Hospital Industry Summary

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

Statistical Results for 2007
Staff Writers

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

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

*Acknowledgements

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

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

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HIPAA and Dentistry

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

About Ahlstrom’s Controversial HIPAA Testimony

By Darrell K. Pruitt; DDS

Dr. Robert H. Ahlstrom, representing the ADA as well as all US dentists, testified in July 2007 before the standards and security subcommittee of the National Committee on Vital and Health Statistics (NCVHS) about the benefits of HIPAA in dentistry. His testimony is featured as an official HHS document titled “Testimony of the American Dental Association, National Committee on Vital and Health Statistics Subcommittee on Standards and Security”, July 31, 2007.

http://www.ncvhs.hhs.gov/070731p08.pdf

The NCVHS Document

The document was presented by NCVHS to HHS Secretary Michael Leavitt as fact – a mistake that not only set back healthcare IT in dentistry, and miracles from trusted Evidence Based Dentistry [EBD] a decade or more – but seriously stained the reputation of the American Dental Association, crippling my profession’s influence in the nation’s capitol. Dr. Ahlstrom is a prosthodontist from Reno, Nevada and a tireless ADA volunteer. At one time, he was a respected proponent of paperless dental practices, and was rewarded with prominent appointments in the ADA, which he continues to silently cling to. However, at some point in his efforts, his enthusiasm for healthcare IT in dentistry caused him to lose perspective of who he was serving. When Dr. Ahlstrom chose to ignore the warnings of the danger from digitalized patient information, he abandoned the needs of dental patients and dentists.

Discussion Avoidance

For at least the last few years, Dr. Robert Ahlstrom has suspiciously avoided discussing the dangers of digital records with ADA members – including me – even in front of a crowd of a hundred or so witnesses in ADA Headquarters.

http://community.pennwelldentalgroup.com/forum/topics/evidencebased-dentistry-my?page=1&commentId=2013420%3AComment%3A17400&x=1#2013420Comment17400

The Challenge

Even though I think it is unlikely that he will accept my open challenge, I emailed him an invitation to defend his testimony here, or on the PennWell forum. In my opinion, the time has come for Ahlstrom to either show courage or be terminally irrelevant. If he fails to respond, I personally call for his resignation from all ADA positions because of clear unaccountability to ADA membership.

Robert Ahlstrom is the only dentist left in the nation who applauds HIPAA, and I don’t expect any official from the ADA to come to his defense. It would be wonderfully entertaining, but that is just too much to ask of the shy good ol’ boys I have bumped heads with. My questions to the ADA about HIPAA have been evaded for years.

Ahlstrom’s Eleven Selling Points

Here are the 11 selling points Ahlstrom presented to our lawmakers in support of HIPAA – which I will contest individually and in depth:

1. Dental office computer systems will be compatible with those of the hospitals and plans they conduct business with. Referral inquiries will be handled easily.

2. Vendors will be able to supply low-cost software solutions to physicians/dentists who support standards-based electronic data interchange. Costs associated with mailing, faxing and telephoning will decrease.

3. All administrative tasks can be accomplished electronically. Dentists will have more time to devote to direct care.

4. Dentists will have a more complete data set of the patient they are treating, enabling better care.

5. Patients seeking information on enrollment status or health care benefits will be given more accurate, complete and easier-to-understand information.

6. Consumer documents will be more uniform and easier to read.

7. Cost savings to providers and plans will translate in less costly health care for consumers. Premiums and charges will be lowered.

8. Patients will save postage and telephone costs incurred in claims follow-up.

9. Patients will have the ability to see what is contained in their medical and dental records and who has accessed them. Patient records will be adequately protected through organizational policies and technical security controls.

10. Visits to dentists and other health care providers will be shorter without the burden of filling out forms.

11. Consumer correspondence with insurers about problems with claims will be reduced.

Pruitt’s Response

1. Dental office computer systems will be compatible with those of the hospitals and plans they conduct business with.

Referral inquiries will be handled easily. Just how important is that to dentists other than you and the insurers you repeatedly represent, Dr. Ahlstrom? Adequate communication with other healthcare professionals has never been an issue in my office, and the US Post Office is hard to beat for safety. Dentists’ offices are not emergency rooms. Even in the most urgent situation, I cannot imagine a general dentist needing anything faster than the telephone and fax machine. And if it is a life-threatening emergency, rather than going online, we simply dial 911 in my office.

Common forms of communication are much more convenient, inexpensive and dependable than computers. But most importantly, like the US mail, they do not endanger dental patients’ welfare like digital records do. In fact, because universally accepted communications are not covered by the HIPAA rule you support, they cannot draw inspections and fines from the HHS.

As far as aiding communication with insurers, that has always been an insurance problem – commonly used to delay and deny payments to dentists. Since dental insurance companies continue to avoid transparency with their own clients for strategic reasons, their greed must never again be officially declared as dentistry’s problem by representatives of the ADA. You are wrong to mislead the federal government. It has never been the mission of the ADA to protect the profits of dental insurance companies. In fact, those you assist compete with dentists for dental patients’ dollars. That means it is unethical as well as against the Hippocratic Oath for you to assist them, Dr. Ahlstrom.

Supply solutions for what problems? How can a prosthodontist be so imprecise as to include vague words like “low-cost” in such important testimony to lawmakers on behalf of the nation’s dentists? Low-cost compared to what – no software? Just how expensive are the postage and telephone bills compared to the $40 thousand vendor problem you describe later in your testimony to the NCVHS?

“One dentist contacted the ADA recently and said that their current vendor was not going to update the current version in use today and instead the dental office would be forced to purchase a new system for $30,000-$40,000 dollars or return to submitting paper claims.” Dr. Ahlstrom, please leave baseless advertisements to healthcare IT vendors. They follow a code that forces them to maintain credibility.

3. All administrative tasks can be accomplished electronically. Dentists will have more time to devote to direct care.

As the best, if grossly exaggerated selling point for HIPAA that Dr. Ahlstrom highlights, this is still a blatant reach that is silly. I find it odd to read that any dentists sacrifice chair time for administrative tasks.

The business of dentistry is actually so simple that it was managed successfully for decades in even the busiest offices with pegboards and ledger cards. The bottleneck in dentistry has never been the front desk. It has always been the speed of the dentist. As a matter of fact, HIPAA forms have actually hurt efficiency. In addition, operatory turn-around is further delayed by another unfunded and unproductive mandate called OSHA, which also offers nothing to hold down the cost of compliancy.

What is the difference between the two? OSHA makes a little bit of sense, is hundreds of times cheaper and it does not harm patients other than increasing the cost of dental care. As for Ahlstrom’s incredible claim that “All administrative tasks can be accomplished electronically,” HIPAA compliance itself increasingly adds serious administrative tasks to covered entities’ overhead even before HIPAA inspections of dental offices begin. Let me provide a partial list of documents that are expected to be handy for HIPAA inspectors: In April 2005, long before Ahlstrom’s deceptive suggestion that HIPAA reduces non-productive tasks, Piedmont Hospital in Atlanta was inspected by HHS for HIPAA violations.

http://www.computerworld.com/action/article.do?command=viewArticleBasic&articleId=9024921

As a result, Piedmont officials were presented with a documented list of 42 items that the agency wanted information on “… including physical and logical access to systems and data, Internet usage, violations of security rules by employees, and logging and recording of system activities. The document also requested items such as IT and data security organizational charts and lists of the hospital’s systems, software and employees, including new hires and terminated workers.”

Has the ADA prepared members for HIPAA inspections? Not at all! They never mention it. Isn’t that odd?

I personally conducted a survey that I posted on the Executive-Post titled “HIPAA Rules and Dentistry.”

https://healthcarefinancials.wordpress.com/2008/09/01/hipaa-rules-and-dentistry/

The results show that the range of compliancy was found to be from 0% for the requirement of a written workstation policy to 88% for that of password security. The average was 49%, meaning that less than half of the requirements are being respected by the dentists in this sample. Once again, neither Ahlstrom nor the ADA has mentioned a word about HIPAA inspections to membership.

4. Dentists will have a more complete data set of the patient they are treating, enabling better care.

This is beyond reaching. This is absurd. If Ahlstrom had not obviously included this false testimony to placate members of the NCVHS who know nothing about dentistry, the intention of his misrepresentation would not make sense at all. What more do dentists need to successfully treat a patient’s oral problems than an uncomplicated, up-to-date and concise health history like the hundreds of millions of paper ones safely in use today in dental offices? Even if one pulls up an interoperable electronic health record, the dentist still must review it before initiating treatment. No time saved there. As more eHRs become imperceptibly altered by health insurance thieves who are not likely to be allergic to the same medications as the true owners of the records, I am determined that my patients’ health histories will always be paper – even if I am forced to pretend to have a paperless practice as mandated by an absurd law. It will cost my patients more to have two sets of records, but they will enjoy less risk of anaphylactic shock.

Let’s face it, dentistry is not heart surgery. Dentists don’t even need to know blood types. A health record complicated with superfluous and possibly tainted information clearly increases the chance for serious error without providing patients any benefit. One complaint already heard from physicians using eMRs is that there is simply too much information in digital records that complicate treatment rather than enhance healthcare.

In addition, unethical employers, bankers, ad executives and insurers find detailed electronic information about patients’ frailties of value and worth paying for, while eHRs are being breached millions at a time. Why should a dentist maintain any more medical information than necessary? There is no black market value for dental records. Why on Earth create one?

5. Patients seeking information on enrollment status or health care benefits will be given more accurate, complete and easier-to-understand information.

This should have never been mentioned by Dr. Ahlstrom. Incomprehensible dental insurance policies can no longer be defended by the ADA. Otherwise the insurance industry will continue to encourage complexity in order to take advantage of their clients. As healthcare providers for trusting patients, we cannot allow agents of the ADA to force the nation’s dentists to be enablers of deceit. Otherwise, like Ahlstrom, we are guilty of deceit as well.

Adequate communication between an insured and the insurer has always been an insurance problem and not a dental problem. ADA leaders must immediately stop encouraging members to assume insurers’ responsibilities of explaining their intentionally complicated dental plans to their clients. The ADA should never again spend a penny of members’ dues to assist insurance companies. Once again, performing work for insurance companies is outside the mission of the ADA. It always has been.

6. Consumer documents will be more uniform and easier to read.

This is pure fantasy. Computerization does not fix sloppy, it empowers sloppy.

7. Cost savings to providers and plans will translate in less costly health care for consumers. Premiums and charges will be lowered.

Although it is undeniable that electronic records benefit insurers more than anyone else, one has to pay close attention to Ahlstrom’s use of the words “cost savings.” If Ahlstrom had said that HIPAA will lower dentists’ overhead, like head ADA lobbyist Michael Graham claims on his ADA website, Ahlstrom’s statement would be just another lie from another ADA representative.

http://www.ada.org/prof/advocacy/agenda.asp

By calling it a “cost savings,” Ahlstrom technically concedes that HIPAA will indeed require an increase in overhead – which dental patients will ultimately have to pay to obtain dental care. Ahlstrom cleverly skirts the lie that Graham continues to post by promising “savings over what it could cost otherwise” – perhaps without the “low-cost” vendors he previously mentioned.

It can no longer be denied by employees of the ADA like Michael Graham. ADA members will have to raise fees to cover the purchase and maintenance of untried and expensive information technology that neither patients nor dentists want. It is also undeniable that because of their deceit, more children will go to bed with toothaches; So much for increasing access to care, ADA.

Will there be problems? You bet! Big expensive ones attached to very angry ADA members similar to the $40 thousand problem mentioned by Ahlstrom himself.

Here is another problem that the ADA has kept hidden from membership: In Subpart D, §160.426, of the HIPAA enforcement rule, there is a section titled “Notification of the public and other agencies” which gives HHS the right to inform virtually everyone if they find a violation in a dental office. When inspections begin, I expect HHS to publicly punish violators. For good reason, there is a growing bi-partisan push for accountability for data breaches which continue to occur copiously. There is no doubt that news about HIPAA violations will be made public on the Internet through the NPPES using dentists’ NPI numbers. Since dentists freely volunteered for the numbers, it makes this legal. Volunteering is legal consent to abide the laws of the revised 1966 Freedom of Information Act which in 1996 was turned 180 degrees away from government entities such as the HHS and directed against US citizens who happen to be dentists. The ADA has also failed to inform members that an investigator can show up unannounced in any covered entity’s office and demand everything digital immediately. This means that office computers can be instantly confiscated even before one is publicly labeled as a HIPAA violator on the Internet.

And to think that some rookie healthcare IT enthusiasts are still foolish enough to mention Hurricane Katrina as a swell reason for going paperless. One can see hurricanes coming.

8. Patients will save postage and telephone costs incurred in claims follow-up.

Once again, this problem will never be solved electronically. Insurers will merely save money for postage on denial letters – which will naturally encourage more denials – and an insurance executive will receive a bonus.

My patients can drop by my office at any time to see their dental records. If they want copies, I can provide those as well. I can even mail them. Nobody has ever had access to my patients’ paper records without my patients’ permission. As for protection, a huge, clunky sheet-metal file cabinet stuffed with hundreds of pounds of paper records, including radiographs, is hard to slip down a flight of metal and concrete stairs quickly without making at least a little noise. On the other hand, hackers, or even dishonest or angry employees raise no alarm whatsoever, and they can be gone in a flash with thousands of IDs. How can Dr. Ahlstrom possibly promise that with HIPAA, electronic records will be adequately protected? What about the organizational policies he casually mentions? Does this mean more staff meetings? I should remind everyone that selling point number three was a decrease in administrative work. Did Ahlstrom change his mind in mid-testimony?

Lastly, effective technical security controls just do not exist. For example: If electronic health records show who has accessed them, can someone discover who has accessed the more than 160 million records that have been reported lost in the last few years? Impossible!

10. Visits to dentists and other health care providers will be shorter without the burden of filling out forms.

Does this mean fewer HIPAA “Notice of Privacy Practices (NPP)” forms? How much time would it take for new patients to actually read the NPP form they sign? How much more time would it take for dentists to disclose to the patients that the form does nothing to protect their rights to privacy? Quite the contrary; “Patients also may ask covered entities to restrict the use or disclosure of their information beyond the practices included in the notice, but the covered entities would not have to agree to the changes.” – abstracted from “Protecting the Privacy of Patients’ Health Information,” released in April 2003 from the HHS.

http://www.hhs.gov/news/facts/privacy.html

11. Consumer correspondence with insurers about problems with claims will be reduced.

Since I am never a legal party in my patients’ insurance decisions, and since very few dental insurance companies hold themselves accountable to anyone, including their own clients, why should I care about patients’ contractual agreements with their dental insurance companies? I do not want that responsibility and such earthly bad advice from an ADA leader is simply not consistent with the mission of the ADA.

Assessment

In closing, I have to ask why Dr. Robert Ahlstrom would invent the fantasy he told lawmakers. It is as if he told the NCVHS what he thought HHS wanted to hear. Why couldn’t he just tell the truth? HIPAA offers no benefit to dental patients. In fact, the mandate endangers their welfare, making it unethical for a dentist to become a covered entity, even if encouraged to do so by a representative of the American Dental Association.

If I am wrong about any part of this national disgrace, Dr. Robert Ahlstrom should immediately stand up and publicly defend HIPAA on this forum. It is failing in dentistry on a national scale and pulling the ADA down with it. If nobody can clear up the apparent absurdity, not only will it hurt my profession, but the Department of Health and Human Services as well as Obama’s administration will suffer embarrassment when the media discovers that HIPAA is in reality, a grand fraudulent scheme of historic proportions.

The Challenge

It is your turn now, Dr. Robert Ahlstrom. Meet the professionals whose interests you misrepresented in front of lawmakers. Otherwise, be forever silent. I will always hold you accountable for abetting fraud against my profession.

Conclusion

Your thoughts and comments on this polemic and Medical Executive-Post are appreciated; especially from dentists, attorneys and health policy wonks, and IT gurus. Does the dentist have a point; or not?

Note: Dr. Pruitt blogs at PenWell and others sites, where this post first appeared.

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Flying Under the Traditional Media Radar

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

New Year Health 2.0 Dreams

By Darrell K. Pruitt; DDS

Allow me to share with you our health 2.0 networks’ growing advantage in modern communication. I sincerely consider myself a lucky person to have so many friends who have been patient with me while I searched for my voice. Sometimes, it was by trial and error that was agonizing for all, I’m sure. Thanks for your patience. I’ll never let you down.

Medical Executive-Post Growth

Recently, I read an article written by Ann Miller, the Executive-Director of this Medical Executive-Post. It is a healthcare financial blog where I feel honored to be a guest columnist among very sharp physicians and financial analysts. The title of Miller’s article is “Our Executive-Post Growth,” and was posted in October, a little over a month after I started contributing to the blog.

https://healthcarefinancials.wordpress.com/2008/10/13/deeper-financial-management-insight/#comment-2524

Successful “Post” Attributes

Even though Ann Miller attributed the sudden increase in Executive-Post readership to the sudden drop in the stock market and other financial concerns, here is how she unknowingly reacted to our power in numbers: “Wow! That’s the best word to describe our recent growth!” So, here is the surprise comment I posted in response to her revelation:

Exciting Niche Market

I think we are in a unique position of having achieved a palpable level of significance in the niche market of the traditionally stoic dental industry – yet our presence is still under the radar of popular media, which is also run by vulnerable top-to-bottom managers. I confess that I find that part of the adventure especially exciting in an ornery way. It is sort of like we are stealthily undermining weak, archaic ways of doing business – using transparency for the benefit of dental patients nationwide… and so what if it becomes entertaining now and then.

So what is on the horizon?

The Road Ahead

A few days ago, I read on the ADA News Online that the ADA intends to resurrect “the Association’s flagship Web site and a key online destination for dentists and their patients.” The article is written by reporter Joe Hoyle and is titled “Reinventing ADA.org.”

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3364

Assessment

Here is something for your imagination. In the entire US, who do you think will dominate ADA.org from the instant it opens until it is shut down the second time? I say it lasts a week. Please, no wagering. It is my pleasure to serve you. Now, isn’t it about time you grabbed a voice of your own? Come on out … post, comment and opine … the air is fine. Have a happy new year.

Conclusion

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Saving Primary Care

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

The British Reimbursement Experience

Staff Reporters

Recent articles in the medical and lay press, this and other blogs, have focused on the growing shortage of primary care physicians in the United States. Of course, there is plenty of blame to go around; from Congress – to the AMA – to medical specialists and the CPT Coding Committee – the shortage is causing a crisis in the nation’s healthcare system.

More: www.healthcarefinancials.wordpress.com/2008/04/02/physician-compensation-trends

JAMA Speaks

For example, a recent article in the Journal of the American Medical Association [JAMA] documented that family medicine, at $185,740, has the lowest average salary of the medical specialties.

More: http://certifiedmedicalplanner.com/MDs.aspx

The UK Experience

A preventive medicine doctor commented on Medscape.com, January 2, 2009, “In the UK, whatever the defects of the system – and they are many – they build around GPs, who get $230,000 a year plus 25% performance bonuses. And, of course, they don’t have huge medical school debts.”

Assessment

In the US, [you] “have it backwards. The most valuable doctors — primary care physicians — get paid the least.”

Conclusion

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

Our Print Books and Related Information Sources:

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Health Industry Analysis Services

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

From iMBA Inc.

Staff Writers

Who we are?

The Institute of Medical Business Advisors, Inc is a consulting and industry analyst firm that conducts research which bridges “healthcare mission and profit”; with a particular focus on organizational management, personal finance and health economics for physicians and their advisors www.MedicalBusinessAdvisors.com

What we do?

The results of our research and development activities may be compiled into reports. Reports come in two forms, those sponsored by a specific client (custom research) or those sponsored by iMBA Inc; and typically released in the form of Award Winning white papers, books, chapters, dictionaries, portfolios and periodicals, etc www.HealthcareFinancials.com

All reports – regardless of sponsorship – use proven methodologies of both primary and secondary references systems and individual and group thought leader citations www.HealthDictionarySeries.com

Educational Activities

Our educational activities are wide and deep, as well, offering both online and on-ground initiatives for individuals and corporations www.CertifiedMedicalPlanner.com

Assessment

Contact Ann for additional details.

MarcinkoAdvisors@msn.com

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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About the Certified Medical Planner™ Designation

Posted on January 4, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

It’s all about Credibility … and Deep Knowledge

Staff Reporters

The Certified Medical Planner™ program was launched in 2006 and its notoriety has grown with RIAs and fiduciary advisors of all stripes; while garnering the ire of industry RRs and brokers. Of course, the recent sub-prime mortgage fiasco, and Wall Street problems and shenanigans with banks and investment houses like Bear-Stearns, Lehman Brothers, USB, Wachovia, Fannie Mae and Freddie Mac, WaMu, SunTrust etc., are well known.

And so, what is the physician-investor to do? Select help from fiduciary–liable and physician focused consultants; suggest some pundits.

Fiduciary Accountability

A recent group of surveyed physicians said that fiduciary accountability, health economics expertise and medical management acumen mattered most to them when selecting a financial advisor [FA]. But, many did not know that the majority of financial “advisors” eschewed accountability. Hence – the existence and very cause [raison de’tra] of the online Certified Medical Planer™

iMBA Survey

In addition, related research of physicians and medical practitioners reveal that:

85% of those surveyed considered practice-related health economics information very important to them.
756% objected to demeaning sales metaphors like “financial-doctor” or “physician for your finances” when informed of a non-fiduciary relationship.
70% heavily favored processes and solutions to specific problems – or needs – versus a general sales or stock-broker approach.
65% found the integrated financial advisor-medical management format more useful than a financial product sales presentation or generic financial services provider.
Most physicians respected the MBA, PhD and JD degrees, and CPA designation; while virtually all other designations were lightly known, including several industry vanguards.
90% felt the finance-services sector knew little about the domestic healthcare industry.
Most physicians ranked financial-services industry ethics as “suspicious”, or not “trustworthy.”
Over 82% of physicians surveyed said they would like to lean more about any new medical and fiduciary-focused designation, like the Certified Medical Planner™ professional charter.

Source: Annual research conducted in 2006 and 2007 by iMBA Inc.

Assessment

Of course, the competitively based CMP™ program is not for everyone; and especially not for those financial advisors uninterested in either fiduciary accountability or the healthcare space.

Disclosure

Executive-Post Publisher-in-Chief, Dr. David Edward Marcinko; MBA, CMP™ is a former Certified Financial Planner™ and founder of the program www.CertifiedMedicalPlanner.com

Conclusion

Your thoughts and comments are appreciated. Is this certification and educational program, with logo trade-mark, needed in the healthcare space; why or why not?

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Filed under: Financial Planning, Investing, Op-Editorials, Portfolio Management, Research & Development, Sponsors | Tagged: Certified Medical Planner™, CMP | 2 Comments »

Top 50 Health 2.0 Blogs

Posted on December 28, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Offering Definitional Clarity [Maybe]

By Staff Writers

There is no concise-precise definition of Health 2.0 as it is a dynamic construct. But, according to Holt, Furst, Crespo, Marcinko, Hetico, www.HealthDictionarySeries.com, and many others; Health 2.0 may be defined as an amalgam of many ideas. Most notably, our best definition:

“Health 2.0 is internet cloud enabled participatory healthcare model characterized by the ability to rapidly generate, share, classify and summarize individual health information with the goal of improving health care systems, experiences and outcomes via integration of patients and stakeholders. It is a modern concept about change in how patients, physician, payers, employers and all stakeholders relate to each other, and the industry, in a personalized manner using new technologies.”

Top 50 Health 2.0 Blogs

Alisa Miller, of nursing portal RNCentral.com, says that Health 2.0 embraces the idea of bringing health care into the community of physicians, patients, and those in the health care industry together with technology and the Internet to provide the best possible health care environment.

Assessment

What better way for the various parts of this community to share their thoughts and communicate ideas than through their blogs? From corporate blogs to blogs that are a part of social networks to individual blogs touching on technology or health care policy, these blogs will help bring you into the community, provide information and resources, and may perhaps help you find your voice as well.

Link: http://www.rncentral.com/nursing-library/careplans/top_50_health_2.0_blogs

Conclusion

Your thoughts and comments on this Medical Executive-Post are appreciated.

References:

Crespo, R. 2007. Virtual Community Health Promotion; Preventing Chronic Disease, 4(3): 75

Furst, I. 2008. Wait Time and Delayed Care. Accessed at http://waittimes.blogspot.com/ on 15/11/20008

Holt, M: www.TheHealthCareBlog.com

Marcinko, DE 2007. Dictionary of Health Information Technology and Security; Springer Publishers, NY

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Public Healthcare Cost-Shifting

Posted on December 27, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Joint Study Results

[By Staff Reporters]

The American Hospital Association, Blue Cross / Blue Shield Association, Premera Blue Cross and America’s Health Insurance Plans recently released a study on public and private health insurance payment rates prepared by the actuarial firm Milliman, Inc.

Findings-in-Brief

Hospitals lost $30 billion on Medicare and Medicaid
Hospitals earn $66 billion on commercial business
Hospitals lost $13 billion on uninsured patients

Privates Employers Hit

Private sector employers, employees and their families pay about 10-11% more than they would otherwise pay for health insurance – to fund the operating deficits created by Medicare and Medicaid.

Assessment

Specifically, Milliman indicated cost shifting is worth a $51 billion differential in hospital payments, and a $40 billion differential in payments to physicians.

Full report: http://www.ahip.org/content/default.aspx?docid=25216

Conclusion

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Introducing America Well™

Posted on December 26, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Extending the New Health 2.0 Marketplace

Staff Reporters

America Well™ is a new healthcare marketplace where consumers and physicians come together online, to acquire and provide convenient and immediate healthcare services. Using the latest technologies in electronic communications and digital telephony, the company extends traditional healthcare services to the home setting www.AmericaWell.com

Origins

Based in Boston, Massachusetts, American Well was founded in 2006 by Drs. Roy and Ido Schoenberg. Previously, they successfully built and implemented three large-scale, mission-critical enterprise solutions for health 2.0 in both domestic and international markets.

Three Target Markets

According to its website, America Well is committed to supporting health plans in meeting consumer and employer demand for affordable, efficient and immediate access to quality care; by serving its three core market segments:

1] Patient-Consumers

Patients may talk to a doctor anytime, without leaving home or scheduling an appointment. Consumers may choose from a variety of specialties.

2] Physicians

Doctors can increase revenues and care for patients on their own terms. This introduces a new balance to the way medicine is practiced by offering medical services online for a fee.

3] Health Plans

Plans capture the value of consumerism by enabling online healthcare services and providing members appropriate access to physicians from home, the most convenient and least expensive care setting.

Assessment

For over 30 years, rising costs and increased demand have limited consumers’ ability to get affordable, quality health care. While other consumer industries have embraced Internet technology, bringing retail, travel, and entertainment services to consumers’ homes; healthcare delivery has remained unchanged – it is still delivered almost exclusively in physician offices and hospitals.

Conclusion

America Well™ aims to close this gap by offering real-time healthcare services through dependable and widely available communication channels. Using the Internet, digital telephony, and the latest interactive technologies, American Well helps consumers get the care they need, without ever leaving home. But, is this new service really a help – or hindrance – to its three core markets segments? Please comment and opine.

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Filed under: Information Technology, Practice Management, Research & Development | Tagged: american well, health 2.0 | 1 Comment »

Unsafe Emergency Rooms

Posted on December 18, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Brutal New AEM Report

[By Staff Reporters]

Hospital emergency rooms are not safely designed or managed, and improvements in working conditions are needed, according to a new study in the Annals of Emergency Medicine [AEM].

AHRQ

According to the Agency for Healthcare Research and Quality [AHRQ], December 9, 2008, the study surveyed 3,562 emergency medicine clinicians in 65 hospitals to examine their perceptions about their emergency department’s safety.

Incriminating Findings

The study found that:

Nearly two-thirds of emergency departments reported insufficient space for patient care.
One third said the number of patients consistently exceeded ER capacity for safe care.
Forty percent reported insufficient physician staffing to handle busy period patient loads.
Two-thirds reported insufficient nursing staff to handle patient loads during busy periods.
Only a third reported frequent patient waiting-room monitoring.

Suggestions

The researchers recommend the following improvements:

Increase or redesign emergency department space.
Increase staffing during periods of high demand.
Improve information sharing between clinicians by reworking team processes.
Improve patient transitions between ER and inpatient areas of the hospital.
Provide more computer workstations and access to eHRs.

Assessment

Recently, there has been a plethora of corroborating reports.

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

Filed under: Breaking News, Practice Management, Quality Initiatives, Research & Development, Risk Management | Tagged: emergency departments, emergency rooms | 7 Comments »

About CDC’s Epi Info Community Edition

Posted on December 17, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

An Open Source Health IT Release

Staff Reporters

According to John Moore of Government Health IT, the Centers for Disease Control and Prevention [CDC], here in Atlanta, just released an open-source version of its software for epidemiological analysis.

History of Epi Info

CDC’s Epi Info originated as a disk-operating system [DOS program] in the 1980s, when epidemiologists sought a PC-based tool to analyze disease outbreaks. The open-source, pre-beta version, named Epi Info Community Edition, marks the beginning of a rewrite of the Epi Info tool suite in the C# programming language. The open source edition also aims to cultivate a wider community of developers www.HealthDictionarySeries.com

Assessment

The CDC has made Epi Info Community Edition available via CodePlex, Microsoft’s open source project hosting Web site.

Conclusion

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

Our Other Print Books and Related Information Sources:

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Hospitals On-Cue™ to Improve Operations

Posted on December 14, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Innovative Healthcare Informatics

Staff Reporters

Allocade Inc, a developer of innovative healthcare informatics solutions, just announced that it has installed its first commercial On-Cue™ system at Peninsula Medical Center in Burlingame, Calif. The company began selling its commercial product in January 2008, and the installation at Peninsula Medical Center was the first of seven sites Allocade completed by the end of 2008.

The Problem

Hospitals spend millions of dollars on solutions designed to shave minutes off of procedures. RIS, PACS, EMR, etc are all designed to improve the workflow of physicians, to enable quicker turnaround time for diagnosis. Most of these solutions focus on improving efficiency “post procedure”.

Human Resources Issues

In contrast, hospital staff is expected to track patients, coordinate between departments, handle real time disruptions, improve quality of patient care, etc using mostly manual processes. Limited tools are available to help technologists, nurses, transport, physicians, and even patients, more effectively navigate through the “chaos” characterized by most hospitals. Investment in “pre-procedure” tools and solutions has been limited, resulting in a sub-optimal use of expensive capital resources.

Focused on Helping Hospitals

And so, www.Allocade.com suggests the following benefits may be derived from using On-Cu™ to improve operating efficiencies:

Manages the real time disruptions and “chaos” that occurs when in-patients, out-patients, ER cases, add-on’s, and unexpected delays all collide while competing for the same shared resources like a CT, MRI, US, IR, or ORs, etc.
Re-schedules patients in real time to more optimally manage resources.
Coordinates the numerous activities that must occur prior to a scan actually being completed, i.e. all the precursor tasks which require constant and real-time coordination between the radiology techs, nurses on the floor, the ER, transporters, and the referring offices.

Assessment

On-Cue™ is a software solution that claims to enable hospitals to reclaim un-used operating capacity.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Anyone out there a user – or convert?

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Filed under: Information Technology, Managed Care, Practice Management, Research & Development | Tagged: On-Cue | 2 Comments »

About PatientsLikeMe.com

Posted on December 11, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Empowering Health 2.0 Social Networks

According to its website, www.PatientsLikeMe.com was founded in 2004 by three MIT engineers whose collective experience spanned from running the world’s only non-profit biotechnology laboratory – to large scale online commerce applications. Today, PatientsLikeMe is a privately funded company dedicated to making a difference in the lives of patients diagnosed with life-changing diseases.

A Personally Generated Idea

A personal experience with ALS [Amyotrophic Lateral Sclerosis] – Lou Gehrig’s Disease – was the inspiration to create this on line social community of patients, doctors and organizations that informs and empowers individuals. The firm has committed to providing patients with access to the tools, information and experiences they need to take control of their disease. Currently, it has signed-up 23,000 participants and membership is growing 35% per month.

The Promise

The promise of PatientsLikeMe is to provide a better, more effective way to capture valuable information and share it with patients, healthcare professionals and industry organizations trying to treat the disease.

The Goal

To reach its goals, the site created an internet based platform for collecting and sharing real world, outcome-based, patient data and is establishing data-sharing partnerships with doctors, pharmaceutical and medical device companies, research organizations, and non-profit organizations. And, since the HIPPA statutes don’t mute patients themselves, a regulatory escape clause – of sorts – enables the virtual dialog.

Cost Coverage

Operating costs are covered by partnerships with healthcare providers that use anonymous data from, and permission-based access, to the PatientsLikeMe community to drive treatment research and improve medical care. The site shares anonymous data with trusted partners and all patient information is kept safe and secure [to the extent possible].

Assessment

Traditionally, physicians, organized medicine and groups like the ALS Association [ALSA.org] assumed [or abrogated] the role of treatment and thought leadership in niche spaces like this. But, the social networking phenomenon, known as Health 2.0, could fundamentally change the practice and business model of all medicine. For example, related concept models include:

*SugarStats.com for diabetics,
*Oncolink.com for cancer patients,
*Eurodis.org for rare diseases,
*Vitals.com to rate physicians,
*Trusera.com for general medical information sharing, and
*Disaboom.com for the disabled; etc

And, many more demonstrate the growing trend of patient empowerment.

More info: Business Week, page 58, December 15, 2008.

Conclusion

What do you think? Let us know with a post, opinion or comment on this topic; either as a doctor, patient, payer, employer, economic or financial advisor, politician or healthcare social engineer.

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

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Filed under: Information Technology, Managed Care, Research & Development | Tagged: health 2.0, Patients like Me | 3 Comments »

Introducing MyMedLab

Posted on December 9, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Direct to Consumer [D2C] Laboratory Services

Staff Reporters

MyMedLab began as a regional lab provider in Missouri in 1993. The company was created to allow patient-consumers to make informed care choices. In 2004, the company aimed to partner with industry leading providers and the power of the Internet to take the company and its electronic interface national.

Health Information Innovation

According to their website www.MyMedLab.com, this new business model created an innovative approach that dramatically lowered costs and gave patient-consumers direct access to the same health information once only available to doctors. Leveraging more than 20 years of laboratory experience, MyMedLab was able to create one of the first “direct to consumer” [D2C] laboratory services in the country.

Mission

From inception, the mission of MyMedLab was to provide consumer-patients with an affordable and convenient way to privately learn about their health. When combined with an annual exam, their screenings create a foundation for health care of the future, one focused on prevention and early detection.

Smart Patient-Consumers

Smart patient-consumers receive this information privately, outside their permanent medical records, and then share results when it enhances their care. Knowing what is important and what questions to ask maximizes the time and money spent with personal physicians. The MyMedLab process combines transparent pricing with the services of a board certified physician in every state. This unique combination eliminates the cost and inconvenience of a doctor’s visit just to order routine testing. It provides essential physician oversight throughout the entire process while still guaranteeing complete privacy.

Purchased Testing

Testing can be purchased 24 hours a day. Tests are listed both individually and in groups called Wellness Profiles based on age, sex and family history. For patient-consumers with testing ordered by their doctor, MyMedLab provides an easy way to purchase the same testing at a cost 50%-80% less than in their doctor’s office or local hospital lab.

Electronic Medical Records

MyMedLab customers purchase testing online, or by phone, and then visit one of nearly 2,000 local Patient Service Centers (PSC) in their neighborhood. Once samples are drawn, results are securely uploaded to their private personal health record (PHR) within 24-48 Hours. A notification email is sent when results have been released and are ready for review. Patients then simply log into their PHR account at MyMedLab to view their results. Each result includes a brief explanation and a direct link to the National Library of Medicine [NLM] for more detailed result information.

Assessment

Everything done at MyMedLab is designed to put the patient-consumer back in control. Since “knowledge is power in health care”, their vision of the future is to continually introduce new technology and services, to enhance the consumer-patient experience, and to transform the way we all learn about our health.

Conclusion

As always, your thoughts and comments on this Medical Executive-Post are appreciated. Does this D2C laboratory model empower or denigrate the physician-doctor relationship in the era of Health 2.0?

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Filed under: Drugs and Pharma, Health Economics, Information Technology, Research & Development | Tagged: blood tests, laboratory services, medical labs | 1 Comment »

The Next Financial Crisis?

Posted on December 9, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Your Opinion Counts

Staff Reporters

The effects of the current financial meltdown are well-known to all citizenry. And, the next economic crisis is still wholly unforeseen. However, research conducted by the Institute of Medical Business Advisors Inc, suggests it may come from one, or more, of the following sectors:

Pension Benefit Guarantee Corporation
Home/Commercial Real-Estate Mortgages
Medicare and Medicaid
Hedge Fund Collapse
Social Security Administration
Autos, Airlines, Manufacturing, etc
Global Financial Catastrophe
Terrorist Attack
Something else?

Assessment

For more info: www.MedicalBusinessAdvisors.com

Conclusion

What do you think? Let us know what’s on your mind with a post, opinion or comment.

Our Other Print Books and Related Information Sources:

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Dueling Universal Health Coverage Proposals

Posted on December 7, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Obama and AHIP Race to the Finish Line

According to the WashingtonPost.com, on December 6, President elect Barack Obama is inviting Americans to spend part of the holiday season talking about health care – in informal ad hoc meetings around the country called Health Care Community Discussions – to be held between December 15 and 31. And, then report the results back to him. HHS Secretary Elect Thomas A. Daschle will prepare a detailed report, complete with video, to present to the next president.

But, according to the Wall Street Journal, December 4, 2008, the AHIP – a trade group for health insurers – is already offering its own universal coverage proposal that calls for Congress to slow the growth of health care costs by 30 percent in five years, envisioning a total savings of more than $500 billion.

Health Spending [16% GDP]

In 2006, health spending in the U.S. reached $2.1 trillion, consuming 16 percent of the nation’s gross domestic product, according to economists at the federal Centers for Medicare and Medicaid Services [CMS].

The AHIP Proposal

In the insurer’s proposal, money could be used to fund coverage of the uninsured and to cut costs for those with insurance. Officials from America’s Health Insurance Plans [AHIP] called on Congress to establish a public-private advisory group to recommend action in three areas:

reducing wasteful spending,
changing how doctors and hospitals are paid,
and reducing administrative costs.

The AHIP reiterated its position that insurers would be required to offer individual policies to people with pre-existing illnesses; as long as all Americans were required to have health insurance.

Assessment

Obama, by applying the high-tech tools and grass-roots activism that helped him win the White House, hopes to circumvent many of the special interests groups that squelched previous health-care reform efforts. And, in yet another indication of the growing interest in health legislation, Sen. Edward M. Kennedy just announced that he will give up his seat on the Judiciary Committee to focus on health care.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How do physicians, medical executives, advisors, employers, payers and patients differ on this issue? Is there really a race, at all? Tell Obama here:

http://change.gov/page/s/healthcare

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Domestic Economy Sickens Hospitals

Posted on December 5, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

AHA Reports Negative Financial-Operating News

Staff Reporters

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

DATABANK Results

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

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

Capital investments are also being postponed or delayed:

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

Assessment

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

Conclusion

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

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Filed under: Health Economics, Health Insurance, Healthcare Finance, Monthly Reports, Research & Development | Tagged: AHA | Leave a comment »

About OSHA’s eTool for Hospitals

Posted on December 4, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

A New Computerized Graphical Safety Interface for 2008

[By Staff Reporters]

***

According to the Bureau of Labor Statistics [BLS] in 2001, the nation’s hospitals reported 293,600 nonfatal occupational injuries and illnesses to their personnel.

Hospital Injury Rates High

Among US industries with 100,000 or more injuries and illnesses, hospitals have the second highest rate of nonfatal injury or illness cases. Only eating and drinking places have more injuries and illnesses. The incidence rate for hospitals is 9.2 injuries and illnesses per 100 full-time workers. The incident rate for industry as a whole is 6.1 injuries and illnesses per 100 full-time workers. During October 2000 through September 2001, OSHA performed 103 inspection activities in SIC code 806-Hospitals. The most frequently sited violations were bloodborne pathogens, lockout/tagout, and hazard communication.

Introducing Hospital eTool from OSHA

OSHA is now providing a new computerized graphical, known as eTool, to help healthcare entities and employers identify and address potential occupational hazards in hospitals. This will be done through a comprehensive safety and health program approach.

Assessment

eTool will help employers in developing and implementing engineering and work practice controls which comply with OSHA requirements and can be incorporated into a health facility’s safety and health plan to reduce the hazards of hospital work and improve worker safety. eTool addresses the following areas:

Administration and Central Supply
Clinical Services and Dietary
Emergency and Engineering
Heliport and Housekeeping
ICU and Laboratories
Laundry and Pharmacy
Surgical Suite and other HealthCare Wide Hazards

More: http://www.osha.gov/SLTC/etools/hospital/scope.html

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: Information Technology, Quality Initiatives, Research & Development, Risk Management | Tagged: eTool, OSHA | 2 Comments »

Call for Sponsors and Advertisers

Posted on November 30, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

The Medical Executive-Post

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Consider confirming or tweaking your campaign, and saving advertising expenses, by first sponsoring your ad on the Executive-Post. We’re the ideal new-wave venue for financial services professionals, technology firms, physician-executives, wealth managers, medical societies and job seekers, too.

For details, or to request a marketing prospectus, please email Ann at: MarcinkoAdvisors@msn.com. You may or telephone 770.448.0769 or fax her 775.361.8831, as well.

We look forward to providing a solution to your next-gen promotional needs!

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Toxic Commercial Mortgage-Backed Securities [CMBS]

Posted on November 26, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Another Impending Financial Crisis?

Staff Reporters

According to industry sources, should commercial real-estate turn out to be the next focus of the financial crisis, life insurers will be among the companies feeling the most heat.

Life Insurance Companies

According to the Dow Jones Newswires, on11/20/2008, life insurers on average have the equivalent of about 41% of their equity invested in Commercial Mortgage-Backed Securities [CMBS], compared with 23% on average for property/casualty insurers.

The Fox-Pitt Kelton Report

According to a recent analysis of 10 large public insurers by Fox-Pitt Kelton analyst, Adam Klauber, Hartford Financial Services Group (HIG); Protective Life (PL) and MetLife (MET) had the highest exposures.

Assessment

Investment banks, by contrast, held about 18% of their equity in CMBS. While the financial crisis has come late to the life insurance industry, it has hit them hard. Shares of life insurers are down nearly 72% so far this year, a bigger drop than for other types of insurers.

Conclusion

Now – forget CitiGroup – what about the health insurers? Your thoughts and comments on this Executive-Post are appreciated.

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

Filed under: Insurance Matters, Investing, Practice Management, Research & Development, Risk Management, Surveys and Voting | Tagged: cmbs, toxic cmbs | 2 Comments »

Hospitals Financially Ailing

Posted on November 25, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Economic Slowdown Cited as Causative

Staff Reporters

According to the Associated Press, November 20, 2008, the current dismal economy has American hospitals ailing. New data shows declines in overall admissions and elective procedures, plus a significant jump in patients who can’t pay for care.

AHA Study

According to a survey by the American Hospital Association [AHA], hospitals also have been hurt by losses on their investments due to the turmoil on Wall Street. Many are finding it more expensive to borrow money, while some of the hardest-hit hospitals began reducing staffing and services as early as last spring and more will follow.

Assessment

The AHA survey also found that 67 percent of hospitals saw some drop in elective procedures, with 6 percent seeing a significant drop; 63 percent saw some decline in overall admissions, with 9 percent seeing a bigger drop; while inpatient and outpatient surgeries and emergency department visits were all down roughly 1 percent in the third quarter.

More info: www.HealthcareFinancials.com

Conclusion

As always, your thoughts and comments on this Executive-Post are appreciated.

Related Information Sources:

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

Filed under: Health Economics, Healthcare Finance, Research & Development, Surveys and Voting | Tagged: hospitals | 1 Comment »

The National Health Care-Scare

Posted on November 24, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

The Markets and Health Economics

By Dr. David Edward Marcinko; MBA, CMP™

As a centrist fiscal conservative – social liberal – I tend to side with libertarian issues and not political parties. Nevertheless, I was dismayed with the recent presidential election and wondered what impact it would have on the stock markets. Mr. Market replied with haste.

The Question

In the short term, the stock market collapsed back in September when most pundits opined that President-elect Barack Obama would become our new leader. In fact, the DOW has not seen its current lows since 1998, or so.

More specifically, according to one analyst from Wall Street – Paul Shread – “the Dowshould have strong support between here and 7000, which would cover the 1998 and 2002-2003 lows (7200-7400), the 50% decline mark (7100) and the October 1997 low (6971). This would be a very important place for the market to make a stand.” But other chartists see the markets falling even further, with the S&P dropping as low as 400. Why is this?

The Answer is Uncertainty, Doubt and Fear

While the mounting credit default swap and mortgage crisis has had a major role in sinking stocks, some speculators worry that Obama will follow through on promises to raise income taxes on dividends and capital gains; eliminate the estate tax exemption, rescue the auto-industry and the: airlines, home builders, furniture, footgear and apparels, textiles, glassware, tobacco, beer brewers and perhaps a few others, and generally make it difficult for private employers to resist unionizing drives. In other words – there is a rising level of fear, doubt and uncertainty over the seeming potential of Keynesianism and governmental guarantees and protectionism – rather than the opportunities of capitalism. All disguised in the “cloak of change”.

Enter the Politicians

Some economists – tax and policy experts – fear that if Obama, Speaker Nancy Pelosi and Senate Majority Leader Harry Reid bailout these manufacturing segments instead of filing for Chapter 11, the country may face a very long recession. Just look to Japan some two decades ago, when the country bailed out its failing banks and corporations instead of letting them fall so that innovative competitors could take their place.

According to Niall Ferguson, a scholar who has studied the relationship between political, banking and financial fortunes –”you can stick money into every orifice of the big banks — their mouth, their nose, their ears, wherever — but if they can’t make loans because they have to reserve against future losses, and if they won’t make loans because there’s a recession, it won’t do any good,” Ferguson says. “If they can’t lend, there’s no money multiplier — they’re stuck, they’re zombies. It’s Japan all over again.” And, some ghoulish traders are indeed hoping for a deep recession. Today, Japan is still in worse shape than we are.

Phoenix Rising

Following such a debacle, the failed companies might then re-organize with some of their current workers under revamped union contracts. Reorganization, new labor contracts and new employee and retiree health benefit plans would make them competitive and profitable after emerging from bankruptcy; much like the proverbial Phoenix.

National Health Insurance, et al

Our physician clients and investors also are also worried that if national health insurance becomes a reality, defense spending is reduced and/or onerous regulations imposed on the surviving banks and Wall Street, the economy will be in for ride rougher than the one we have experienced to-date. No wonder a recent poll suggested that more than half of all doctors did not encourage their offspring to follow their career footsteps.

Other pressing issues for the medical profession, according to the HealthCare Group – Co-Chaired by Angela Braly of Wellpoint Inc., Dr. Denis Cortese of the Mayo Clinic, Jeffrey Kindler from Pfizer Inc., and Dr. Daniel Vasella from Novartis AG – include tort reform,defining and measuring medical value, payment reform, and building the health care workforce of the future with an emphasis on primary care, nursing and other allied health professionals. Moreover, true healthcare reform must involve integrating issues like Single Payer Systems, Consumer Directed Health Plans, Pharmaceutical Price Competition, Advanced Electronic Medical Records, and Quality & Outcomes Disclosure, etc.

The Obama Cabinet

President-elect Obama’s staff and cabinet appointments will also offer important clues for the markets, going forward. In addition to Rahm Emanuel, as the President-elect’s Chief of Staff, hearsay suggests Laura Tyson or Bill Richardson for Secretary of Commerce, Hillary Clinton as Secretary of State and Timothy Geithner as Treasury Secretary. Other considerations include Renee Glover for Secretary of Housing and Urban Development [HUD], Max Cleland as Secretary for Veteran’s Affairs, Janet Napolitano for Homeland Security, Jim Jones as National Security Advisor; and Richard Danzig and/or Chuck Hagel for other Cabinet Posts. Yet, Tom Daschle as Secretary of HHS is not exactly an “agent of change”, as the term is commonly understood.

Assessment

As the world’s markets sink, the pressure on our new administration will be to clarify these issues. Only then, will a stock market bottom be reached, and the dismal economy begins to reverse itself. Hopefully, the health care-scare will then be mitigated.

Conclusion

Your thoughts and comments on this Medical Executive-Post are appreciated.

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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Filed under: Health Economics, Health Insurance, Health Law & Policy, Insurance Matters, Managed Care, Research & Development | Tagged: economy, markets, national healthcare | 2 Comments »

Medicaid MD Acceptance Slows

Posted on November 22, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Delayed Reimbursements Cited as Root Cause

Staff Reporters

According to the Wall Street Journal, November 18, 2008, fewer doctors are accepting Medicaid patients. And, it’s not just because fees are so low – but because it often takes months to get paid.

Health Affairs Analysis

An analysis by the Center for Studying Health System Change says Byzantine bureaucracies can delay Medicaid payments for months. Using data provided by Athenahealth, a specialist in processing claims and payments for doctors, researchers at the Center for Studying Health System Change found that even in states with relatively high Medicaid payments yet long delays, only 50 percent of doctors took all new Medicaid patients.

Assessment

By contrast, in states with higher and speedier payments, doctor participation was 64 percent. Variations in payment delays varied wildly state to state – from a low of 37 days in Kansas to a high of 115 days in Pennsylvania.

Conclusion

What do you think is the reason for the Medicaid patient slowdown; delayed cash-flow or some other cause? As always, your thoughts and comments on this Executive-Post are appreciated

Related Information Sources:

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

Filed under: Career Development, Health Insurance, Practice Management, Research & Development, Surveys and Voting | Tagged: Medicaid | Leave a comment »

Evidence-Based Medicine

Posted on November 18, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

An Emerging Trend Vital to Physicians

[Staff Reporters]

According to Associate Professor Gregory O. Ginn, PhD; MBA, CPA, MEd., of the University of Las Vegas, an emerging trend for all medical providers is evidence-based medicine that offers the promise of improving the quality of clinical services. And, some argue that evidence-based medicine is a trend that will prevail for the foreseeable future.

Definition

According to the Dictionary of Health Insurance and Managed Care, EBM involves the judicious use of the best current evidence in making decisions about the care of the individual patient. Evidence-based medicine (EBM) is meant to integrate clinical expertise with the best available research evidence and patient values. EBM was initially proposed by Dr. David Sackett and colleagues at McMasters University in Ontario, Canada.

Expert Driven Standards of Care

In the past, standards of care were often set by panels of experts. Today, however, there is a greater demand for empirical evidence to establish the efficacy of clinical protocols. Evidence-based medicine can directly affect financial performance because it facilitates the elimination of therapies that cannot be demonstrated to be effective.

Example:

For example, evidence-based medicine can reduce a hospital’s prescription drug costs. Evidence-based medicine may also affect operations management if it shows that multiple approaches to treatment can be efficacious. Of course, in order to accommodate different modalities of treatment, hospitals will need more sophisticated information systems that allow for data integration.

Assessment

Evidence-based medicine may also be used to support another trend, the development of alternative and complementary medicine.

Channel Surfing the ME-P

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

Conclusion

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: Health Insurance, Managed Care, Practice Management, Research & Development | Tagged: EBM, evidence based medicine | 3 Comments »

iMBA Inc. [Meet a Sponsor]

Posted on November 17, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

iMBA Inc., Press Release

Atlanta Georgia

November 20, 2008

Hello, my name is Ann Miller of the Institute of Medical Business Advisors www.MedicalBusinessAdvisors.com in Atlanta, Georgia.

We are an independent medical consulting, health economics, educational publishing and information firm. We specialize in topical and analytical white-papers; dictionaries www.HealthDictionarySeries.com and books; compliance, regulatory, legal, business and financial reports; market research; and quality print-journals for all medical providers, hospitals and healthcare organizations www.HealthcareFinancials.com.

We are read by CEOs, CFOs, CXOs, physician-executives and nurse administrators, and related financial services professionals in the domestic healthcare space www.CertifiedMedicalPlanner.com

After researching and reading industry publications, I would like to share some news that your own loyal subscribers, readers and clients will appreciate. We are working with iMBA Inc., to bring you this new web forum at: www.HealthcareFinancials.wordpress.com. It is designed to serve the needs of all involved in HealthCare 2.0.

The website blog, Executive-Post, provides breaking industry updates, insider essays, editorials, interviews, expert commentaries, case models, news, a job board, an Editorial Advisory Board and moderated practice management forums with comments from both leading industry experts, grass-roots practitioners, and the internet cloud.

And, much content created for the Executive-Post is freely licensable under the GNU Free Documentation License (GFDL).

Sample Engagements: engagements

For more information, please contact:

Ann Miller; RN, MHA [Executive-Director]

Suite 5901 Wilbanks Drive

Norcross, Georgia 300923-1141

30092-1141 USA

770.448.0769 [voice]

775.361/8831 [fax]

E-mail: MarcinkoAdvisors@msn.com

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Referrals: Thank you in advance for your electronic referrals to the Executive-Post

Filed under: Practice Management, Research & Development, Sponsors | Tagged: iMBA, Inc., press release | Leave a comment »

The Re-Emergence of Medical Capitation?

Posted on November 13, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Re-Thinking Fixed Payment Medicine

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

[By Hope Rachel Hetico; RN, MHA, CMP™]

In February 2008, the industry leading California legislature passed “Welfare and Institutions” Code Section 14105.19. It required a 10% fee-for-service payment reduction to Medi-Cal physicians and mental healthcare providers. The new law took effect on July 1, 2008 and the rush seeking managed care capitated contracts was on.

Capitation Back-in-the-Day

Yet, only a decade ago, astute physician executives and healthcare administrators thought it incredulous that they should accept pre-payment for unknown commitments to provide an unknown amount of medical care or health services. It seemed to create an unnatural and difficult set of incentives where fewer patients were seen, and less care rendered. It never equated to additional reimbursement. And, more than a few medical providers and healthcare facilities had a natural aversion to capitated, fixed payment or contractual medicine. It had always been associated with the worst components of managed care; hurried office visits and soul-less physicians.

Fixed Payments Re-Emerging

Today, the national conversion to a modified form of capitation financing is again re-emerging as a marketing force, and not merely a temporary healthcare business trend. More than 40% of all physicians in the country are now employees of a managed care organization that uses, or is re-considering, actuarially-equivalent medical capitation.

The Promise?

Has medical capitation reimbursement finally fulfilled its promise as a quality improving and revenue enhancing machination; or is it just another managed care cost reduction strategy that financially squeezes doctors and hospitals, and limits patient care and choice? To answer this query, one needs to review the Stark Laws.

Whole-Sale Medicine

Curiously, Stark Laws I, II and III were created to eliminate self-referral concerns potential leading to excessive medical care and fee-for-service payments. Ironically, these types of economic enriching paradigms of less-care were perfectly acceptable. Many, also never understood how a commitment to treat an entire patient population cohort could be made with little or no actuarial information. Hence frustration was the initial exposure of many medical providers to capitated reimbursement; also known as “wholesale medicine.”

Aligned Incentives

But, since inception, more modern medical cost accounting endeavors have gradually demonstrated that capitation has some advantages over traditional fee-for-service care. For example, it can create and align incentives that help patients, providers and payers by limiting their contingent fiscal liabilities. So, capitation in the current credit-deprived nationally economy is increasingly being viewed in a more positive way. More importantly, those healthcare organizations and providers that embrace it may thrive going forward; while those opposed may not!

Assessment

So, how should physician and nurse executives, administrators, CXOs, managers and financial advisors navigate these treacherous fixed-payment waters? One sound approach is to rely on a leader in the hospital, medical clinic and healthcare administration publication industry. Our 2-volume, 24 chapters, quarterly journal-guide is relevant to the entire fluctuating healthcare space and can be a valuable navigation tool – in these troubling economic times.

Capitation “ReDux” – Part Two

MORE: Capitation & Actuarial Medical Econometrics

Conclusion

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

Filed under: Health Economics, Managed Care, Op-Editorials, Practice Management, Research & Development | Tagged: capitation, fixed payment medicine, wholesale medicine | 10 Comments »

Non-Profit Hospitals Seeking Financing

Posted on November 13, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Association of Debt Financing with Not-For-Profit Hospitals

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

US not-for-profit hospitals undertook unprecedented amounts of debt in the mid-to-late 1990s. This happened because sparse corporate finance theory – and the modicum of economic literature on hospital financing at the time – suggested that debt constrained hospitals’ capacity to deliver uncompensated care.

Little Research

Yet, few health economists empirically evaluated the potential association of debt financing with uncompensated medical care. Of the first perhaps – in our space – was Stephen A. Magnus; PhD, MS Assistant Professor, Department of Health Policy and Management, University of Kansas School of Medicine; Dean G. Smith, PhD, Professor and Chair, Department of Health Management and Policy, University of Michigan School of Public Health; and John R.C. Wheeler, PhD, Professor, Department of Health Management and Policy, University of Michigan School of Public Health [personal communication].

Multi-State Statistical Analysis

In one of the first statistical analyses of a multi-state sample of audited hospital financial statements in 1997 – and ultimately published in the Journal of Health Care Finance in 2004 – the researchers found that hospital debt levels predict higher levels of uncompensated care.

More Tax-Exempt Debt Issued

As further studies yielded similar results over time; hospital boards, policy makers and regulators concerned with the provision of uncompensated care encouraged hospitals to issue more debt. This encouragement was provided through explicit flexibility, such as removing requirements for hospitals to issue tax-exempt bonds through state finance authorities and/or removing the project financing constraint. Likewise, hospital CFOs and physician-executives who managed their organizations’ financial risk, benefited from a realization that optimizing the sources of financing did not impede mission-related objectives.

Assessment of Temporal Trade-Offs

Relationships between hospital operations, including uncompensated care, and capital structure represent a fruitful area for future investigations. A key issue to explore is the possibility of inter-temporal trade-offs. Higher levels of debt may initially help to fund public services like uncompensated medical care, but debt repayment eventually could limit a hospital’s ability to provide core community benefits.

Bankruptcies

Up until the recent financial meltdown and credit market freeze, even current studies still seemed to offer no evidence to support concerns that debt had a negative impact on uncompensated care. However, hospitals filing bankruptcy in the fourth quarter, of 2008 included: a two-hospital system in Honolulu; one in Pontiac, MI; Trinity Hospital in Erin, Tennessee; Century City Doctors Hospital in Beverly Hills, Lincoln Park Hospital in Chicago, and four hospital system Hospital Partners of America, in Charlotte.

Assessment

On the other hand, research results simply may have reflected the unusual economic and stock-market conditions prevailing in the mid 1990s; that are certainly not present today.

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: Health Economics, Healthcare Finance, Research & Development | Tagged: charity care, pro bono care, uncompensated health care, uncompensated medical care | 3 Comments »

The “Health-Cloud” Defined

Posted on November 10, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

What it is – But not how it works!

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

As commentators, IT pundits, health economists, journalists and so-called experts, we all know that any market is immature when an industry can’t agree on a definition or term-of-art.

Of course, that’s why we just released the Dictionary of Health Information Technology and Security, and several other related works like: Dictionary of Health Insurance and Managed Care – and – Dictionary of Health Economics and Finance.

Of Doctors and Confused Customers and Vendors

The lexicon problem is exacerbated in healthcare IT however, as customers, er-a doctors and medical professionals, still don’t understand what the “computing cloud” or “grid” actually is. This is no doubt important with the recent – and older – governmental pushes toward eHRs, as well as economic bonuses [Medicare 5.1%] for implementation of same.

And, eHR vendors compound the obfuscation when they themselves use the term to describe just about any product they can sell that can be delivered from, or touching a data center. The word “health-cloud” clutters the definitional standardization scene much as the terms “HIPAA”, “HL-7”, and “compliance” did back-in-the day. So, after editing three dictionaries – with a fourth in progress – here goes our modified definition of the “health cloud” with cudos from non-physician colleague Rob Preston of Information Week.

Health-Cloud Defined

The “health-cloud” or “health-cloud computing” refers to:

a highly scaleable health information technology source – hardware, software, CPUs, and storage capacity – that is housed outside of medical data centers, and available on-demand by doctors, patients, payers, government and employers over the Internet, and whose secure variable usage is measured and invoiced incrementally.

Private health clouds mimic those characteristics inside health entity firewalls, but lack the economies-of-scale found in public health clouds.

Assessment

Now that a workable definition has been proposed and we have some definitional clarity, bring on the eHR products and HIT services that physicians can use.

Conclusion

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Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

Filed under: Information Technology, Op-Editorials, Research & Development | Tagged: cloud, grid, PaaS, SaaS | 6 Comments »

For-Profit versus Not-For-Profit Healthcare

Posted on October 27, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

An Often Contentious Problem

[By Staff Writers]

In general industry, as well as in healthcare, there has been a longstanding discussion on the relative efficiencies of for-profit businesses versus not-for-profits, which concerns the very merits of competition itself.

The Studies

According to Robert James Cimasi MHA, ASA, AVA, CMP™ of Health Capital Consultants in St Louis, a number of recent studies, some more controversial than others, have investigated the effect of tax status on the relative costs and quality of services at these different types of hospitals.

For example, Bob Cimasi of www.HealthCapital.com reported that one study, published in the New England Journal of Medicine (NEJM), compared Medicare spending (adjusted for local costs, patient demographics, and the types and numbers of local healthcare providers and facilities) in markets with only non-profit hospitals, only for-profit hospitals, and those with both types.

The results for the years studied, 1989, 1992, and 1995, showed that the government spends more for every type of service studied (hospital, physician, home health, and other facility services) in those areas with only for-profit hospitals. Costs for areas with only not-for-profit hospitals were the lowest, with spending in markets with both for-profit and not-for-profit hospitals falling in the middle of the range.

This study also tracked adjusted mean per capita spending for hospitals that had a change in their tax status.

For the period of the study, 1989-1995, they found that areas where all hospitals were non-profit, and remained so, had cost increases of $866, compared with $1,295 for areas where non-profits converted to for-profit status. Areas with only for-profit hospitals had cost increases of $1,166 from 1989-1995, whereas those which changed to non-profit hospital areas had the smallest cost increases of $837.

These results may indicate that the tax status of hospitals affects the costs of health services provided by physician providers and other healthcare facilities. Further, this reported effect, if real, may be considered by many to be detrimental to the public good. In the six years examined by this study, the difference in costs between these market types was indicated to have grown from 12.7% to 16.5%. In 1995, annual Medicare spending was $732 higher per enrollee in markets with only for-profit hospitals than in non-profit markets. This difference may be extrapolated to $5.2 billion dollars in total extra annual costs to Medicare.

Even More Studies

Other studies, according to Cimasi, have examined these cost differences and have found them to result from increased administrative and ancillary services costs. For-profits appear to spend less on personnel, charity care, hired help, and length of stay than not-for-profits. Moreover, spending differences are reflected in measurements of outcomes and quality. A study of death rates has presented them to be 6-7% lower in not-for-profit hospitals as compared to for-profits and 25% lower for teaching hospitals.[1]

The fact that costs in those markets with both for-profit and not-for-profit hospitals were in the middle of the range may be interpreted as resulting from the averaging of costs from these different classifications of organizations. However, the behavior of the not-for-profit class was apparently also affected by this “competition” with for-profits in mixed markets. For example, studies have shown that charitable care by non-profits in these markets is reduced to levels similar to those provided by for-profits.

The NEHJM Editorial

A NEJM editorial, several years ago, discussing several hospital costs studies attributes these higher costs to a lack of competition (or other motivation such as charity) that might act to prevent for-profit companies from seeking to maximize their profits at the cost of the public good.

“Market medicine’s dogma, that the profit motive optimizes care and minimizes costs, seem impervious to evidence that contradicts it.” Then further, “The competitive market described in textbooks does not and cannot exist in health care for several reasons.”[2]

Thus, even if competition could improve care and lower costs, this isn’t happening because expected results from competition are missing in the healthcare markets.

Competition

An examination of hospital competition is also of interest, as many hospital markets are too small to support more than one hospital (a monopoly) or more than a very few competing organizations. The authors of the NEJM editorial went on to cite hospital monopolies and “virtual monopolies” as one of the barriers to competition, stating that roughly half of Americans live in markets too small to support medical competition and that for-profit chains have focused acquisitions on these markets.

More Barriers

The next barrier discussed is constraints on consumer demand imposed by illness. The authors point to the difficulties consumers have in comparing costs, outcomes, and quality in order to choose among competing services.

Lastly, the fact that the government makes the purchasing decisions and pays the majority of healthcare costs, rather than the consumers or employers who are using the services, is presented as a significant barrier to competition.

Assessment

Many healthcare planners find these studies to be a stark illustration of the argument that the benefits of competition for profits are lost whenever competitive market controls are absent to prevent the abuses of profiteering. As one might expect, for-profit hospital companies might point out that this is the case for both not-for-profit and for-profit dominated markets.

References:

1. Wolfe, S. M., M.D., Editor, “Hidden Rip-off in U.S. Health Care Is Unmasked In New England Journal of Medicine Articles.” Health Letter 15: 9, Public Citizen Health Research Group, (Sept. 1999):

2. Woolhandler, S. and Himmelstein, D. U. “When Money Is the Mission — The High Costs of Investor-Owned Care.” NEJM 341: 6 (Aug. 5, 1999): 444

Conclusion

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

Filed under: Health Economics, Health Law & Policy, Healthcare Finance, Practice Management, Research & Development | Tagged: for-profit hospitals, not-for-profit hospitals | 9 Comments »

New-Wave Thoughts on Investing

Posted on October 25, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

“Last-Gen” Financial Planning Concepts

[By Steve Schroeder]

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

Welcome to this op-ed piece where we take pot shots at commonly accepted financial planning industry standards to sharpen your investing skills and stimulate your mind. With the recent sub-prime mortgage fiasco, and Wall Street’s problems and shenanigans with banks and investment houses like Bear-Stearns, Lehman Brothers, USB, Wachovia, Fannie Mae and Freddie Mac, WaMu, Merrill Lynch, SunTrust and AIG, etc, rethinking strategy and “conventional wisdom” seems a prudent idea. What about Wells Fargo, more recently.

And so, what is the physician-investor to do? Select help from fiduciary–liable and physician focused consultants; suggest some pundits http://www.CertifiedMedicalPlanner.org

***

We suggest you now take a minute to think “outside the box”?

In this post, and as a physician-investor, we want to take a crack at all of your favorite themes, including:

Buying low and selling high
Staying in for the long haul
Asset allocation
Automatic portfolio rebalancing
Fees vs. commissions
Institutional money managers
Market timing
Personal capital gains inside of mutual funds.
Reinvest those dividends.

Buying Low and Selling High

What a silly concept this is! First of all, what is “low” and what is “high”? If a stock is at an all-time high—like Apple was recently, for example—does that mean you should not buy it? Of course not! It probably means you should; there are good reasons when the stock is at an all-time high. So, the real statement should be changed to: “buy high and sell higher.” All you need do is sell it higher than the price you bought it. Don’t worry about all the weird definitions of low, high, and medium; that’s all conjecture. Next time you meet with your financial advisor, tell him to buy high and sell higher!

Staying in the Market for the Long Haul

What does this mean—to ignore problems like the perennial ostrich? What if you see events in the world that could lead to serious decline? Does that mean you just stand pat and ignore everything? This sounds absurd to me! I think this mindset should be changed to staying in for the “U-Haul.”

In other words, as soon as it looks like a good time to move, I pack my stock blanket and go elsewhere. Now, does this mean to leave stocks; altogether? Maybe; or maybe not! There are all kinds of investment options, ETFs, etc, other than mutual funds. With all the new technology and research available, we should be looking at strategies, sectors, styles, methods, shorts, puts, options—all kinds of different things; rather than a mindset to sit and ignore news as it happens. Yes, we are in for the long haul, but we are going to change our long-haul strategy many, many times throughout the trip. This sounds obvious, but many doctors and financial planners sit with the exact same strategy for 30 years when the game has obviously changed. Staying in for the long haul does not have to mean staying with the same strategy.

Asset Allocation

This is like betting on every horse in a race to win. Are you guaranteed to have a winner? Yes, you have to have one because you are holding a winning ticket on the entire field. The key is targeting risk and reducing asset allocation. Go with the sectors that are hot, and get rid of the ones that are weak. We are telling you, a blind dog can find good sectors with all the information we have at our fingertips. Tell yourself to forget every horse to win, do good research, bet on the best ones, and target their risk. If you have too many “horses,” you avoid too much loss, but you also limit your gain by huge margins.

Automatic Portfolio Rebalancing

Wow, do we hate this one! Portfolio rebalancing is the Robin Hood of investments: it takes from the profitable to feed the losers. Doctor-investors may have some good sectors making large gains until an automatic rebalance program their profits to buy more losers! What’s up with that?

Counsel yourself not to be in certain sectors that have much greater risk with much less chance of return. Do you know how many investors were invested in Japan two decades ago or the financial sector today; and don’t even know it? And when you find out that your money was automatically pulled from large cap US funds to be the financial sector; you will not be happy.

Fees vs. Commissions

Do you realize how much more a fee-based Financial Advisor [FA] takes from the doctor-client than a commission-based planner?

Look at 1% of $100,000; this comes to $1,000 per year. If a client is in “for the long haul,” we can see why: you want his money for the long haul. Twenty years of this philosophy comes out to nearly $50,000 in fees!

If a FA was going to stick you in some investment and leave him alone, would it not have been better to take $5,000 from the company, not from the doctor’s account? This way you keep the $50,000.

Now, don’t try to argue that this puts FAs on the “same side of the fence as the client”, and allows FAs to take better care of them. It may foster excessive risk taking. Remember, the “advisor” gets less money for bonds or cash, so s/he will not encourage these asset classes under this payment system. And, don’t think for a moment that this service is customized for you. It is not! Why do you think it’s called a “turn-key” asset management program in the business? Automation! Or, can you say; mass-customization thru technology, for “masses-of-asses?”

Q: To financial advisors.

A: Why not give all your clients a choice? Why not explain two ways you could get paid and let them decide?

Institutional Money Managers

Here is a great idea—as long as doctors are institutions; and they are not! I work with people, not institutions. Institutional money managers, for the most part, have a pre-tax mindset because they are used to dealing with large amounts from 401(k)s, 403(b)s, annuities or pension plans. This means they manage in a preservation-of-capital mentality, rather than a growth mentality. Now, I’d guess that most doctors are not institutions and need a much better investment philosophy than holding thousands of stocks with numerous money managers. By selecting an institutional money manager, you have assured them of mediocrity.

Market Timing

Can you time the market? Of course you can. It opens at a certain time and it closes at a certain time. “Seriously”; what is market timing?

We often hear this term bantered about when somebody wants to change his or her investment strategy. Changing investment strategies is not timing the market. In 2008, maybe you ought to make it a goal to initiate a new strategy, rather than waiting for the declining manufacturing industry to kill you financially? Should you have done this a few years ago when the mortgage industry began to implode? How about September 2017.

Mutual Funds

Let’s wrap this up with one of our favorites. I hate mutual funds and so should you. Everyone gets to share in the gains and losses together. How sweet. How democratic; or is it socialistic? Can you imagine telling your patients to buy all kinds of drugs at a price that was paid three years ago even though he or she has never used them a day! Who would take that advice? Why leave yourself vulnerable to the whims of someone he or she does not even know? How about having control over what stocks are bought and sold? Can you imagine an investment option that does all of these things? The mutual fund was good when we did not have computers or discount brokerage houses. Today, you would be much better off buying a few bellwether stocks, or whatever, and just holding them forever.

As simple as this sounds, at least the client is buying something and paying tax on the price he or she paid, not what someone else paid three years ago. Times have changed. Understand how mutual funds work and select 15 or 20 of their diversified stocks and hold them. That is much better than any mutual fund.

Reinvest those dividends

Many folks believe that the markets advance two steps, for every step it retreats; sort of a truism. If you are of the same ilk, then reinvesting dividends automatically only assures that you will buy high, 66.67% of the time. It will also be tax inefficient and not allow you to have some dry powder [cash] available cash for extra-ordinary opportunities [i.e., buying low].

***

stock-exchange

***

Assessment

Well, we hope you have enjoyed this op-ed piece. As always, we’re happy to debate the issues we address here.

Conclusion

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

***

Filed under: Financial Planning, Investing, Op-Editorials, Research & Development | 9 Comments »

Patient Focused Health Care 2.0

Posted on October 21, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

An Emerging Competitive Trend

Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

One emerging competitive trend in medicine today is patient-focused healthcare. This concept focuses on patient needs and attempts to humanize patient care.

A Multi-Dimensional Approach

According to Professor Gregory O. Ginn; PhD, MBA, CPA of the UNLV department of healthcare administration, patient focused health care [PFHC] 2.0 is protean and multidimensional, and therefore incorporates the following:

patient education;
active participation of the patient;
involvement of the family;
nutrition; art; and music, etc.

Benefits

These issues are thought to improve patient outcomes. Furthermore, some think that patients will benefit from learning how to cope with healthcare processes before they enter into those processes and that this knowledge will result in better outcomes.

Example:

A case model example by Professor Ginn, as seen in www.HealthcareFinancials.com, would be classes to prepare couples for childbirth.

“These classes teach prospective parents the different stages of labor and strategies for dealing with the challenges associated with each stage. They cover options for pain management such as breathing and relaxation techniques and/or analgesics. The classes also provide education about clinical options such as induced labor and caesarian sections, and they cover practical issues such as what to wear and what kind of car seat to buy to transport the newborn home.”

Other Trends

According to the October 2008 issue of Managed Healthcare Executive, other emerging competitive healthcare trends include:

Consumer engage care choices,
Payment reform,
Industry quality and economic benchmarks,
Medical home models,
Evidence-based medicine,
Disease Management, and
Comparative effectiveness studies.

Assessment

PFHC 2.0, medical and health education is enormously beneficial in reducing stress and improving the decision-making ability of patients who are involved in healthcare processes. Related disease management [DM] examples include: asthma, diabetes, hypertension, CHF, COPD, CAD, obesity, arthritis and a host of others.

Conclusion

Please subscribe and contribute your own thoughts, experiences, questions, knowledge and comments on this topic for the benefit of all our Executive-Post readers.

Related Information Sources:

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

Filed under: Career Development, Managed Care, Op-Editorials, Practice Management, Research & Development | Tagged: healthcare 2.0 | 1 Comment »

Q & A Interview on Medical Practice Valuations

Posted on October 9, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

An Interview with Dr. David Edward Marcinko; MBA, CMP™
[By Karen Caffarini: Reporter: American Medical News]

Hot Topic

Medical Practice Appraisals and Valuations

[Unedited Question-Answer Interview]

Excerpt

“The allocated purchase price must be reported to the IRS. Goodwill is considered a capital asset. Therefore, the seller will want to allocate as much of the selling price to goodwill as possible. The buyer will want to allocate more of the selling price to non-goodwill assets because goodwill amortization is not tax deductible while depreciation and amortization of other assets is tax deductible. This “negotiated” goodwill will stand as the IRS value.“

Assessment

Thus, the IRS has effectively forced the controversial goodwill determination on practice buyers and sellers. This makes it even more imperative for buyers to specifically identify any hidden practice assets they are acquiring at the time of purchase; or for purchasers to discover them.

Humor

Q: What asset might have less value than a toxic credit-debt-obligation [CDO]?

A: A private medical practice

Conclusion

Your comments are appreciated; especially if you have bought, sold or merged a medical practice recently.

Read it here: ama-news-reply

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Filed under: Career Development, Interviews, Op-Editorials, Practice Management, Research & Development | Tagged: appraisals, valuations | 3 Comments »

Seeking Writers and Contributors

Posted on September 27, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Business of Medical Practice [3^rd edition]

Ann Miller; RN, MHA

Project Manager

MarcinkoAdvisors@msn.com

As readers of the Executive-Post may know, our textbook the Business of Medical Practice is a best seller http://www.springerpub.com/prod.aspx?prod_id=23759

Invitation

Accordingly, we wish to personally invite all subscribers to contribute to our third edition now in progress. New and prior chapter are still available for updating; for a low-effort but high-yield contribution. We have others ideas for this peer-reviewed publication, as well.

Goal

Our goal is to help physician colleagues and medical executives benefit from nationally known experts as an essential platform for their success in the healthcare industry.

Assessment

And so, please advise and thanks again for your consideration and possible contributions.

Conclusion

Feel free to email me 24/7 for more information about this peer-reviewed publishing opportunity.

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Health Administration Terms: www.HealthDictionarySeries.com

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Filed under: Book Reviews, Breaking News, Career Development, Managed Care, Media Mentions and PR, Nominations Sought, Practice Management, Recommended Books, Research & Development | Tagged: books, textbooks, writers | Leave a comment »

Such a “Sleazy” Company

Posted on September 19, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

About Delta Dental

[By Darrell K. Pruitt; DDS]

“A contract provision that holds dentists to Delta’s maximum allowed fee for non-covered services will affect all of Delta’s Premier and Preferred Provider Organization participating dentists throughout the country by January 2011″ (my emphasis).

“Delta Caps Rates Nationally for Two Networks”

I copied the line from an American Dental Association News online article by Arlene Furlong’s article is titled “Delta caps rates nationally for two networks.”

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3218

This means that if a Delta preferred provider wishes to make up for the profit lost from providing Delta customers 25% discounts on dentistry, doing more cosmetic dentistry will no longer help keep the doors open. Delta is telling its providers that it will demand discounts on everything for its customers.

Discount Factor Costs

How much does a 25% discount cut into a dentist’s pay? Overhead in dental practices typically run about 65%. Do the math. If the net profit is 35%, and Delta knocks off 25% the dentist’s fee; that means the dentist takes a 70% cut in pay to treat Delta patients. How happy do you think dentists are to see Delta patients who show up for appointments? You guessed it. Delta Dental preferred providers are disagreeable already, according to Doctor Oogle (www.doctoroogle.com), a Patient Driven Referral Site [PDRS].

The Delta Dental Rankings

To see how Delta Dental preferred providers rank in patient satisfaction against all other dentists, pick a few names off of Delta’s list and see where they fall on DR. Oogle’s ranking. I recently saw such a study involving Austin, Texas dentists from almost a year ago. The Delta dentists’ ranks averaged 206 out of 297 Austin dentists listed on the site. That is the bottom 30%. One could say the 70% cut in pay buys Delta Dental clients dental work from the most unpopular 30% of dentists; interesting coincidence.

Cogent Thoughts

Think about this way: In a little more than two years, if a dentist’s practice consists entirely of Delta Dental patients, the doctor cannot raise fees at all. What makes leaders of Delta think they can get away with tyranny in the land of the free?

Furlong further writes: “Tom Dolatowski, Delta’s vice president of marketing and communication, estimates that some 75 percent of dentists nationally are participating in the Delta Dental Premier plan, while some 25-30 percent are participating in the Delta Dental PPO plan.”

That’s how; effective sales techniques

Delta Dental is Simply a Sleazy Company.

This spring, at the Southwest Dental Conference in Dallas, Delta Dental employees encouraged me and other dentists to apply for NPI numbers. NPI application forms were prominently displayed in Delta’s booth. The Delta saleswoman who covers the east side of Fort Worth, my neighborhood, said, “You don’t want to wait until the last minute. May 23rd is the [final] deadline.” (The deadline had been delayed a few times).

Then she and other Delta employees emphatically agreed that the NPI number will soon become a licensure requirement for all Texas dentists anyway. That is an unethical and unlawful lie – condoned, if not encouraged by the leaders of Delta Dental to enhance corporate profits using deception. Everyone knows that the NPI number helps nobody but insurance companies.

Assessment

There is no question that Delta Dental desperately wants dentists to volunteer for NPI numbers. When a dentist applies for the number it gives Delta permission to mine the uninformed dentist’s “Freedom of Information Act-disclosable” data from dental claims. Delta will use its proprietary algorithms to rate the dentist. Then Delta will display the dentist’s value to society on an Internet website. This way Delta can direct its clients to the best neighborhood dentists according to Delta’s preferences – but not necessarily the patients’.

The fact that Delta’s customers generally don’t like Delta’s dentists means that the last thing Delta wants published is patients’ opinions – like those in DR. Ogle.

Conclusion

In my opinion, Delta Dental is such a sleazy company. What is your opinion?

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Filed under: "Doctors Only", Health Law & Policy, Managed Care, Practice Management, Research & Development | Tagged: delta dental | 12 Comments »

Healthcare Industry Prognostications

Posted on September 18, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

The PWC Report

By Staff Writers

A recent study by PriceWaterhouseCoopers [PWC] suggests that 2008-09 could be a big period for the healthcare sector with structural changes that could alter the industry. These include alterations to hospital Medicare reimbursement, further IRS pressure on non-profit hospitals, the growth of the retail clinic market and the continued emergence of consumer-directed healthcare, according to the PWC Health Research Institute [HRI].

Predictions

For example, with CMS changing the way it pays hospitals – adding 200 diagnosis codes for severity while refusing to pay for some medical errors and “never-events”, some hospitals will see less income, while others more. The firm also predicts that the retail clinic sector will continue to expand, that the FDA will boost drug and medical device safety standards, and that the IRS will bear down hard on non-profit hospitals to prove that they’re providing adequate community benefits.

Assessment

Health economic Sustainable Growth Rate [SGR] prognostications also suggest that the present path of Medicare reimbursement can not be sustained; with harsh cutbacks like 20% physician payment reductions, threatened.

Conclusion

Since these predictions will be spurred, in part, by the shift in political power triggered by November’s presidential election; your thoughts are appreciated?

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

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Filed under: Managed Care, Op-Editorials, Practice Management, Research & Development, Surveys and Voting | 1 Comment »

The “Balance-Billing” Conundrum

Posted on September 17, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Doctors versus Patients

Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Recently, it was reported to the public that millions of patients are paying medical bills they don’t actually owe after being confused about the practices of “balanced billing.” .

Formal Definition

According to the Dictionary of Health Insurance and Managed Care – and others – balance billing [BB] may be defined as:

“The practice of a physician, medical clinic, hospital, ASC or medical provider billing a patient for all charges not paid for by an insurance company or healthcare plan. Balance billing is generally prohibited by managed care plans”.

The story in Business Week, on page 40 by Chad Terhune in the September 8, 2008 issue, goes on to discuss how it’s illegal for doctors, hospitals or labs to bill patients for the difference if they deem the insurance payment too low, but that it happens routinely to the tune of $1 billion each year.

And, healthcare journalist Sarah Arnquist similarly noted the practice with more patient BB horror stories in The Health Care Blog [THCB], a policy and political e-periodical not unlike this Executive Post in format; but not content.

Not a New Problem

However, long before the threatening horror-stories first ran about doctors aggressively pursing collections, maybe even as much as a two decades ago, our network of physicians, attorneys, insurance and risk management experts have been writing about this situation in both peer-reviewed and non-peer-reviewed print and traditional publications.

So, the conundrum is not really a new one. In fact, Medicare first prohibited BB, in 1991. But, its ferocity; pitting patient against doctor, might indeed be an emerging issue. And, it is deeply distasteful on many levels.

Managed Care Contracts

Over the years, managed care has replaced usual, customary and reasonable [UCR] fee-for-service [FFS] medicine with a contracted fee-schedule. Essentially under managed care, an MD can “charge” just about anything s/he might want, but the managed care organization (MSO) will only reimburse up to its maximum contractual allowance as determined by a previously set fee schedule; known as a managed care legal-contract.

In other words, medical providers have pre-accepted a fee schedule and have agreed and been contracted to accept “payment-in-full” for services rendered. And, the greater the difference between the MD charge and the allowable reimbursement, the more the MD will eventually write off as artificially inflated accounts receivables [ARs].

Therefore, there is no “balance-bill” to pay [sans fine print specials, out-of-network provider and venue clauses, etc].

Physician Mindset

Yet, the balance billing mindset continuers by some, especially older, doctors and patients! Why mature docs and patients? It’s because the current and next-generation of doctors, and patients, never practiced or worked in a FS environment, and know little of it?

Now, this might occur benignly; but more often than not today – and in my experience as a multiple-hat wearing medical provider, insurance agent, physician-executive and health economist – it occurs maliciously and greedily; pitting the doctor against patient.

Of course, a common physician defense ploy is the cry: “I didn’t know it was wrong” – or – “my staff was doing the balance-billing; not me.”

Staff Education and Training

So, the doctor’s medical staff is an extension of the physician. And, the physician can become vicariously liable for staff transgressions.

Furthermore, several federal regulations, including HIPAA, the False Claims Act, and OSHA have specific staff training requirements. Failure to provide the required training not only subjects the physician to the risk of employee transgression, but also to the risk of administrative discipline for failure to conduct proper training of staff.

Patient Mindset

Now, since most patients receive health insurance their employers, it seems odd that some remain so naive about this conundrum; ethics aside. I mean, managed care has been around for almost 20 years now, and its risks and benefits are well known. Contract-medicine did not begin yesterday.

And so, where have such gullible patients been living? In a hole void of newspapers, magazines, TVs and the internet? What about their neighbors, gossip, HR advisors or benefits departments at work? I know of Corporate America, and have participated in several educational programs where employees are informed of their duties and responsibilities in this managed care contracted world.

And so, at the risk of sounding harsh, I often wonder where have these souls been?

In other worlds; naiveté has a price and if you don’t look out for yourself; who will ultimately look out for you? No one! So, get a clue, already! It’s 2008; not 1988.

The Offensive Plan

As a patient, if this occurs to you, as it did to me when I once visited an out of state optometrist who tried to BB me while on vacation, you might consider the following pre-emptive strike. Forewarned is forearmed and it is far better to play offense, than defense, with these aggressive and greedy docs:

Read and understand your managed care plan contract. Know your duties and responsibilities. Follow the rules.
Privately inform your medial provider that you are aware of the “contract-medicine” concept.
Confidently tell the provider to put the BB invoice in writing, under his personal signature.
Whisper to him/her you will fax it to your employer, third-party payer, attorney, IRS, OIG, DOJ and/or insurance commissioner for a collegial second-opinion check.

Finally, once the problem has been resolved, politely inform the provider that true BB is illegal; and suggest that if your health plan’s compensation is too low, he/she should not re-enlist on the plan.

Outcome

This was all I had to do, as the flustered provider apologized to me, citing personal and staff ignorance. Of course, I then told him of my credentials and my doubt about his “excuse”; but was willing to give him “benefit-of-doubt” this time. No harm-no foul, I reckoned.

Assessment

By personality – maternal side – I tend to employ the passive-aggressive posture of conflict resolution. So, always be knowledgeable but respectful, polite and most of all ‘umble; just like David Copperfield’s fictional character, Uriah Heep.

And, although there will always be miscreant doctors who try to game-the-system, according to David McKalip MD, Chair, Council on Medical Economics [CME] for the Florida Medical Association [FMA], “A free market with price transparency, quality accountability and private contacting between patient and doctor, is the answer” to the unfortunate balance-billing conundrum.

Conclusion

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
Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Health Insurance, Practice Management, Research & Development | Tagged: balance-billing | 15 Comments »

Quality Improvement Initiatives

Posted on September 15, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

We Want to Hear from You!

Dr. David Edward Marcinko; MBA CMP™

Publisher-in-Chief

Hope Rachel Hetico; RN, MHA, CMP™

Managing Editor

Our Questions

As new-wave publishers, we value the personal opinions of our complimentary Executive-Post readers.

And, as traditional contributing editors, we also value opinions on our 2 volume, 1,200 pages, premium-print periodical, Healthcare Financials [Journal of Financial Management Strategies] www.HealthcareFinancials.com for institutional subscribers; $535/year.

And so we ask, regardless of venue, do you agree or disagree with what you read in these publications? And, what would you like to read or learn more about?

Your Answers

Have your voice be heard by sending a letter, opinion or comments on topical suggestions to Executive-Director, Ann Miller RN MHA at: MarcinkoAdvisors@msn.com

Assessment

“Our goal is to augment iterative innovation, and see the health economics sector through your eyes. Otherwise, unlike gravity, our goal of a vibrant interactive professional-sticky-network just won’t happen.”

Conclusion

Remember; “What doesn’t get measured – does not get improved.” Help us to improve!

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Filed under: Op-Editorials, Quality Initiatives, Research & Development | Leave a comment »

Emerging Healthcare 2.0 Initiatives

Posted on September 12, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Questions to Consider

Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Hope Rachel Hetico; RN, MHA, CMP™

[Managing-Editor]

Although not always prone to professional introspection, we nevertheless had the recent occasion to ponder the future of the emerging initiative [healthcare business model or philosophy] known as healthcare 2.0.

But, of course, before any discussion begins we must operatively define our terms.

Definitions

Ever since the term “web 2.0” was used in 2004, there has been an inordinate amount of chatter about what web 2.0 really is and its true impact. No one’s really defined it clearly, but we think the web evolution essentially falls into 3 generations:

Web 1.0 – information is communicated from a company [medical practice or hospital] to its customers [individuals or patients]. This is your basic B2C or [business-to consumer] website. The web becomes one big encyclopedia of information by aggregating all these information repositories.

Web 2.0 – information is communicated between company and individuals AND collaboratively between and among individuals. And so, if web 1.0 was a book, web 2.0 is a live discussion.

Healthcare 2.0 – Scott Shreeve MD of Cross Over Health defines healthcare 2.O as:

“A New concept of healthcare wherein all the constituents (patients, physicians, providers, and payers) focus on healthcare value (outcomes/price) and use competition at the medical condition level over the full cycle of care as the catalyst for improving the safety, efficiency, and quality of health care.”

Questions to Consider:

And so, we offer these questions to consider about Healthcare 2.0:

How are Web 2.0 technologies like social networks, wikis, podcasts, blogs and micro-blogs, mash-ups and online communities like this Executive-Post changing the face of the healthcare industry?
How are hospital systems, ASCs, medical clinics and physician practices evolving as a result of rapid technological change?
How can health plans evolve in the face of emerging challenges with the help of new technologies and new thinking?
What will come of the recent controversies over genetic testing, the human genome project and 23andMe for example, and the privacy of patient data?
How does transparent financial and reimbursement data impact the competitive scene?
How does transparent physician and hospital quality information affect the competitive scene?
Where does the hype over social networks and user-generated content end and the reality begin?
Does the initiative enhance or detract from traditional medical care delivery models?
Does the initiative enhance or detract from new-wave concierge or retail medical modes?
Is this positive or negative for patients, providers, payers and venues?

Healthcare 3.0

Soon it will not be information anymore; it will be intelligence – artificial or virtual intelligence. You’d interact with it almost like another person. The web won’t just blindly do what we tell it do to, it’ll think for you.

Web 3.0 presents some amazing opportunities in healthcare. For example, imagine being able to be diagnosed by your computer or have your toilet run a SMAC 10 or SMAC 20 on you? Imagine going to Costco®, scanning a barcode with your web-enabled phone, and being instantly notified that your purchase is HSA-eligible.

One day, you’ll type into some (probably Google-like Chrome) search engine or MSFT interface:

“I want to find a podiatric surgeon who’s done at least 100 ankle fusions, who operates on Saturdays near my house, who takes my insurance at XYZ surgery center, who has never been sued, and enjoys playing the flute.”

Voi-la! – Your results would be back with an offer to set up an appointment.

Assessment

Anyway, we digress and don’t have to worry about healthcare 3.0 just yet. Let’s get back to 2008 and see where healthcare is with 2.0.

The primary question really is: where on the web do you go to interact with others about healthcare-related topics? And,is the digital workforce leading, or lagging, in the adoption of social and AI computing for healthcare?

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: Information Technology, Op-Editorials, Research & Development | Tagged: healthcare 2.0 | 2 Comments »

Medicare Benefits Report

Posted on September 11, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

2007 Payment Services Review

Staff Reporters

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

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

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

Part B: Supplemental Medicare Insurance = 28%

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

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

Part D: Prescription Drug Benefit = 12%

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

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

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

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

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

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

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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Filed under: Drugs and Pharma, Health Insurance, Healthcare Finance, Monthly Reports, Research & Development | Tagged: medicare | 1 Comment »

Launching iGuard.org

Posted on September 7, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Institute for Safe Medication Practices

Staff Reporters

A new patient-oriented Web site is scheduled for release this fall to reduce mix-ups over drug names.

The ISMP

The Web site is a partnership of the nonprofit Institute for Safe Medication Practices, and online health service www.iGuard.org, which will send users email alerts about drug-name confusion.

Dug Mix-Ups Not Rare

According to an Associated Press report on September 2^nd, nearly 1,500 commonly used drugs have names so similar to at least one other medication that they’ve already caused mix-ups.

Patient Harm

And, according to a major study by the U.S. Pharmacopeia, at least 1.5 million Americans are estimated to be harmed each year from a variety of medication errors, and name mix-ups are blamed for a quarter of them.

The Food and Drug Administration [FDA] – which currently rejects more than a third of proposed names for new drugs because they’re too similar to old ones – is preparing a pilot program that would shift more responsibility to manufacturers to guard against name confusion.

The Site

According to the website, iGuard.org is a healthcare service initiative that helps monitor the safety of medications (including prescription drugs, over-the-counter drugs, nutritional supplements and herbal extracts).

iGuard.org reportedly will help patients stay safer by:

Checking the safety of medications, and screening for drug-drug and drug-disease interactions.
Alerting members and doctors (optional) as important safety information arises for medications.
Provide accessible medication summaries for healthcare teams.
Help patients learn and share treatment satisfaction and side effect information within its social community.

Assessment

The goal of the site is to spell-out how to better test for potential mix-ups before companies seek approval to sell their products.

Conclusion

Your thoughts and comments are appreciated.

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Filed under: Drugs and Pharma, Information Technology, Professional Liability, Quality Initiatives, Research & Development, Risk Management, Uncategorized | Leave a comment »

Call for “Executive-Post” Content

Posted on September 6, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Seeking Expert Contributors

The Executive Post at www.HealthcareFinancials.com is currently calling for medical professionals, financial advisors, financial services professionals, accountants, health economists and related CXOs, medical administrators, managers and healthcare business organizations around the world to contribute content to www.HealthcareFinancials.wordpress.com

Call for Editors

The Executive-Post aims to inspire a new generation of doctors, advisors, nurses, accountants, medical and financial professionals, and healthcare administrators and CXOs by allowing unprecedented numbers of individuals the ability to contribute to the well-being of the healthcare industrial complex and humanity. The goal is to create an invaluable clearinghouse for all the best related information that cuts across disciplines, socio-economic status and geography to provide valuable medical business information to anyone, anywhere, at any time.

The Executive-Post website is continually evolving and was officially launch in late 2007. It is maintained by the Institute of Medical Business Advisors, Inc, in Atlanta, Ga. Most content created on the Executive-Post is freely licensable under the GNU Free Documentation License (GFDL). Contact us for advertising details.

Print Edition Healthcare Journalism

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

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Medically-Focused Insurance Agents?

Posted on September 3, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Avoiding the “Managed Care Ripple Effect”

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

The healthcare industrial complex represents a large and diverse industry, and the livelihood of other synergistic professionals who advise doctors depend on it as well. These include insurance agents who themselves wish to avoid the collateral ripple effects of the current healthcare debacle.

The Name Game

As a registered health underwriter, insurance counselor, long term care or life insurance agent, it seems that almost every insurance agent is also acquiring a general securities license, or CFP®, in addition to the CLU or ChFC after their name.

The Transition

Currently, about 240,000 life insurance agents, down from more than one million in 1965, are being pressured to move toward financial planning, as distribution of insurance products over the Internet spreads like wildfire.

Meanwhile, the same insurance and investment companies that are knocking on your door are also courting the medical professionals with their practice enhancement programs. Even if you are not interested in going into the financial planning business, you have seen the status of the American College erode of late, even as your own business has declined because of the World Wide Web and various discounted insurance companies.

More Competition

And, in the eyes of your former golden-goose doctor-clients, you may have become a charlatan with the recent mortgage, insurance and banking industry collapse of 2008. Now, it seems as though everyone is clamoring for a piece of your insurance business and cloaking it in the guise of the contemporary topic of the day; medical practice risk-management and financial planning.

If you think this is an exaggerated statement; think again? More than a decade ago, an October 1997 survey conducted by Deloitte & Touche Consulting Group of New York, found insurance agents ranked last in having the trust of a wide selection of the public! The insurance debacle today only exacerbates this opinion.

Regaining Trust

But, how do you regain this lost trust, and what about this new entity known as managed care. How do you learn about it at this stage in your career?

What ever happened to whole-life insurance; or traditional indemnity health insurance, with its deductibles, co-payments and 80/20 patient responsibility? It was so easy to sell, provided good coverage and the agent made a nice profit.

As an insurance agent, all you want to know is, can I still sell insurance and make a living? Like all struggling collateral advisors, you find yourself asking, how do I “talk the talk, and walk the walk”, in this new era of insurance, transparency and liability turmoil?

Assessment

Slowly, as you read about the Certified Medical Planner™ online educational program, you become empowered with knowledge and ideas for new insurance product derivatives that actually provide value to your physician clients www.CertifiedMedicalPlanner.com

After the proscribed course of study, you are no longer just an insurance salesman, but a trusted risk-management advisor and Certified Medical Planner™ for the healthcare industry. You have avoided the “managed care ripple effect.”

Disclaimer: Dr. Marcinko, a former insurance agent and Certified Financial Planner™, is Founder of the Certified Medial Planner™ program for all fiduciary consultants in health economics, finance and medical practice management.

Conclusion

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Filed under: "Advisors Only", Insurance Matters, Quality Initiatives, Research & Development, Risk Management | Tagged: insurance agents | 3 Comments »

Healthcare Stock Performance

Posted on August 30, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Doing Well by Doing Good – To Date in 2008

By Staff Reporters

According to Anne Zieger of FierceHealthFinance, healthcare stocks are doing well.

The Standard & Poor’s Benchmark

With healthcare facing some of its biggest financial challenges in years, particularly a growth in bad debt and slides in federal reimbursement, you wouldn’t think that industry stocks would be doing too well.

An Illogical Market

As usual, however, the market has followed its own logic, bringing several healthcare stocks to high points and pushing up the overall value Standard & Poor’s healthcare stocks average by 4.4 percent (compared with a 7.9 percent drop in the overall index).

Meanwhile, mutual funds focused on healthcare are up 6.84 percent over the past three months, according to Morningstar, the only category of stock funds in positive numbers during this period.

Big Pharma and Biotechnology Driven

And, San Francisco Chronicle analysts say that rising healthcare stock performance is driven more by biotechs and big-pharma than provider companies. Their strong performance is partly due to improved performance by the stocks themselves, but also due to investors running away from finance and energy as well.

Healthcare stocks have also been pushed up by foreign investors with strong currencies, who have been on the prowl to take over U.S. companies with below-expected valuations.

The Gainers

Big gainers among the S&P 500 include generic drug-maker Barr, Amgen, Varian Medical Systems and King Pharmaceuticals.

On the other hand, it’s not all good news in this sector, as several managed care companies have lost value, including UnitedHealth Group and Aetna.

Assessment

Of course, hospital companies like HMA and Tenet haven’t done well, lately.

Conclusion

You thoughts and comments are appreciated; especially from wealth managers, financial professionals, insiders or investment advisors.

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

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Filed under: Financial Planning, Investing, Portfolio Management, Research & Development | Tagged: Standard & Poor's | Leave a comment »

23 and Me

Posted on August 29, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Personal DNA Analysis and Reporting

[By Staff Reporters]

Ever wondered why you were left-handed and your sibling or parent wasn’t?

A not-so-new new company, 23andMe, provides an analysis of DNA, where you can learn more about yourself, your immediate family and even your ancestry.

Target Markets

Those who would be especially interested in this personal genome service include:

Methodology

Customers [sic patients] submit a small saliva sample that is processed using a proprietary custom DNA chip. The resulting data is then presented on a secure website using interactive tools that offer information about ancestry, inherited traits and disease risk.

Board of Directors

This is no lightweight company. It technology founders include:

Linda Avey
Anne Wojcicki
Esther Dyson

While its’ medical advisors are:

Uta Francke; MD [Professor of Genetics and Pediatrics, Stanford University].
Itsik Pe’er; PhD [Assistant Professor of Computer Science, Columbia University].
Peter A. Underhill; PhD [Senior Research Scientist, Stanford University].

Assessment

You can also better understand your genetic tendencies for things like obesity or health issues.

There is even an interactive blog: http://spittoon.23andme.com

Users can find other members with similar genetic makeup and start discussions. And, it is $999 to order a kit for the DNA test.

Conclusion

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ADVISORS: www.CertifiedMedicalPlanner.org
PODIATRISTS: www.PodiatryPrep.com
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Filed under: Drugs and Pharma, Information Technology, Media Mentions and PR, Research & Development | Tagged: DNA, genome | 12 Comments »

Dental Managed Care Survey

Posted on August 28, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Delta Dental Plans Association (DDPA)

By Darrell K. Pruitt; DDS

The common sense truth about managed-care dentistry was recently confirmed by Delta Dental data mining.

Preliminary Oral Care Report

Concerning what one can do to assure the best oral care for oneself or one’s family; allow me to share some significant news about research that has not yet been formally published.

On the morning of August 14 2008, less than two weeks ago, a representative for Delta Dental Plans Association (DDPA) revealed the results of an in-house study that confirms that remaining with the same dentist for the long term prevents fillings.

The 2008 National Dental benefits Conference

It was during the first day of the 2008 National Dental Benefits Conference in ADA Headquarters in Chicago that Maxwell H. Anderson DDS, the dental affairs advisor for DDPA, located in Oak Brook Illinois, announced that by data mining their proprietary dental claims over 11 years, Delta uncovered evidence-based information revealing that clients who change dentists regularly are likely to receive more fillings than those who stay in consistent “dental homes” where they are content.

Dr. Anderson told the audience of about a hundred dentists and dental industry representatives that “The greatest hazard to teeth is changing dentists.”

A Righteous Finding

I find it remarkable, as well as noble, that a managed care insurance company like Delta, based on preferred provider lists that are valid for only 12 months at a time, would voluntarily reveal findings that can only bring harm to their business model.

However, when one thinks about it, Delta’s results clearly make sense. If a patient or family of patients is comfortable with a dental team, they are more likely to keep their check-up appointments as well as take better care of their teeth at home. And, consequently, enjoy better health.

Perhaps Delta came to the righteous conclusion that to hide such landmark findings would be unethical?

Assessment

How do preferred-provider lists cause more fillings?

When dentists can rely on a dental care broker like Delta Dental for new patients, there is an inherent absence of accountability that occurs when guided by the invisible hand of competition in the marketplace, naturally. That is an undeniable fact. Managed care dentistry is dentistry by the lowest bidder with no quality control; also an undeniable fact.

Note: Dr. Pruitt, an attendee of the 2008 National Benefits Conference on August 14 and 15 in ADA Headquarters, is the sole proprietor of a fee-for-service dental practice in Fort Worth, Texas. He represents only himself for the benefit of dental patients. His name cannot be found on any preferred provider list. Report posted with permission.

Conclusion

Your thoughts and suggestions are appreciated. Are this dentist’s “facts” and quality assessment true; please opine and comment?

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Filed under: "Doctors Only", Career Development, Managed Care, Research & Development, Surveys and Voting | Tagged: delta dental | 2 Comments »

Coming Healthcare Worker-Shortage

Posted on August 27, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

It’s All in the Demographics

[A New AAHC Report]

[By Staff Reporters]

Current domestic policies will not avert a US health work-force crisis, according to a new report released by the Association of Academic Health Centers [AAHCs]. Moreover, it recommends developing a national planning body to unite efforts to slow/end work-force shortages.

The Report

The association’s report, “Out of Order, Out of Time: The State of the Nation’s Health Workforce,” points to a long and growing list of challenges. These include projected shortages in primary care and nursing; as the baby-boomer wave of retiring physicians and increasing medical needs of the growing elderly population exacerbate.

Lifestyle Preferences

Also, as reported in the American Medical News, on August 25, other issues fueling shortages of health-care workers include lifestyle preferences (regular work hours and family), economic disparities, rising medical school debt loads, and a dwindling pool of medical school faculty, with fragmented health care work-force policymaking.

Assessment

If this all isn’t enough to discourage new entrants from joining the healthcare industry, the plummeting value of present-day small-to-medium sized private medical practices just might.

In fact, our Publisher-in-Chief, Dr. David Edward Marcinko was recently interviewed by the American Medical News on this very topic. And, the un-edited version of that interview will appear in an upcoming issue of the Medical Executive-Post, shortly after AMNews publication.

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, Health Economics, Research & Development, Surveys and Voting | Tagged: healthcare work force | 3 Comments »

Of Hospital CXOs

Posted on August 27, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Benchmarks versus Hunches

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

By Hope Rachel Hetico; RN, MHA, CMP™

Managing Editor

As administrators and physician-executives, we have often wondered about the managerial thought processes of some former hospital CXOs.

Our History in Georgia

For example, since arriving in Atlanta in the early 1980s, we have seen more than a dozen hospitals and five free-standing outpatient treatment centers shuttered due to fiscal insolvency. Included among the closures were urban and suburban entities, as well as private and public organizations following both profit and not-for-profit business models.

The recent public plight of Grady Memorial Hospital, our only Level III trauma center, is another good illustration. And, there seems to be no commonality among the casualties.

CXO Hunches

We can only surmise that these healthcare organizations were run according to CXO “hunches” regarding cash flow analysis, revenue augmentation and cash conversion cycles, etc.

If true, this reinforces our belief that, although providing high-quality medical care remains the primary concern of all healthcare organizations, profitability does matter … and the maxim “no margin, no mission” still applies.

CXO Benchmarks

Fortunately, we are better informed today as real [entity specific] business benchmarks – not best guesses – can be used to help us make wiser strategic and more profitable financial decisions for almost any healthcare organization.

Assessment

Therefore, we are grateful for the opportunity to edit this blog’s companion print journal guide, Healthcare Organizations [Financial Management Strategies] www.HealthcareFinancials.com

It’s a behemoth at 1,200 pages – in 2 volumes – and produced in arm’s length fashion by iMBA, Inc www.MedicalBusinessAdvisors.com

We trust you, and your healthcare organization, will review, use and profit by it.

Print TOC: http://www.stpub.com/pdfs/toc_ho.pdf

PS: Don’t forget to review-read-rave and rant online at this communications forum:

www.HealthcareFinancials.wordpress.com

Conclusion

Let benchmarks, this blog, and Healthcare Organizations: [Financial Management Strategies] take precedence over your gut in guiding your decisions.

orders@STPub.com

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Filed under: "Doctors Only", Career Development, Healthcare Finance, Op-Editorials, Practice Management, Research & Development | Tagged: CEOs, CFOs, COOs, CXOs, hospital administrators, physician-executives | Leave a comment »

Physician Owned Hospitals

Posted on August 24, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

New Patient Disclosure Rules

Staff Reporters

According to Bloomberg News, August 19, 2008, doctors with financial stakes in hospitals where they work must tell patients being referred to those facilities about the ownership link, under new rules from Medicare.

Patient Queries

Patients who ask about investors in a physician-owned hospital must be furnished with a list of all doctors, and their immediate family members, who own or have an investment interest and make referrals.

Assessment

Medicare is seeking to make it harder for doctors to boost their payments by referring patients to their own facilities; and it already bars self-referrals for 11 services. The agency said it would end reimbursement agreements with physician-owned hospitals that don’t follow the new disclosure requirements.

Conclusion

What do you think about this, “if they don’t ask – don’t tell” policy; your informed opinions and comments are appreciated. Is it too much disclosure, or not enough?

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IT Start-Up QWAQ

Posted on August 20, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Introducing QWAQ Forums

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

QWAQ Forums, yes that name is spelled correctly, is a new start-up company in Palo Alto, California. Founded in 2006 by CEO Gregory Nuyens and CTO David Smith, it just raised $7 million in venture capital funding. Early customers include industry giants Intel and BP.

What It Is?

QWAQ is a [Software-as-a-Service [SaaS] provider that combines enterprise-wide collaboration with a three-dimensional interface environment, akin to Second Life, etc. It provides virtual workspaces for program management, virtual offices and virtual operations centers. Most interestingly, its users create virtual avatars, and meet with co-workers in a 3-D environment to share and edit documents and use other business applications.

For example, QWAQ users upload, share and edits documents like MSFT® WORD files, MSFT-PowerPoint® slides, Open Office® and MSFT-Office® documents. Users can launch FireFox® in a forum to browse the web. There are also VOIP and text chat capabilities

The Healthcare Connection

QWAQ, it seems, is already popular with some doctors like radiologists in different locations who use medical imaging applications inside its forums. And, applications can be co-located and employed behind hospital or health enterprise firewalls, for added security protection.

Assessment

This new-wave application currently lacks granular permissions as all documents can be copied by anyone in the Forums; which are self-invited and self-hosted. Yet, it does seem to possess, next-generational “fly.”

Link: www.QWAQ.com

Conclusion

Current cloud computing competitors include Central Desktop, Basecamp and PBwiki; while MSFT-SharePoint dominates the collaboration space.

But, since no one else offers the 3-D experience of QWAQ, your opinions and comments are appreciated; especially from radiologists and all those HIT experts “out there.”

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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Next-Gen Health Accountants and Tax Advisors

Posted on August 19, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Avoiding the “Managed Care Ripple Effect”

By Dr. David Edward Marcinko; MBA, CMP™

The healthcare industrial complex represents a large and diverse industry, and the livelihood of other synergistic professionals who advise doctors depend on it as well. These include CPAs, tax specialists and Enrolled Agents [EAs] who themselves wish to avoid the collateral ripple effects of the current healthcare debacle.

Unappreciated CPAs Working Diligently

The nation’s 330,000 or so CPAs know little about the new healthcare dynamics and managerial accounting mechanics. Many often feel as though they are laboring away in obscurity and that their doctor clients do not appreciate what they do or how hard they work.

If you are a CPA, your workweek is ridiculously long, especially January through April; and you often deliver bad news to your clients. You do not earn a generous salary, but you do receive their ire for your efforts.

The Epiphany

So, you begin to scratch your head and ponder, quietly at first, and then out loud. Perhaps managing the medical practice(s) of a physician, or providing consulting services to other medical professional is a business and financial planning opportunity that won’t require a new client base? You can keep your accounting practice during the first four months of the year, and supplement your income with something that may actually earn more than you are making now.

A light then goes off in your head, epiphany! Enter the CPA/PFS designation, exhorting doctor clients to “never underestimate the value”, through an additional 750 hours of financial planning experience and a six-hour comprehensive examination.

New Wave Terms and Definitions

However, new-wave terms such as capitated medicine; per member-per month fixed fees; payment withholds; activity based costing with CPT codes; utilization and acuity rates; and other investment, business and economic nomenclature is likely quite unfamiliar to you.

Furthermore, you may not have the temperament to be a fiduciary, responsible for the financial affairs of others. Then you realize that MBAs and actuaries may actually be the new denizens of the healthcare bean counting and practice management scene. Rather than present numerics of the historic past, they make logical and mathematical inferences about the future. Slowly, you realize that this has occurred because these professionals are proactive, not reactive, as the accounting profession is loosing its premier advisory position within the medical profession.

And, since some doctors are paid a fixed fee amount, regardless of the number of services performed, these futuristic projections are the most important accounting numbers in healthcare today.

Assessment

In fact, your research suggests that as a result, there are now several accountant managers and broker-dealers on the investment scene, as well as an increasing number of accounting-financial planning firms, such as Miller Ray & Houser Business Advisors and CPAs, in Atlanta, who set up a separate investment advisory firm to which they refer clients.

Moreover, the AICPA is providing encouragement to CPAs who wish to provide more professional client services by building a financial planning practice for the new millennium.

Disclaimer: Dr. Marcinko, a member of the Microsoft accounting network, is Founder of the Certified Medial Planner™ program for all fiduciary advisors in health economics, finance and medical practice management www.CertifiedMedicalPlanner.com

Conclusion

Your thoughts are appreciated; please opine?

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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