Stock Broker Report Card Survey

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

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Doctor – Does your Broker Make the Grade?

[By Staff Reporters]Medical staff

Dear Colleagues,

Does your stock-broker or brokerage firm make the grade?

Be sure to participate in the annual broker report cards survey. And, if you work for Merrill Lynch, UBS, Morgan Stanley Smith Barney, Wells Fargo Advisors or Edward Jones, this trade magazine [Registered Rep] survey is for you.

Assessment

Click here to participate!

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Conclusion

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Our Recent Experience with CFP® Mark Utility

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

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Certification Falling from Grace – Deserved or Not?

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief] dem21 

The Premise

In the summer [2008], we sent a random email blast to the first 200 Certified Financial Planners® on our list-serve. These were folks who had previously contacted us, and/or purchased our textbooks, handbooks, tools and/or dictionaries that assist accountants, financial advisors, attorneys, medical management consultants and all those working to assist physicians and medical professionals on business and economics matters.

The “Straw-Poll” Query

Our email blast asked the simple question:

“Did you ever voluntarily resign your license to use the CFP® mark?”

First Round Results

We received four positive responses [2%]. We then followed up to learn that 2 of the 4 were CPAs, one was a CFA and another was an MBA. Now, what do these results signify – probably nothing – or maybe an emerging trend?

Repeat

So, last summer [2009], after the continuing Wall Street collapse, and the Somnath Basu PhD article on “CFP Trust” in Financial Advisor magazine and this blog, we sent out a follow-up email to the exact same 200 Certified Financial Planners® as before; but carved-out and replaced the 4 CFPs who had resigned the mark, with 4 others.

Link: I Jealously “Shake my Fist” at Somnath Basu PhD

This time we asked the question:

“Have you recently considered allowing your CFP mark to lapse; or resigning it?”

Second Round Results

This time we received exactly eight positive replies [4%] or double the number from the first round. One CFP® said:

“I am rethinking my entire business and marketing philosophy. This includes separation from any taint left over from recent industry scandals – and yes – even including my CFP® mark”

 CMP logo

http://www.CertifiedMedicalPlanner.org

Assessment

This little experiment was not statistically significant by any means. And, again it probably is indicative of nothing. Yet, these types of questions must be boldly asked today; even if they were not even timidly asked yesterday.

Nevertheless, cited plausible reasons for the increased negative CFP® mark response may be:

 

  • CFP BoS lacks modernity and membership alliance. 
  • SEC mismanagement.
  • NASD/FINRA impotence.
  • Wall Street greed.
  • Lack of true fiduciary accountability.
  • Client anger and public distrust.
  • Advisor frustration at lost income.
  • College for Financial Planning and American College credibility.  
  • ME-P operations in the medical niche advisory space.
  • CFP® mark and related industry certification taint.
  • Alternative degrees and available designations.
  • Rise of RIAs and the fiduciary CMP™ mark for healthcare specificity.
  • Resigning [doing] and considering [thinking] are not equivalent;
  • etc, etc. 

It is interesting to note that no CFP® resigned their mark who did not hold either another graduate degree [MBA, MSFS, MA, MS, PhD], or more rigorous industry [CFA and CPA] certification.

Assessment 

So, is CFP mark allegiance just a union-like mentality of “united we stand – divided we fall”, by those with little to no gravitation pull of their own – or something else; ie., industry group think? You decide; and do tell us what you think.

Note: I am the founder of the CMP™ online education and certification program for financial advisors and consultants interested in the health economics, finance and medical practice management space, and a former [resigned] certified financial planner www.CertifiedMedicalPlanner.org 

Update 2013:

Conclusion

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Our New ME-P Rating System

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

Drilling Down on our Rating System –  Eyeing your Rankings 

By Ann Miller; RN, MHA

[Executive Director]ME-P Eye

The direct rating of posts is now available on the ME-P. This enables you to rate each post individually using the traditional five star system [one star = very poor post – five stars = excellent post]. To get started, just look for the five red-star ratings system at the bottom of each post. Then, Read * Submit * Share * Rank * Publish * Prosper.

Assessment

Until now, ME-P readers were only able to indirectly rate each post. These ratings appear on the left home page side-bar, under the heading Engagement Rankings, and are updated hourly. It was a pretty decent system.

But, with room for only 15 rankings, those posts thereafter were never prioritized or appreciated. So now, these worthy posts – and contributing authors – can still be appreciated by their fans. You can even rate this new 5-star rating system feature; below!

Conclusion

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

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

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

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

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VOTE: Poll on Rule 206(4) of the IAA of 1940?

Posted on September 2, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

 Please Vote

 

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ME-P Healthcare Reform Survey?

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

Off-Road Touring with Dr. Marcinko [Part V]

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

About Marquette, Michigan

As our ME-P readers are aware, Marquette Michigan has a population of 20,714, and is the UP’s largest community. In addition to being a population center, it serves as the regional center for education, health care, and outdoor recreation. This regional draw is particularly evident due to Northern Michigan University and Marquette General Hospital [MGH]. Naturally, during my recent tour there, I was able to visit both small and large medical practices, clinics and hospitals. Everywhere, the topic of conversation was the Obama Administration’s vision of domestic healthcare reform. And so, after unofficially asking local residents on their feelings in the matter, we are pleased to offer this survey to all readers and subscribers to our Medical-Executive Post.

Bell Medical

 

About Off Road with Dr. Marcinko

These sporadic off-road segments will continue through-out my 2009 summer promotional tour. On the one hand, formal attendance at several engagements was a bit sparse because of the death of several recent celebrities and entertainer types. On the other hand, local book stores and sponsors noted a spike in our CD and book sales, as well as interest in our online www.CertifiedMedicalPlanner.com program and premier quarterly guide: Healthcare Organizations [Journal of Financial Management Strategies] www.HealthcareFinancials.com

Part IV: https://healthcarefinancials.wordpress.com/2009/08/13/off-road-touring-with-dr-marcinko-part-iv/ 

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

 

 

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ME-P Invitational Challenge

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

Now Open to all Mixed Media Types

By Ann Miller; RN, MHA

[Executive-Director]

people_top

The Medical Executive-Post is now open to all submissions of articles, reviews, artwork, videos, surveys and polls, MP3s and photographs for publication. All unsolicited materials becomes the property of ME-P; and the ME-P will not be responsible for them; for publication, or to return them.

Otherwise; all media submissions and formats are invited.

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

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Credit Card Acceptance in Medical Practice

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

One-third of Physician Practices Not Accepting CCs

By Staff ReportersGold Coins

The Physician Office Credit-Card Acceptance Survey, by SK&A Information Services, an Irvine, Califironia based provider of healthcare information solutions and research, suggests physician practices are limiting credit card [cc] payments because patients are being adversely affected by high interest rates, maxed out credit limits and a more challenging ability to qualify for unsecured credit.

Assessment

Read this report in HealthcareFinance News, on May 29 2009, by Richard Pizzi,

http://www.healthcarefinancenews.com/news/one-third-physician-practices-do-not-accept-credit-card-payments

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Do our physician ME-P readers accept CCs? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Opinion Poll on eMRs

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

SPONSORED ADVERTISEMENT

www.MedicalBusinessAdvisors.com

Please Vote

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AHRQ Report on Uninsured Hospitalizations

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

Differs from Insured Hospitalizations

By Staff Reportershorizontal-nurses

According to Tracey Walker, Senior Editor of Healthcare Executive News on March 13, 2009, the number of uninsured hospitalizations increased by 34%, over the last 10-year period, and the number of Medicaid hospitalizations increased by 36%. However, a newt report from the Agency for Healthcare Research and Quality (AHRQ) suggests the number of privately insured hospitalizations remained about the same.

AHRQ Report

According to the report, hospital charges increased for the uninsured faster than for overall hospital charges (76% for compared with 69% for all hospital stays). The average hospital charge for an uninsured stay in 2006 was $19,400 compared to $11,000 in 1997 (after adjusting for inflation). The average length of stay for the uninsured remained the same at about 4 days per hospital visit. Other findings included: 

  • Compared to all hospital stays, uninsured hospitalizations begin in the emergency department much more frequently (60% for the uninsured compared to 44% for all hospital stays).
  • The number of uninsured hospitalizations for skin infections rose sharply over the 10-year period, increasing from about 28,000 stays in 1997 to about 75,000 stays in 2006. Early appropriate outpatient treatment for skin infections can usually prevent the need for hospitalization.
  • There was a 36% increase in hospitalizations billed to Medicaid during the 10-year period.

Assessment

According to AHRQ, on average the costs (not charges) to provide hospital care to the uninsured are about $1,500 less expensive ($6,800 vs. $8,400 per hospital stay) than costs for all other hospital stays.

Assessment

Lack of health insurance has serious consequences on individuals and societies. For example, the uninsured may be more likely to delay or forgo necessary medical care until eventual hospitalization makes care much more expensive. And philosophically,

“As spending on Medicaid increases; the number of uninsured hospitalizations ought to decrease proportionally—adjusted for population increases”

So says, Hope Hetico; RN, MHA, CMP™ of www.HealthcareFinancials.com.

“But, this was not the case, and determining exactly why will require more studies.”

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Does a similar inverse relationship hold for public versus private education, housing and transportation?

Why or why not? Some pundits wonder if it is due to private entities having more “skin-in-the game?” Please opine?

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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Consumer Directed Health Plan Survey

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

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Costs Hold Steady

[By Staff Reporters]

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

Watson Wyatt – National Business Group Survey on Health

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

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

Assessment

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

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

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

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

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Conclusion

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

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

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Public Healthcare Cost-Shifting

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

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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

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

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

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D2C Drug Advertising Criticized

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

FDA Updates Some Standards

Staff ReportersME-P Logo.2

According to the Wall Street Journal, December 11, 2008, prescription drug makers updated their voluntary standards for direct-to-consumer advertising to make the ads more informative. But, the measures stop short of changes sought by government and industry critics.

The FDA and “Actors”

The companies said they will halt advertising that includes promoting prescription drugs for non Food and Drug Administration [FDA] approved uses; or using actors as physicians. The guidelines say celebrity endorsers shouldn’t say they use a drug – unless they actually use it.

PRMA Industry Trade Group

The Pharmaceutical Research and Manufacturers of America [PRMA], the industry trade group that issued the standards, reported their aim was to address the concerns of doctors, and Congress while continuing to keep patients informed about valuable treatments. Critics said the changes didn’t go as far as advocated by a panel on drug safety from the Institute of Medicine [IOM], including making company’s wait two years before advertising a prescription drug directly to consumers so that effects can be better understood. Critics also said that television ads should include the phone number at the FDA for patients to call to report side-effects.

Assessment

Under the voluntary standards, only print-ads would include the phone number.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Are these restrictions enough; or too much?

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: Drugs and Pharma, Quality Initiatives, Risk Management, Surveys and Voting | Tagged: | 3 Comments »

PPO Pharmacy Benefits Survey

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

Managerial Results for 2007 – Just Released

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[By Staff Writers]

  • In 2006, the average number of eligible employees in PPOs that used managed care pharmacy programs was 203,768, up 7.2% from 190,097 the previous year.
  • For the sixth straight year, the share of PPOs that used PBMs for drug utilization review (DUR) services fell, to 62.7% from 66.1% in 2005.
  • The percentage of reporting PPOs that followed drug formularies increased fractionally in 2006, to 98.6% from 98.3% the year before, the sixth consecutive annual rise.
  • For the fifth consecutive year, the percentage of reporting PPOs that contracted with mail-service pharmacies grew, to 98.9% in 2006 from 98.3% in 2005.
  • Between 2005 and 2006, the overall share of PPO prescriptions filled with brand name drugs fell modestly, to 53.8% from 55.4% the previous year.
  • The average number of contracts between PPOs and hospitals jumped 18.9% in 2006, to 145 from 122 the year before.
  • The percentage of PPOs using a pharmacy benefit manager (PBM) was 99.2% in 2006, up slightly from 98.6% the year before, and the highest such share since this Digest began tracking this measure.
  • In 2006, PPOs contracted with an average of 38.9 ancillary providers per 1,000 eligible employees, up 28.4% from 30.3 the previous year, and the highest such number since 2002 (41.4).
  • At PPOs with at least 1 million eligible employees, the average number of hospital contracts per plan climbed a notable 14.2%, to 1,804 from 1,579 in 2005.

*Acknowledgements

The editors acknowledge 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.

Conclusion

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The Next Financial Crisis?

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

Your Opinion Counts

Staff Reporterslifeguard-warning

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.

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

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Doctor Discontent

Posted on December 2, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Physician’s Foundation Survey Results

Staff Reporters

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

Legal Origins

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

Survey Results:

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

Assessment

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

Conclusion

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

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Filed under: "Doctors Only", Career Development, Health Law & Policy, Monthly Reports, Practice Management, Surveys and Voting | Tagged: | 1 Comment »

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.

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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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.

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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

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

The Healthcare Capital Budgeting Crisis

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

Your Vote Counts 

Staff Reporters

Did you know that South Carolina’s Department of Health and Environmental Control [SCDHEC] will likely close some of its rural health clinics due to the state’s budget woes? It’s true; according to reports from The State of Columbia, SC. Moreover, the SCDHEC would also offer early retirement to its employees.

Hospital Bankruptcies

On another front, hospitals filing bankruptcy last quarter 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. 

Private Medical Practice Impact

And, according to consultants from the Institute of Medical Business Advisors, in Atlanta [www.MedicalBusinessAdvisors.com], similar negative impacts have occurred in private medical practices, and clinics, as well.

Assessment

Will the current economic crisis have a chilling effect on your healthcare organization’s capital spending?

Conclusion

Please vote.

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: http://www.medicalbusinessadvisors.com/marcinkobio.asp and www.stpub.com/pubs/authors/MARCINKO.htm

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Barack Obama and Health Policy

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

What Do -U- Think?

Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Dr David E Marcinko MBAFirst it was Nixon’s supply-side national healthcare proposal; then it was managed care and HMO’s; next came HillaryCare, and finally the Republican’s “Contract with America”. So, will the next domestic healthcare policy initiative be; “Obama Care?”

Number 44 is Official

Now, that the United States has officially elected Barack H. Obama – the 44th president with 62 million popular votes – what does it mean to you as a doctor, financial advisor, politician, healthcare administrator, CEO, physician or nurse executive? And, what will this mean for – healthcare policy and administration  – patients and virtually all of us going forward?

Election

After nearly two years of campaigning – countless debates about McCain versus Obama’s health plan – and the possibility of reform; the US has a president-elect and put Democratic majorities in both the House of Congress and the US Senate.

Opinions Vary

And so, what do you predict the next four years will bring? This is your chance to reflect, comment, opine and debate. Please share your thoughts, and let’s get a vigorous discussion going. Medical practitioner input is especially appreciated.

Assessment

Don’t forget to integrate your opinions with the current dismal economic scene; include challenges like the aging population, personal biomedical and genetic engineering initiatives, and related competitive healthcare 2.0 concepts. As an inside – or outsider – what is the future? 

Conclusion

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

Conclusion

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Anonymous Doctor Rating Websites

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

Worthwhile or Worthless?

By Staff Writers

All medical professionals are aware of the power of the internet and the rise of anonymous MD rating sites. These include RateMDs.com, WLPT-Zagat, Vimo, Careseek, Drscore and a host of others. But, however cool and empowering they may seem; their value is still questioned.

Assessment

And so, we would like to get your input (along with other readers, subscribers and experts) on the value of these social sites for patients and consumers, as well as the possible risks and benefits for MDs.

Conclusion

Your thoughts and comments are appreciated; real life stories and anecdotes are encouraged.

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  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Charity Care versus Managed Care

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

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Physician Participation in Managed Care Levels

By Staff Writers

According to Robert James Cimasi of Health Capital Consultants LLC, in St. Louis, Researchers at the Center for Analyzing Health System Change [CAHSC] completed a study several years ago on the effect of competition and managed care on charity medical care, provided by physicians, that further illustrates the effects of dysfunctional competition in healthcare.

The Study

The study was based on data on the amount of charity care provided by over 10,000 physicians between 1996 and 1997.

Definition of Charity Care

According to www.HealthDictionarySeries.com and others, charity medical care was defined as healthcare provided without cost or at a reduced cost because of the inability of the patient to pay for the cost of the service.

Inverse Relationship Findings

An inverse relationship was found between the amount of physician revenue derived from managed care and the amount of time spent providing charity care. Specifically, physicians who received 85% or more of their income from managed care provided only half of the hours of charity care provided by physicians who received less than 85% of their revenue from managed care contracts.

Also, physicians practicing in areas with high managed care penetration provided less charity care. Further, a relationship was observed between increased practice size and diminished time spent on charity care.

Assessment

The reporter of the study, a contributor to www.HealthcareFinancials.com and others, attributed these practice differences to increasing financial pressures faced by physicians because of increased competition and their reduced ability to use “cost shifting” to shift excess charges from paying patients to cover costs for those unable to pay. Under the scenario they describe, increasing numbers of the uninsured and the prevalence of managed care plans will continue to shift costs back to the government and the public for indigent care unless systemic changes are made to incorporate provisions for charity care into an increasingly for-profit healthcare system.

References: Cunningham, P. J., et al. “Managed care and physicians’ provision of charity care.” JAMA 281 (1999): 1087.

Conclusion

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Hospital Acquired Conditions

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

Survey from Aon Insurance Corporation

Staff Reporters

According to a new analysis by insurance giant Aon Corporation, hospital-acquired conditions accounted for 12.2 percent of total legal-liability costs incurred by health care facilities in 2007.

Top Four Injury Claims

In addition, according to a brief about the Aon study in Modern Physician, one out of six claims against health care facilities was associated with hospital-acquired conditions, in 2007. Claims for these injuries were the most frequent of the four hospital-acquired condition categories:

  • Infections
  • injuries,
  • pressure ulcers, and
  • foreign objects left in the body after surgery.

Assessment

Costs of claims associated with pressure ulcers were the most expensive for health care facilities, which paid about $145,000 on average in claims for that condition. Aon analyzed nearly 78,000 claims with a total $9.3 billion of incurred losses for its professional liability report, which included information from more than 1,200 facilities that provided loss and exposure data.  

Conclusion

Your thoughts and comments are appreciated; especially by our physician, medical quality improvement, risk management and insurance agent readers and subscribers.

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Filed under: Health Economics, Health Law & Policy, Professional Liability, Quality Initiatives, Risk Management, Surveys and Voting | 1 Comment »

Hospital Charge Reports

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

Charging the Poor – More?

Staff Reporters

According to a new report from the Agency for Healthcare Research and Quality [AHRQ], on September 18, 2008, hospital charges increased in 2005 – the latest reporting period.

Charges; Not Actual Costs

Hospital charges – what patients are billed for their rooms, nursing care, diagnostic tests and other services; and not actual costs – jumped from $873 billion in 2005 to $943 billion in 2006.

www.HealthDictionarySeries.com

Data Summary and Survey Results

Between 2005 and 2006, hospital charges increased by:

  • $38 billion to $44 billion – 15 percent for people with no insurance.
  • $124 billion to $135 billion – 9 percent for Medicaid patients.
  • $411 billion to $444 billion – 8 percent for Medicare patients.
  • $272 billion to $287 billion – 6 percent for patients with private insurance.

Assessment

The steep increase occurred even though hospitals admissions increased only slightly, from 39.2 million to 39.5 million. And, it is interesting to note that charges for uninsured and Medicaid patients, those presumably least able to pay and/or protest, rose more than charges for those with private insurance or Medicare?

Conclusion

Your thoughts and comments are appreciated. Is this fair, not fair, an example of “reverse-charge” shifting, or something else?

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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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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?

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

HIPAA Rules and Dentistry

Posted on September 1, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

A Survey of Dentists [Pilot Study]

By Darrell Pruitt; DDS

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

Frustration with the tenets of the mandate, as well as open defiance is evident by the written responses.  In addition, it appears that a dentist’s likelihood of satisfying a requirement is related to the dentist’s perceived importance of the requirement.

Even though this is a limited pilot study, there is convincing evidence that more thorough investigation concerning the cost and benefits of the requirements need to be performed before enforcement of the HIPAA mandate is considered for the nation’s dental practices.

Excerpt:

“Dr. Gerald Daniel seems to have captured many of the dentists’ feelings about the HIPAA Rule when he lamented, “We try to comply, however many times I feel every government agency in the country wants to run my practice without regard to the problems, expense or aggravation it causes the health provider.”

READ IT HERE: hipaa-survey-dentists4

GRAPHS: hipaa-survey-graphs1

Conclusion

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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?

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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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.

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Conclusion

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Domestic Healthcare Access Survey

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

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Still an Elusive System for Many

[By Staff Reporters]

Access to health care in the United States continues to elude more and more Americans, and the nation’s health care system hasn’t improved overall, even though the U.S. spends more on medical care than any other industrialized nation, a new Commonwealth Fund survey shows.

The Study

The authors compared average performance in the United States to those of top-rated performers across the country and abroad. Overall, the U.S. score averages just 65 out of a possible 100, falling far short of benchmarks with wide gaps in all dimensions of the health system, while the score was lower than that achieved in the Commonwealth Fund’s 2006 scorecard, according to  HealthDay, on July 17, 2008.

Efficiency Scores Low

For example, scores for efficiency were particularly low, held down by fragmented, poorly coordinated care; lack of access that leads to avoidable hospitalizations; variations in costs with no return in quality; lack of investment in information technology; and very high insurance overhead costs.

USA is Dead-Last

Although no pun is intended, the United States is now “dead-last” among 19 industrialized nations in premature deaths that might have been prevented by better access to health care. In 2006, the United States was 15th on the list.

The scorecard also found that health care varies widely from state to state, region to region, and from one hospital and health plan to another, while the difference between the best and worst performers can be as much as fivefold.

On the positive side, mortality rates in hospitals improved 19 percent over the past five years, the result of concentrated public-private efforts to improve hospital safety.

Adult-Resources

Related Findings also Disappoint

Related other findings of the scorecard included:

  • Basic preventive care hasn’t improved, with only 50 percent of all adults receiving recommended preventive care, such as cancer screenings.
  • Health insurance premiums continue to rise faster than wages. In 2007, 41 percent of adults said they had medical debt or trouble paying medical bills, up from 34 percent in 2005.
  • The number of primary care doctors using electronic medical records rose from 17 percent in 2001 to 28 percent in 2006, but this gain still lags some other countries where 98 percent of doctors use electronic records.

Assessment

Disparities in health care continue to be pervasive, with minority, low-income and uninsured adults more likely to wait to see a doctor and encounter delays and poorly coordinated care. Also, they have worse dental care, more uncontrolled chronic disease, more avoidable hospitalizations, and worse outcomes.

Conclusion

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Eroding Doctor-Patient Relationships

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

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The “Bed-Side Manner” Deterioration Continues

[By Staff Reporters]

A growing chorus of discontent suggests that the once-revered doctor-patient relationship is on the rocks.

Results

About one in four patients feel that their physicians sometimes expose them to unnecessary risk, according to data from a Johns Hopkins University [JHU] study published in the journal, Medicine, while two recent studies show that whether patients trust a doctor strongly influences whether they take their medication, according to the New York Times, on July 29, 2008.

Tell-all-Books

In bookstores, there is now a new genre of “what your doctor won’t tell you” books promising previously withheld information on everything from weight loss to heart disease, while the Internet is bristling with frustrated comments, blogs, text-messages and wiki’s, etc., from patients.

Raison Detra’

Reasons for the frustration include declining reimbursements and higher costs that give doctors only minutes to spend with each patient, news reports about medical errors and drug industry influence fueling patients’ distrust, and the rise of direct-to-consumer drug advertising and medical Web sites that have taught patients to research their own medical issues and made them more skeptical and inquisitive.

Of course, related quality improvement initiatives seem to be loosing ground.

Assessment

One can only wonder if more extensive use of physician-extenders; like PAs, CRNAs, CNMWs, NPs and DNPs are part of the solution; as well as well-trained limited licensed providers like podiatrists, dentists, optometrists and psychologists; along with walk-in, on-site and retail medical clinics, etc?

Conclusion

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Medicare GAO Report on Radiology

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

Prior Imaging-Authorization Suggested

Staff Reporters

As reported in the Wall Street Journal, on July 14, 2008, Medicare may be soon requiring prior authorization to curtail unnecessary utilization of CT scans, MRIs and other forms of medical imaging, a new Government Accounting Office [GAO] report suggests.

The Medicare Report

To cut imaging costs, Medicare has been reducing certain physician payments, sifting through its data to spot improper claims, and educating medical practitioners about the issue. But, the GAO reported that post-payment claims review alone is inadequate to manage medical imaging – one of the fastest growing parts of Medicare – and suggests that Medicare include prior authorization as a possible front-end tactic.

The Findings

The GAO pointed to new evidence of imaging overuse in physician practices, including:

  • The proportion of Medicare spending on in-office imaging rose from 58 percent to 64 percent from 2000 to 2006.
  • Imaging became an increasingly large slice of doctors’ revenue pie. For example, cardiologists got 36 percent of their total Medicare revenue from in-office imaging in 2006, compared with 23 percent in 2000.
  • In-office imaging spending per Medicare patient varied widely nationwide in 2006, from $62 in Vermont to $472 in Florida.

Assessment

What might proponents of the classic Dartmouth Study on healthcare quality say about these findings?

Conclusion

Please comment on the above; opinions from health economists, actuaries and our radiology colleagues are especially welcomed.

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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Blue Cross – Blue Shield Administrative Survey

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

Cost Trends Demonstrate a Decline in 2007

By Douglas B. Sherlock; CFA

PRESS RELEASE REPORT

Gwynedd, Pennsylvania

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

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

Sherlock Expense Evaluation Report

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

Benchmarks and Metrics

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

Administrative Growth

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

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

Assessment

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

Conclusion

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

###

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

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

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

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CMS to Bonus Doctors for PQRI

Posted on July 31, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

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July – December 2007 Reporting Period

[By Staff Reporters]ME-P Logo.2

According to Anne Zieger, of Fierce Health Finance, the Centers for Medicare and Medicaid Services [CMS] will pay out more than $36 million in monetary incentives to medical providers who reported data on quality of care delivered between July 2007 and December 2007; as part of its Physician Quality Reporting Initiative [PQRI]. 

Physician Quality Reporting Initiative [PQRI]

Under the PQRI, healthcare providers who choose to participate get bonuses of 1.5 percent of their total CMS payments during the reporting period in which they reported quality data.

Assessment

Average payments for the most recent period range from $600 for individual physicians to $4,700 for groups. The largest payment CMS plans to make to a practice is more than $205,700. Solo physicians, physician group practices, and other PQRI-eligible professionals should receive their payments by August, according to the agency.

Source: CMS press release

Conclusion

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Baby Boomers Financially Unprepared

Posted on July 31, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Potential Medical Disability Survey

Staff Reporters

According to findings from a recent Harris Interactive survey conducted on behalf of America’s Health Insurance Plans (AHIP) between April 25 – 29, 2008, baby boomers are financially unprepared if they themselves, or the primary wage earner in their household, suffered a medical disability and was unable to work for an extended period of time.

Survey findings:

  • More than half (55 percent) of baby boomers said that they are either not at all or somewhat unprepared financially should they themselves or the primary wage earner in their household became disabled.
  • One in five (22 percent) say they are “not at all prepared” if a disability occurred.
  • Conversely, only 15 percent report that they are very or extremely prepared for a potential disability.
  • More than half (55 percent) say that it is at least somewhat likely that they would tap into their retirement savings in the event that they or the primary wage earner in their household became disabled and could not work for an extended period.
  • Nearly a third (32 percent) reported that it is extremely/very likely/likely that they would need to tap into retirement savings.
  • Nearly one in five boomers (19 percent) reports that it is not at all likely that they would tap into retirement savings.
  • 17 percent report that they do not have any retirement savings at all.

Source: Harris Interactive Inc.

Assessment

What does this survey reveal to doctors, hospitals, financial advisors and the entire health insurance industry?

Conclusion

Please opine and comment.

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Internet Drug Rx Abuse

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

NCASA Study

Staff Reporters

A large majority of 365 Internet sites that advertise or sell controlled medications by mail are offering to supply the drugs without a proper prescription, while the online trade is stoking the rising abuse of addictive and dangerous prescription drugs, according to a National Center on Addiction and Substance Abuse [NCASA] at Columbia University.

The Study

Federal and state efforts to crack down on Internet sales appear to have reduced the number of sites offering such drugs, from 581 last year, according to a New York Times report on July 9, 2008. Drugs offered online include generic versions of opiates like OxyContin, methadone and Vicodin, which are legitimately prescribed as painkillers; benzodiazepines like Xanax and Valium, which are prescribed for anxiety; and stimulants like Ritalin.

DEA Assessment

The Drug Enforcement Administration [DEA] found that 85 percent of all Internet prescription sales involved controlled drugs, compared with just 11 percent of those filled through regular pharmacies, suggesting that online sales often are destined for misuse.

Conclusion

Do you think the current eRx initiatives will drive or reduce this phenomenon; please opine and comment?

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Prescription Quantity Survey

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

The IMS Health Data Study

Staff Reporters

Did you know that the number of prescriptions dispensed by pharmacies in the U.S. is growing at its worst rate in at least a decade, as consumers are squeezed by both a troubled economy and the growing burden of out-of-pocket health-care costs?

The IMS Report

Data from market researcher IMS Health and Wall Street analysts indicate that the rate of prescription growth has fallen steadily since early last year, with preliminary data suggesting the number of prescriptions actually fell in the second quarter, according to the Wall Street Journal on July 16, 2008.

Big Pharma Brands Collapse

The hit is coming at the expense of some of the industry’s biggest brands. For example, in May 2008, branded medicines accounted for 30.6 percent of treatments dispensed, down from 45.9 percent in 2003, the WSJ noted.

Assessment

Pills for such chronic conditions like cardiovascular disease are also vulnerable, since patients tend to think they can do without treatments for so-called silent diseases more easily than for conditions such as cancer, or HIV.

Conclusion

Your thoughts are appreciated. Have you seen this happening in your practice, clinic or hospital setting? Please comment and opine.

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Culture Change in Nursing Homes

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

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Commonwealth Fund Survey of Nursing Homes

[Staff Reporters]

The “medical culture change” movement is working to radically transform nursing home care, and help facilities transition from institutions to home.

Survey Highlights

The following highlights just a few of the findings from the Commonwealth Fund 2007 National Survey of Nursing Homes report, released in May 2008:. 

  • Fifty-eight percent of culture change adopters allow residents to determine their own schedules, compared with only 22 percent of traditional nursing homes.
  • Nearly two-thirds (64%) of culture change adopters implement bathing practices that are more resident-centered, while only 37 percent of traditional nursing homes do so.
  • Seven of 10 culture change adopters reported that residents are involved in decisions about their facility, but only one-quarter of traditional nursing homes (27%) involve residents in such decisions. 

Source: M. M. Doty, M. J. Koren, and E. L. Sturla: Culture Change in Nursing Homes: How Far Have We Come? Findings From The Commonwealth Fund 2007 National Survey of Nursing Homes, The Commonwealth Fund, May 2008 http://www.commonwealthfund.org

Conclusion

In any case, early planning is the key to supporting both your kids’ futures and your retirement. Making logical college funding decisions, rather than emotional ones, creates a win/win for everyone.

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Financial Advisors Not “Up” on Annuities?

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

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Results of a New Survey

[By Staff Reporters]

In the interactive June edition of Investment Advisor magazine, Savita Iyer-Ahrestani reported on a new study of annuities.

Of course, subscribers of the Medical Executive-Post already know that more and more Americans are counting on financial advisors to help them prepare for a secure retirement; rightly or wrongly. And, this includes physicians and medical professionals.

But, what if the “advisors” are not up to the task – or even just product salesmen – as reported by Iyer-Ahrestani?

The Spectrem Group Survey

Mitch Politzer, senior VP of Lincoln, Nebraska-based Ameritas Advisor Services, had a suspicion that might be the case, so he teamed up with Chicago-based market research firm Spectrem Group and put together a survey aimed at testing advisor know-how and opinion on the kinds of investment products available on the market today.

Results

“The results of the survey showed that most financial advisors are really very skilled at investing for their clients, as they’re driven by equity markets (and to a lesser degree bond markets) and a desire to outperform industry benchmarks,” Politzer says.

“This works for the accumulation phase of a client’s life, yet advisors are less skilled when they have to shift gears for the phase of a client’s life when they’re interested in income and sustaining their assets.”

Gun-Shy on Annuities

Most advisors, Politzer says, seem to have dated beliefs about various retirement products, are slow to innovate, and most are gun-shy when it comes to annuities. According to the survey, 70% of advisors are concerned about locking their clients into a long-term retirement income product, and if they do, they would prefer the product not be an annuity.

Assessment

This survey of professional advisors shows strength in the “accumulation-phase” that is not matched when it comes to income and asset preservation during the “distribution-phase.” www.MedicalBusinessAdvisors.com

And, are FAs really shy about annuity product sales with their traditionally high commission rates?

Conclusion

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1/3 of Medical Procedures Fail to Improve Health

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

A Startling Congressional Budget Office Report!

Staff Writers

Almost one-third of the procedures that doctors perform fail to improve a patient’s health!

Of course, this may come as quite a surprise to most citizens, but not so to readers of the Executive-Post, or the books, white-papers and dictionaries of its sponsor, the Institute of Medical Business Advisors, Inc [www.MedicalBusinessAdvisors.com]

Congressional Budget Office Report

Congressional Budget Office [CBO] Director Peter Orszag opined thusly to federal lawmakers in a recent special report. Mr. Orszag noted that the collective cost for these services top more than $700 billion each year, or roughly five percent of the nation’s total economy.

Misaligned payment, disparate health care costs and an overabundance of untested procedures have placed health care on a fiscally unsound path, which was likened to “running up credit card debt,” according to Modern Healthcare on June 18, 2008.

Assessment

Senate Finance Committee Chairman Max Baucus (D-Mont.) called on the CBO and Government Accountability Office [GAO] to study the potential development of an independent health reform board, possibly like the Federal Reserve Board [FRB] that would set health policy absent of political pressure.

Conclusion

Your thoughts and comments are appreciated. Do you believe the Orszag CBO report is more factually, or heuristically true; why or why not? Is it a startling report at all; or just medical de-rigueur?

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Consumer Health Plan Satisfaction Survey

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

New Deloitte Center for Health Solutions Survey

Staff Reporters

Nine out of 10 Americans are not completely satisfied with their health plans, according to “The Deloitte Center for Health Solutions 2008 Survey of Health Care Consumers.”

The Survey:

According to the survey of what more than 3,000 Americans thought about a variety of healthcare issues; these findings were reported:

  • 73 percent are interested in accessing information about quality or price from their health plans,
  • 78 percent would rather customize their insurance by selecting the benefits and features they value, rather than choose their plans from a few pre-packaged options,
  • 78 percent are interested in online access to medical records and test results,
  • 76 percent want e-mail communication with doctors,
  • 72 percent support online office visit scheduling, and
  • 46 percent would like a software program or web site [cloud computing] to create a personal health record.  

Assessment

Tommy Thompson, senior advisor at Deloitte and former secretary of health and human services in the Bush Administration, said dissatisfaction with health plans should serve as a wake-up call for health insurers to offer more quality and transparency information; according to HealthLeaders Media, June 20, 2008

Conclusion

Is there a disparity-gap in this study between provider and patient opinions; or is it more accurate than not? Please comment?

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Economics of Variable Annuities

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

The “Ups and Downs” of Variable Investments

[By Staff Writers]

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The chief advantage of variable annuities is that investment income or gains are not currently taxable. However, when distributions are made, all gain is ordinary income, even if substantially all of the gains realized on the investment were capital gains.

Investments made directly by a Family Owned Business [FOB] member, for example, does not achieve tax deferral. But, assuming the dividends and other income are small (e.g., a growth portfolio), and all gains are capital gains taxed at the maximum rate, then direct investment may be a far superior method of investment.

Forbes summed it up, saying, “Don’t be a sucker!”

Despite Forbes’ warning, variable annuities are not necessarily an easy investment decision.

Sales Growth

Sales of variable annuities have continued to grow despite the reduction of capital gain rates in the recent years of the Bush Presidency, and the future is unknown. But, if the deferral is long enough, or if the portfolio throws-off ordinary income (e.g., a bond portfolio), then variable annuities may be desirable. However, doctors and medical professionals should exercise caution about variable annuities.

Fees and Expenses

Variable annuity fees vary widely from carrier to carrier but in many cases they are still high, putting such investments at a competitive disadvantage. If the fees are reasonable, and the medical professional client intends to invest in high yield bonds (also know as junk bonds), then a variable annuity can be attractive.

The same is true for traders who move in and out of funds and earn a large amount of short-term capital gains. In any event, all doctors should check the fees charged by the insurance company because they vary widely. Some funds that charge fees also have outperformed other funds.

Taxation

Investing in traditional equity can give rise to dividends of 1.5% (the average) that is subject to taxation. Variable annuities shelter the dividends, but at a cost often reaching 1.25%. This is not exactly an attractive investment trade-off.

Capital Gains

In addition, all capital gains derived from the portfolio are taxable as ordinary income when distributed; also not a good result.

Distributions upon Death

Assets held outright get a step-up in basis upon death. Variable annuity distributions are income-in-respect-of-a-decedent. Thus, there is no step-up in basis. This is harsh taxation, and the combined estate and income taxes can be 100% (e.g. the decedent’s estate may be is subject to a 5% surtax).

Thus, a 55-60% estate tax and a 35-40% ordinary income tax rate results in 100% taxation and confiscation. Counting the limitation on a deduction, the effective tax rate might be 42%, causing the combined taxes to exceed 100%. If the estate taxes can be deducted from the income taxes, the taxation of variable annuities is lessened.

Moreover, if a family business client has a charitable interest, using income-in-respect-of-a-decedent property to fund a gift to charity is a sound planning idea (the charity pays no income taxes and gifts to charities are not subject to estate taxes). Here, variable annuities may have one big advantage; they can prevent creditors from reaching assets. However, if this is a concern then the same results can be achieved by using an asset protection trust.

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Assessment

Tax deferral always appeals to medical and other clients, but in some cases, variable annuity tax deferral may not be a effective tax planning tool. In addition, postmortem planning can help to reduce the tax burden to children.

Variable annuities require clear analysis and discussion. Doctors, and their accountants and financial advisors should discuss this issue before investing in them. The reason, quite simply, is that most doctors do not like to pay current tax and they may leap at a variable annuity which can result in increased taxation. How ironic!

Conclusion

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CRNA Salaries Rise – Exceed Some MDs

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

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Merritt Hawkins & Associates Study  

[Staff Reporters56399869]

Some nurses land higher salaries than primary care doctors, according to staffing firm Merritt Hawkins & Associates.

The Survey 

In the past year, nurse anesthetists recruited through the staffing firm Merritt Hawkins & Associates, landed salaries that averaged $185,000; compared to the pay for family practice doctors hired through the firm, who averaged $172,000; and internists, who averaged $176,000; according to a Wall Street Journal report, on June 18, 2008.

Assessment

The Merritt Hawkins figures for the nurses are higher than some other sources, like the Medical Group Management Association. The MGMA also tracks health care salaries and puts nurse anesthetists’ median compensation at $140,000 per year. The discrepancy may be because fewer employers go through recruiters to hire the nurses, and those who do are willing to pay top dollar.

Related Information Sources

Medical Assistant Job Description: Learn about the salaries of those who assist with medical procedures: http://www.medicalassistantschools.org/what-does-a-medical-assistant-do/

Conclusion

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Faux Healthcare 2.0 Collaboration for Terminal Patients?

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

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American Society of Clinical Oncology Study

[By Staff Writers]

Only one-third of terminally ill cancer patients said their doctors had discussed end-of-life care, according to a recent federally funded study presented at the American Society of Clinical Oncology conference in Chicago.

Study Results

According to the study, patients who had these talks were no more likely to become depressed than those who did not. Moreover, they were less likely to spend their final days in hospitals tethered to machines, avoided costly futile care, and with loved ones more at peace after they died, reported the Associated Press on June 15, 2008.

Assessment

The study was the first to look at what happens to patients if they are, or are not, asked what kind of care they’d like to receive if they were dying, according to lead researcher Dr. Alexi Wright of the Dana-Farber Cancer Institute in Boston. The study involved 603 people in Massachusetts, New Hampshire, Connecticut and Texas. All had failed chemotherapy for advanced cancer and had life expectancies of less than a year.

And so, is the emerging new concept of collaborative or participatory medicine – known as Healthcare 2.0 – fact, fiction or just plain hype?

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Conclusion

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The Cure for Claims Campaign [CCC]

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

Reducing Healthcare Administrative Burdens and Costs

Staff Writers

To help reduce the administrative burden of ensuring accurate insurance payments for physician services, the American Medical Association [AMA] recently launched the “Cure for Claims” Campaign [CCC] and unveiled the first AMA National Health Insurer Report Card on claims processing.

Goals

The goal of the AMA campaign is to hold health insurance companies accountable for making claims processing more cost-effective and transparent, as physicians divert substantial resources – as much as 14 percent of their total revenue – to ensure accurate insurance payments for their services.

The National Health Insurer Report Card [NHIRC]

The AMA’s new National Health Insurer Report Card provides physicians and the public with information on the timeliness, transparency and accuracy of claims processing by health insurance companies. Based on a random sample pulled from more than 5 million electronically billed services, the NHIRC examines the claims processing performance of Medicare and seven national commercial health insurers: Aetna, Anthem Blue Cross Blue Shield, CIGNA, Coventry Health Care, Health Net, Humana and United Healthcare.

Study Results

According to the June 16, 2008 AMA study: 

  • There is wide variation in how often health insurers pay nothing in response to a physician claim (from less than 3 percent to nearly 7 percent), and in how they explain the reason for the denial. There was no consistency in the application of codes used to explain the denials, making it expensive for physician practices to determine how to respond.
  • Health insurers reported to physicians the correct contracted payment rate only 62 to 87 percent of the time. When health insurers report an amount that does not adhere to the contracted rate, it adds additional, unnecessary costs to the physician practice to evaluate the inconsistency.
  • More than half of health insurers do not provide physicians with the transparency necessary for an efficient claims processing system.
  • There is wide variation among payers as to how often they apply computer generated edits to reduce payments (from a low of less than .5 percent to a high of over 9 percent). Payers also varied on how often they use proprietary rather than public edits to reduce payments (ranging from zero to as high as nearly 72 percent).

Assessment

The use of undisclosed proprietary insurance claims edits, only serve to inhibit the flow of transparent information to physicians, adding additional administrative costs to reconcile their health insurance claim issues.

Conclusion

Your thoughts and comments are appreciated. Will likely outcomes of the CCC and NHIRC be real, or illusionary?

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Perceptions of Electronic Health Records

Posted on July 8, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

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New Awareness Study

[By Staff Writers]

Kaiser Permanente, through independent market research company StrategyOne, conducted a nationwide survey between May 8-11, 2008 to gauge the awareness and perceptions of electronic health records.

Survey Findings:

  • 38 percent have used their insurance company’s online tools to learn more about their care, up from 29 percent in 2007.
  • 47 percent had a preference for doctors who use EHRs and 61 percent had a preference for insurance companies who employed EHRs.
  • 51 percent agreed that health IT should be a top priority for the next president to ensure that all Americans have access to their own personal medical records [PMRs] electronically.

Assessment

Americans continue to have concerns about privacy issues. Assurance is required, from all who store personal medical data, that patient information is secure.

Source: Kaiser Permanente, June 12, 2008.

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Ask a Financial Advisor

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

Certified Medical Planner

Second-to-Die Life Insurance

QUESTION: Why has second-to-die life insurance become so popular with medical professionals and others?

Conclusion

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Survey on Convenient Care Medical Clinics

Posted on June 8, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Possible Solution to the Healthcare Dilemma?

Staff Reporters

Another new survey suggests that convenient care medical clinics (CCMCs) could be a potential solution to health care issues, if fears can be alleviated; at least in the Keystone State.

The Survey

The survey by Widener University in Elder Pennsylvania, found that while baby-boomers aged 43 to 64 were most interested in using these clinics, many also expressed concerns regarding the quality of care likely to be delivered.

Aged played a significant role in a person’s likelihood of using a CCMC: among respondents aged 43 to 49, more than half (54 percent) were very likely or somewhat likely to use the clinics, while that number dropped to a mere 25 percent among those over 80 years of age.

Assessment

Access to health insurance influences an individual’s likelihood of using a CCMC: the percentage of respondents who were very likely or somewhat likely to use a CCMC was higher among individuals without health care insurance, than among those with insurance (65 percent versus 40 percent).

Women in the survey indicated they were very likely to worry about misdiagnosis (25 percent), yet they were more inclined to use these types of facilities than men (43 percent versus 37 percent).

Please visit related Executive-Posts for more information on this emerging topic.

Conclusion

Your thoughts and comments on the above survey are appreciated? Is the CCMC concept revolutionary, or merely evolutionary, and how do DNPs fit in the model?

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New Hospital Rating Service

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

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Consumers Union

[By Staff Reporters]Hospital Access Management

The nonprofit Consumers Union is launching a new hospital ratings service, adding to the growing competition to provide online consumer information about health care, as reported in the Wall Street Journal.

A Consumer Reports Publication

The effort, by the publisher of Consumer Reports magazine, is a gamble that the credibility of the magazine’s name and its no-advertising stance can translate into the field of health care.

Of course, it is no secret that doctors and other medical providers have objected to some evaluations proposed previously, by insurers and others,

Content and Functionality

The online hospital service will include about 3,000 facilities, and consumers will be able to view a graph showing how intensely each hospital treats patients, on a scale from zero for the most conservative, to 100 for the most aggressive.

Intensity of care is based on time spent in the hospital and the number of doctor visits, while the index reflects the hospital’s handling of nine serious conditions, including cancer and heart failure when it treats patients in the last two years of life.

Assessment

The new Consumer Reports online offering will also include a dollar figure that reflects an average out-of-pocket cost for doctor visits during the last two years of life, for the nine listed conditions, though that doesn’t match up to the charge for any particular service.

Link: http://www.consumerreports.org/health/home.htm

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