BOARD CERTIFICATION EXAM STUDY GUIDES Lower Extremity Trauma
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Posted on August 17, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
BY NIHCM
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Value-based care has the potential to transform health care, improving quality and access for millions of people, while addressing COVID-19 related disparities. As a result of the pandemic, many rural communities and communities of color face significant reductions in access to health care.
More than 8% of practicing physicians nationwide closed during COVID-19 despite 82 million Americans living in “health professional shortage areas.” The financial strain and burnout experienced by providers has fueled interest in accelerating the adoption of value-based care. As of 2017, only 34% of health care dollars were the result of value-based care payments. This low rate of adoption exists despite evidence tying payments to patient health outcomes and rewarding higher quality care leads to reduced costs.
This webinar brought together experts who are driving innovative initiatives, achieving excellence in health outcomes, and uncovering more effective ways to implement value-based care.
Posted on August 10, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
BY PROPUBLICA
Investigative Journalism in the Public Interest
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A settlement is about to shield members of the Sackler family from civil litigation regarding their alleged roles in the opioid crisis. So it’s a good time to release the full video of Richard Sackler’s 2015 deposition.
–Just Seeing the Cost of the Lab Test DECREASED the Number of Labs Ordered Per Patient by 9%.
–Doctors Also SUBSTITUTED a Lower Cost Lab Test for a Higher Cost Lab Test 10,000 Times.
The Doctors Were NOT Clinically Directed to Change Their Behavior.
The Doctors’ Pay Was NOT Affected by Their Lab Ordering Either Way.
This Study Illustrates How Giving Doctors Cost Information in a Setting of Clinical and Financial Independence AUTOMATICALLY Decreases Healthcare Waste.
Doctors Can Be Much Better Stewards of Healthcare Dollars … and the Technological Innovation Needed is Minimal.
Disclosure: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health.
There is Copay for Each Office Visit and Visits are Unlimited.
Direct Primary Care Doctors Are Most Frequently Family Practice Physicians, but Internal Medicine and Pediatricians Can Also Have Direct Primary Care Practices.
The Average Direct Primary Care Practice Has a Panel of 345 Patients, with a Goal of About 600 Patients at Full Capacity.
For Comparison, the Typical Fee-for-Service Primary Care Doctor Has a Patient Panel of 2,500.
57% of Direct Primary Care Practices Contract with Employers That Pay the Monthly Membership on the Employee’s Behalf.
Direct Primary Care is a Strategy to Increase the Quality of Care and Decrease Healthcare Costs for an Employee Health Plan.
Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health.
Health Insurance Carriers Are Misaligned by Owning PBMs That Make More Money in Rebate Kick-Backs When the Employee Health Plan Spends More Money on Expensive Prescription Drugs.
Doctors Are Misaligned When They *Are Employed by Hospitals That Tie Test and Procedure Ordering Volume to Doctor Compensation.
Hospitals are Misaligned When They Buy Physician Practices and Raise the Prices for In-Office Testing and Procedures by 300%… Even Though NOTHING Has Changed Other Than the Sign on the Door.
Accordingly, True Employee Health Plan Innovation is ALIGNMENT Innovation That Provides Care Outside the of the Status Quo Fee-for-Service System.
Onsite Clinics, Near Site Clinics, Direct Primary Care and Capitated Virtual Care All Provide Real Alignment Innovation for Employee Health Plans.
Posted on July 18, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
THE SHERLOCK COMPANY
This podcast features a brief discussion by colleague Doug B. Sherlock CFA, Senior Health Care Analyst and President, Sherlock Company http://www.sherlockco.com featuring his insights into the quarterly financial reports of health plans, for the first quarter 2021.
The Charges Were Regarding Illegal Payments and Kickbacks to Doctors that Were Thinly-Veiled as ‘Speaker Fees’ and Fancy Dinners.
Why Where the Doctors Not Held Accountable and What Does This Say About a Doctor’s Mentality on Money?
Learn the Psychology of Doctors and Money.
Understand How It Leads to Counterproductive Relationships Between Physicians and Drug Companies, Which Can Compromise the #1 Rule in Medicine: The Patient Comes First, Always.
Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health
Posted on July 16, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
HSA Update 2021
By Michael Thompson
High-deductible health plans have been popular, but it’s becoming clear they are not right for all employees, said Michael Thompson, president and chief executive officer of the National Alliance of Healthcare Purchaser Coalitions.
Specifically, Forrester Research Says That Customer Service is ‘Poor’ at Blue Cross of Texas and Illinois, Blue Shield of California, CareFirst Blue Cross, Anthem, United Healthcare, Cigna and Aetna.
Hospital Billing Customer Services Is Bad Too.
Hospital Billing Complexity is So Troublesome to Patients, that 40% Say They Avoid Preventive Care and Screening Tests Just to Avoid the Billing Headache.
Healthcare Customer Service is Terrible Because Health Insurance Companies and Hospitals Do Not Need Good Billing Customer Service to Be Successful, As Demonstrated by High and Rising Health Insurance Stock Prices and Large and Growing Hospital System Revenue.
For Health Insurance Companies and Hospitals, Not Fixing Their Poor Customer Service May Be a Calculated Business Decision.
Implications:To Help Make Their Employees’ Lives Better, Employers May Need to 1) Hire a Healthcare Navigation Company or 2) Deliver More Care to Their Plan Members Outside of the Traditional Health Insurance and Hospital Systems… and Avoid the Terrible Customer Service All Together.
Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health and is the Former Co-Founder of Compass Professional Health Services.
–The Private Equity Firm Offers an Up Front Lump Sum of Money and Administrative Services Such as Billing and Collections for the Practice.
–In Return, the Doctors in the Practice Agree to Have 30-40% of All Future Revenue Go to the Private Equity Firm.
The Up Front Lump Sum Can Be Equal to as Much as 10 – 20 Years of Income for a Physician.
The Older Doctors in the Practice Who Are Usually the Partners Frequently Take This Deal, Resulting in the Younger Partners Making Less Take-Home Pay.
Implication for Employers:
Private Equity Firms Create Larger Group Practices to Have Better Negotiating Leverage with Commercial Insurance Carriers and Obtain Higher Fee-for-Service Reimbursement.
Overall Healthcare Costs for Physician Services Go Up, While the Take-Home Pay for Doctors Goes Down… and the Private Equity Firm Keeps the Difference.
NOTE: The Older Doctors Who Are Paid the Lump Sum Are Still Required to Stay at the Practice for a Certain Number of Years After the Transaction.
Depression is Highest Among 18-25 Year Olds at 11%.
19% of US Adults Have Anxiety and 56% of Those with Anxiety Are Impaired By Their Condition.
12% of People with Diabetes Have Associated Depression… Resulting in Missed Appointments, Poorer Diet, Decreased Medication Adherence and Increased Complications.
To Address This Problem, The Intermountain Health System Incorporated a Mental Health Provider in Their Primary Care Clinics.
Results: Improved in Diabetes Care, Decreased Hospitalizations and Decreased ER Utilization.
Treating Mental Health Not Only Improves Mental Wellbeing, But Also Lowers Overall Healthcare Costs as Well.
Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health.
NOTE: If you or someone you know is considering suicide, please contact the National Suicide Prevention Lifeline at 1800-273-TALK (8255), text “help” to the Crisis Text Line at 741-741 or go to suicidepreventionlifeline.org.
1) The 90s HMOs: Lower Premiums, Lower Out-of-Pocket Costs, Many Many Rules Restricting Care.
2) The 2000s PPOs: High and Even Higher Premiums, Lower Out-of-Pocket Costs, Fewer Rules Restricting Care.
3) The 2010s CDHPs: Lower Premiums, HIGH Out-of-Pocket Costs, Fewer Rules Restricting Care.
The Last 30 Years Have Taught Us that Employer-Sponsored Health Plans CANNOT Have All 3–Low Premiums, Low Out-of-Pocket Costs and Few Care Restrictions.
In the 2020s, Employers Are Moving More of Their Employee Healthcare OUTSIDE of the Traditional Healthcare and Health Insurance System with On-Site Clinics, Near-Site Clinics, Virtual Urgent Care, Virtual Primary Care and Bundled-Payment Centers-of-Excellence.
Posted on July 7, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
BOOK REVIEW
BY ERIC BRICKER MD
Our Brains Have a Reward Chemical Called Dopamine That Causes a Brief Pleasurable Feeling Followed by a Worsening of our Mood.
However, Our Brains Also Have a Contentment Chemical Called Serotonin That Causes Peace and a Calming of our Mood.
Substances and Behaviors That Stimulate Dopamine Include: Sugar, Caffeine, Alcohol, Nicotine, Illicit Drugs, Prescription Narcotics, Social Media Apps, Gambling and Sex.
Substances and Behaviors That Stimulate Serotonin Include: The Amino Acid Tryptophane, Positive Relationships with Others, Service to Others, Prayer and Meditation.
Corporations Tailor Their Products with Dopamine Stimulating Strategies to Increase Sales.
Facebook’s Chamath Palihapitiya Even Admitted on CNBC that Facebook Intentionally Designed its Social Media Platform to Stimulate Dopamine in the User’s Brain To Make Them Use the App More.
Unfortunately, the Constant Stimulation of Dopamine in Our Brains Has Increased Obesity, Metabolic Syndrome, Cancer, Cardiovascular Disease, Diabetes and Depression.
Lustig Estimates That 75% of the $4 Trillion Spent on US Healthcare is for These Diseases That Can Be Traced to Our ‘Hacked Minds.’
1) Prospecting: The Strategy of Aaron Ross in Dividing Prospecting into Seeds, Nets and Spears Was Effective in Generating Leads at Compass Professional Health Services.
2) Pitching: The Miller-Heiman Strategy of Identifying Economic, Outcome and Technical Buyers Allows for Effective Pitching to a Buying Team.
3) Closing: The Model of ‘Fit-Risk-Price’ is Essential To Understanding How and When to Close a Sale.
Posted on July 5, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
At Least in PartACCORDING TO THESE BOOKS
BY ERIC BRICKER MD
Understandably, Many Doctors Take Issue with This Accusation and Say They Treat Their Patients with Integrity and Accountability. Both Statements May Be TRUE … How is That Possible?
Because of ‘Bad Apples.’
While the Majority of Physicians May Put Their Patients First, There Are a Minority of Physicians that Put Money, Power, Prestige and Promotions Ahead of Patients. It’s These Bad Apples That Ruin Physician Culture.
Problem: Fee-for-Service Rewards Bad Apple Physicians, While Paying the High-Integrity Doctors as Well.
Assessment: If Doctors Want to Keep Fee-for-Service, Then the Bad Apples Must Be Reduced Through 1) Increased Transparency, 2) Greater Doctor Self-Regulation, 3) More Federal Oversight and 4) Increased Employer Investigation.
1) Some Individual Doctors Were Paid Upwards of $5.8 Million Dollars by Medicare in Just a Single Year!
2) The Specialists That Charged Medicare the Most Tended to Be Vascular Surgeons, Ophthalmologists, Oncologists and Cardiologists.
Implications for Employer-Sponsored Health Plans:
1) Medicare Data Can Be Used to Identify High Volume Physicians and Surgeons.
2) The Highest-Costing Doctors Are Concentrated in a Relatively Small Number of Specialties That Can Be Targeted for Detailed Review, Feedback and Possible Exclusion/Steerage Away.
ASSESSMENT: Your thoughts and comments are appreciated.
Reimbursement Typically Takes the Form of a Bundled Payment or a Lower Rate of Fee-for-Service.
Employers with Greater Than 500 Employees Tend To Engage in Direct Contracting.
Mid-Market Employers with a High Concentration of Employees in One Geographic Area Tend to Engage in Direct Contracting as Well.
The Employer Frequently Uses an Independent TPA to Process the Claims for the Direct Contract.
Also, the Employee Health Plan Changes the ‘Benefit Level’ Such that Care at the Direct Contract Facility is Often at $0 Out-of-Pocket Cost for the Member.
Engaging the Plan Members with Navigation Services is Helpful to Make the Experience Integrated with the Overall Health Plan Offerings.
However, That 5% of High-Cost Claimants is a Heterogenous Population
2.5 Percentage Points of the 5% Are Claimants That Were Either High-Cost Claimants the Previous Year with On-Going Complex Medical Situations or Generated Claims Related to Chronic Diseases Such as Diabetes or Multiple Sclerosis.
HOWEVER, the Other 2.5 Percentage Points of the 5% Are Claimants That Generated Zero or Almost-Zero Claims in the Previous 12-Months.
They Essentially ‘Blow Up’ Out of Nowhere.
This Video Describes the 4 Categories of These High-Cost Claimants:
1) Previously Known and Prolonged High Costs
2) Previously Known and Episodic High Costs (that no longer continue)
3) Previously Unknown and Prolonged High Costs
4) Previously Unknown and Episodic High Costs (that no longer continue)
Learn the Clinical Diagnoses That Make Up Each Category and the Secret of Which Groups to Target and Why.
Nurses on General Medical and Surgical Floors Typically Have a 4:1 Patient to Nurse Ratio During the Day and an 8:1 Patient to Nurse Ratio Overnight.
Nurses in the ICU Typically Have a 2:1 or 1:1 Patient to Nurse Ratio.
Nurses on a Floor or Unit Have a ‘Charge Nurse‘ Who is the Head Nurse for the Floor for That Specific Shift.
Those Charge Nurses Then Collaborate with the Shift Coordinator Who is a Very Senior and Experience Nurse Who Coordinates All the Patient Beds for a Particular Division at a Large Hospital (e.g. All Medicine Patients vs. All Surgical Patients) or for the Entire Hospital If It Is a Smaller Hospital.
Medical Techs Provide Support Roles in Patient Rooms Such as Checking Vitals, Blood Glucose Finger-Sticks, Etc.
The Clerk Sits at the Nurses Station for the Floor and Typically Answers the Call-Button for Each of the Patient Rooms During the Day in Addition To Their Administrative Responsibilities.
Consequently, When the Supply of a Healthcare Service is Limited, then the Price Goes Up … Way Up, Since the Quantity Demanded Does Not Change.
Examples of Inelastic Demand with Limited Supply in Healthcare Are:
1) Emergencies
2) Patented Medications for Diseases That Have No Other Alternatives
3) Doctor Specialties Where the Patient Has No Choice in the Services Such As Radiologists, Anesthesiologists and Pathologists
The High-Cost Claimants with Inelastic Demand Drive the Majority of Healthcare Costs for a Group. They Generally Fall into 3 Diagnosis Categories: 1) Orthopedics, 2) Cardiovascular and 3) Cancer.
Orthopedics Should Be the 1st Priority for Lowering Healthcare Costs for a Population … While Demand May be Inelastic, Usually There is Choice and Not a Limited Supply of Orthopedic Services.
Efforts in Orthopedics Should Focus on Increasing Choice, Such as Free Travel to Centers-of-Excellence with Bundled Pricing.
Cardiovascular Care and Cancer Care Tend to Have Inelastic Demand AND Limited Supply. Therefore, the Best Way to Lower Healthcare Costs in These Areas is Through Prevention.
Posted on June 16, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
DEFINITION:Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions.
Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.
Rich talks with veteran Telehealth executive, C.J. Mark about the growth of Telehealth in the last decade. They discuss the issues surrounding Telehealth, and how Covid has accelerated the importance of remote medical care.
Posted on June 15, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
BY ERIC BRICKER MD
[Book Review]
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The Technology Adoption Lifecycle Was Explained in Geoffrey Moore’s Famous Book ‘Crossing the Chasm.‘
If You Are a Healthcare Entrepreneur or Innovator Your MUST Understand and Apply the Technology Adoption Lifecycle.
It States that Disruptive Innovation (i.e. Innovations that Require Behavior Change) Is Not Evenly Adopted Across a Population.
Rather, People Segment Themselves into Sub-Groups That Adopt the New Innovation Differently. To Whit:
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Early AdoptersLove Tinker and Like New Innovations Just Because They Are New. Early Adopters Tend to Not Be Price-Sensitive.
PragmatistsHave a Specific Problem that the New Innovation Will Solve and If They See Other People Using It, They Will Use It Too. Pragmatists Are Somewhat Price-Sensitive.
Conservatives Would Rather Not Adopt the New Innovation, but if it is Already Built-in to Something They Already Buy, Then They Will Be More Likely to Use It. Conservatives are Very Price Sensitive.
Skeptics Will Never Adopt the New Innovation.
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To Spread a New Innovation, One Must Cross the Chasm Between the Early Adopters and Pragmatists With a ‘Niche‘ and ‘Bowling Pin‘ Strategy.
Two of the Largest Purchases Were KKR‘s Purchase of Envision’s 25,000 Doctors for Almost $10 Billion and Blackstone‘s Purchase of Team Health’s 20,000 Doctors for $6 Billion.
QUERY: If Corporate Practice of Medicine Laws Say that Doctors Cannot Work for a Corporation, How are Private Equity Purchases of Physician Practices Legal?
Posted on June 5, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Turning Potential into Actual Value
By Erin Benson and Rich Morino
Social determinants of health can directly be used to improve risk stratification and care management initiatives. But first, it’s important to identify how to effectively use this data to get the most value for your members and organizations.
And so, we present a brief recap of the webinar: “Social Determinants of Health: Turning Potential into Actual Value,” sponsored by LexisNexis Health Care, with Erin Benson, Director Market Planning and Rich Morino, Director, Strategic Solutions.
This recap includes discussion of 5 categories of SDOH. Then, the full webinar discusses elements of success for social determinants of health and opportunities for health plans to leverage social determinants of health data to attain quality goals while managing cost and enhancing member experience.
Posted on June 4, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
A Post Pandemic OVERDOSE AND ADDICTIONUpdate
By NIHCM Foundation
The opioid epidemic continues to devastate communities, with provisional data showing overdose death rates rising during the pandemic. Isolation and economic upheaval, as well as hindered access to treatment options and support systems, have increased the risk of addiction and relapse. These new pressures exist along with the stigma that often prevents people from receiving care for substance use disorder (SUD) and the ongoing need to adopt harm reduction strategies.
Speakers Discuss:
The latest federal priorities for addressing the overdose and addiction epidemic, including a focus on harm reduction efforts and ensuring racial equity in drug policy
Strategies for state agencies to meet existing and increasing SUD treatment needs
A health plan’s innovative approaches to expand SUD care through an in-home addiction treatment program and recovery coaches
ASSESSMENT: And so, this podcast / webinar further explores solutions to reduce overdose rates, with a focus on efforts to expand access to evidence-based recovery programs after the corona virus pandemic.
Posted on June 3, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Dr. Robert Pearl’s Book from Moral Injury to Fee-for-Service … and More
By Eric Bricker MD
Dr. Robert Pearl Was the CEO of the Permanente Medical Group from 1999 to 2017. Permanente is the Physician Group for all of Kaiser Permanente. It is the Largest Physician Group in America with 10,000 Doctors, 38,000 Staff and 5 Million Members.
EDITOR’S NOTE: Normally, book reviews are boring but this presentation from colleague Eric Bricker MD is well worth a watch.
So, how can AI be integrated into healthcare in a way that maximizes its potential while also protecting patient safety and privacy?
In this session faculty from the Stanford AI in Healthcare specialization discuss the challenges and opportunities involved in bringing AI into the clinic, safely and ethically, as well as its impact on the doctor-patient relationship.
They also outline a framework for analyzing the utility of machine learning models in healthcare and will describe how the US healthcare system impacts strategies for acquiring data to power machine learning algorithms.
The COVID-19 pandemic has spurred—and aggravated—a range of mental health and substance use issues in the United States.
In this episode of Critical Point, Milliman’s Stoddard Davenport discusses the rising demand for mental health services and how different populations are being affected. Stoddard also highlights recent statistics on the topic and what the road ahead may look like for mental health in America.
Posted on May 26, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
The Pandemic is Ending?
How Are Hospitals Doing?
Interview with Brian Peters
Rich Helppie brings back Brian Peters, the CEO of The Michigan Health and Hospital Association to talk about the current state of Covid-19; what we may have gotten right, what we may have gotten wrong and how to move forward.
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EDITOR’S NOTE: I first met Rich in B-school, when I was a student, back in the day. He was the Founder and CEO of Superior Consultant Holdings Corp. Rich graciously wrote the Foreword to one of my first textbooks on financial planning for physicians and healthcare professionals. Today, Rich is a successful entrepreneur in the technology, health and finance space. -Dr. David E. Marcinko MBA CMP®
Posted on May 25, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Why we remember more by reading – especially print – than from audio or video
By Naomi S. Baron
PREMISE: Recently, several readers of this Medical Executive-Post have asked why we have not embraced vlogging, podcasting and / or videos even more on our growing platform?
Professor Naomi S. Baron [unrelated] explains most eloquently.
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EDITOR’S NOTE: Dr. Naomi S. Baron does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond academic appointment. She is a Professor of Linguistics Emerita, at American University.
Posted on May 24, 2021 by Dr. David Edward Marcinko MBA MEd CMP™
Have you gotten your COVID-19 vaccine yet?
Haven’t gotten your COVID-19 vaccine yet? Now’s your chance! Find a COVID-19 vaccine provider near you quickly and easily with the redesigned Vaccines.gov website. Vaccines.gov COVID-19 vaccines are the best way to protect yourself and your loved onesfrom COVID-19 — and an important tool to help us get back to normal.
And remember, the vaccine is available at no cost to you at doctor’s offices, clinics, hospitals and retail pharmacies across the country.
Already vaccinated? That’s great! Visit CDC.gov to see the activities you can do safely when you’ve been fully vaccinated.
EDITOR’S NOTE: I first met Vicki Rackner MD FACS a few years ago. day. She is the founder of Thriving Doctors. Vicki calls on her personal experience as a practicing surgeon, clinical faculty member at the University of Washington School of Medicine and serial entrepreneur, to help financial advisors thrive. We appreciate her contributions to the ME-P.
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