” February 25, 2022

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PODCAST: Primary Medical Care: US versus Other Countries

By Eric Bricker MD

The Commonwealth Fund Released a Study in March 2022 Comparing Primary Care in the United States to Other Industrialized Countries.

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PODCAST: The Healthcare Price versus Quality Disconnect

By Dr. Eric Bricker MD

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CITATION: https://www.r2library.com/Resource/Title/0826102549

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Medical School Ethics VERSUS Business School Ethics

Join Our Mailing List 

Is Business Finally Embracing Medical Values?

[By Render S. Davis MHA CHE]

[By David Edward Marcinko MBA]

dr-david-marcinko

In the evolutionary shifts in models for medical care, physicians have been asked to embrace business values of efficiency and cost effectiveness, sometimes at the expense of their professional judgment and personal values.

While some of these changes have been inevitable as our society sought to rein in out-of-control costs, it is not unreasonable for physicians to call on payers, regulators and other business parties to the health care delivery system to raise their ethical bar.

Tit-for-Tat

Harvard University physician-ethicist Linda Emmanuel noted that “health professionals are now accountable to business values (such as efficiency and cost effectiveness), so business persons should be accountable to professional values including kindness and compassion.”

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face-off

[Medicine versus Business]

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Assessment

Within the framework of ethical principles, John La Puma, M.D., wrote in Managed Care Ethics, that “business’s ethical obligations are integrity and honesty.

Medicine’s are those plus altruism, beneficence, non-maleficence, respect, and fairness.”

About the Author

Render Davis was a Certified Healthcare Executive, now retired from Crawford Long Hospital at Emory University, in Atlanta, GA He served as Assistant Administrator for General Services, Policy Development, and Regulatory Affairs from 1977-95.  He is a founding board member of the Health Care Ethics Consortium of Georgia and served on the consortium’s Executive Committee, Advisory Board, Futility Task Force, Strategic Planning Committee, and chaired the Annual Conference Planning Committee, for many years.

More:

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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PODCAST: History Applied to Health Economics

Divining the Future?

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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The Difference Among Pedagogy, Andragogy and Heutagogy

ON EDUCATION – The Difference Among Pedagogy, Andragogy, And Heutagogy

[By David E. Marcinko and Terry Heick]

Heutagogy; developing agile, reflective lifelong learners | Skilla

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Jackie Gerstein’s passionate thinking about learning is some of my favorite to read. She is rarely pulled down by trend or fad, but is unquestionably progressive and forward-thinking in her approaches to learning and thinking about learning.

She and I also share a passion: self-directed learning. (As does the original summarizer/author of the thinking embedded in table below, Lindy, McKeown Orwin).

I’m embarrassingly interested in any kind of learning at all–formal or informal, self-directed or teacher-centered, authentic or academic. Doesn’t mean I regard them all equally, but I do see a role for almost any system or approach that can cause, support, or glorify the processes of understanding.

Gerstein’s presentation, “Education 3.0 and the Pedagogy of Mobile Learning” uses the concept of mobile learning as a spearhead into a broader discussion of how people learn–different approaches, different domains, and different technologies.

We recently shared some thinking about what “Education 3.0” might mean as well, and are nauseatingly effusive in our praise of self-directed learning (And a primer on self-directed learning here as well.)

HEUTAGOGY: https://www.skilla.com/en/heutagogy-developing-agile-reflective-lifelong-learners/

Assessment

With the progress of technology and the rise in mobile learning, now more than ever Self-Directed Learning–or Heutagogy–isn’t just possible, but natural, and almost awkward to not use, something Gerstein capture’s thoroughly and with her characteristic passion in the presentation below.

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[click image to enlarge]

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MORE: http://etale.org/main/2013/04/23/a-primer-on-three-gogies-pedagogy-heutagogy-andragogy/

Conclusion

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

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

Book Marcinko: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

Subscribe: MEDICAL EXECUTIVE POST for curated news, essays, opinions and analysis from the public health, economics, finance, marketing, IT, business and policy management ecosystem.

DOCTORS:

“Insurance & Risk Management Strategies for Doctors” https://tinyurl.com/ydx9kd93

“Fiduciary Financial Planning for Physicians” https://tinyurl.com/y7f5pnox

“Business of Medical Practice 2.0” https://tinyurl.com/yb3x6wr8

HOSPITALS:

“Financial Management Strategies for Hospitals” https://tinyurl.com/yagu567d

“Operational Strategies for Clinics and Hospitals” https://tinyurl.com/y9avbrq5

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

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62% of Nurses Would Consider a Change in Career Paths

By Staff Reporters

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A recent survey by StaffHealth of 250 RNs, LPNS, and CNAs found the following:

 •  86% of respondents say their workload/job responsibility has increased in the last year.
 •  54% of the above respondents say that the increase in workload has negatively impacted their mental health.
 •  83% of those surveyed agree that an increase in compensation/incentives would alleviate nurse burn out and shortages.
 •  62% of nursing professionals would currently consider a change in career paths.
 •  66% of respondents say access to mental health resources at work would be beneficial.

Source: StaffHealth via PRNewswire, February 8, 2022

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COVID INFECTIONS: The Un-Vaccinated

By Staff Reporters

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33.6% of COVID Infections Were in Unvaccinated Persons

According to a recent CDC study. Among 422,966 reported SARS-CoV-2 infections in LAC residents aged ≥18 years during November 7, 2021–January 8, 2022:

 •  33.6% were in unvaccinated persons
 •  13.3% were in fully vaccinated persons with a booster
 •  53.2% were in fully vaccinated persons without a booster
 •  Unvaccinated persons were most likely to be hospitalized, representing 2.8% of COVID infections
 •  Unvaccinated persons were most likely to be admitted to an ICU, or 0.5% of COVID infections
 •  Unvaccinated persons were most likely to be require intubation for mechanical ventilation, or 0.2% of COVID infections.

Source: CDC, Morbidity and Mortality Weekly Report, February 1, 2022

Lost Vaccine Card: https://portal.ct.gov/vaccine-portal/Vaccine-Knowledge-Base/Articles/Lost-Vaccine-Card?language=en_US

CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: Healthcare is Great for People with Medicare.

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Greater than 90% of Medicare Beneficiaries Are Satisfied with Their Care

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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R.I.P. Paul Edward Farmer MD PhD

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By Dr. David Edward Marcinko MBA

[Editor-in-Chief]

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Paul Edward Farmer MD PhD

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Paul Edward Farmer (October 26, 1959 – February 21, 2022) was an American medical anthropologist and physician. Farmer held an MD and PhD from Harvard University, where he was the Kolokotrones University Professor and the chair of the Department of Global Health and Social Medicine at Harvard Medical School. He was the co-founder and chief strategist of Partners In Health (PIH), an international non-profit organization that since 1987 has provided direct health care services and undertaken research and advocacy activities on behalf of those who are sick and living in poverty. He was professor of medicine and chief of the Division of Global Health Equity at Brigham and Women’s Hospital.

Paul and his colleagues in the U.S. and abroad have pioneered novel community-based treatment strategies that demonstrate the delivery of high-quality health care in resource-poor settings in the U.S. and abroad. Their work is documented in the Bulletin of the World Health Organization, The Lancet, The New England Journal of Medicine, Clinical Infectious Diseases, British Medical Journal, and Social Science and Medicine.

Dr. Farmer had written extensively on health and human rights, the role of social inequalities in the distribution and outcome of infectious diseases, and global health.

He was known as “the man who would cure the world,” as described in the book Mountains Beyond Mountains by Tracy Kidder. The story of Partners In Health is also told in the 2017 documentary Bending the Arc. He was a proponent of liberation theology.

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MORE: https://www.msn.com/en-us/news/world/paul-farmer-global-health-care-pioneer-dies-at-62/ar-AAU8wJj?li=BBnb7Kz

HARVARD: https://ghsm.hms.harvard.edu/faculty-staff/paul-farmer

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Rest in Peace

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PODCAST: How to Write a Medical Prescription [Rx]

There are 7 Parts to a Physican’s Drug Prescription

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: The “Secret” to Doctor Pay = RVUs

Relative Value Units

By Eric Bricker MD

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PODCAST: How Doctors are Really Paid in 2022?

Learn the Incentives in Physician Compensation

BY ERIC BRICKER MD

RAND and Harvard University Researchers Recently Published a Study in the Journal of the American Medical Association Examining How Doctors are Paid by Hospital System-Owned Practices. The Study Found that only 9% of Primary Care Physician Compensation was Based on Value (Quality and Cost-Effectiveness) and only 5.3% of Specialist Compensation was Based on Value.

The Study Concluded: “The results of this cross-sectional study suggest that PCPs and specialists despite receiving value-based reimbursement incentives from payers, the compensation of health system PCPs and specialists was dominated by volume-based incentives designed to maximize health systems revenue.”

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MORE: https://medicalexecutivepost.com/2020/09/19/what-doctors-must-do-to-file-an-aetna-claim-to-get-paid/?preview_id=237387&preview_nonce=44f9028974&preview=true

RELATED: https://medicalexecutivepost.com/2008/09/12/how-doctors-get-paid/

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CMS: MSSP ACO Growth 2012-2022

By Staff Reporters

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DEFINITION: An accountable care organization is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitioners. They use alternative payment models, normally, capitation.

CITE: https://www.r2library.com/Resource/Title/0826102549

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See the source image

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CMS MSSP ACO Growth 2012-2022

Performance YearACOsAssigned Beneficiaries
202248311.0 million
202147710.7 million
202051711.2 million
201948710.4 million
201856110.5 million
20174809.0 million
20164337.7 million
20154047.3 million
20143384.9 million
2012+20132203.2 million

Source: CMS 2022 Shared Savings Program Fast Facts – As of January 1, 202

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PODCASTS: Medicare Cost Reports Explained

By Eric Bricker MD

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PODCAST: Medicare Bad Debt Reimbursement: https://www.youtube.com/watch?v=LMa4at0wlRU

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PODCAST: Data Science and Statistics in Healthcare

HYPOTHESIS TESTING

BY ERIC BRICKER MD

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CORRELATION / CAUSATION: https://medicalexecutivepost.com/2021/02/05/correlation-is-not-causation/

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UPDATE: Stock Markets, the Economy and Pandemic

By Staff Reporters

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  • Stock Markets: US stocks staged a big afternoon comeback for the second day in a row … but still not big enough to close in the green. American Express was the top performer in both the S&P and the Dow after the company reported its highest billings volume ever in Q4. And, enthusiasm over meme stocks more broadly appears to be dwindling along with cryptos. And, while NASDAQ took a hit, Microsoft reported quarterly sales of more than $50 billion for the first time ever.
  • Economy: The weight of the financial world is on Jerome Powell’s shoulders today. The Federal Reserve chair will provide an update on the central bank’s views on sky-high inflation and its plan for interest rate hikes this year (though none are expected until March).
  • Pandemic: Pfizer and BioNTech started clinical trials for an Omicron-specific vaccine yesterday. The results will help the pharma partners decide whether to replace their current jab formula with one that targets the most dominant Covid variant. The new vaccine is being tested both as a three-shot series for un-vaccinated participants and as a booster for the already vaccinated.
  • CITE: https://www.r2library.com/Resource/Title/082610254

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On Cultural Sensitivity in Education and Medicine

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A Modern Integral Component of Healthcare Training

[By Render S. Davis MHA CHE]

[By Dr. David Edward Marcinko MBA]

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While America has often been called a “nation of immigrants,” it has never been more true than today. Consequently, the challenge for physicians and other health care providers, in both large cities and small communities, is meeting the health care needs of increasingly diverse and multi-cultural populations who speak different languages and have social norms, traditions, and values that may substantially differ from their own. Problems arise when clinicians expect, even demand, that patients and their families discard their cultural foundations and adhere to the health care provider’s view of the care and decision-making process.

Instead, the health care team should be more aware of and sensitive to the values and beliefs of patients who come from other cultures; working within to assure that the patient’s individual rights are supported and wishes honored to the fullest extent possible.

In her award-winning book, The Spirit Catches You and You Fall Down, Ann Fadiman chronicled this tragic clash of two cultures in medical care for a child of the traditional Hmong people of Laos, transplanted to California after the Vietnam War.

In the book, Fadiman recounts a conversation with Professor Arthur Kleinman of Harvard University, a highly regarded expert in multicultural relations and conflict, who noted that “If you cannot see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture?”

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Former U.S. Surgeon General David Satcher, M.D., Ph.D., now Director of the Satcher Health Leadership Institute at Morehouse College of Medicine in Atlanta, Georgia, helped develop a special curriculum designed to foster greater cultural competence among physicians and health care providers.

Called the “CRASH Course,” the program emphasizes:

  1. Cultural Awareness. Acknowledging the diversity and legitimacy of the many cultures that make up the fabric of American Society;
  2. Respect. Valuing other cultural norms, even if they differ or conflict with your own;
  3. Assess and affirm. Understanding the points of both congruence and difference among cultural approaches to decision-making; learning how to achieve the best outcomes within the cultural framework of the patient and family unit;
  4. Sensitivity and self awareness. Being secure in your own values; while willing to be flexible in working through cultural differences with others;
  5. Humility. Recognizing that every culture has legitimacy and that no one is an expert in what is best for others; being willing to subordinate your values for those of another to achieve the goals of treatment.

There is little doubt that multi-cultural sensitivity will continue to grow as an increasingly integral component of medical education and risk management in health care practice.

Dr. Marcinko Teaching Philosophy

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anatomy-254120_640

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Channel Surfing the ME-P

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

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Conclusion

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About the Author

Render Davis was a Certified Healthcare Executive, now retired from Crawford Long Hospital at Emory University, in Atlanta, GA He served as Assistant Administrator for General Services, Policy Development, and Regulatory Affairs from 1977-95.  He is a founding board member of the Health Care Ethics Consortium of Georgia and served on the consortium’s Executive Committee, Advisory Board, Futility Task Force, Strategic Planning Committee, and chaired the Annual Conference Planning Committee, for many years.  

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

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PARKINSON’S LAW: Beware in 2022

The 2-Ps [80/20] Rule

[By staff reporters]

Pareto’s law is either of the following closely related ideas: Pareto principle or law of the vital few, stating that 80% of the effects come from 20% of the causes Pareto distribution

Pareto distribution

The Pareto distribution, named after the Italian civil engineer, economist, and sociologist Vilfredo Pareto, is a power law probability distribution that is used in description of social, scientific, geophysical, actuarial, and many other types of observable phenomena. en.wikipedia.org

Parkinson’s law

Originally, Parkinson’s law is the adage that “work expands so as to fill the time available for its completion”, and the title of a book which made it well-known.

Assessment

However, in current understanding, Parkinson’s law is a reference to the self-satisfying uncontrolled growth of the bureaucratic apparatus in an organization.

COMPARISON

Conclusion

Your thoughts are appreciated.

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

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PODCAST: Future Hospital “Profit Pool” in 2022?

McKinsey Healthcare Industry Analysis – Future Sources of Hospital Profit

BY ERIC BRICKER MD

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PODCAST Year End 2021: Rich Helppie Interviews Dr. James R. Baker, Jr., M.D.

The Common Bridge

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Entering the Last Chapter of Covid, From Omicron and Beyond – With Dr. James R. Baker, Jr., M.D.
Richard Helppie welcomes back University of Michigan Professor Emeritus of Internal Medicine, and Virologist, Dr. James R. Baker, Jr., M.D., who brings words of both encouragement and warning as the world comes to what he feels is the beginning of the final throws of the Covid-19 pandemic. 

Dr. Baker has been a valued guest on the Common Bridge since the beginnings of the coronavirus over a year ago, and brings thoughtful, scientific, data-driven analysis to the most significant health issue of our lifetime.

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PODCAST: https://richardhelppie.com/james-baker/

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PODCAST: CIGNA Executive Public Relations “Whistle Blower”

Wendell Potter is a Famous Ex-Executive from Cigna Who Left His High Paying PR Job in 2007 to Reveal the True Story Behind Health Insurance Carrier Public Relations.

BY ERIC BRICKER MD

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“Don’t Weigh Me” Cards

Wither a Good Idea?

READ HERE: https://more-love.org/free-dont-weigh-me-cards/

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please don't weigh me cards

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PODCAST: Patient Trust in Health Care?

PERSUASION = Ethos, Pathos and Logos

BY ERIC BRICKER MD

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PODCAST: Milliman Medical Care Guidelines

Pervasive MCG Health Insurance Denials

BY ERIC BRICKER MD

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PODCAST: What a Hospital CEO Should Do?

Operational and Financial Changes

BY ERIC BRICKER MD

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Recent Weekend Stock Market Volatility

By Staff Reporters

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WHAT A WEEK!

  • Markets: Stocks ended a topsy-turvy week with another stinker yesterday, dragged netherward (big word alert) by the tech sector. Meta shares nearly entered a bear market, falling almost 20% from a closing record in September. Still, the S&P was down less than 1% for the week.
  • CITE: https://www.r2library.com/Resource/Title/0826102549
  • Covid: The first bits of solid Omicron data are starting to trickle out. One study from South Africa showed that the new variant may cause a higher rate of reinfection in people who already got Covid. Critical information on the effectiveness of current vaccines against Omicron could come in a few days, a WHO scientist said.

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PODCAST: What Hospital CEOs Should DO?

TOP 4 PRESUMPTIONS!

BY ERIC BRICKER, MD

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LONG Health Effects Post September 11th, 2001?

The Enduring Health Legacy

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As noted on this ME-P previously, surely 9/11 touched each and every American significantly. It was the end of American innocence, sending a powerful message about our place in the world.

Today, almost without exception, each of us can say that because of that bright September morning, we have been changed for life. Mothers were left without sons; brothers without brothers, and friends were taken from friends by this senseless act of violence.

Unfortunately, the ultimate legacy of 9/11 many still bear as they deal with the long-lasting health effects associated these terrorist attacks.

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RELATED: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors : Best Practices from Leading Consultants and Certified Medical Planners™ book cover

Conclusion

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

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

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PODCAST: Healthcare Bio-Statistics

Data Science in Healthcare

BY ERIC BRICKER MD

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BIO-STATISTICS COURSE: https://www.youtube.com/watch?v=1Q6_LRZwZrc-

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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PODCAST: The RAND Corporation Found that Commercial Health Insurance Plans Pay Hospitals 241% What Medicare Pays

The RAND Corporation Found that Commercial Health Insurance Plans Pay Hospitals 241% What Medicare Pays.

But Also That It Varies from 150% to 400%.

Dr. Boram (Kim) Park, MD - Dallas, TX | Internal Medicine

BY ERIC BRICKER MD

Health Insurance Companies Paid for Hospital Outpatient Services at an Even Higher Average Rate of 293% of Medicare.

A Detailed Look at the RAND Analysis Reveals that the ‘Basket’ of Services at Each Hospital Had Very Little Data.

For Example, the RAND Study’s Data for the Baylor Scott & White Hospital System in Dallas – Fort Worth Represented Only 0.4% of the Hospital’s Total Revenue.

For the Texas Health Hospital System Also in Dallas – Fort Worth, the RAND Study’s Data Only Represented 0.96% of the Hospital’s Total Revenue.

That Sample Size Is Likely Too Small to Make Accurate Comparisons from One Hospital System to Another Regarding their Commercial Insurance Prices Relative to Medicare.

ASSESSMENT: Your thoughts and comments are appreciated.

THANK YOU

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COVID-19 UPDATE: Vaccine Booster Shots

BY MEDICARE TEAM

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Important update on COVID-19 vaccine booster shots
If you previously got 2 doses of the Pfizer-BioNTech COVID-19 vaccine, you can get a booster shot of the Pfizer-BioNTech COVID-19 vaccine if you fall into one of these groups:

You’re 65 and older,You’re 18+ and have certain underlying medical conditions, or
You’re 18+ and work or live in a high-risk setting.

You can get your booster shot at least 6 months after you complete your second dose of the Pfizer vaccine.
The booster shot can help strengthen and prolong your protection against COVID-19.

Learn More: Visit CDC.gov for more information on other groups already vaccinated with the Pfizer vaccine that may be eligible for a booster shot.

Remember: Medicare covers a Pfizer vaccine booster shot at no cost to you.

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Oregon says it's ready to provide COVID-19 booster shots to those eligible,  but asks for patience - KTVZ

Sincerely,
The Medicare Team
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PODCAST: How Health Care Can Win by Adapting to Changes in Consumer Behavior

LESSONS FROM THE RETAIL SECTOR

See the source image

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Discover how ProMedica uses customer feedback and a digital-first approach to consumers to achieve stellar results across more than 400 facilities in 28 states.

PODCAST: https://www.youtube.com/watch?v=861em_pJfVM&t=3070s

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PODCAST: “Un-Accountable” Healthcare Quality

BOOK REVIEW

By Dr. Eric Bricker MD

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MEDICAL ETHICS: https://medicalexecutivepost.com/2021/05/28/medical-ethics-managing-risk-is-a-component-of-caring/

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PODCAST: NCQA and HEDIS [Health Effectiveness Data Information Set]

90 NCQI MEASUREMENTS

BY ERIC BRICKER MD

The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by more than 90 percent of U.S. health plans to measure performance on important dimensions of care and service. More than 190 million people are enrolled in health plans that report quality results using HEDIS.

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HEDIS Explained - BHM Healthcare Solutions

CITE: https://www.r2library.com/Resource/Title/0826102549

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The National Committee for Quality Assurance is an independent 501 nonprofit organization in the United States that works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation.

CITE: https://www.r2library.com/Resource/Title/0826102549

MORE: https://www.dhcs.ca.gov/provgovpart/Documents/6422/NCQAAccreditationOverview-1-21-20.pdf

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Qualit8 | Pulse8 | Revolutionizing Healthcare Analytics Platform

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PODCAST: https://www.ahealthcarez.com/how-hedis-quality-scores-work

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What Exactly is a PONZI SCHEME; etc?

AND OTHER INVESTING SCAMS!

By Dr. David E. Marcinko MBA CMP®

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SPONSOR: http://www.CertifiedMedicalPlanner.org

A Ponzi scheme (/ˈpɒnzi/, Italian: [ˈpontsi]) is a form of fraud that lures investors and pays profits to earlier investors with funds from more recent investors. Recall Bernie Madoff.

More: https://medicalexecutivepost.com/2010/06/04/the-madoff-circle/

The scheme leads victims to believe that profits are coming from legitimate business activity (e.g., product sales or successful investments), and they remain unaware that other investors are the source of funds. A Ponzi scheme can maintain the illusion of a sustainable business as long as new investors contribute new funds, and as long as most of the investors do not demand full repayment and still believe in the non-existent assets they are purported to own.

Link: https://en.wikipedia.org/wiki/Ponzi_scheme

A pyramid scheme is a business model that recruits members via a promise of payments or services for enrolling others into the scheme, rather than supplying investments or sale of products. As recruiting multiplies, recruiting becomes quickly impossible, and most members are unable to profit; as such, pyramid schemes are unsustainable and often illegal.

CITE: https://www.r2library.com/Resource/Title/0826102549

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How to Spot and Protect Yourself From Investment Fraud

Pyramid schemes have existed for at least a century in different guises. Some multi-level marketing plans have been classified as pyramid schemes.

And, there are MANY other schemes in the financial services sector.

MORE: https://www.msn.com/en-us/money/other/are-you-about-to-be-the-victim-of-a-ponzi-scheme/ar-BB1cqabu?li=BBnb7Kz

Front Running: https://medicalexecutivepost.com/2018/02/06/what-is-front-running/

Churning: https://medicalexecutivepost.com/2021/07/23/churning-front-running-and-pumping-dumping/

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MEDICAL RISK MANAGEMENT: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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The HISTORY of Messenger RNA

A Tangled History of mRNA

Hundreds of scientists had worked on mRNA vaccines for decades before the coronavirus pandemic brought a breakthrough.

By Elie Dolgin

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Messenger RNA Medicines | Translate Bio | mRNA Therapeutics

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LINK: https://www.nature.com/articles/d41586-021-02483-w?utm_source=pocket-newtabBy

RELATED: https://www.msn.com/en-us/health/medical/pfizer-biontech-say-covid-19-vaccine-is-safe-for-young-children-generates-immune-response/ar-AAODfco?li=BBnb7Kz

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PODCASTS: Surgery Safety Checklists

ATUL GAWANDE MD

Medical Culture

BY ERIC BRICKER MD

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RISK MANAGEMENT TEXTBOOK: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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