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    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

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    Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

    Later, Dr. Marcinko was a vital recruited BOD member of several innovative companies like Physicians Nexus, First Global Financial Advisors and the Physician Services Group Inc; as well as mentor and coach for Deloitte-Touche and other start-up firms in Silicon Valley, CA.

    As a state licensed life, P&C and health insurance agent; and dual SEC registered investment advisor and representative, Marcinko was Founding Dean of the fiduciary and niche focused CERTIFIED MEDICAL PLANNER® chartered professional designation education program; as well as Chief Editor of the three print format HEALTH DICTIONARY SERIES® and online Wiki Project.

    Dr. David E. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA, FPA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

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May Patients Privately Contract with their Doctors?

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Ask-An-Advisor

QUESTION: A question to ME-P readers and subscribers.

Medicare may disallow private contracting by federal law. But, can private insurances, whether PPO or managed care, legally prevent a patient from privately contracting with their doctor for services or goods above the contracted rates, as long as informed consent and appropriate waivers are executed in advance of the service?

IOWs: Do private managed care insurance companies have the legal  right to limit a person’s liberty to seek care above the constraints of the health insurers contract, if the patient so desires?  I understand that an insurer by contract with provider and patient is obligated to pay only a negotiated fee for a specific service or good, but if the patient desires a more accommodating service or extra features to a durable good, do they have the right to privately contract for such services beyond the contract payment or benefit restraints. I believe that this goes into state law safeguards for patient welfare in as much as most non-federal or non-ERISA health insurances are guided by state law.

Assessment

This is not a naïve question for I have posed it to various plan medical directors in our area and have had surprisingly varied responses.

I welcome your crowd-sourced comments with thanks in advance.

Dr. Mark D. Dollard

Loudoun Foot and Ankle Center

46440 Benedict Drive

Suite #111  – Sterling, VA 20164

703 444-9555 [ph] 703 444-1190 [fax]

mdollard@erols.com

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The DDS / Doctor [Salesman] will See [Up-Sell] you Now

Blurring the Line between Medical Professionalism … and Mercantilism

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Concerns and complaints about pushy dentists are apparently becoming more numerous among consumers, as elective cosmetic treatments and marginally effective tests and modalities are increasingly available from the same providers that patients formerly turned to for unbiased dental advice and oral healthcare. All for a price!

http://www.msnbc.msn.com/id/37198272/ns/health-oral_health

So, enter the cosmetic [rank-and-file] dentists and the elective renaissance of the profession – at least economically. An entire industry has even sprung up teaching dentists how to sell various products, and up-sell related services and procedures.

[picapp align=”none” wrap=”false” link=”term=dentists&iid=166771″ src=”0163/1731b859-b744-4a0e-b055-a9e985ad8673.jpg?adImageId=12959860&imageId=166771″ width=”372″ height=”459″ /]

Root-Cause [pun intended]  

Why is this happening? Economics of course! Dental profession success in eradicating cavities, caries and other common mouth disorders – which used to comprise 80% of dental procedures and income – is now a two-edge sword working against their financial self interests … damn!

In fact, I recall about three decades ago when the situation first became acute, as more than a few of our nation’s dental schools closed for lack of interest in matriculation. Right here in Atlanta, the prestigious Emory University School of Dentistry closed its doors while I myself was a patient there; and employed as a surgical resident at a nearby acute care hospital. Contemporaneous cocktail party talk and medical gossip centered on the “death of dentistry” as I exhaled a sigh of relief at my career choice.

Going forward, years later, far too many managed care contracts reimbursed so poorly that they became a loss-leader [access portal to a patient population] for dental practitioners. In other worlds, lose money or break-even on the covered services contract, but profit handsomely by offering [pushing] non-covered services to cohort contract members … and their sphere of influence.

One Word from Mrs. Robinson – Plastics

Plastic surgeons, of course, are still the doctors most commonly associated with non-covered and purely cosmetic and elective treatments such as Botox injections, facelifts and tummy tucks. But, similar elective procedures — which generally aren’t covered by insurance — are being offered by a wide variety of medical specialists.

For example, many dermatologists, who treat patients for skin cancer and other diseases, also promote treatments to smooth wrinkles, lighten age spots and remove hair. Otolarnygologists, who care for patients with conditions of the ear, nose and throat, commonly perform nose jobs, brow lifts and eyelid surgery. And, podiatrists, who are often experts at foot reconstructive, diabetic and ankle surgery, sell shoes, shoe-inserts, laser beam treatments for fungus toenails and various cosmetic and prosthetic devices for deformed toenails and crooked digits.

Medicare Limits – Privates Don’t

At least Medicare requires an ABN [advanced beneficiary notice] for non-covered medical services, and limits non-participating doctors to 115% of the Medicare fee schedule for all providers. Increasingly, some private health plans are doing and proposing, same.  

Practice Management Guru

Now, I have no issue with efficient medical practice management operations, for any specialty. In this era of managed care and health 2.0, governmental intervention is onerous, competition is fierce and patient empowerment is reversing the aging command-control medical establishment. Nor, do I have a problem with offering the entire range of therapeutic and/or elective options to any patient. This is a “good – better – best” elective marketing concept.

In fact, the third edition of our best-selling book, the Business of Medical Practice [Transformational Health 2.0 Skills for Doctors] will soon be released this autumn www.BusinessofMedicalPractice.com. In it, we seek to educate doctors about modern business, management and economics practices; as well as the emerging participatory health 2.0 philosophy and information technology skills. Our goal is enhancing the survival potential of the independent practicing medical professional.

But, the ever expanding menu of treatment options – promoted by a trusted medical professional – should include procedural risks and complications, period of recovery and alternatives, including benign neglect [watchful waiting], marginal benefit and marginal utility, as well as price transparency.

Call this new-wave litany, a type of “informed patient business consent”.

[picapp align=”none” wrap=”false” link=”term=doctor+money&iid=182012″ src=”0178/66353b45-9776-48b9-9bdd-2993a48f32bf.jpg?adImageId=12959922&imageId=182012″ width=”372″ height=”459″ /]

Aphorisms of the Past

Over the years, we have heard phrases like the following from all sorts of independent specialists. I know I have, and so have you. Many are the butt of “insider” jokes:

MD: I’m sure that appendix is hot – I have a car payment to make

DPM: Even the normal foot can be surgically improved

DO: Now, I can bill like a real MD

DDS: We can straighten out – the straightest teeth

DC: I’ll crack your back in only forty sessions … and I finance

But, these are aphorisms of the last-generation. Today we are responsible adults. Let’s grow up and become medical professionals and “DOCTORS” again … not healthcare merchants, sales sharks or equipment shills that offer strategic competitive advantages; but not real patient benefits.  

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Assessment

The old practice management business adage of yesteryear – to work longer hours, see more patients quicker, up-sell marginally effective procedures, or do more treatments in order to realize more income – will not necessarily hold true in the modern era.

http://www.washingtonpost.com/wp-dyn/content/article/2010/05/17/AR2010051703034.html

According to colleague, financial advisor and ME-P thought leader Brian J. Knabe MD – a primary care physician and current www.CertifiedMedicalPlanner.com matriculant – and textbook chapter 27 co-author on physician compensation and salary:

In the environment of Healthcare 2.0, those doctors who embrace efficiency, innovation and appropriate business models will be better positioned to optimize their incomes. 

http://businessofmedicalpractice.com/chapter-27-salary-compensation-2/

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