Thomas Jefferson and ADA Sentiment

Posted on July 14, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

A Book Review … and More!

By Darrell K. Pruitt; DDS

I’m currently reading “American Sphinx – The Character of Thomas Jefferson” by Joseph J. Ellis (1998). According to Ellis, Jefferson was often accused of plagiarism – sometimes even for lifting quotes from his own work. I think if the gifted writer were technically guilty of such a crime, he arguably had forgotten the origin of the “stolen” ideas – much like a composer who unwittingly copies a catchy riff from an obscure song that emerges years after being devoured.

Answering Critics

Ellis offers this as Jefferson’s standard answer to his critics:

“’Neither aiming at originality of principle or sentiment, nor yet copied from any particular and previous writing,’ he explained, he drew his ideas from ‘the harmonizing sentiments of the day, whether expressed in letters, printed essays or in the elementary books of pubic right, as Aristotle, Cicero, Locke, Sidney, etc.’”

We are what we eat.

Not Anonymous

On my good days, I like to compare myself with great people who successfully represented others’ interests in the same spirit as Hippocrates. Like Jefferson, I concentrate sentiment, but in looser wrapped packages. Even though I also cannot always claim authorship of my ideas, like Jefferson, I’m not anonymous.

———————

Wake up, @ADANews. Did you think I was going to somehow disappear? It is probably discouraging to know that I can keep this up for years.

But I don’t think that is necessary. You will surrender soon, ADA, because you are defenseless. You’re policy of silence has you trapped.

Your bureaucracy is caving in on you. The only way out is to renew the ADA’s pledge to be transparent with members. This just has to be.

You can blame one unprofessional ADA member for your PR crisis, and I enthusiastically invite and cherish all blame as a badge of honor.

Yesterday I pointed out that my letter to the editor of the JADA that was never acknowledged suddenly became ME-P’s 8th most popular piece.

ME-P has 221,223 readers … and the JADA? My article had been dormant for months. Know what happened? I posted its link, like this:

Link: https://medicalexecutivepost.com/2009/07/28/journal-of-the-american-dental-association-letter-to-the-editor/

I just looked at the article’s rank it popularity. It has climbed to #3. It’s not just me. You are being voted out right now, ADA leaders.

Proots

Did you know that Thomas Jefferson, the author of the Declaration of Independence, ostensibly risks being discounted in today’s history books because scientists discovered he marked out “subjects” and replaced it with “citizens” in the Declaration? That’s petty. You should see some of the nouns, adjectives and verbs I reject in early drafts – sometimes all three derivatives of the same word.

Assessment

It’s my opinion that it is Thomas Jefferson’s religious beliefs that’s keeping vocal conservative activists employed in a bad economy – not his alleged desire to be king. A few, loud, slow-thinkers also shop the lame argument that Obama isn’t a US citizen. Let’s move on, already. Regardless how one feels about the man, citizenship is simply a disingenuous dead-end argument. That’s what I think. But that’s an entirely different rant that will one day get a whole new class of disagreeable people pissed at me. Can’t wait.

Conclusion

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Filed under: Book Reviews, Op-Editorials, Pruitt's Platform | Tagged: ADA, American Sphinx - The Character of Thomas Jefferson, Darrell Pruitt, Joseph J. Ellis, ME-P | Leave a comment »

Is the Texas Dental Association too Authoritarian?

Posted on June 18, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

About Employee Mary Kay Linn

[By Darrell Kellus Pruitt; DDS]

Texas Dental Association Executive-Director Mary Kay Linn seems to think that TDA members owe her respect for some reason. I don’t see it. You get what you give TDA employee Mary Kay Linn.

Link: TDA response to Pruitt

I’ve attached the partially answered, authoritarian response from the TDA. I think it speaks for itself. And, I posted the following Twitterpoem today.

Mary Kay Linn, the executive director of the TDA just doesn’t get it.

@theTDA, I received the responses to some of the 30+ questions that were invited by the TDA. Linn’s evasion is transparent and regrettable.

@theTDA, when a Judicial Committee member delivered the PDF, he said Linn told him to tell me that “This is it. No more questions.”

Assessment

He added that: “There will be no follow up responses and that the very busy TDA staff spent far too much time on my questions already.”

TDA Executive Director Mary Kay Linn, this will not end well for you.

Assessment

How responsive was the TDA; just right, under or overwhelming when pushed? Or, was Dr. Pruitt over-the-top? Does he expect too much from his professional association? Does almost every DDS except him know that the “emperor has no clothes?” Or, is he one member with critical thinking skills instead of blind [misplaced] faith?

Finally, is there an analogy here for the AMA, ADA, APMA, ANA, AOA, etc? Are the aging command-control medical association monopolies crashing down in the era of internet connectivity and professional networking? Do we need new norms and etiquette models of communication? Please opine.

Conclusion

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Filed under: Career Development, Health Law & Policy, Information Technology, Pruitt's Platform | Tagged: ADA, American Dental Association, Darrell Kellus Pruitt, EMRs, HIPAA, Mary Kay Linn, TDA, Texas Dental Association | 29 Comments »

Some Dental Consultants Say the Most Incredible Things

Posted on June 7, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Are Dentists like … Rodney Dangerfield?

By Darrell Kellus Pruitt; DDS

“Let’s face it — in our world dentists do not get the respect they deserve. They are not perceived to be ‘real’ doctors … Perhaps the lack of sex appeal in dentistry is part of why dental coverage for everyone is an afterthought in the national health care conversation.”

Gary Kadi DDS, DentistryiQ

http://www.dentaleconomics.com/index/display/article-display/4196579430/articles/dental-economics/volume-100/issue-5/features/the-cavity_in_the.html

Even if Dr. Kadi is correct, and the barrier between a 12 year old and his toothbrush is a world-wide lack of respect of dentistry, that hardly means that electronic dental records (eDR) are going to make the kid brush any better. Experience tells me that if mom’s nagging won’t motivate the stinker, the computer won’t either.

eDR Rationalization?

For those who read the article, did you notice how Dr. Kadi, a dental practice consultant, attempts to subtly insert a fat rationalization for adopting eDRs into the middle of a comment lamenting dentistry’s lack of respect? Tricks like Kadi’s make stakeholders look silly at times, and it bothers me that hardly anyone notices and appreciates the humor that these pros bring to marketplace conversation. That’s why I like to point out mistakes like Kadi’s when I come across them. It’s getting harder to find these kinds of articles about eDRs. My pleasure!

Working Both Sides of the Consulting Fence

As far as I can tell, all but a few dental consultants work both sides of the fence in order to please vendors who give them good deals, as well as dentists who pay for unbiased help. Sponsorship by vendors is the bottom level of a consultant career if one chooses to make a living at selling advice. In this way, the dental consultant business is a lot like the financial advice business. Some advisors push their favorite investments that serve them well no matter what happens to their clients’ money. If a client wants advice, but prefers not to pay full price, interested vendors can be counted on to quietly chip in on an advisor’s bill. And that is why the customer must always be cynical. What’s more, it is arguably one’s community obligation to publicly challenge such artists by luring them out into the open to explain further what they meant to say to naïve people. Dr. Kadi begins:

“The national health-care debate cannot be complete unless we include dental care as part of the discourse.”

He then presents oft-repeated, convincing findings which support the widely held conclusion that one’s overall health is dependent on one’s oral health. Even though this chunk of common sense has recently been supported with well-respected research, the news isn’t a revelation. Other stakeholders have proclaimed the findings as an example of ultra-modern “Evidence-Based Dentistry,” and proof of the need for thousands of their dental products. However, let’s not kid ourselves. A healthy mouth has less to do with computerization than the proper application of a low-tech toothbrush. 10,000 years ago, even buzzards recognized that bad breath from advanced gum disease smells like imminent death from a long way off if the wind is right. The results Dr. Kadi leans his reasons against only confirm traditional Evidence-Based Superstition.

eDR Lobbying

By half-way through the article Dr. Kadi turned “The cavity in the health-care debate” into a PR piece for eDRs. He’s in so deep that he cannot recognize that his misplaced concerns about image have nothing to do with dental patients’ oral health. Image is only cosmetic.

“A validation [of bringing “sex appeal” to the profession] is the inclusion of dentistry in the recently mandated National Healthcare Information Infrastructure (NHII). The purpose of the NHII is to create an information network to facilitate the creation of an electric health record [eHR] for all aspects of health care. The primary impetus is to achieve interoperability of health information technologies used in the mainstream delivery of health care.”

Note: Dr. Kadi admits that the goal is HIT, and sharing health information is the tool – not the other way around. As anyone can see, that kind of nonsense will never work out well in the US. Why that would be as foolish as stuffing a certifying commission for eHRs with industry, government and academic leaders rather than providers – and then tossing billions of dollars that could otherwise be used for treating disease out in the street for the biggest and fastest stakeholders who grab the most. That would be simply ridiculous.

Dr. Kadi bravely continues: “This will enable an individual’s health care information to be shared by all the necessary health care parties in a secure manner, including dentistry. It will improve patient care and reduce the number of patients, currently 100,000 plus, who die each year due to a lack of accurate, complete, or timely information. The federal government estimates a cost savings of $85 billion to $100 billion per year with electronic health records [eHR].”

Is HIT – Or any IT – Really Secure?

In a secure manner – really? There are so many other misleading statements in this paragraph as well. First of all, how can an eDR improve a dentist’s chance of successfully extracting a molar in one piece? It can’t. Secondly, how many of the alleged 100,000 victims died because of lack of electronic DENTAL records? Third, how many patients will die because of faulty information in interoperable records that would not have occurred if the records were paper? Fourth, to insinuate that patient information can only be shared over the Internet is plain silly. Telephone, fax and the US mail have been sufficient for dentistry for decades, and none involve HIPAA. Finally, the $85 to $100 billion in savings Dr. Kadi casually throws out is based on a five year old Rand study that’s been widely trashed for being biased in favor of the stakeholders who funded the research. That happens. It just amazes me that anyone in the healthcare industry who knows anything about HIT is foolish enough to still shop discarded garbage. And once again, regardless of the success of electronic medical records, how will eDRs save even $10 in dentistry? It’s impossible without re-defining “savings.”

Cost Savings

“Dentists and hygienists will play a vital role in this cost savings because people who go for regular cleanings will have their medical history updated in the shared system during each visit. In some cases, dental cleanings may be the only medical attention a person receives yearly.”

“Cost savings”? Where have I heard that term? And why didn’t Dr. Kadi simply say “savings”?

Now I remember. It was Dr. Robert Ahlstrom, the ADA’s eDR expert, who coined the handy buzzword in his testimony describing the benefits of paperless dental practices for the US Department of Health and Human Services in July of 2007. “Cost savings to providers and plans will translate in less costly health care for consumers. Premiums and charges will be lowered.” That would be the seventh of his 11 reasons that are each one so lame that other than Dr. Kadi, stakeholders never borrow them. Although it is undeniable that electronic records benefit insurers and the government more than the patient, if Ahlstrom hadn’t been coy, and had clearly stated that eDRs will save money in dentistry, his testimony would have been false. By calling it a “cost savings,” Ahlstrom technically concedes that using eDRs will indeed require an increase in cost of overhead – which dental patients will ultimately have to pay to obtain dental care. The saving part comes from “what could have been.” Whatever that could possibly mean, HHS Secretary Michael Leavitt bought it.

The PennWell Article

Because of a situation beyond my control, I am unable to provide a link, but to find more of my opinion of Ahlstrom’s testimony that is still used by lawmakers to establish national policy, simply google “Dr. Robert Ahlstrom.” My PennWell article from a year ago or so, “Dr. Robert H. Ahlstrom’s controversial HIPAA testimony,” is probably still his first hit. It could be on his first page the rest of his life.

Assessment

If necessary, I’ll make a few more examples of insensitive HIT stakeholders who know better than to offer such crap to the nation’s lawmakers as well as providers who are too busy to pay attention to the welfare of their profession. The ADA should reassure the nation that there are cheap, effective low-tech ways dental patients can stay healthy that don’t risk their identities and won’t bankrupt a dental practice because of a stolen computer. But; they won’t do it.

Conclusion

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Filed under: Op-Editorials, Practice Management, Pruitt's Platform, Quality Initiatives | Tagged: ADA, Darrell Pruitt, DDS, dental consultants, dental economics, dentistry, DentistryiQ, DMD, Dr. Robert Ahlstrom, eDRs, EHRs, EMRs, Gary Kadi DDS, HIPPA, HIT, NHII, PennWell | 37 Comments »

On American Health Care and Financial Services Competitiveness

Posted on May 31, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

A MEMORIAL DAY OPINION – EDITORIAL

[Innovation – Not Nationalization – Can Again Lead]

By Dr. David Edward Marcinko; FACFAS, MBA, CPHQ, CMP™

[Publisher-in-Chief]

By Hope Rachel Hetico; RN, MHA, CPHQ, CMP™

[Managing Editor]

Ann Miller; RN, MHA

[Executive-Director]

On this 2010 Memorial Day weekend, please allow us to directly reflect for a moment on the decline of the healthcare, banking and financial services industry in America. And; then somewhat indirectly comment on the hopeful emergence of the web 2.0 phenomena of which we all are a part. The competitive applicability to these sectors should be appreciated by the insightful ME-P reader.

Collapse of Command and Control Monopolies and Oligarchies

Old monopolies everywhere are crumbling because of tougher new competitors and the transparency wrought by electronic connectedness. For example, our old newspaper has to compete with the internet, your electric utility company battles low-cost local start-ups, telephone companies must begin installing fiber optic lines to fend off cable companies; and RIAs and fiduciary focused financial advisors [FAs] will supplant BDs and stock brokers in the financial services sector.

www.CertifiedMedicalPlanner.com

The airline industry collapsed a few years ago, the banking industry has just collapsed, and the auto industry is recovering as we pen this post. [We have a particular affinity for the auto sector however, as the son of a UAW member and step-daughter of Michiganders]. Regardless, the rush to more intense competition cannot be stopped. As a doctor, FA or other business competitor; you either keep pace or get crushed by quasi-oligarchic organizations like the American Medical Association [AMA], American Podiatric Medical Association [FPMA], American Dental Association [ADA], American Osteopathic Medical Association AOMA], Financial Planning Association [FPA], Certified Financial Planner Board of Standards [CFP BoS], College for Financial Planning [CFP] or the National Association of Personal Financial Advisors [NAPFA], etc. What have they, and Wall Street, done for you … lately? Scandal, taint, doubt, lost-credibility, a business-as-usual ennui, lethargy and ruin! Enter www.Sermo.com

Link: https://healthcarefinancials.wordpress.com/2009/04/19/calling-for-cfp%c2%ae-fiduciary-status-real-education-and-higher-duty/#comment-4136

Health Insurance Companies

In the last-generation of health insurance companies and related fraternal medical organizations, patients exercised great control over physician selection, had quicker access to specialists and encountered fewer restrictions on care. The reverse was true with financial services. But, because of advancing technology, aging demographics, intense R&D, global manufacturing, and escalating domestic HR costs – competitive market forces against traditional and structured staff model managed care companies – many industry analysts [like us] predicted growth would decline [Yes, greed was also involved as healthcare was presumed a recession-proof sector; and didn’t we all own behemoth big-pharma and HMO stocks in our 401-K, and 403-B plans]? But now, many former stock-brokers and FAs are going rogue; er – independent!

“Although inefficiencies in any business often open up in the short term, and can be greatly exploited by creative and visionary entrepreneurs – as in most business structures – market forces will prevail in the long run”.

Leo F. Mullin, MBA

[Former CEO – Delta Airlines]

Next-Gen with “Fly”

Fortunately, a new generation of enlightened physician and FA entrepreneurs is coming “out-of-the-shadows” as new-wave web 2.0 corporations and RIAs are becoming more flexible, competitive and market responsive. Simultaneously, monolithic and collectivist political ideas keep trying to regulate the medical and financial services workplace with rules, regulations and contracts to control entire populations. Yet, in the new healthcare economy, this new generation of doctors and FAs with “fly,” is headed toward more competition; not less – with more collaboration with patients and clients – regaining self autonomy.

Physician and FA Advocates

Meanwhile, as medical professionals, FAs and patient advocates, we must all choose between staying flexible to ride out tough times – or – adopting a hard, brittle line that will crack under the pressure of competition. We know where we stand at the ME-P, do you?

Flexibility and Virtual Reality

In recent years, many large corporations and top-down business models were not market responsive and change was not inherent in their DNA. These traditional organizations represented a rigid or “used-to-be” mentality, not a flexible or “wanna-be” mindset; according to business columnist Alan Webber. Some financial advisory corporations, and today’s emerging health 2.0 initiatives, may possess the market nimbleness that cannot be recreated in a controlled or collectivist [nationalistic] environment. And so, going forward, it is not difficult to imagine the following new rules for the new financial and virtual medical ecosystem.

[A] Rule No. 1

Forget about “SEC suitability and FINRA rules”, large office suites, surgery centers, fancy equipment, larger hospitals and the bricks and mortar that comprised traditional medical practices or financial product delivery systems. One doctor or niche focused FA with a great idea, good bedside manners or competitive advantage, can outfox a slew of public servants, the AMA, SEC, ADA or FINRA “faux copy-cat examiners”, while still serving the public – and patients – and making money. It’s now a unit-of-one economy where “Me Inc.”, is the standard. Physicians and FAs must maneuver for advantages that boost their standing and credibility among patients, peers, payers, customers and clients. Examples include patient satisfaction surveys; outcomes research analysis, evidence-based-medicine, physician economics credentialing and true integrated fiduciary-focused financial planning.

However, we should also realize the power of networking, vertical integration and the establishment of virtual RIAs or medical practices, which come together to treat a patient, or help a client, and then disband when a successful outcome is achieved. Job security is earned with more successful outcomes; not necessarily a degree, automatic AUMs, certifications or onsite presence. In fact, some competition experts, like Shirley Svorny PhD, a professor of economics and chair of the Department of Economics at California State University, wonder if a medical degree is a barrier – rather than enabler – of affordable healthcare.

Link: https://healthcarefinancials.wordpress.com/2009/01/08/medical-licensing-obstacle-to-affordable-quality-care

Others even presume the establishment of virtual medical schools and hospitals, where students and doctors learn and practice their art on cyber-entities that look and feel like real patients, but are generated electronically through the wonders of virtual reality units. The same can be said for the financial services industry, although much farther down-line given its current slow rate of real education and quasi-professional acceptance.

[B] Rule No. 2

Challenge conventional wisdom, think outside the traditional box, recapture your dreams and ambitions, disregard conventional gurus and work harder than you have ever worked before. Remember the old saying, “if everyone is thinking alike, then nobody is thinking”. Do collective-nistas and nationalized healthcare advocates react rationally; or irrationally? [THINK: Wall Street, medical unions]

[C] Rule No 3

Differentiate yourself among your healthcare and financial advisory peers. Do or learn something new and unknown by your competitors. Market your accomplishments and let the world know. Be a non-conformist. Conformity is an operational standard and a straitjacket on creativity. Doctors and FAs should create and innovate, not blindly follow organization or political “union” leaders [shop stewards, BDs, etc] into oblivion.

[D] Rule No 4

Realize that the present situation is not necessarily the future. Attempt to see the future and discern your place in it. Master the art of the quick change with fast but informed decision making. Do what you love, disregard what you don’t, and let the fates have their way with you. Then, decide for yourself if you are of this ilk – and adhere to any of the above rules? Or, just become an employed [government, BD] doctor or FA shill. Just remember that the political party, or monopoly that can give you a job, can also take it away [THINK: LB, ML, Wachovia, national healthcare, etc].

Memorial Day Considerations

Finally, on this Memorial Day weekend, consider that life and career is a journey, and that in this country we have the choice to ponder or pursue any, and all of the above options, and more. We have the ability to think, cogitate and ruminate, as we have done here today. So – please – thank those who have helped turn this idealistic philosophy, into pragmatic daily reality.

For us personally, we thank Bonze Star Medal Winner Captain Cecelia T. Perez, RN. Now – ponder and consider – who do you thank? If no one has impacted you up-close on this Memorial Day weekend and national holiday, please visit our military channel to reflect, comment and opine.

Link: https://healthcarefinancials.wordpress.com/category/military-medicine

Conclusion

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Filed under: Career Development, CMP Program, Military Medicine, Op-Editorials, Sponsors | Tagged: ADA, alan webber, AMA, ann miller, AOA, APMA, BD, broker-dealers, bronze star award, business competition, cecelia perez, certified financial planner, certified medical planner, CFP, CFPBoS, CMP, College Financial Planning, david marcinko, dentists, doctors, FA, financial advisor, financial planning association, financial services, financial services sector, FPA, health 2.0, healthcare, hope hetico, labor unions, Managed Care, Memorial Day, NAPFA, national healthcare, osteopaths, physicians, podiatrists, RIA, RIAs, stock-brokers, UAW, Wall Street, web 2.0 | 10 Comments »

Do We Have A False Sense of HIT Security?

Posted on April 17, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Data Breaches More Common than Realized

By Darrell K. Pruitt; DDS

Here is an article titled “Report: Healthcare Organizations may have a False Sense of Data Security,” written by Neil Versel for FierceHealthIT.

http://www.fiercehealthit.com/story/report-healthcare-organizations-may-have-false-sense-data-security/2010-04-12?sms_ss=twitter#ixzz0kzNS6lq

Versel describes the results of a study commissioned by Nashville, Tenn-based Kroll Fraud Solutions. Kroll estimates that 19% of healthcare organizations in the nation suffered a data breach in the last 12 months. That number is up from 13% a year ago. It is based on this information that I estimate that in the last year, at least 24 million dental patients in the nation have been unknowingly exposed to the danger of identity theft. Everyone agrees that the only ethical thing for a dentist to do if he or she knows that patients’ identities have been exposed is to notify the patients and HHS. The shameful fact is, data breaches in dentistry are not being reported.

Enter the Dentists

But, who can blame American dentists for underreporting breaches without first blaming the heavy-handed, stakeholder-friendly system that forces honest professionals to be dishonest? If a dentist self-reports a breach of 500 or more patients’ Protected Health Information (PHI) it can easily bankrupt a practice. The harm to one’s reputation in the community is just too great a disincentive for even the best of us, even without the added expense of patient notification, subsequent fines and lawsuits. It’s ugly, but that’s the hard, hidden truth about HITECH-HIPAA in dentistry – a piece of lame, one-sided “feel good” legislation that rather than preventing data breaches in dentists’ offices, it drives them underground. As healthcare providers, we should have warned our patients about the growing danger from electronic dental records long ago. Besides me, there are no practicing dentists discussing the topic. Why?

Accepting Ownership of the Dilemma

Would anyone like to argue that the bi-partisan federal mandate for an interoperable, national eHR system relieves dentists of their obligations to the Hippocratic Oath? Let’s face it: Dentists’ computers continue to threaten up to 20% of dental patients in the nation. We cannot ignore it any longer, doctors. Once we finally accept ownership of our problem, what are we going to do about it? I’ve suggested that we use common sense and simply remove the dangerous information from dental patients’ files. Anyone see any problem with this idea? Anyone have a better solution?

Assessment

So what do the leaders of the ADA think of de-identification?

Conclusion

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Filed under: Information Technology, Pruitt's Platform | Tagged: ADA, Darrell Pruitt, eDRs, EMRs, HHS, HIPAA, HITECH, Kroll Fraud Solutions, protected health information | 7 Comments »

Need a New Career in Dentistry – Become a Consultant

Posted on March 26, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Or – Maybe Just a Hobby

By Darrell K. Pruitt; DDS

One might ask how much knowledge of dentistry is required before a person is qualified to call oneself a “dental practice management consultant” – beyond maybe being able to spell HIPAA with only one P, and Hippocrates with two.

Meet Jill Coon, Inc

An anonymous management consultant who works for Jill Coon, Inc of Florida posted this brave suggestion on the company Facebook today:

“Why not take 3 max anterior PA’s and 1 mandibular PA once a year with bitewings to check for caries in front teeth? We actually bill insurance for 3 PA’s not 4. Hygiene production just increased!”

My Translation

Here is a translation of her question from dental-speak to English:

“Why don’t dentists take routine x-rays of front teeth like they do for back teeth, when doing so increases hygiene production and payments from the insurance companies?”

[Dental team members, please sit on your hands for this one].

Bonus Round

Bonus question: Can anyone think of any reason why one might not want additional routine x-rays – even if insurance pays for it at 100% (of usual and customary fees)?

Hint: It can be trickier to avoid irradiating the thyroid when taking anterior x-rays than while taking routine bitewing x-rays.

Assessment

I’ll be back soon with the tricky opinion I will have posted on Jill Coon, Inc Facebook. It will be her first if nobody beats me to it.

http://www.facebook.com/home.php#!/pages/West-Palm-Beach-FL/Jill-Coon-Inc/125510596754?v=wall&ref=mf

Conclusion

Is there anyone out there with almost no knowledge of dental care who wants to match wits with a sales rep for a consulting company that “specializes in dental insurance billing and treatment planning for dental practices”?

Industry Indignation Index: 47

How about it – HHS Secretary Kathleen Sebelius, JD?

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Filed under: Career Development, Ethics, Health Insurance, Industry Indignation Index, Practice Management, Pruitt's Platform | Tagged: ADA, bitewing X rays, Darrell Pruitt, DDS, dental consultants, dentist, dentistry, HIPAA, ionizing radiation, Jill Coon Inc, Kathy Sebelius, thyroid gland | 5 Comments »

A New Survey on Dental Insurance

Posted on March 22, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Come on out Kim E. Volk – CEO of Delta Dental

By Darrell K. Pruitt; DDS

Today, Julie Frey posted “Dentist & Dental Insurance: No Love Lost” on Jim Du Molin’s Blog.

http://www.thewealthydentist.com/blog/1186/dentist-dental-insurance/

Frey hosts dentists’ frank criticism of dental insurance – their harsh sentiments backed up with fresh results from yet another of the blog’s timely studies that nobody else can compete with. Frey writes “Half of dentists have mostly or completely stopped accepting dental insurances, according to this survey.” One dentist captured the mood of the dentists with the statement, “Do the math … somebody is making hell of a lot of money on these plans, and it is not the dentist!” I smelled blood and posted the following comment.

Bloody Sunday

Anonymous members of the obscure National Association of Dental Plans (NADP) are losing the fat, collective thumb they once oppressed us with – even using our own ADA News to present their non-negotiable terms. Apart from common sense appearing in the marketplace about the same time as transparency, multiple other interconnected factors are causing dental insurance companies to lose business. The bad economy, corporate greed and pride are a few of their more serious handicaps that come to mind. Wasteful, deceptive insurance practices have aggravated my patients and me for decades before modern networked recourse became available on the Internet through progressive Websites like Jim Du Molin’s Blog. I’ll go out on a limb and say it is not unprofessional for us to enjoy protecting those we serve by showing no mercy to unfair stakeholders like the NADP.

There. I said it. In fact, as US citizens and taxpayers I think blowing the whistle on unneeded expense and danger in the nation’s healthcare delivery is the least we can do for meaningful healthcare reform. I say do your part. Make an insurance CEO like Delta Dental Plans Association’s Kim E. Volk feel discomfort on the Internet. Do you know that Kim E. Volk is the only person who has ever refused to accept me as a friend on Facebook?

http://www.jbpub.com/catalog/9780763733421/

Assessment

We really don’t want to allow Delta Dental, UnitedHealthcare, United Concordia and others to dictate fees for non-covered dental services, do we? I also don’t think they deserve continued protection from FTC anti-trust litigation. I say we punish the NADP hard every chance we get until the repeal of the McCarran-Ferguson Act and finally make such in-your-face collusion illegal for crying out loud.

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Filed under: Career Development, Ethics, Health Insurance, Practice Management, Pruitt's Platform | Tagged: ADA, Darrell Pruitt DDS, DDS, delta dental, dental insurance, eDRs, FTC, Julie Frey. Jim Du Molin, Kim E. Volk, McCarran-Ferguson Act, NADP, National Association of Dental Plans, United Concordia, UnitedHealthcare | 13 Comments »

Electronic Medical Records and Dentistry

Posted on March 16, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

A Note to Diane Rehm

[By Darrell K. Pruitt; DDS]

Dear Diane Rehm,

I always enjoy your show.

You add value to my drive to work.

As a dentist, I was especially interested in your March 10 show “Electronic Medical Records.”

http://wamu.org/programs/dr/10/03/10.php?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+WAMU885DianeRehm+%28WAMU%3A+The+Diane+Rehm+Show%29&utm_content=FaceBook#30598

In all the excitement that surrounds the 19 billion dollars our grandchildren have unwittingly granted to physicians and hospitals for “meaningful” adoption of certified eMRs, you probably haven’t noticed that nobody is talking about including dentistry in the conversion from paper to digital. Do you find that odd?

Small and Mid Sized Practices

Like small and mid sized physicians’ practices, small dental practices are intended to be part of the federal mandate for interoperable eMR adoption – even without the help from stimulus money that physicians receive. You probably weren’t aware that the stimulus money will run out before HHS gets around to defining “meaningful use” of eMRs in dental office. That would be impossible, but nevertheless, I anticipate that the attempts will be entertaining. Physicians in small practices typically have tens of thousands of paper charts as thick as phone books. On the other hand, a busy solo dental practice, like the majority of practices in the US, might have 5,000 files that are very thin in comparison to files that involve the whole body instead of just the bottom third of the face. That makes sense, doesn’t it?

Marginal Benefits May Not Exceed Marginal Costs

I listened to your guest Dr. Carol Horn, who practices internal medicine in private practice, as well as others involved in the actual delivery of healthcare. They list not only the benefits of eMR adoption, but in fairness, they also described the expense and liability of digital records that continue long after the tedious and dangerous conversion from paper to digital. In other words, it appears that the benefits for physicians barely make the effort worth the price, even with 19 billion dollars in help.

Editor’s Note: In economics, we say that the marginal benefits may not exceed the marginal costs; all things being equal.

Assessment

And so, it occurs to me that if dentists are to be included in the plans for digital interoperability, we will be very, very slow adopters for natural reasons: like eMRs in physicians’ offices, eMRs in dentists’ offices are more expense and trouble than they are worth – even before considering the bankruptcy-level liability of a data breach.

Most of those who champion eMRs for the entire healthcare system in the nation don’t realize that the bottleneck in dental offices isn’t the front desk. It’s the dentist who is hopefully taking his or her time providing care with those hands instead of working a keyboard.

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Filed under: Information Technology, Pruitt's Platform | Tagged: ADA, ARRA, carol horn, CCHIT, Darrell Pruitt, DDS, dentists, diane rehm, eDRs, electronic dental records, electronic medical records, EMRs, HHS, HIMSS, HITECH Act, meaningful use | 11 Comments »

Are You Prepared for a HIPAA Dental Audit?

Posted on February 26, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Why – or Why Not?

By D. Kellus Pruitt; DDS

If you are a dentist and pay ADA dues year after year to be kept better informed about protecting your patients as well as your practice, your ignorance of HIPAA is not entirely your fault. The ADA clearly dropped the ball. Nevertheless, you could still suffer fines as high as $1.5 million for what our leaders failed to emphasize.

It’s time members accept the shameful truth about the ADA Department of Dental Informatics, headed by Ms. Jean Narcisi. Narcisi, working under the direction of ADA Sr. Vice President Dr. John Luther, has been abysmally negligent in preparing members for HITECH HIPAA, and now the compliance deadline is only days away. It’s been months since any information about HIPAA has been published in any ADA publications. Why?

HIPAA Avoidance

Why do ADA leaders avoid discussing HIPAA? They are ashamed, not unlike embarrassed scam victims. About six years ago, Newt Gingrich visited ADA Headquarters and “lied” to ADA Delegates about the future of eHRs in the US. Then he bribed the ambitious career bureaucrats in the crowd with millions of dollars in federal grants to play along with the scam. I can only imagine that the Delegates must have been star-struck by the former Speaker of the House, because nobody dared asked the tough questions.

Newt’s Slick

So here I am, Ms. Jean Narcisi. I’m again doing your job because your mistakes I pointed out years ago now have you frozen in shame. If you disagree, and consider self-respect as something worth defending, let’s discuss your innocence in front of everyone – including the ADA members who pay your salary. Or, you can continue to hide from your responsibilities. This crap will catch up with you soon enough, Ms. Narcisi, and Dr. Luther no longer has the courage to stick his neck out to protect you. He’s also scared of me. You are alone.

Newsletters

Dom Nicastro, senior managing editor at HCPro, edits the Briefings on HIPAA and Health Information Compliance Insider newsletters. He posted an informative article on HealthLeadersMedia.com today titled “HIPAA Compliance Questions to Ask as HITECH Date Nears.”

http://www.healthleadersmedia.com/page-1/TEC-246514/HIPAA-Compliance-Questions-to-Ask-as-HITECH-Date-Nears

The article features Chris Apgar, CISSP, president, Apgar & Associates, LLC, in Portland, Oregon. Mr. Apgar notes that “many covered entities and business associates have consistently failed to comply with the HIPAA Security Rule.” Apgar adds, “I find this over and over when conducting compliance audits.”

The lack of compliance described by Apgar is consistent with the results from my study in 2008, “HIPAA Rules and Dentistry.”

https://medicalexecutivepost.com/wp-content/uploads/2008/08/hipaa-survey-dentists4.pdf

Study Abstract

A survey of 18 dentists was performed using the Internet as a platform. The volunteer dentists’ anonymity was guaranteed. 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.

The range of compliancy was found to be from 0% for the requirement of a written workstation policy to 88% for that of password security. The average was 49%, meaning that less than half of the requirements are being respected by the dentists in this sample.

Frustrated at Mandates

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.

Questions to Consider

Apgar says that the security rule requires covered entities to consider these questions:

Has a risk analysis been conducted lately? Was it properly documented? Were damages mitigated and were the risks acceptable?
Is privacy/security training current? Have new workforce members who will have access to personal health information (PHI) been adequately trained? Has refresher training for all staff been accomplished? Have security reminders been provided?
Are the office policies and procedures complete, current and enforceable? Are workforce members trained on the policies and procedures they are required to respect?
Has a comprehensive audit program been implemented? (The security rule requires three periodic audits and an “evaluation” or compliance audit). Are evaluations current? Have audit findings been addressed and documented?
Have up to date disaster recovery and emergency mode operations plans been communicated and recently tested?
Are CMS’ remote access guidelines being followed? (These are not part of the rule, but CMS earlier indicated remote access management would be included as audit criteria).
Are data in transit and data at rest encrypted? Are non-electronic PHI being protected?

Office of Civil Rights

Mr. Apgar adds that even though the Office of Civil Rights isn’t saying when audits will start, if a complaint is filed with OCR alleging ”willful neglect,” OCR is mandated by statute to investigate. The fines for “willful neglect” are much more devastating than fines for simple carelessness. And “willful neglect” is a subjective judgment call made by inspectors … who work on commission.

Assessment

Unfortunately for the nation’s dentists, the statute invites disgruntled patients and employees to celebrate revenge via federal inspectors. And, the more dentists are fined, the more the inspectors make. That can’t end well. Where are you hiding, Jean Narcisi? You’ve been silent far too long. Let’s talk. Don’t make me come get you.

Editor’s Note: The applicability of this post to all medical specialties is obvious.

Conclusion

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Filed under: Health Law & Policy, Information Technology, Practice Management | Tagged: ADA, Apgar & Associates, Chris Apgar, CISSP, CMS, Darrell Pruitt, Department of Dental Informatics, Dom Nicastro, Dr. Luther, EHRs, EMRs, HIPAA, HITECH, Jean Narcisi. Narcisi, Newt Gingrich, OCR, Office of Civil Rights, PHI, president | 14 Comments »

Sales of Dental Equipment and eDRs Down

Posted on February 20, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Peterson Dental Supply Reveals a Decline

By Darrell K. Pruitt; DDS

Yesterday, Kevin Henry posted “Dental news of the day for Thursday, Feb. 18” on the DentistryiQ Blog.

The source for the day’s dental news was a sales report provided by Patterson Dental Supply.

http://community.pennwelldentalgroup.com/profiles/blogs/dental-news-of-the-day-for

Soft Sales

“Sales of dental equipment and software declined 10% from the year-earlier level, which was consistent with Patterson’s forecast for this period.”

If one remembers the economy at the last of 2008, it is not difficult to understand why Patterson’s analysts forecast that sales of dental equipment would drop. But, how did they know that sales of Patterson EagleSoft, their clinical and practice management software would also fall by 10%? I find it interesting that their accurate prediction was made shortly after Patterson announced the release of EagleSoft Version 15.00 on October 10, 2008. That must have been discouraging to EagleSoft employees.

When is the last time you’ve heard of a company roll-out of a new version of software – expecting it to be even less successful the previous version? That’s interesting.

Health Policy and Politics

What makes Patterson’s valiant prediction of a decline in software sales even more remarkable is that a year ago, President-elect Barack Obama was giddy enthusiastic for digital health records, which includes Patterson’s EagleSoft. Not to say I told you so [maybe-a-little], but Patterson’s analysts obviously recognized what I did long before: Digital dental records are losing popularity among dentists. What’s more, none of my patients have ever said that they wish I had digital dental records. Dental patients simply do not desire them.

As a matter of fact, some have expressed relief that my paper records are more secure than anyone’s digital records. They also like not having to sign HIPAA forms – a meaningless waste of trees and appointment time.

Assessment

A year after Patterson privately admitted doubt about paperless dental practices, the slow-moving ADA House of Delegates met in Hawaii in October ‘09 and officially encouraged ADA members to adopt eDRs. Why doesn’t the American Dental Association know at least as much about dentistry as Patterson Dental?

This is an intriguing time in dental history. I can’t wait until the ADA opens up about their mistakes in dental informatics. One of these days we’ll all have a good laugh about their lame, expensive shenanigans.

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Filed under: Information Technology, Practice Management, Pruitt's Platform | Tagged: ADA, ADA Department of Dental Informatics, DDS, dental records, DentistryiQ Blog, EagleSoft, eDRs, EMRs, healthcare reform, HIPAA, Kevin Henry, obama, Patterson Dental Supply | 7 Comments »

DrBicuspid.com is Biased against Dentists

Posted on February 9, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

More on Delta Dental

By Darrell K. Pruitt; DDS

Kathy Kincade, Editor-in-Chief of DrBicuspid posted the article, “Studies urge adding adult dental benefits to Medicare” on January 29, 2010.

http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=303755

Ms. Kincade has always been generous to Delta Dental, making me suspect that she is less than unbiased.

Of Delta Dental

For example, at the end of the article, she devotes the last words about dental coverage for the elderly to an advertisement for Delta:

“Through a relationship with Delta Dental, the AARP offers the AARP Dental Insurance Plan, a dental PPO for AARP members that includes more than 100,000 dentist locations across the U.S. Delta also offers individual plans that are ‘particularly popular among retirees,’ according to Chris Pyle, director of public relations and community benefits at Delta Dental.”

Kincade closes her ad with a quote from Chris Pyle:

“Delta Dental has been a pioneer in developing affordable dental insurance options for those who do not have coverage through an employer. Retirees who take the time to do the math are finding individual and family dental insurance plans to be a wise option.”

How much does advertisement space on DrBicuspid go for these days?

Dr. Hamm

That is when Dr. Hamm got involved. He first requested that Chris Pyle document his claim:

”Prove it, Mr. Pyle. Let’s see your figures. Be sure to include comparison of the quality of care between PPO dentistry and fee-for-service dentistry. Do you think discounting fees – even for non-covered expenses – improves the quality of intricate care?”

When Dr. Hamm failed to get an immediate response, he went to the source. Here is what he had to say to the Editor in Chief of DrBicuspid:

——————————————————–

Kathy Kincade, pardon me for being straightforward, but at the risk of making it difficult for DrBicuspid reporters to obtain future interviews with Delta Dental PR professionals and ADA presidents, I proclaim that it is DrBicuspid readers’ rights – indeed Americans’ obligation – to challenge unsupported, self-serving statements that strategically discount facts in healthcare to protect stakeholders from principals (that would be dentists and patients).

DDPA Employee

Chris Pyle, the on again – off again DDPA employee, isn’t the first Delta PR specialist who has told DrBicuspid outrageous statements before failing to answer the bell when challenged. A year ago, in an article by DrBicuspid Associate Editor Rabia Mughal, another shy and unaccountable Delta Dental PR professional poked his head up before diving for cover. Delta employee Ari Adler is reported to have said that “direct reimbursement to out-of-network dentists is a problem because it allows them to enjoy the benefits provided by the network without following cost guidelines and quality control measures of the network.”

http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=301436

“We put our dentists thorough a credentialing process and provide quality assurance. That means if a dentist does a filling that should last a certain amount of time and it doesn’t, they have to fix it without charging the network or the patients.”

– Ari Adler, communications administrator at Delta Dental of Indiana

Even after repeated requests for an explanation of Delta’s unprecedented guarantee of dental work done by Delta’s preferred providers, Ari Adler, a very popular master of Twitter who also teaches PR as a part-time job, declined to answer (So much for popularity on Twitter). I assume the PR and social network expert thinks that since he’s the Communications Administrator for such a powerful company, he’s protected from accountability. Besides, American dentists love and respect Delta Dental, don’t they?

Dr. Ron Tankersley

And; what about Dr. Ron Tankersley who is President of the American Dental Association. Is he also simply too good to talk with us?

————————————————

I may or not know Dr. John Hamm. I know Editor in Chief Kathy Kincade, though. She kicked me off of DrBicuspid over a year ago – the day before DrBicuspid consummated a contractual relationship with the ADABEI to receive the ADA seal of approval.

An Invitation

I should warn readers that I could be wrong about what may have been just an odd coincidence, so I invite you, Kathy Kincade, to discuss journalism ethics with me on Pruitt’s Platform. I trust someone will warn you, Kathy, of this invitation before it comes up on your first page in a Google search. My article “DrBicuspid, the ADA and split allegiances” from 2/15/09 is the 8^th hit already. Now do you remember me?

http://community.pennwelldentalgroup.com/forum/topics/drbicuspid-the-ada-and-split

Assessment

Come on out, Kathy. I’ve been waiting for this a long time. Come on out where everyone can see you defend Delta Dental. Please invite Brian Casey as well. He was the Editorial Director of IMV Publishing a year ago. Is he still around – policing the Internet?

Conclusion

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Filed under: Career Development, Op-Editorials, Pruitt's Platform | Tagged: AARP, ADA, ADABEI, Ari Adler, Brian Casey, Chris Pyle, Darrell Pruitt, DDPA, DDS, delta dental, dental managed care, dental PPO, Dr. Hamm, DrBicuspid.com, Kathy Kincade, Rabia Mughal, Ron Tankersley | 10 Comments »

Shopping for Health Software

Posted on February 3, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Some Doctors Get Buyer’s Remorse

By D. Kellus Pruitt; DDS

Dear Huffington Post Investigative Fund

As a dentist, I read Emma Schwartz’s “Shopping for Health Software, Some Doctors Get Buyer’s Remorse” with interest.

It was like watching a slow, grinding train wreck from a still safe, but shrinking distance.

http://www.huffingtonpost.com/2010/01/29/shopping-for-health-softw_n_442651.html

Duped Physicians

The numerous stories about physicians who lost hundreds of thousands of dollars because of bad software purchases – including the case where some doctors alleged they were locked out of their patients’ medical records – is awe inspiring if one isn’t mandated to live the misery. I hope it’s a long, long time before paper dental practices are outlawed. If as Ms. Schwartz describes, broad-band interoperability fails to save money for physicians where it makes sense, I promise that dentists will never invest in interoperability beyond occasionally purchasing a new fax machine, telephone, or postage stamps. Dentistry simply isn’t emergency room medicine, and non-productive technology is especially costly if it fails to function properly.

A Volatile Industry

Steven Lazarus, president of consulting company Boundary Information Group, was quoted:

“This is a very volatile industry. Any product doctors buy could be bought or changed within two years.”

You want to see volatile? Try explaining that to thousands of disappointed dentists in solo practices – one disagreeable SOB at a time.

A Canadian Illustration

Believe it or not, there’s still more kinetic energy behind the train wreck – even without mentioning data breach bankruptcies. As illustrated by Schwartz’s example of Canada-based MedcomSoft, even if a company’s EHR system is CCHIT-certified, bankruptcy can occur unexpectedly – again leaving doctors holding the bag. To stay in business, providers who lose money on EHRs either must cut corners or increase fees to cover the loss … volatile!

A Dentist’s Question

Why, oh why, would a dentist want to spend $40,000 on software including thousands of man-hours in transition, just to risk pulling this tangled, expensive mess down on top of one’s practice? And – for what? There is no return on investment beyond the stakeholders in the EHR industry – which is ultimately paid by unrepresented patients through their healthcare in higher medical fees. As one can imagine, dentists are staying away from EHRs in droves.

For example, what does it mean that there are few if any advertisements for electronic dental records in industry journals, junk mail ads or Internet venues? I think it means that the Father of Economics Adam Smith is quietly warning ambitious, would-be dental software salespeople that their dangerous and expensive products will get them thrown out of dental offices.

The ADA

But then again, I could be wrong. Here is what Dr. John Findley, the immediate past president of the American Dental Association, told ADA Reporter Judy Jakush in a September 2008 interview a month before taking office:

“The electronic health record may not be the result of changes of our choice. They are going to be mandated. No one is going to ask, ‘Do you want to do this?’ No, it’s going to be, ‘You have to do this.’ That’s why we absolutely need the profession to be represented in the discussions about EHR to make sure our ideas are enacted to the greatest extent possible.”

To me, that’s scary. It smells a lot like tyranny.

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Filed under: Career Development, Health Economics, Information Technology, Pruitt's Platform | Tagged: ADA, Boundary Information Group, CCHIT, Darrell Pruitt, eDRs, EHRs, Emma Schwartz, EMRs, Huffington Post, john findley, Judy Jakush, MedComSoft, Steven Lazarus | 1 Comment »

I Want Obama Transparency for the ADA

Posted on January 22, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

No More Hiding Places

By D. Kellus Pruitt; DDS

Today, Ed O’Keefe of the Washington Post posted “New Obama Orders on Transparency, FOIA Requests.”

http://voices.washingtonpost.com/federal-eye/2009/01/_in_a_move_that.html

O’Keefe writes:

“In a move that pleased good government groups and some journalists, President Obama issued new orders today designed to improve the federal government’s openness and transparency. The first memo instructs all agencies and departments to ‘adopt a presumption in favor’ of Freedom of Information Act requests, while the second memo orders the director of the Office of Management and Budget to issue recommendations on making the federal government more transparent.”

Soon, other ADA members are going to bluntly ask Pres Dr. Ron Tankersley:

“If the President of the United States has the courage to face those whom his actions affect, why oh why doesn’t the President of the American Dental Association support transparency in the non-profit organization that belongs to dues-paying members?” After all, ADA members pay more than $1000 per year for ADA services.”

“If you are an ADA leader, pay close attention. This is the future I warned you about that far too many of you avoided out of convenience. As you can read below in his memos, Obama promises, “The Government should not keep information confidential merely because public officials might be embarrassed by disclosure, because errors and failures might be revealed, or because of speculative or abstract fears.”

Who will be held accountable for the ADA/IDM blunder… among other bone-head ideas?

Obama promises that his administration:

“Will work together to ensure the public trust and establish a system of transparency, public participation, and collaboration. Openness will strengthen our democracy and promote efficiency and effectiveness in Government.”

I think openness will do the same in healthcare if we can move a handful of entrenched ADA leaders on down the road. They are weighing us down with their selfish special interests.

Assessment

Did you hear that, Dr. Ron Tankersley, President of the American Dental Association? There are simply no more hiding places for the anonymous ADA hobbyists who elected you. I’m sure the long run of irrelevant ADA Presidents was fun before electricity and social networks, though.

Conclusion

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Filed under: "Doctors Only", Health Law & Policy, Op-Editorials, Pruitt's Platform | Tagged: ADA, American Dental Association, Darrell Pruitt, DDS, DMD, Ed O'Keefe, FOIA, IDM, obama, Ron Tankersley, Washington Post | 22 Comments »

Who Admires the EU Healthcare Model?

Posted on January 15, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

Not so Fast – Old Man

By Darrell K. Pruitt; DDS – el Viejo

Here’s something interesting I found on Courthouse News.com about Germany’s mandatory retirement age for dentists.

“EU Court OK’s Age Limits for Firefighters, Dentists” (no byline).

http://www.courthousenews.com/2010/01/14/European_Courts.htm

European Court of Justice

“The European Court of Justice released a ruling reconciling a ban on age discrimination with German age limits for firefighting and dentistry.”

The article continues:

“For dentists, the high court agreed with the national court that an age limit is justified by the need to protect patients from declining performance.”

As we wait for octogenarian Gordon Christensen DDS to discover and describe the lame “declining performance” claim in that statement, let me focus on the rest of the paragraph:

“But it said that such a limit must apply across the board, not only for panel-certified dentists within the public sector, but also for private practitioners.”

Touting the Next Generation of Dentists

It gets worse. The EU openly states that it intends to hand young dentists (and mid-level providers?) an immediate chance at making swell money with a huge demand for dental care that will arise when thousands of thriving dental practices across Europe close.

“The Court of Justice also agreed that such a limit is reasonable to provide work positions for young dentists, but only if it can be proven to fulfill this purpose.”

Assessment

Hell, I’ll probably still have kids in college if US HIT stakeholders fall in love with this plan. Not only that, but since thousands of dental practices like mine will be up for sale at the same time, the business I’ve built over the last 27 years will be worthless on the open market.

So what are my plans? I hope the ADA is adequately protecting Americans from such folly.

And – if not?

Porque hablo español, tengo la intención de mover el culo viejo a una ciudad en la costa en México y sacar dientes a los extranjeros ilegales a su regreso desde el norte. ¡Viva el NAFTA!

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Filed under: Career Development, Health Economics, Pruitt's Platform | Tagged: ADA, Darrell Pruitt, DDS, EU, European Union, Gordon Christensen DDS | 2 Comments »

Kathleen Sebelius Please Pay Attention to Dr. Darrell Pruitt

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

Deferred Investment [An Incentive to Access]

By D. Kellus Pruitt; DDS

On Friday, the editor of the Chicago Dental Society’s [CDS] blog “Open Wide” posted a progressive, brief article titled, “State of Illinois offers incentive for dentists to treat Medicaid patients” (no byline).

http://chicagodentalsociety.blogspot.com/2009/12/state-of-illinois-offers-incentive-for.html

CDS says that last week, Governor Pat Quinn signed a law which allows Illinois dentists who treat Medicaid patients to accept payment deposited into a tax deferred investment portfolio instead of the traditional delayed, unpredictable payments that offer no tax advantages – only headaches.

Illinois Governor Quinn is a vast improvement over his predecessor. What was his name? He’s gone on to become a TV personality …. Oh yeah. Blagojevich!

I don’t know about you, but for me, Quinn’s incentive to access could offer not only more relief for those who cannot afford dental care in Texas, but it could also be a more or less painless way for dentists to fund IRAs – rather than having to do it at the last minute like I’ll do in a few months – just like every year. Instead of having an IRA hanging over my head, all I would have to do is donate my skills to help a few more people every now and then. That’s noble, charitable duty, friends – even with the Quinn incentive.

I especially respect current Medicaid dentists who work for nothing at all on the more profitable days.

To HHS Secretary Kathleen Sebelius

Pay attention. You only think you run the show.

The nations’ dentists you need aren’t being paid what they deserve, yet they put up with expensive and threatening CMS bureaucracy and struggle on – simply because they wish to ease suffering everyone else chooses to ignore.

Medicare dentists are American heroes to be sure. But let me warn you, Ms. Sebelius, they will turn on you hard and cold if you try to push them around. It’s time that you welcome real dentists to the bargaining table instead of ambitious ADA-approved stakeholders. You need us more than we need you, Ms. Sebelius. Forget the ADA. That is a foundation on which we can build … or not.

And this is for my stunned dentist colleagues in Texas who cross the street to ignore grandiose special bastards like me. Most of you detest the messy stuff I drag around, but nevertheless can’t stop watching from a safe distance. Rather than get your own hands messy, most of you simply pay the TDA to quietly and ineffectively hide or delay huge approaching problems. So what’s the trade-off? To remain “In the Loop,” you must obediently take up your differences with leadership in the approved, professional manner through designated ADA representatives. And. that’s so cute.

Now that you read about Quinn’s incentive, don’t you also hope that a TDA committee has already approved a draft of a deferred investment proposal to be offered to state lawmakers as soon as possible? After all, similar plans are already being tried in not only Illinois, but in four other states as well: Louisiana, Florida, Mississippi and Arkansas.

Hope as we may, nimrods, I fear those in Austin who should be paying attention to legislative opportunities such as this only heard about Quinn’s incentive to access law a minute or so ago at best.

Of Face Book Accounts

Both the TDA and the ADA desperately need functional Facebook accounts like Chicago Dental Society’s. By the way, it is the CDS which will be hosting their annual mid-winter dental conference in Chicago – reliably a tremendous meeting. This year it is Thursday-Saturday, Feb. 25-27, 2010 in the McCormick Place West Building.

http://www.cds.org/mwm_2010/

The TDA’s Facebook Wall is pristine white and graffiti-ready, and the spray paint is free to any artist who walks by. Not unexpectedly, it’s a mess. Nobody is joining, and whoever is in charge of managing the site is busy deleting unacceptable comments from a jerk who has no respect for anyone. (It’s not me). The TDA Facebook is in trouble, and it has been suggested that it should be shut down. It is indeed an embarrassment.

Assessment

Here’s something we’ll all laugh about later: The one dentist in Texas who could have sent the rogue artist on down the road (me), was kicked off for badmouthing BCBSTX and the NPI number as well as 13 other listed allegations, including posting pornography. I’ll let the TDA Director of Membership explain that and the other allegations if you are curious. I was not provided access to the evidence on which the sudden and uncontestable revocation of my TDA benefit was based. But there’s still hope because a friend of mine resented the way I was treated and complained to the TDA using the approved channels. That was 2 months ago. I wonder how well that one is progressing from the Austin City dump.

The ADA Facebook is no better. Over 1600 fans have piled up at the door waiting for the ADA’s grand opening, yet nothing is happening. What do you think is going on there?

If you’ve missed hearing from me for the last 2 weeks and have an inquisitive mind, I’ve been pursuing answers for such questions about ADA and TDA transparency on Twitter. They call me Proots.

Conclusion

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Filed under: Breaking News, Funding Basics, Health Insurance, Health Law & Policy, Pruitt's Platform | Tagged: ADA, BCBSTX, Blagojevich, Chicago Dental Society, CMS, Darrell Pruitt, DDS, dentists, IRAs, Kathleen Sebelius, Medicaid, NPI, Pat Quinn, Proots, TDA, Texas Dental Association, twitter | 10 Comments »

Top Ten Signs the ADA is Hunkering Down

Posted on November 23, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

About the American Dental Association

By Darrell K. Pruitt; DDS

Today, I especially cherish my right as a dues-paying member of the ADA – and as an American – to share my blunt, un-requested opinion as if you were a colleague, a patient or disinterested lawmaker.

For by early 2011, such liberty could warrant official sanction by the yet to be revealed national enforcer of the 2010 ADA Code of Conduct … if by then they find someone in the ADA capable of publicly announcing my crimes with a straight face, just before I receive a good talking-to about professionalism. If the future Ethics Enforcer would like me to help burnish his or her brand new gunslinger reputation quickly and deeply, I will gladly link any ADA official’s name to mine, and we’ll be companions for as long as I feel our union helps bring even more transparency to my profession. I’ve been an SEO assist for several ADA leaders for a couple of years already. Just ask ADA President Dr. Ron Tankersley – or – just Google his name.

Getting Spanked?

I’m not too worried about getting spanked. What can the ADA possibly do to me? Besides, officially, nobody will utter as much as a peep because of the transparency thing. Unofficially, ADA officials will privately send more attaboys because they trust me. They know by now that I never betray friends. I’m selectively transparent – which is my right but not yours, non-profit ADA. I think we both know, Dr. Tankersley, that I’m not the only one who thinks a minority of ADA leaders are playing naïve, childish and costly games.

Then again, it could just be my persistent, egocentric stage of emotional development that causes me to imagine that Resolution 82 is pointed directly at the nose of D. Kellus Pruitt; DDS.

“Patient rights, ethics considered” was posted on Nov 16 on the ADA News Online, and was written by Jennifer Garvin

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3843

Garvin writes, “Res. 82 asks that the following principles be considered for an ADA member Code of Conduct:”

1. Members will maintain high standards of integrity and conduct their dealings as members of the Association in a professional manner.

2. Members will treat other members and Association officers, trustees and staff with courtesy and respect, and shall refrain from conduct that is unreasonably disruptive or is harassing.

3. Members will respect the decisions and polices of the Association and will not engage in conduct that is disruptive to Association staff or causes the Association to expend an unreasonable amount of time or effort to address.

4. Members are encouraged to use proper Association channels of communication to address differences.

5. Members will comply with all applicable laws and regulations, including but not limited to antitrust laws and regulations.

6. Members will respect and protect the intellectual property rights of the Association, including any trademarks, logos and copyrights.

7. Members will not use Association membership lists for personal solicitation purposes.

8. Members will not use all or part of Association lists, including membership directory, online member listings, conference attendees and education course participants for selling, prospecting or creating a directory or database.

9. Members will treat all information furnished by the Association as confidential and will not reproduce materials without the Association’s written approval.

10. Members will avoid conflicts of interest.

Assessment

Garvin concludes: “The resolution also states that a proposed member code of conduct, together with proposed sanction and enforcement procedures, be presented for consideration by the 2010 House of Delegates.” It is probably earthly unprofessional to make light of authoritarian bluster, but this really reminds me of the John Landis film “Animal House” when Dean Wormer put John Belushi and other ΔΤΧ Fraternity misfits on double secret probation. ADA Trustees shouldn’t take themselves so seriously. It looks silly to those watching. Or then again, keep it up. After all, it looks silly to those watching.

Toga Party! Dentures 2 for 1! Just ask for Dr. Ron.

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Filed under: Op-Editorials, Pruitt's Platform | Tagged: ADA, ADA News Online, American Dental Association, DDS, Dean Wormer, DMD, Jennifer Garvin, John Landis, Ronald Tankersley | 4 Comments »

Don’t Hide a Security Breach if You Can’t Do the Time

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

When Will Costs Outweigh Health Information Technololgy?

[By Darrell K. Pruitt; DDS]

At what point will security data breaches become so costly that dentists will abandon computerization and return to pegboards and ledger cards?

Senate Judiciary Committee

A week ago, the Senate Judiciary Committee approved two separate bills which would mandate that dentists who store digital PHI notify patients if their data is breached. Of course, that would be the ethical thing to do anyway, wouldn’t it?

Senate Bill 139, also known as the Data Breach Notification Act, was introduced by Dianne Feinstein of California and is similar to existing state notification bills – including California’s own landmark Bill 1386 which set the standard 7 years ago.

Two Hundred Ten Dollars Cost – Per Record – for Notification

Considering that in October, the Ponemon Institute reported that it costs an estimated $210 per record to notify patients of a breach, there are a lot of angry lawmakers who are missing the point. Mandated fines for a breach are meaningless. Simply notifying thousands of patients of a breach will bankrupt any dental practice, even if it is an insurance company employee who loses a laptop computer containing a dentists’ patients’ personal data – like a BCBS employee did recently with over 800,000 physicians’ personal information.

Personal Data Privacy and Security Act

Even now, a dentist whose practice is a victim of a breach, whether it is from stolen computer, hacker or dishonest employee, might take a quick look at the notification path to certain bankruptcy and gamble that patients’ data won’t be used before hiding the incident. That is why Senator Patrick Leahy of Vermont has sponsored the other breach bill which reflects the prevailing attitude of frustrated constituents throughout the nation. It is known as the Personal Data Privacy and Security Act.

Leahy is more concerned with punishment than with breaches themselves. In addition to a fine, he would establish a jail term of up to five years for failing to disclose a breach when required.

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:s1490is.txt.pdf

§ 1041. Concealment of security breaches involving sensitive personally identifiable information

‘‘Whoever, having knowledge of a security breach and of the obligation to provide notice of such breach to individuals under title III of the Personal Data Privacy and Security Act of 2009, and having not otherwise qualified for an exemption from providing notice under section 312 of such Act, intentionally and willfully conceals the fact of such security breach and which breach causes economic damage to 1 or more persons, shall be fined under this title or imprisoned not more than 5 years, or both.”

If dentists want to continue to use computers in their practices, Leahy would have them put serious skin into the game. The bill was read twice and referred to the Committee on the Judiciary.

On the ADA Advocacy page, dental leaders still maintain that electronic dental records will lower the cost of dentistry. And as recently as last month, the ADA House of Delegates again publicly endorsed the adoption of eDRs, yet still neglect to adequately warn ADA members of their dangers, now including possible imprisonment.

Assessment

ADA President Dr. Ron Tankersley is already irrelevant.

Conclusion

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Filed under: Health Law & Policy, Information Technology, Practice Management, Pruitt's Platform | Tagged: ADA, Darrell Pruitt, Data Breach Notification Act, dentists, Dianne Feinstein, EHRs, EMRs, HIPAA, Patrick Leahy, Personal Data Privacy and Security Act, PHI, Ponemon Institute, Ron Tankersley, Senate Bill 139 | 13 Comments »

Don’t Tread on Me – Obama

Posted on November 12, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Bite Me – CMS

[By D. Kellus Pruitt; DDS]

Shy but proud Texas Dental Association leaders still direct employees to encourage members to volunteer for permanent, mandated National Provider Identifier numbers. Why? “Just ‘cause.”

As part of an agreement the TDA made with the state to help politicians out of a lawsuit they brought upon themselves for not providing adequate dental care for the poor in the state, TDA leaders followed someone’s bad advice to encourage Texas dentists to accept CHIP (Medicaid) – which requires dentists to have arbitrary 10 digit NPI numbers to participate.

Don’t get me wrong. I have the highest respect for dentists who treat the poor for pay that doesn’t even cover overhead. That is compassion to a fault – even before CMS investigators arrive with subpoenas based on vague, nuisance complaints from disappointed patients, disgruntled employees and hungry competitors. Getting even with rich, greedy, or otherwise mouthy dentists has never been easier because I’ve heard that CMS intends to investigate all complaints.

Yes, low pay is only part of the nasty package that TDA officials are officially discouraged from discussing with membership – even as they beg for us to sign up for CHIP and “do our part to return our debt to society by helping those who cannot care for themselves.” So who would dare question the reason for the faux sentiment expressed by a long string of TDA Presidents? That would be me.

There are simply so many other charitable ways of publicly and privately returning help to the community that don’t add to the risk of donating one’s skill. Even if one does not help local free clinics, how hard can it be to quietly give away care, Doc, in these hard times? It’s just between you and God anyway, isn’t it? One simply enters N/C in the fee column. Confidentially I sometimes get hugs that so far can be neither controlled nor taxed.

It appears to me that CMS is arguably more influential with TDA leaders than common TDA members like me. If I am correct, this means that dentistry is at risk of being overrun by authoritarian bureaucrats hired by ambitious politicians who often promise more than they can deliver before ducking accountability for earthly bad decisions. The business model even reminds me of the TDA’s.

So now that the TDA played its hand with regard to its fondness for BCBSTX and the NPI number, what does it mean for Texas dentists if Obama’s imminent “Public Plan Option” turns into “Medicaid for All” – as some naively hope and others justifiably fear? This week, the AMA gave its support to the Public Option. Will the ADA be next?

Dentistry unhurried is value-added service. One cannot get rich at it, but it’s an honorable living.

Regardless of whether you approve of my tactless vitriol or not, I have to say that when it comes down to feeding my family, even this special bastard could be silenced if there is no longer a market on the east side of Fort Worth for dentistry unhurried. Especially if it meant a monthly visit by CMS inspectors like Dr. Annie Bukacek is going through right now. Like me, she also gives her patients the time they deserve. But unlike me, she doesn’t have time to pick fights with shy bullies who hide behind employees.

I’ll get to the physician’s story in a moment. But first, just how important are secrets to the leaders of the nation’s preeminent non-profit dental organization? It’s important enough that many in the ADA House of Delegates want the power to mete out punishment to fellow officers who cannot keep their mouths shut. Some of those we elected even want to make the sanctions retroactive to deal with colleagues who have already broken the traditional unwritten good ol’ boy code of stoic conduct. At the same time, the TDA is begging dentists in the state to run for ADA office – starting on the local level. Why do you think dentists in Texas don’t want to get involved? Nobody accepts delivery from the cluetrain in Austin. It probably stops there at least a couple of times each week day.

I copied below three of the ADA Delegates’ referred resolutions from Judy Jakush’s November 2 ADANews article, “Delegates vote on Association business matters,”

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3821

1] Res. 70 states that if any member of the ADA, including delegation member, council, committee or task force member, or Board of Trustees member has been acknowledged as breaking the attorney-client privilege or executive session, that member is, at a minimum, barred from ever again participating in an attorney-client or executive session within the ADA. This shall include such acts which have been acknowledged as occurring prior to the enactment of this resolution.

2] Res. 67 would specify that candidates for elective or appointive officers may not have had any sanctions bestowed upon them by the Association. Also referred was Res. 67RC, which would direct that anyone found by the Committee on Credentials, Rules and Order to have violated his or her duties to the Association would be disqualified from holding elective or appointive office.

3] Res. 68 was referred to the Council on Ethics, Bylaws and Judicial Affairs for report to the 2010 House with recommendations for Bylaws changes. The proposal calls for CEBJA to review the Bylaws and craft language that would define the mechanism for sanctions up to and including removal from office of a delegation member or Board of Trustee member if there is found to be cause for removal as shall be defined. That cause, at a minimum, should include those causes as delineated currently for council members. Res. 68 also calls for a method for fair and impartial hearings to be recommended and the establishment of an authorized House committee that can be held on an ad interim basis between annual sessions of the House of Delegates with authority to determine and impose any such sanctions deemed appropriate.

Remember, the ADA is a non-profit, professional organization whose only purpose for existence is to serve dental patients through dentist members who support it with dues. When one reads these and other resolutions in Jakush’s article, it looks like ADA President Dr. Ron Tankersley is running the Pentagon. We’re only dentists for crying out loud!

Dr. Annie Bukacek’s 6-month battle with CMS

This morning I read what has turned out to be a popular article titled “Investigators descend on doctor,” written by Candace Chase, writing for the Daily Inter Lake which serves northwest Montana.

http://www.dailyinterlake.com/news/local_montana/article_d8cde54e-cc2d-11de-9ddd-001cc4c03286.html

“Dr. Annie Bukacek of Hosanna Health Care in Kalispell was surprised when a 30- to 40-foot-long command-post vehicle pulled up unannounced last week, along with a posse of state and federal health-care fraud investigators.”

“Bukacek points out that anyone – a disgruntled ex-employee or patient or someone who doesn’t like a physician’s looks or politics – could trigger an investigation and cost a physician as well as the government thousands of dollars.”

I wonder what would happen if a dentist openly taunts CMS leaders? As I previously mentioned, it is Dr. Bukacek who claims, “They said they have to followup every allegation made.”

When all American dentists are required to volunteer for NPI numbers and can no longer be legally paid in cash at the time of service, we’ll all be hung by an ADA-approved mistake of historic proportions. I suggest that ADA members take time right now to jot down names so that when judgment day inevitably arrives, one will be prepared to hold accountable the ADA employees who recommended the numbers. After reading how ADA leaders are hunkering down, it looks like going through employees will probably be the only way to touch the bosses they bravely try to shield.

Oh yeah. I posted the 5^th of almost 30 comments that so far follow Candace Chase’s provocative article:

“Dr. Annie Bukacek’s experience is why as a US citizen in the land of the free, I simply refuse to do business with the US government. Bite me, CMS. Did you hear me? I said bite me!”

Assessment

It’s not likely that I’ll regret those words because I am powerless to stop myself from typing them anyway.

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Filed under: "Doctors Only", Career Development, Health Insurance, Managed Care, Practice Management, Pruitt's Platform | Tagged: ADA, AMA, Annie Bukacek, BCBSTX, Candace Chase, CEBJA, CHIP, CMS, Darrell Pruitt, Hosanna Health Care Kalispell, Judy Jakush, National Provider Identification number, NPI, Ron Tankersley, Texas Dental Association | 2 Comments »

ADA Opens a Facebook

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

Perhaps too Early?

[By Darrell K. Pruitt; DDS]

Something strange has happened to www.DentalBlogs.com I think they have partially shut down their Facebook account. They no longer feature original articles such as those by Dr. Rhonda Savage and Ms. Linda Miles, and in the last couple of weeks, they eliminated their collection of photos. Now the site only features ads and press releases. Does anyone else wonder what happened? Sure you do! This is exciting.

Perhaps Re-Tooling

Unless they are just re-tooling this weekend, I suspect that since their previous format was biased heavily in favor of advertising dollars in a tough economy, their funding simply dried up. Like so many other advertising-related careers, the dinosaur found it couldn’t compete in a 2.0 market. Nevertheless, today I did learn something important from the DentalBlogs Wall: The ADA has opened a Facebook account.

http://www.facebook.com/home.php#/pages/American-Dental-Association/32252997166?ref=mf

Such transparency is inspirational

When I announced this news on Twitter a few hours ago (“Proots”), neither the ADA nor the TDA had yet told membership. Yea, I scooped them on their in-house news. It happens all the time. Naturally, I became a fan of the ADA Facebook. When I joined, there were already 1205 fans, even though the site is yet operational. I found that intriguing because it usually takes a long time for most FBs to attain 1200 fans – especially when all one can gather is the mission statement of the ADA’s newest Internet site.

My View

Here’s what I see: About the time DentalBlogs laid off employees from their fully active Facebook, the ADA opened theirs (Gasp)! The ADA was well known to DentalBlogs because the ADA once advertised with them regularly. That is where I found an article about the ADA-approved CareCredit/GE that ended up causing problems for some people and entertainment for others. Let’s face it, friends. I just know that I’m not the only dentist in the nation with at least two burning questions. I bet at least 4 others are wondering who were the first seven fans to sign up for the ADA Facebook and Has Kim Volk, CEO of DDPA signed up yet?

Because the number of fans is rapidly piling up, such information from a few weeks (?) ago could soon be just too difficult to uncover from the fans list on the ADA site. It took a long time for me to scroll down through 1200 names – looking for those I recognize (Gasp)!

Scrolling Quickly, but Carelessly

I could have easily missed several easily recognizable names in contemporary dentistry, but as far as I can tell, not only was Delta Dental Plans Association CEO Kim E. Volk’s name not present in the list of 1200 fans, but there were very few names I recognized … and I’m sorry if I insulted anyone. I also did not see “Ron Tankersley” and other ADA officials’ names on the fans list. Didn’t the ADA try partial transparency like this once before? I may be wrong, but I think I played a role in shutting it down a few years ago with my persistent and still unanswered questions about the NPI number.

More Semi-Reliable Information

Here’s another bolus of semi-reliable information: I also quickly scrolled through DentalBlog’s list of 400 fans and did not notice an unusual amount of matches with the ADA Facebook fans list.

Those who dare to do so, might just ask, “So if the ADA fans didn’t come from dentalblogs, where did they come from?” I think one possibility is that the ADA effort has been in Beta and limited to a select group of people up until now. Doesn’t it seem strange that nobody is able to post anything? Did someone open the doors a few hours early? So who were the first 7 fans? No, you don’t have to scroll down to find out for yourself. I’ll tell you.

Who is John Hergert?

The first person to become a fan of the ADA Facebook account is named John Hergert from Chicago, Illinois.

2nd – Laurie Rich

3rd – Amy Lund

4th – Kelsey Majors

5th – Jessica Stevens

6th – Samantha Campbell

7th – Lina Kulkormi

I don’t recognize any of the seven, and I have not searched anyone’s name other than John Hergert’s – the first person to become a fan of the ADA Facebook. I found someone named John Hergert in Chicago, Illinois who is Associate Vice President at Lipman Hearne Inc. – an advertising agency.

http://www.spoke.com/info/p6JVgPy/JohnHERGERT.

Here is the bio of the person I only suspect is the first to become a fan of the ADA Facebook.

John Hergert’s Biography

John Hergert Associate Vice President John Hergert has a keen understanding of what it takes to capture and hold the attention of marketing audiences via innovative marketing techniques. Formerly Associate Director of Marketing Communications at DePaul University in Chicago, John works with both traditional and interactive media to design and implement marketing strategies that build a client’s image, increase support, and grow enrollment or attendance. John’s experience includes developing ROI-based marketing strategies for a variety of nonprofit and for-profit clients. Prior to DePaul, John was an account executive overseeing marketing and advertising strategy, web development, direct mail, print production, and promotional development for clients including Disney, Marconi, Owens Corning, and Reynolds. John began his marketing career while at the University of Wisconsin, where he was hired by a Los Angeles firm to implement cutting-edge marketing programs for Saturn and Trek Bicycle Corporation. John received his B.A. in Journalism from the University of Wisconsin and his Master of Science in Information Systems from DePaul University.”

Assessment

What do you want to bet that the ADA Facebook is Mr. Hergert’s baby?

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Conclusion

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Dictionary of Health Economics and Finance
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Filed under: "Doctors Only", Career Development, Ethics, Op-Editorials, Pruitt's Platform | Tagged: ADA, Amy Lund, CareCredit, Darrell Pruitt, DDPA, delta dental, DentalBlogs, GE, Jessica Stevens, John Hergert, Kelsey Majors, Kim Volk, Laurie Rich, Lina Kulkormi, Linda Miles, NPI, Rhonda Savage, Ron Tankersley, Samantha Campbell | 32 Comments »

Why ADA / Intelligent Dental Marketing Failed?

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

The ADA is an Incredible Dinosaur

By Darrell K. Pruitt; DDS

As a member of the ADA, I am also a part owner in any business venture the leaders of the organization enter into. I’ve observed the loss of my investment in a business deal because my employees made mistakes. As a business owner, it would be simply irresponsible for me to ignore something like this.

The Embarrassing Story

Do you know what part is missing from this embarrassing story? The ADA has not uttered a word about the ADA/IDM failure… Or, as the ADA Business Enterprise Inc. leaders call it – the ”ADA/idm” failure.

The fact that the two business entities never came to an agreement on what to even call their doomed joint venture reveals a lot about the egos that gummed up the machinery. It’s possible that pride undermined our non-profit/for-profit partnership from the very start. We just don’t know what happened because there are so many possible reasons for this business model to fail. Will loss of ADA members’ investment happen again if the cause is not recognized and eliminated? I think the chances are pretty good that even more embarrassment is on the way. Given the soft environment, it’s only natural.

Over my 27 year career as a dentist, I have met many ADA officials, both employed and elected, on all three levels of the tripartite system of governance – local, state and national. From the topmost quality of character I have witnessed in all but a few politically-empowered and proudly insensitive exceptions, I can assure you that like all major projects of the ADA, the failed ADA/IDM adventure into dental marketing was assembled with nothing but noble intentions and benevolent wishes for ADA members and dental patients – at least from the ADA side. Whether the leaders of the ADA’s new business partner, Intelligent Dental Marketing out of Utah, were dedicated to serving ADA members in a captive market is unlikely. The ADA/IDM business model is sort of like managed care dentistry. When dentists sign contracts that provide them with clients regardless of how they are treated, there is a natural tendency for dentists to become unappreciative of those who pay their bills.

Little Consumer Competition

The ADA allows Americans to experience what socialism is like in markets where there is no competition for consumers: Professionals such as dentists stop trying to please their patients, and IDM stops trying to please dentists. If IDM was a decent company before the business venture with ADA membership, the ADA ruined them with a sweetheart deal that included protecting them from competition, as well as shielding them from complaints by angry ADA members. And like dental patients with preferred provider lists, ADA members noticed the bad treatment. However, complaints were never made transparent even as more ADA members where signing contracts with ADA/IDM. That is unfair and unethical.

Just Google for Complaints

Want to see what an embarrassment in situ looks like? Just Google “CareCredit complaints.” ADA-approved CareCredit/GE has a long history of sweetheart deals like the one they made with ADA leaders. Their trail is always marked by complaints. The ADABEI is selling ADA members’ reputations. I just read ADA reporter James Berry’s article highlighting outgoing ADA President Dr. John S. Findley’s address to the House of Delegates that he gave on Friday. The article is titled, “We built our home on a foundation of science and values: Dr. Findley”

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3771

One free-standing paragraph in the article caught my attention that perhaps exposes a symptom of the pride and secrecy that surrounds the ADA/IDM disaster. In the middle of the article, James Berry offers this cryptic message that was obviously not meant for all members to understand:

“On the Association itself, the president noted that the ADA has undergone significant change in the past year and a half. As problems were discovered and defined, he said, the leadership acted to resolve them.”

Was the ADA/IDM fiasco one of the problems that was resolved? Did they resolve the problem with CareCredit/GE causing ADA members to be covered by the Red Flags Rule – and not letting members know about it? Did they resolve the problem of data breaches and how they can mean certain bankruptcy for ADA members, even if the members do the right thing?

Possibly

We just don’t know which problems were resolved, but somehow we should feel much better, now that President Findley got the message out to mid-level ADA leaders who probably know exactly what he is referring to. And, by protecting lower caste members from knowing things they don’t need to know, problems are quietly resolved and the profession’s image is preserved. “Image is everything” – ADA/IDM business slogan.

“Findley for the future”- Dr. John S. Findley’s campaign slogan.

Bingo! We have a match.

We should not forget that before IDM leaders got in way over their heads and started doing foolish things like marketing Search Engine Optimization (SEO) talents they lacked, there has not been a dues increase for a couple of years – in part because of the profits that were churned from ADA/IDM purchases ADA members made. I am certain that the ADA Business Enterprise Inc’s failure breaks the hearts of sincere and devoted leaders in the ADA who would have never recommended going outside the ADA’s Mission Statement had ADA employees been transparent with them. The officials of IDM couldn’t care less. Their part of the venture is much easier to dissolve for the Utah businessmen. They just picked up and walked away. However, the ADA officials have a fiduciary responsibility to members who trusted them. Once again, virtually all of the ADA leaders are just like you and me. Some just got in too deep on our behalf and couldn’t shut the mistake down before members got needlessly hurt.

Officials in other businesses the size of the ADA are held accountable for their mistakes and are not afforded the opportunity to filter communications with the owners because of image concerns. This kind of sweetheart deal for business executives, most of who come from Delta Dental, UnitedHealthcare or both, as in the case of the new executive director, Dr. Kathleen T. O’Loughlan, occurs only in the ADA and to a lesser extent in the US government and dental insurance industry.

Assessment

The state of the ADA is not nearly as rosy as Dr. Findley would have us believe. I think we have all seen authoritarian leaders re-write history. The ADA is an incredible dinosaur.Business can be ugly in the highly competitive land of the free. If businesses don’t take risks, we cannot move forward. For that reason, mistakes are expected. But never forget. Owners expect to be told about them.

Channel Surfing the ME-P

Conclusion

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FINANCE: Financial Planning for Physicians and Advisors
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Dictionary of Health Economics and Finance
Dictionary of Health Information Technology and Security
Dictionary of Health Insurance and Managed Care

Filed under: Career Development, Ethics, Managed Care, Marketing & Advertising, Op-Editorials, Practice Management, Pruitt's Platform | Tagged: ADA, ADA/IDM, ADABEI, CareCredit, Darrell Pruitt, DDS, delta dental, DMD, doctoroogle.com, Dr. John S. Findley, Dr. Kathleen T. O’Loughlan, IDM, Intelligent Dental Marketing, James Berry, UnitedHealthcare | 11 Comments »

Encrypt or De-identify PHI

Posted on September 28, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Which One Just Might Work?

[By Darrell K. Pruitt; DDS]

The United States’ advancement in Healthcare Information Technology, which has the potential to lead to wonderful money-saving cures through research using trustworthy interoperable health records, is currently stopped cold by patient security problems that are only getting worse. Our lawmakers cannot get around the security obstacle without resorting to authoritarian means using CMS’s power to withhold providers’ discounted payments and threats of obscene fines from the HHS and the FTC. History shows that tyranny is not tolerated well in this part of the world. Lawmakers can get their butts voted smooth out of office in my neighborhood.

HITECH

Here is something nobody mentions: Despite the current hope in a thick, political fantasy called HITECH, encryption of patients’ Protected Health Information [PHI] is a non-starter in the land of the free. Everyone knows that resourceful, cynical Americans will simply never trust encryption to protect their secrets, and will reliably withhold important information from their eMRs – one way or another. Doctors as well as patients can be expected to go out of their way to sabotage technology they fear. We all intuitively know this is true, don’t we? We aren’t so naïve to think all the players will happily play by the rules, are we? And I think we can all agree that an untrustworthy digital health record in an emergency room is worse than no patient information at all. Security is a grand problem with eMRs that started with HIPAA changes in 2003 that made eHRs so slippery. And the problem is clearly not being resolved. Not yet.

Public Lacks Trust

Regardless of the campaign donations which follow him, there is nothing Newt Gingrich and his entrepreneurial friends in high places can do about the public’s lack of trust in encryption. It gets worse: Encryption hasn’t a chance of isolating PHI from dishonest employees in doctors’ offices, and slippery digital patient data can be moved soo easily. Everyone knows that as well, don’t they? It is estimated that two-thirds of the identities stolen in the nation are lifted from doctors’ offices. That’s us, Doc. HIPAA is not only irrelevant, it is an expensive distraction – it gives future ID theft victims a false sense of security.

HIPAA Approved

De-identifying digital records is not mentioned in HITECH as a HIPAA-approved method of security. Yet it is the ONLY solution that promises to be even more secure than paper records. Because of heavy stakeholder stakes in hospital care, it will take longer for CEO-types to embrace patient-friendly de-identification. Other than identifiers such as names, social security numbers, birthdates, addresses and other items that have street value, NOBODY cares what is in a dental record. I actually think this opens a tremendous opportunity for someone courageous in the Texas Dental Association to discuss the feasibility of de-identification of dental records. Otherwise, instead of leading the nation in solving security problems, the TDA will look just as stupid as the ADA.

Encryption would also provide a dangerous false sense of security in eMRs – that is if it had a chance in the marketplace. But encryption will never go far because consumers simply won’t buy it. That is a marketplace fact that stoically optimistic HIT stakeholders are trying hard to avoid. They also know they are running out of time. Deadlines are quickly approaching for both HIPAA and the Red Flags Rule that providers are far from prepared for.

Former Attorney Speaks

Bill Lappen, a former attorney and author of the ad I copied below, as well as a partner with his brother David in the de-identified health record venture says: “Since no identifying information is ever entered, a hacker can’t determine whose information is shown.”

So in addition to protecting one’s practice against dishonest or vindictive employees, de-identification of dental records would make hacking a dentist’s computer a complete waste of time, and hackers wouldn’t endanger dental patients and bankrupt dentists.

My Confidence

I confidently tell you that soon, someone smart will come upon the unprecedented idea that the ultimate answer to our security problem in healthcare will be de-identification of medical records, not encryption. De-identification allows a compromise of privacy for only a miniscule percentage of physicians’ patients. We cannot allow that to stand in the way of better health for everyone else. Those special cases are so few that I am confident that they can be dealt with individually. We simply must move forward. I’ll have to retire some day. I may need help from Medicare.

Encryption gives us only danger and protects nobody but a thief with a key.

Assessment

We’ve wasted enough time on HITECH and HIPAA, as well as CCHIT. It’s time to say no to stakeholders and pay attention to patients’ needs instead of those who would needlessly increase the cost of their care. Stimulus money attracts cockroaches.

In the name of Hippocrates, disregard the tainted HIPAA mandate. It is dangerous, and especially absurd in dentistry.

Link: http://www.theopenpress.com/index.php?a=press&id=58568

Life-Saving Patient Information can be Online, Anonymous and Usable

Published on: September 26th, 2009 12:19am

By: blappen

Los Angeles, CA (OPENPRESS) September 26, 2009 — Hospital Emergency Rooms need instant access to patient medical information. Allergic reactions and dangerous drug interactions can be deadly. Time is critical. Until now, privacy was a large concern. Two brothers, who have developed medical software over the past 15 years, think they have a simple first step towards moving patient information on to the internet.

“The ER doesn’t need to look up the information by patient name” said Bill Lappen, a former attorney. “We have implemented secure systems in the past, but no matter how secure we make the site, we have to assume that it will be hacked” added David Lappen, a computer design engineer from Stanford. “But providing instant access to life-saving information is too important to ignore”, he added. To protect patient privacy, their system does not know to whom the medical information belongs. Since the person’s identifying information is never on the system, it can’t be stolen. “By enabling anonymous entry, we have protected people’s privacy while allowing them to put their life-saving information in a place where it can be instantly accessed when needed”, added Bill Lappen.

www.AMCC.me is the public service website they created. It allows anyone to enter medical information anonymously. The site provides a random ID which the user carries in his/her wallet. For someone to see that user’s medical information, they merely enter the ID into the site. Unless the user has given them their ID, the information shown is meaningless. That same information, when associated with a patient, can save their life.

Since no identifying information is ever entered, a hacker can’t determine whose information is shown. “Secure patient-controlled Electronic Medical Records are now available on the internet” said David Lappen. A sample ID has been set up on the site to allow users to evaluate the concept before setting up their own free ID.

Contact:

Bill Lappen

Bill@AMCC.me

(818) 789-6531

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Filed under: Ethics, Health Law & Policy, Information Technology, Op-Editorials, Pruitt's Platform | Tagged: ADA, ARRA, Bill Lappen, CCHIT, CMS, Darrell Pruitt, David Lappen, EHRs, electronic medical records, EMRs, encryption, FTC, healthcare information technology, HHS, HIPAA, HIT, HITECH, ID theft, Newt Gingrich, PHI, protected health information, red flag rules, www.AMCC.me | 3 Comments »

Dr. Pruitt Invites Dr. Cohen to Discuss eDRs

Posted on September 10, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Where is the ADA’s Representative?

By Darrell K. Pruitt; DDS

He or she should have been talking with me long ago. I have the audience and I’m giving you that opportunity I promised you, Dr. Donald Cohen.

Rest Easy

I’m aware that I possibly make you uncomfortable, considering how “unprofessionally” I’ve publicly treated lesser devoted HIPAA consultants. Rest easy! As soon as I read your article, I could tell that you’re different from your colleagues I’ve met. First of all, like me, you’re a dentist. That’s very important. Secondly, your credentials are impressive and reveal that compliancy is not a hobby for you like it is for others. Nobody can accumulate a history as impressive as yours without professional dedication. The last point, and the most important of the three, you seem honest about HIPAA compliance.

A Professional

It wasn’t lost on me that in your article you were professionally non-judgmental of the Rule. Instead of trying to justify a defenseless law, your job is to help dentists comply with the mandate as it is written or risk significant fines. Like tax-collecting, someone’s got to do the job of delivering bad news. You have a legitimate purpose to be involved in the dental industry, even if what you teach makes little difference at all if a dentist’s records are breached. I argue that following the inevitable bankruptcy from a breach, HHS fines are hardly a deterrent. And that is the issue: eDRs containing patient identifiers are too risky for the marketplace.

Electronic Dental Records

I think you would have to agree that eDRs are going nowhere until records are safe, and encryption is not going to be sufficient to protect dentists against dishonest employees. Ambitious bureaucrats in waiting, such as HIPAA consultants Travis Criswell, Sharalyn Fichtl, Kelly Mclendon and Olivia Wann – not a dentist among them – hooked their careers to the HIPAA mandate to avoid the tough sales jobs competition otherwise demands in the free market. All four share an authoritarian misconception that since it is the law, dentists will be forced to purchase their products – even if they are utterly senseless. I think we both know that they are oh so wrong. I promised earlier to give you an opportunity to publicly support truth in eDRs if you so choose. Perhaps we could rationally discuss in front of everyone how dentists can wriggle free of the approaching mess. There is no pressure here, other than this is public invitation. Since you haven’t made unrealistic claims about eDRs like others have, I am not interested in hounding you further. I simply ask you to consider responding to the article I posted in your name on PennWell titled “Dr. Donald Cohen’s opportunity.”

http://community.pennwelldentalgroup.com/forum/topics/dr-donald-cohens-opportunity

Assessment

I sincerely appreciate the respect you have shown me, and I pledge to afford you the same. Of all the consultants I have approached with my concerns about HIPAA and eDRs, you are the first to even acknowledge a problem simply by posting my concerns. I think you have the courage to face the realities of the marketplace, while others foolishly think dentists are a captive market.

Note: I submitted this to be posted following an August 28^th press release posted by HIPAA consultant Dr. Donald Cohen titled, “Dentists Should Know about New HIPAA Rules.”

http://www.dentalblogs.com/archives/administrator/dentists-should-know-about-new-hipaa-rules/comment-page-1/#comment-35672

If you are interested in discussing the topics of interoperability with fax machines, de-identified eDRs and security that surpasses paper records, in front of you is the opportunity to address your largest audience yet, Dr. Cohen. I’m self-syndicated.

Note: Do you realize that if Dr. Cohen takes me up on the offer, this will be the first time two dentists have openly discussed eDRs on the Internet? Do you think it’s about time?

Conclusion

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Filed under: Information Technology, Practice Management, Pruitt's Platform, Quality Initiatives | Tagged: ADA, American Dental Association, Darrell Pruitt, DDS, dental records, DMD, doctoroogle.com, Dr. Donald Cohen, eDRs, EHRs, ePRs, health information technology, HHS, HIPAA, HIT, IT, kelly McLendon, medical records, Olivia Wann, PennWell, Sharalyn Fichtl, Travis Criswell | 11 Comments »

Your Chance to be Heard on the ME-P

Posted on August 29, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

What Gripes You?

By Ann Miller; RN, MHA

[Executive Director]

The Medical Executive-Post is among the web’s most influential and well-read health economics and financial blogs, with more than 100,000 subscribers. But, we refrain from Twitter triteness on our more than 50 topic channels with deep experienced gravitas.

Reach our Audience and be Heard

You can have the opportunity to reach this target audience by submitting a guest opinion piece or post on anything related to health care economics, medical practice management and physician focused financial planning. Articles of about 500 words in length, free of grammatical and spelling errors are preferred. Accepted pieces will not only be published on the blog, but may be syndicated on affiliated networks, as well as an e-newsletter distributed to thousands.

Professional Organization Members

Members of professional organizations, such as the American Medical and Dental Association, and the Financial Planning Association, already contribute as individual readers and subscribers. Other writers refuse to join these organizations for various reasons. They too are welcomed. There is also an opportunity to become a regular contributor to the blog if several, quality, guest posts have been accepted and published.

Assessment

Articles for consideration can be e-mailed directly to me.

MarcinkoAdvisors@msn.com

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ADA President and Broken Promises

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

The Future President

By Darrell K. Puritt; DDS

The election for a future ADA president occurs the first week in October in Hawaii at the 2009 annual meeting. A couple of days ago, the ADA News Online posted the ADA President-elect candidates’ statements.

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3133

All three sound like they support meaningful dialogue with membership: Candidate Dr. Raymond Gist says one of his goals is: “To protect and preserve ownership of the intellectual property of the ADA while demonstrating transparency and fostering an understanding of how our system works.” Candidate Dr. William Glecos says “My first goal will be to coordinate and improve our communication efforts within the ADA. To make sure we are engaging all our members and imparting a sense of connection and transparency.” Candidate Dr. Marie Schweinebraten says “… communication, internal and external, must be improved to respond in today’s world … barriers must be eliminated to allow member input and volunteer involvement when solving specific issues.” I’ve seen candidates use these same buzzwords before, but not mean them. Dentistry is being severely threatened right now, and I’m too young to retire. So I want to see a future leader confident enough to walk through fire with me on behalf of my patients.

Promises from ADA President-elect candidates have been very disappointing so far. Past President Dr. Mark Feldman, President Dr. John Findley and President-elect Dr. Ron Tankersley each promised “transparency.” Feldman and Findley broke their promises very early, and so far, Tankersley has done no better. Nine months ago I invited Dr. Tankersley to a conversation about the future of electronic dental records and he chose to insult me with silence rather than respond. I took it personally, Ron, and I’ll never forget it. Because all three of these presidents are simply rude people, it wouldn’t bother me to never ask any of them for friendship.

So do you think our fresh leaders are any more sincere about transparency with membership? Or are they also hoping to be safely elected. This could be an opportunity for one or more of the three to break loose and be counted as a brave leader… or not. Let me show you what Feldman, Findley and Tankersley have gotten us into. Below is a list of duties expected of dentists with NPI numbers that came out today on ANCO Online. If any of you three candidates have the courage to respond to my challenging comments about what I consider to be a perfect example of a renegade department, jump right in. Concerned members need to be warned about the courage we can count on. If you cannot defend the Department of Dental Informatics, just say so. We’ll all be better off. And on truth, we can build. What an opportunity for you! I bet one could easily gain the delegates’ attention by doing the right thing, even if it is unpopular at first to those who may have helped you to power.

Responding to this article in a respectful, professional way could be just what it takes to get a person elected to the highest position in the American Dental Association. That’s what you intensely want, isn’t it? You just have to recognize what I am spelling out for you, Raymond, William and Marie. Just look at the growing discontent with the ADA on the Internet. Whoever is the first to show sincerity and courage, will become a hero to those of us who feel betrayed by those we once trusted. Victory will never be easier. I’ve had a look around. Believe me when I tell you that things are soo bad that even I could be a contender. Don’t make me run for the job.

Here is the first issue for discussion if you are interested: For dentists who were persuaded by the ADA Department of Dental Informatics to quickly volunteer for the 10 digit identifying number, let me ask you this: If you had been told what ADA employees are paid to tell you, which you can read below, would you have applied for an NPI number? And if you were forced to apply for a number by a managed care contract with BCBSTX, Delta Dental or other discount dentistry broker, would that be considered an unfair business practice?

Let’s look at fairness: Who does the NPI number help? Dental patients or BCBSTX? Or perhaps the ADA? We were told again and again in ADA News Online articles written by Arlene Furlong that the best reason for the NPI number was convenience. She said office managers would love it because it would replace numerous identification numbers. When one reads the list of NPI obligations a dentist volunteers their office manager for, all those other numbers don’t seem so bad after all. Why was HIPAA so important that the ADA Department of Dental Informatics forced employees under its supervision to intentionally mislead membership? Does the ADA work for dentists and their patients or for CMS? There you go, Dr. Raymond Gist, Dr. William Glecos and Dr. Marie Schweinebraten. It’s your turn now. If you have the guts to step up to a challenge, it could pay off big. Besides, even if you get elected without first responding to my concerns doesn’t mean you’ll get rid of me. Oh heaven’s no.

D. Kellus Pruitt; DDS

http://anco- .blogspot.com/2009/08/asco-coa-cms-palmettoj1mac-news.html

**** CMS NEWS ****

This message is for health care providers, particularly physicians and other practitioners, who have obtained National Provider Identifiers (NPIs) and have records in the National Plan and Provider Enumeration System (NPPES). The Centers for Medicare & Medicaid Services (CMS) recommends that each health care provider, including individual physicians and non-physician practitioners: · Secure and maintain their own NPPES account information (i.e., User ID, Password, and Secret Question/Answer) for safety and accessibility purposes. Health care providers should maintain the confidentiality of their User ID, password, and Secret Question/Answer in order to protect their NPPES information from unauthorized access. Reset their NPPES passwords at least once a year.

See the NPPES Application Help page at https://nppes.cms.hhs.gov/NPPES/Help.do and select the ‘Reset Password Page’ for applicable rules. Those rules indicate the length, format, content and requirements of NPPES passwords. Review their NPPES records in order to ensure that the information reflects current and correct information. Covered health care providers are required to update their NPPES information within 30 days of the effective date of the change.

Viewing NPPES Information Health care providers, including physicians and non-physician practitioners, can view their NPPES information in one of two ways: (1) By accessing the NPPES record at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created. If the health care provider has forgotten the password, enter the User ID and click the “Reset Forgotten Password” button to navigate to the Reset Password Page. If the health care provider enters an incorrect User ID and Password combination three times, the User ID will be disabled. Please contact the NPI Enumerator at 1-800-465-3203 if the account is disabled or if the health care provider has forgotten the User ID. OR (2) By accessing the NPI Registry at https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do.

The NPI Registry gives the health care provider an online view of Freedom of Information Act (FOIA)-disclosable NPPES data. The health care provider can search for its information using the name or NPI as the criterion. Information regarding NPPES data that are FOIA-disclosable can be found at http://www.cms.hhs.gov/NationalProvIdentStand/ by selecting ‘Data Dissemination’. Please note: Business Mailing Address and Business Practice location information (full address and corresponding telephone numbers) are key data elements that are FOIA-disclosable.

Health care providers should not report their residential address unless it is their Business Mailing Address or Business Practice location. The NPPES data appearing on the NPI Registry cannot be deleted; however, it can be updated or changed. Updating NPPES Information Health care providers, including physicians and non-physician practitioners, can correct, add, or delete information in their NPPES records by accessing their NPPES records at https://nppes.cms.hhs.gov/NPPES/Welcome.do and following the NPI hyperlink and selecting Login. The user will be prompted to enter the User ID and password that he/she previously created.

Please note: Required information cannot be deleted from an NPPES record; however, required information can be changed/updated to ensure that NPPES captures the correct information. Certain information is inaccessible via the web, thus requiring the change/update to be made via paper application. The paper NPI Application/Update Form (CMS-10114) can be downloaded and printed at http://www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf.

Deactivating the NPI Health care providers, including physicians and non-physician practitioners, can deactivate their NPIs if the NPIs are no longer required or needed. Reasons for deactivation include retirement, business dissolved, or death of the health care provider. A request for deactivation must be submitted via paper application. The paper NPI Application/Update Form (CMS-10114) can be downloaded and printed at http://www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf.

Health care providers should review the instructions located on the application regarding deactivations in order to properly complete the deactivation request. The Power of Attorney or Executor of the Will may complete the application for deactivation due to death of the health care provider.

Need More Information?

Providers can apply for an NPI online at https://nppes.cms.hhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203. Visit CMS’ dedicated NPI web page at www.cms.hhs.gov/NationalProvIdentStand for additional NPI information.

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Filed under: Career Development, Ethics, Health Insurance, Health Law & Policy, Information Technology, Managed Care, Op-Editorials, Practice Management, Pruitt's Platform | Tagged: ADA, American Dental Associaion, ANCO, Arlene Furlong, BCBSTX, Darrell Pruitt, DDS, delta dental, Department of Dental Informatics, DMD, doctoroogle.com, HIPAA, john findley, Marie Schweinebraten, mark feldman, NPI, NPPES, OSHA, Raymond Gist, Ron Tankersley, William Glecos | 8 Comments »

Journal of the American Dental Association [Letter to the Editor]

Posted on July 28, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

ADA Image Tarnished?

[By Darrell K. Pruitt; DDS]

Dear Editor,

This is a sincere letter which I am sure you will agree should be published in the October 2009 edition of the JADA. Today is July 19, 2009. I am allowing for the six weeks minimum time it requires for letters to appear in print following their selection for publication. It will be posted on the Internet immediately. In spite of this, I trust you will eventually agree to publish it in spite of your archaic rules. Otherwise, by November, history could show that the editor of the JADA arguably denied representation of dental patients’ interests at a most critical time in the history of the profession. That would be regrettable for your own professional reputation as well as for the JADA’s. As an ADA member, if my concerns are ignored, I will hold you publicly accountable for an explanation for a long time.

Public Laundry

From now on, we will agree to wash our laundry in public because otherwise it doesn’t always come clean. You can call the pressure I bring unprofessional if you want, but following the ADA News’ public exhibition of their shoddy ethics this week, it would be foolish to use my methods as an excuse to deny my access to membership. As I am certain you are aware, there were three revisions of “ADA/idm to phase out service” on ADA News Online (7/10, 7/13 and 7/16). I not only welcome a wide-open public discussion about ethics in journalism with representatives of the JADA, but I encourage it. We both know that the ADA needs clean laundry now more than ever before in its history.

ADA Business Enterprises, Inc.

For members who haven’t heard, the 2 ½ year old joint venture of our ADA Business Enterprises, Inc. (ADABEI) with Intelligent Dental Marketing – a Utah-based private business – fell apart in late spring of this year. Months later, our ADA leaders are still less than transparent with membership about what went wrong. I’ve been in business long enough to know that if mistakes by employees are not revealed and discussed, they are bound to happen again and again. And, it’s not like the leaders of the ADA were not warned. They just didn’t take heed. By late 2007, many knowledgeable people involved in the dental industry easily recognized the faults in the partnership between our non-profit professional organization and a for-profit Utah advertising company. In hindsight, anyone can see that ADA/IDM’s slogan, “Image is everything,” clearly betrays an attitude inconsistent with both the mission of the ADA and the Hippocratic Oath. Nevertheless, even the spirit of the slogan was regretfully adopted by the leaders of the ADA’s Business Enterprises, Inc. Now it is the image of the entire ADA that is suffering the damage.

ADABEI

I personally began questioning the accountability of the tricky ADA/IDM business model over two years ago when the profits from ADABEI had officials excited about avoiding the need to raise membership dues last year. Not unexpectedly, in the atmosphere of euphoria, nobody in Chicago wanted to acknowledge the concerns of a handful of alert members. We were cast aside as troublemakers. So how critical is the risk? With massive, unprecedented health care legislation imminent, this is the worst time imaginable for our stoic, image-conscious officers to lead us to nation-wide embarrassment.

Following the Money

The surrender to such temptations for leaders of non-profit organizations is not unprecedented. Do you know why the dues for the American Association of Retired People (AARP) have been kept so low? Not unlike the ADA, the non-profit AARP reaps profits from insurance policies and other products that its leaders sell to membership – even using misleading ads in AARP dues-supported publications. However, unlike dues money, vendor “kickbacks” don’t depend on accountability to members. A few years ago, the profits derived from agreements with vendors predictably became the lifeblood for AARP’s self-perpetuating bureaucracy – eventually influencing their lobbying efforts. Since non-profits like the AARP and the ADA are traditionally respected by lawmakers who like huge campaign donations, a non-profit entity’s lobbyists can be tempted to quietly represent vendors’ interests at members’ expense. Sometimes they get caught.

Lost Confidence

Almost a year ago, the AARP lost valuable member confidence when the organization was forced to suspend sales of “limited benefit” health plans backed by UnitedHealth Group (of Ingenix fame). Sen. Chuck Grassley said the plans which leave policyholders vulnerable to tens of thousands of dollars in costs were sold by the AARP to naïve and trusting members using misleading marketing tricks – not unlike those used in the ADA’s promotion of ADA/IDM. Sen. Grassley sent a detailed letter to CEO Bill Novelli demanding answers to questions about health insurance plans promoted to over a million dues-paying AARP members. Grassley told USA Today reporter Julie Appleby that “Insurance is supposed to limit your exposure to the potentially high cost of a serious illness and these plans do the opposite.” (Nov 7 2008).

http://www.usatoday.com/news/health/2008-11-07-aarp-insurance_N.htm

Is AARP-level accountability as good as it gets?

I say no. Attention ADA members – It is my opinion that our leaders are losing the control of our professional organization. The recent failure of ADA/IDM isn’t the first glaring sign of trouble in Headquarters. Over a year ago, the executive director, Dr. James Bramson, was suddenly fired with no explanation. In fact, then President Dr. Mark Feldman commanded that the reasons for the firing will not be disclosed. Obediently, ADA leaders have so far maintained firm control of the top secret information which if released could somehow endanger dental patients (?). Because Bramson’s severance pay came from my dues and not out of Dr. Feldman’s pocket, I think I deserve to know more details. Otherwise, this mistake could happen again and again.

The ADA/IDM disaster is also not the only ADABEI embarrassment I see on the horizon. It is my opinion that CareCredit is also showing signs of silent desperation. On July 9, the officials of the wholly-owned ADA subsidiary purchased an ad on dentalblogs.com titled “Press Release: CareCredit Adds 24-Month, No-Interest [sic] Payment Plan” (no byline).

http://www.dentalblogs.com/archives/administrator/press-release-carecredit-adds-24-month-no-interst-payment-plan/

Even though I approve of the benevolence in the idea of extending credit to those with worsening dental problems – especially during these hard financial times for patients – the anonymous CareCredit (ADA) representative who posted the ad failed to respond to my timely and important question: “If the Red Flags Rule is not delayed for the third time in three weeks, how will it affect those who offer Care Credit?”

Assessment

Nor did he or she respond to my follow up response on July 13. “On July 9 at 4:54 pm, I submitted a sincere question concerning how the Red Flags Rules will affect ADA members who sign up for CareCredit. Instead of posting it with the promise of an answer, you regretfully chose to censor an ADA member. Today, July 13, I have a second and third question: Why did you ignore my first one and who is your boss?”

Conclusion

So far, I’m still waiting for responses to all three questions. I trust you will treat my concerns with more respect, Editor.

Conclusion

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Filed under: Breaking News, Career Development, Ethics, Health Insurance, Managed Care, Op-Editorials, Pruitt's Platform, Research & Development | Tagged: AARP, ADA, ADA Business Enterprises, ADA News, ADA News Online, ADA/IDM, ADABEI, American Association of Retired People, American Dental Association, Bill Novelli, CareCredit, Chuck Grassley, Darell Pruitt, DDS, denturist, DMD, Dr. James Bramson, Dr. Mark Feldman, Hippocratic Oath, Inc., Ingenix, Intelligent Dental Marketing, JADA, Journal American Dental Association, Julie Appleby, LD, red flags, red flags dentistry, UHG, UnitedHealth Group, USA Today | 4 Comments »

Janis Oshensky Lobbies Congress – Not Dentists

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

Show Me the Math

By Darrell K. Pruitt; DDS

I have noted here far too many times how it disappoints me that Delta Dental Plans Association vice president Janis Oshensky repeatedly chooses to turn to politicians rather than discuss Delta Dental’s arguably egregious and harmful policies with me, a dentist. I intend to put a stop to such disrespect one PR expert at a time if necessary.

Long ago I warned Oshensky that if she didn’t talk to me, she should probably just shut up in order to preserve what’s left of her Internet reputation. Since by posting her Letter to the Editor on POLITICO.com today, she obviously ignored my advice, this highly critical comment will reliably join three others of mine on her first page soon enough. Her employer is sacrificing her like a pawn.

The following comment is the one I posted on POLITICO.com in response to Oshensky’s letter. It might just help the vice president to finally come to a decision on this issue one way or the other. Either way, marketplace conversation like this cannot help but lead to safer air for the community … My pleasure.

http://www.politico.com/news/stories/0709/24873.html

Dear POLITICO.com Editor:

This comment and subsequent invitation to Janis Oshensky is in response to the Delta Dental Plans Association vice president’s July 14, 2009 letter to you. Her letter is the most recent message she successfully sent Congress using a political news Website. Even though Ms. Oshensky holds the position of VP of dental relations as well as public policy, she has avoided answering this dentist’s questions about Delta Dental’s policies for months. If Ms. Oshensky is willing to do so, I would love for her to join me in discussion of Delta Dental’s taxation subsidy right here on POLITICO.com so that our lawmakers can witness a more balanced view of the issues.

Hello – It’s Me

Hello. My name is D. Kellus; Pruitt DDS, and I’m a practicing dentist in Fort Worth, Texas. It is my professional opinion that my patients are harmed by the policies of managed care dental plans like that sold by DDPA because there is no accountability to their clients or dentists. There is barely any accountability to those who select and pay for Delta’s products – dental patients’ naive bosses.

Like virtually every US citizen, your readers probably couldn’t care less about the dental industry. It is precisely because dentistry has been uninteresting for decades that make the microcosm of health care incredibly interesting to me. Let me uncover for your appreciation the event horizon in dental history. You could learn about more than just dentistry.

If left to natural forces of human nature, what happens to value when there is no accountability? For example, what do the 1975 East German Trabant and the 1979 Ford Pinto have in common? By popular vote, those products not only represent the two worst automobiles ever made, but the state shielded both manufacturers from accountability to consumers. Poor quality happens.

Oshensky argues against the taxation of managed care dental benefits like those sold to employers by Delta Dental. Let me offer that if Delta’s product were taxed like income, its value would quickly dive below the market threshold that attracts purchasers’ consideration.

Allow Me to Show-You the Math

Recently, Delta Dental of Michigan lost the accounts of thousands of GM retirees when their group dental benefits were cut in bankruptcy negotiations with UAW. Suddenly, Delta found itself forced to market their product to individuals who for once have the choice to keep their money. Faced with true competition for healthcare dollars, Delta leaders desperately cobbled together individual policies for the retirees who want to continue with their coverage. Even though Delta did everything possible to lower the cost of their coverage, the cheapest of the plans they offered still runs about $30 per person per month, and covers only 50% of everything, including preventive. So for premiums of $360 per year plus half the preferred providers’ 20% to 30% discounted fees, is this a bargain for Michigan retirees?

Free Markets

In my free-market, fee-for-service practice, if a patient comes in for two cleanings and routine x-rays during a year, 100% of my bill is $208. This is the market price in my neighborhood that is continually challenged by lively competition with other dentists for new patients who may not even have dental benefits. Those customers pay in full at the time of visit, just like most people whose bosses purchased Delta Dental Plans.

Value Comparisons

So let’s compare value of Delta Dental’s product with cash. If I were a Delta Dental preferred provider, my fee of $208, less Delta’s 25% discount would be $156. Never mind that my wife has problems with my 70% cut in pay, let’s move on.

The patient’s half of the $156 I earned is $78. $360 + $78 = $438. So for one uneventful year of discounted dental services with a dentist chosen from a list of names, a patient can expect to spend more than twice as much than if they paid the free-market price at the point of service.

Assessment

Not only is that hardly a bargain, but it is my opinion that managed care dentistry is dentistry by the lowest bidder with no quality control. That should be enough meat to get this conversation rolling. Now it’s your turn Ms. Oshensky. I think you have to admit that you’ve got holes to mend in the dental relations part of your job.

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Filed under: "Doctors Only", Career Development, Ethics, Health Insurance, Managed Care, Practice Management, Pruitt's Platform | Tagged: ADA, Darrell Pruitt, DDPA, DDS, delta dental, Delta Dental Michigan, dentists, DMD, GM, HMO, Janis Oshensky, managed dental care, POLITICO, PPO, UAW | 3 Comments »

ADA / IDM Breakup – You Heard it Here First

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

Will CareCredit be the Next ADA Subsidiary to Fail?

I saw a warning sign last week.

By Darrell K. Pruitt; DDS

My aggressive writing hobby has understandably brought me in hard contact with public relations people whose job is to insulate good ol’ boys from accountability – even if it means taking hits for the team and staining their reputations. Let’s face the fact we all of us involved in public relations know but don’t dare discuss: Depending on the ethics of one’s employer, PR professionals are sometimes used up like expendable pawns. And avoiding bylines for press releases no longer shields anyone from accountability.

I often silently stalk PR employees (Gasp!) on the Internet who work for sleazy companies just to better understand them. I’ve discovered that it is not hard to find and exploit the weaknesses of those whose heart isn’t behind selling their employer’s product. Sometimes all it takes is a fistful of transparency to cause defenseless representatives to completely shut up, and that alone makes our neighborhood safer. Committee-approved methods of evasion are as simple-minded as committees, so it doesn’t take long to figure them out – exposing the shameful ethics of those who sign off on the use of lame, institutional trickery.

For example, here’s a very popular, traditional PR trick: If a huge business entity such as the ADA has bad news they can no longer keep secret from customers, professional PR-types will advise their bosses to post bad news on a Friday to soften the blow. When traditional leaders find that they can no longer sidestep accountability, delaying accountability until a busy news day is the next best thing one can purchase. Even though the tricks seem simple, there are people who study evasion science as part of obtaining a degree in marketing.

So how good is the ADA’s PR team? How much time did ADA members’ employees buy for leaders before they had to quietly acknowledge an expensive failure?

On July 10, a Friday, “ADA/idm to phase out service” was posted on ADA News Online without a byline. (Another PR trick: When the ADA posts an orphan without a name, it means someone is ashamed of the bastard.)

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3655

“ADA Business Enterprises, Inc. (ADABEI), a wholly owned ADA subsidiary, announced today that ADA Intelligent Dental Marketing (ADAidm) of Salt Lake City, one of its joint venture companies, is no longer able to provide marketing services to its customers due to significant production and operational difficulties.”

Now the ADA must refund money to members in a depressed market. Could this embarrassment for our professional organization have been quietly avoided instead of delayed and magnified? I personally started seeing clues of CEO Trajan King’s reticence long ago, and warned ADA leaders in Chicago about my concerns. Nobody ever responded to my numerous, sincere warnings.

These are highly critical times on Capitol Hill and our patients trust us to represent their welfare. Dentists are their last hope, because there is nobody else who cares. Practicing dentists are solely responsible for assuring the benevolence of our niche market, and we are losing control publicly. Disasters like the ADA/IDM make the ADA look foolish to Congress, and word gets around fast on the Internet.

This morning, I read an article posted on The NY Times titled “Study Measures the Chatter of the News Cycle, “ written by Steve Lohr.

http://www.nytimes.com/2009/07/13/technology/internet/13influence.html?_r=1

Researchers at Cornell used powerful computers and sophisticated algorithms to accomplish an unprecedented analysis of news articles and comments on the Web during the 2008 presidential campaign. They studied the characteristics of the news cycle by scanning 1.6 million mainstream media sites and blogs for repeated phrases and tracking the history of their appearances.

Lohr writes: “The researchers’ data points to an evolving model of news media. While most news flowed from the traditional media to the blogs, the study found that 3.5 percent of story lines originated in the blogs and later made their way to traditional media.”

The study also shows that traditional news outlets are still quicker than blogs by 2.5 hours. I should now point out that the Cornell study was performed using data from very popular, huge news items collected during a presidential election – not hidden, niche news like dentistry’s.

If you are involved in the dental industry, where are you more likely to read time-sensitive news about our profession first? In an ADA publication, or from D. Kellus Pruitt; DDS?

Whereas traditional media is 2.5 hours quicker with popular topics, I scooped traditional ADA News Online by three weeks when I posted “ADA/idm – A bad union after all?” on the PennWell forum.

http://community.pennwelldentalgroup.com/forum/topics/adaidm-a-bad-union-after-all

So what about the warning sign I saw concerning CareCredit – a wholly-owned subsidiary of the ADA?

When Trajan King, former CEO of the defunct ADA/IDM partnership refused to acknowledge my questions, I immediately suspected something was terribly wrong with the union of my non-profit professional organization and his for-profit Utah advertisement company. Six months later, my fears were confirmed. Now then, I hope it grabs someone’s attention that I see the same warning signs coming from the ADA’s CareCredit business. Note this date: July 13, 2009.

On Thursday, July 9, CareCredit purchased a press release on dentalblogs.com: “CareCredit Adds 24-Month, No-Interst [sic] Payment Plan” (no byline).

http://www.dentalblogs.com

Since dental problems only get worse, I consider the idea of extending credit to dental patients is a benevolent thought during these hard financial times. I also say that the offer appears to have been put together out of generosity and not greed like the ADA/IDM disaster. However, at 4:54 pm on the same day that CareCredit’s press release was posted, I submitted a difficult question for the anonymous author of the piece who works PR for CareCredit – and is an ADA employee.

“If the Red Flags Rule is not delayed for the third time in three weeks, how will it affect those who offer Care Credit?”

I was given the hopeful response “Your comment is awaiting moderation,” but days later there is no sign that my question is being considered at all. Please, oh please ask yourself: What could CareCredit leaders be hiding and how much will it end up costing ADA membership?

I will not be ignored by anyone. Today, I submitted two follow-up questions on dentalblogs.com. I considered warning the anonymous moderator that this is being simulposted on other blogs, as well as described on Twitter, but then I thought, why spoil the fun? Let the leaders of the ADA Business Enterprises, Inc. (ADABEI) get word of my e-Attack from their colleagues. Won’t they be surprised!

Oh, and for those who are wondering what happened to ADA/IDM CEO Trajan King – he quit.

Dear Dentalblogs.com moderator:

On July 9 at 4:54 pm, I submitted a sincere question concerning how the Red Flags Rule will affect ADA members who sign up for CareCredit. Instead of posting it with the promise of an answer, you regretfully chose to censor an ADA member. Today, July 13, I have a second and third question: Why did you ignore my first one and who is your boss?

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Filed under: "Doctors Only", Breaking News, Career Development, Ethics, Health Insurance, Information Technology, Marketing & Advertising, Media Mentions and PR, Pruitt's Platform, Research & Development | Tagged: ADA, ADA Business Enterprises, ADA/IDM, ADABEI, American Dental Association, CareCredit, Darrell Pruitt, dentists, IDM, Intellignet Dental Marketing, red flag rules, Steve Lohr, Trajan King | 12 Comments »

Blue Cross/Blue Shield of Texas on Facebook

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

Let’s Have Some Fun!

[By Darrell K. Pruitt; DDS]

Hello, sports fans. Have you missed me? It’s been about five days since I posted a comment that didn’t follow an article authored by someone else.

My last one was “Pruitt’s Platform – Introduction to an Adventure.” It’s unusual for me to go so long between posting stand-alone pieces, but after putting that title to my introduction, and compounding the challenge by promising to never push out bland stuff, I set my standard high. It took me a few days, but I finally found a deserving old target on a brand new venue that I think will hold your interest. BCBSTX and I have an intense history, so I assume they charged someone anonymous and shy to follow everything I write. I welcome you, whoever you are. Yea, you. The one hiding in the dark corner, justifiably afraid to utter a peep. Keep your pointed head down, friend, and try not to wet your nice pants.

BCBSTX, you should be disappointed to learn that I found your Facebook account. Even for a fat dinosaur, you are an especially thick and slow-moving easy target. I recommend you just surrender now to transparency and start the confessions and reparations before the lawsuits become huge and the lawyers profit more from your collapse than the Texan dental patients you’ve harmed. Let me remind you that the repeal of the McCarran-Ferguson Act is just around the corner, and we all know about the rumor (started by me) that there are attorneys across the nation just waiting to file class-action lawsuits against BCBS for unfair business practices, including restraint of trade for using the NPI number to drive satisfied patients from dental homes they preferred. Finally, BCBSTX will be subject to the same anti-trust laws as the doctors they fear, and I am here to make sure BCBSTX feels the pain. Look what happened to Dell Computer when that huge dinosaur was surrounded by Jeff Jarvis and Dell Hell. The game I’m playing with you is a more nimble, improved variation of Dell Hell, using fewer vulgar words.

You should know by now you are too fat and too slow to hide from me and the sports fans I bring. Nevertheless, I am always fair in telling my targets my goals before I go on to accomplish them. Here is what I am going to do to you, BCBSTX: I intend to pull your anonymous, unaccountable butt out into the wide open for everyone to see – especially the lawmakers you lobby and support with generous donations. Did you know that there is a rumor (also started by me) that some of those same lawmakers you consider friends are aware of most of what I write on the same day I post it? The transparency I bring will eventually trap and crush you, BCBSTX. Or, you can immediately come out and meet me for an open discussion about the inevitable reformation of dental insurance in Texas – putting humble, obedient bureaucrats with names under the direct control of dentists and patients. And of course, it is understood that in order to save Texas citizens millions of dollars in healthcare expense, there will be drastic downsizing of BCBSTX Dental, just like Delta Dental and ADA/IDM are experiencing right now. That means no more bonuses and no more frivolous pursuits like publishing, printing and mailing to Texas dentists those expensive self-serving brochures joyfully titled “NPI Times.” I suggest you get your resumes in order, BCBSTX employees. I’m very good at having my way with archaic business models. Others I have attacked, such as ADA/IDM and Delta Dental, are clearly failing. Coincidence? Perhaps you’d like to tell yourself that when I undermine your support every time you come up for air. Why not send out your sharpest PR specialists? Oh please, would you? Also, equip them with committee-approved talking points that I’ll hang around their necks for a long time.

When I discovered that BCBSTX had a Twitter account, I started asking anonymous employees of BCBSTX about their new NPI number requirement for processing dental claims – even for dentists who have no contractual relationship with the company. But rather than answer a dentist’s questions about their dental policy (incredibly stupid, BCBSTX), the leaders of the command and control company who can no longer command or control their own socks, responded by blocking me from following them. That was irresponsible, childish behavior from one of the largest and most powerful dental insurance companies in the state. Shouldn’t it be important for BCBSTX to respect dentists who must deal with their cumbersome rules?

At a time when managed care dental companies like BCBSTX are lobbying Congress hard to preserve their taxation subsidy, I think it is important for lawmakers to recognize that these huge stakeholders neglect the welfare of those they serve: the principles – dentists and their patients. We are your constituents who count, Congress. Not discount dentistry brokers whose products will not sell in the free market without mandates and taxpayer assistance – simply because they are lousy products.

If BCBSTX had not opened a Facebook account, I would not have opened one myself. I discovered my fat, defenseless opponent when I googlesearched “BCBSTX” the other day. On their first page was the link “What is the NPI number of BCBSTX? – Facebook.” It features a client’s naïve, insignificant question about the NPI number, and it opened the door for my informed, significant one which I copied below, as well as posted on Twitter.

http://www.facebook.com/topic.php?uid=93487018652&topic=8926

By the way, I was disappointed to see that my comment “BCBS-TX Dental Insurance is Rude to everyone,” which I posted on the Medical Executive-Post over three months ago, was no longer on BCBSTX’s first page. It was their third hit for weeks. But since I hadn’t given the comment a bump lately, it has dropped down to the bottom of their second page. Can’t have that! If you don’t mind, please click once or more on the following link and stay there a few minutes. That way, it will push the blunt criticism back up onto BCBSTX’s first page and will once again warn potential clients of BCBSTX’s poor business ethics. If you’re going to be there anyway, why not go ahead and read the sucker? You could find it interesting. Lots of people do.

https://healthcarefinancials.wordpress.com/2009/03/27/bcbs-tx-dental-insurance-is-rude-to-everyone/

As I wrap up this comment, I’ll share with you with the question I left BCBSTX on Facebook almost 6 hours ago concerning their NPI policy. I don’t think Facebook was a good idea for BCBSTX leaders. Sit back and watch me get someone fired today.

Dear BCBSTX:

I would like to point out to readers more information about the NPI number which you are not likely to share. If you have BCBSTX dental insurance, and your dentist does not have an NPI number, BCBSTX will not process your dental claim and the premiums you will have paid to BCBSTX will become unearned profit for BCBSTX.

Is that true, BCBS-TX? Yes or no?

Conclusion

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Introducing Darrell Pruitt’s Platform

Posted on July 1, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Pruitt’s Platform – Introduction to an Adventure

By Darrell Kellus Pruitt; DDS

I’d like to take this opportunity to thank Managing Editor Hope R. Hetico RN, MHA and the ME-P staff, as well as loyal readers, for providing me a featured spot on this unprecedented free forum – which is rumored to be even monitored by a few in Congress. I do hope so. If we are to cultivate fresh ideas, we’ve got to do some groundwork to clear some weeds.

Let me say that I am flattered and excited that you believe in me enough to offer such a tremendous blog opportunity. I consider it a popular mandate and a responsibility to continue on my path of straightforward, intrusive discovery – bringing you along every step of the way to share in the excitement of accelerated social evolution. I find it fun to undermine traditional bureaucratic bozos who think they are too good to wrestle in the dirt. The fact that our neighborhood entertainment is still under the surface makes it seem sort of like ornery-fun as well.

The World is Flat

Five years ago, New York Times foreign affairs columnist Thomas Friedman, in his national bestseller “The World is Flat,” predicted that “Individuals from every corner of the flat world are being empowered.” He had no idea he was talking about a dentist in Fort Worth, Texas.

Hang on tight, everyone, because I will take this blog on a fast-moving, multi-pronged adventure of a kind never before witnessed on any media venue. What’s more, I will continue to probe for weak, deceptive links in our neighborhood – and I’ll do it between checking my hygiene patients, and just for grins. I would warn newcomers as well as future targets that I don’t avoid hurting feelings if it speeds progress to a better democracy – including, of course, better state and national representation for my dental patients. They trust me to watch after their welfare. And as far as I can tell, I’m their last hope. Besides, since I hold myself accountable for what I post on the Internet, I see not a single reason why everyone else shouldn’t be held to the same standard, or to simply shut the hell up.

Assessment

I know it took work to put together “Pruitt’s Platform.” I promise I will never make you ashamed of giving me such esteemed consideration, and I won’t let you down by pushing out boring, pointless, superficial content. Get ready to plow new ground deep, friends. Once we break up the fallow impenetrable crust, soon it will be time to plant new ideas for fresh leadership. Hey, lawmakers – you’re next: Deep renewal isn’t limited to the field of dentistry. It was just close by, mostly vacated and has been hidden from view for years.

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Medical Coding and Billing Vocabulary

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

Basic HIT Nomenclature and HIPAA

[By Richard J. Mata; MD, MIS, CMP™ [Hon]

For the Health Information Technology [HIT] department of a hospital, clinic or medical practice and its coders, the following medical vocabularies are mandated by the Health Insurance Portability and Accountability Act [HIPAA].

Diseases

For diseases: the 9th or 10th International Classification of Diseases (ICD) Clinical Modification should be used. ICD9-CM is maintained by the Centers for Disease Control National Center for Health Statistics, while ICD-10 is maintained by the World Health Organization.

Procedures

For medical procedures: a combination of ICD-9-CM, Current Procedural Terminology maintained by the American Medical Association, the Current Dental Terminology maintained by the American Dental Association, and Healthcare Common Procedure Coding System (HCPCS) maintained by CMS, which is also used for medical devices.

Pharmaceuticals

For drugs: these should be coded according to their National Drug Code classification.

Assessment

“A recent change to Medicare policy made by the Centers for Medicare & Medicaid Services (CMS) helps ensure claims processing isn’t delayed when the only missing information on the CMS-1490S form is the provider or supplier’s National Provider Identifier (NPI).

CMS Transmittal 1747, Change Request 6434, issued May 22, notifies A/B Medicare Administrative Contractors (MAC) and carriers of editorial changes to Medicare policy in Pub. 100-04, Medicare Claims Processing Manual, chapter 1 regarding the monitoring of claims submission violations and the handling of incomplete or invalid claims.

In either case, as stated in the transmittal, “If the beneficiary furnishes all other information but fails to supply the provider or supplier’s NPI, the contractor shall not return the claim but rather look up the provider or supplier’s NPI using the NPI registry.”

http://www.aapc.com/news/index.php/2009/06/missing-npi-no-reason-to-deny-says-cms/

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Why Coding Professionals?

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

More on the NPI, the AAPC, Censorship and Quality Health Care

By Darrell K. Pruitt; DDS

For those who have been following me recently on Twitter (Proots), you know that unlike me, John Hamm has not yet been kicked off of DrBicuspid, and is awaiting a response from Dr. David J. Pettigrew – a dental coding expert with 14 years of experience as Chief Dental Officer for BCBS of New Jersey. I can only shadow the conversation because, as I said, I was kicked off.

Through John Hamm, I sent word to Dr. Pettigrew that he should just shut up and not enter into a discussion about the NPI number. Pettigrew told Johnhamm that I should come onto the DrBicuspid forum and say that in front of everyone. Of course, I am unable to do that because as shameful as it is to my family, I am still banned from posting anything on DrBicuspid.

For real-time developments concerning Dr. Pettigrew’s public defense of the NPI number, it would be better to follow that chunk of drama on Twitter or DrBicuspid. I’ve got other things cooking here. Can you smell it yet?

As you can see, sports fans, I have had Internet contact with a new class of fat, slow-moving healthcare IT stakeholders, and I haven’t been building long-term relationships fortified by good will – if you know what I mean. 14 years of employment at BCBS of New Jersey fails to impress me much.

American Academy of Professional Coders

Those who have studied alphanumeric science have a national organization called the American Academy of Professional Coders [AAPC] which represents business consultants in a growing healthcare niche. Most are employed by providers who are too busy actually performing healthcare to play games with insurance companies for the money owed them. Like SEO professionals who know gimmicks to increase a client’s page rank in relation to competitors, or perhaps a bolus of bad news from a special bastard, professional coders maximize providers’ profits by keeping on top of the ever-changing hoops involved in paying doctors almost all that is owed them following a shorter than average delay.

ICD-10 is Coming

Learning coding is job security these days because in a few years the mandated ICD-10 codes will force even dental offices to hire IT staff, which also cuts down on the nation’s unemployment. I’ve taken a peek at the ICD-10, and it makes the ICD-9 look like simple algebra. I’d stick with well-trained coding professionals. They’ll cost more but you do want to approach making a profit, don’t you?

Of Censorship

I submitted the following stinker to be posted on the AAPC Website. To their credit, it was posted almost immediately. That could be a good sign … OOPS! Several minutes later it went back under moderation. I think someone is having problems with it. You’ll have to read it to understand why. It’s tricky to let go of, yet if it remains posted, it looks like a concession. Some poor slob in the AAPC is in a bad position. I hope you are enjoying this as much as I am.

-Darrell

CMS Transmittal 1747, Change Request 6434, issued May 22, notifies A/B Medicare Administrative Contractors (MAC) and carriers of editorial changes to Medicare policy in Pub. 100-04, Medicare Claims Processing Manual, chapter 1 regarding the monitoring of claims submission violations and the handling of incomplete or invalid claims.

http://www.aapc.com/news/index.php/2009/06/missing-npi-no-reason-to-deny-says-cms/

“How does an NPI number improve patient care?”

By D. Kellus Pruitt DDS – posted on AAPC Website, 6.4.09

I see that nobody from the American Academy of Professional Coders has yet attempted to answer my question. Some visitors to the AAPC Website who have followed the comments to the article “Missing NPI Won’t Delay Processing – CMS” (no byline) may think the lack of an answer is odd – that is if they happen to notice. The novice professional coder who still does not know much about HIPAA could easily assume that since the article itself is almost a week old, the lack of a response to my question is nothing more than the natural fading of interest. At some point, people logically move on to newer posts and other parts of their lives.

But I know a secret.

Based on nothing more than glaring silence from anonymous officials of AAPC, I know that my question of whether the NPI number improves care did not go unnoticed by a few knowledgeable and sharp individuals. They know enough not to touch a transparently trick question. The answer of course is:

The NPI number does nothing to improve patient care (Gasp!)

There’s more. Five years ago informatics experts (coders), promised that the ten digit identification number for providers will speed payments lightning fast. When is the last time you heard that fib? I cannot fault abundant optimism, AAPC, but by now you are surely aware that physicians have had to wait for a year or more for payment because of foul-ups at NPPES. Some have had to take out loans to pay the salaries of coding professionals and other new IT members of their staffs.

Improving Healthcare?

And as far as “improving” patient care? That would be worse than a fib. That would be called a harmful lie that upsets me in a very personal way. I know where it is documented that dental patients have been forced to leave dentists they preferred simply because one-third of the dentists in Texas do not have NPI numbers. BCBSTX requires that their clients only see dentists who have the numbers. Otherwise, the client has to pay their dental bill in full and BCBSTX isn’t even obligated to refund the employer the insurance premium. Yet BCBSTX sales reps tell these employers that their employees can see any Texas dentist they choose.

I’m sorry. Sometimes I ramble.

To keep it fair, I will ask if there is anyone who would like to point out the benefits of the NPI number. Your AAPC members and many others, including enthusiastic newbie coders, are interested in hearing from leaders of the organization. Many careers are built upon the complexities caused by digitalization and informatics. I don’t blame you for the complications. After all, you don’t make the rules – you just get along with them really well. It’s like our unavoidably complicated tax code and accountants. Accountants call themselves professionals. So why the hell shouldn’t you?

The Medical Executive-Post

Let me say that I am grateful that you believe enough in transparency that this comment remains posted. It wouldn’t surprise me if someone briefly considered deleting it until they discovered that it will be on the PennWell forum and probably on the Medical Executive-Post anyway. And of course, we can all see that you chose the honorable thing to do.

NPI Fallacy

The NPI fallacy reminds me of a scene in the Mike Judge movie “Idiocracy,” when a character 500 years in the future named Frito is asked why fields are fruitlessly irrigated with a politically-correct brand of green colored sports drink instead of water. Frito, who got his law degree from Costco, doesn’t even have to suffer minimal thought before he quickly repeats what he’s heard so many times, “’Cause it’s got ‘lectrolytes.”

Grnerod finds it incredible that I don’t have an NPI number. “How on earth are you billing and getting paid without an NPI?”

I told him (?) that I don’t work if I don’t get paid. Call me an old school radical.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. What are your feelings on the NPI situation? Does it really improve health care, or not? 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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Filed under: Glossary Terms, Health Economics, Health Insurance, Information Technology, Op-Editorials, Practice Worth | Tagged: A/B Medicare Administrative Contractors (MAC), AAPC, ADA, AMA, American Academy of Professional Coders, BCBS New Jersey, BCBS New York, CMS, CMS Transmittal 1747 Change Request 6434, CMS-1490S, CPT codes, Darrell Pruitt, david marcinko, Dr. David J. Pettigrew, DrBicuspid, ICD-10, ICD-9, John Hamm, medical billers, medical coders, Medicare Claims Processing Manual, National Provider Identifier, NPI, NPI Number, Proots, Pub. 100-04 | Leave a comment »

Obama, HIT and Transparency in Government

Posted on June 5, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Enhancing Transparency in Government using the Internet

By Darrell K. Pruitt; DDS

I recently came across news that could possibly be the first tangible step in the inevitable demise of traditional lobbyist representation that we have known and endured all our lives. True to what the man promised in the fall of 2007, Barack H. Obama is ready to show the nation that he intends to decentralize power by enhancing transparency in government using the Internet.

Decentralization

Decentralization naturally scares entrenched, oppressive leaders inside and outside government who in the best of all worlds, shouldn’t be entrusted with power in the first place. It is my opinion that we are witnessing a huge Presidential step in the inevitable progress of the Internet-powered social revolution many have predicted for a decade or more. According to the unprecedented lobbying rules, virtually anything anyone says to public officials about the Recovery Act and Stimulus package must be immediately posted on the Internet (if it is not there already). No kidding. For example, I discovered this news in an article on the White House blog, posted by Jesse Lee on Friday, Its title is “Update on Recovery Act Lobbying Rules: New Limits on Special Interest Influence” (copied below).

Here is a line from the article: “Following OMB’s review, the Administration has decided to make a number of changes to the rules that we think make them even tougher on special interests and more focused on merits-based decision making.”

I am hopeful that Obama is sincere in his effort to steer our legislative body to make decisions based on merits rather than undocumented conversations funded by special interests. If he succeeds, one class of losers will be managed care stakeholders like Delta Dental who prefer to spend healthcare dollars to lobby congress rather than work things out with dentists who have to deal with their calculated lies. A perfect example of Delta’s stupidity is documented in “National insurer asks legislators to keep dental benefits in mind in health care reform” featuring Delta’s shy PR rep, Janis Oshensky.

http://ifawebnews.com/2009/04/01/national-insurer-asks-legislators-to-keep-dental-benefits-in-mind-in-health-care-reform

Insurance and Financial Advisor Website

The fact that Delta would pay for such a disingenuous PR piece on the Insurance & Financial Advisor Website shows how out of touch Oshensky is. It was posted appropriately enough on April 1. Two months later, I still cannot figure out the purpose of the ad. Just who was the vice president of dental relations and public policy for DDPA trying to impress? Her insurance buddies? Was this Janis Oshensky’s swell idea, or did a committee come up with the stinker? I don’t think we’ll ever know. Also, among the losers to transparency will be healthcare IT stakeholders with lousy goods to move. Rather than compete with each other, they prefer lobbying for mandated sales of worthless, but nevertheless CCHIT-certified products. Fair sales without the help of billions of stimulus dollars are impossible because doctors don’t want eMRs for unanticipated reasons of intelligence.

Healthcare IT Business Leaders

Recognized leaders of big healthcare IT businesses, such as Glen Tullman, the CEO of Allscripts, won’t like handing over political empowerment one bit. Did you know that Tullman and Obama are long-time Chicago buddies? I think the new rules mean Americans will finally have immediate access to their discussions about HIT. Sweet; I think I could learn to like Obama. I bet Tullman keeps his mouth shut. That’s sweet as well. If this news is as significant as it appears to be, I’m surprised it hasn’t attracted more attention by now. While nobody knows yet how Obama’s plan to post transcripts of oral communications with government officials is going to ultimately affect the way professional organizations are represented in Washington (or if it in the end changes anything at all), I’m pretty sure that what I have been reading carefully has the potential to turn the government over to those who can create content independent of committees, talking points and traditional hierarchy. I interpret Obama’s rules as the manifestation of what Thomas Friedman (“The World is Flat”) long ago called individual empowerment.

Got a beef? How are your writing skills these days? How effective is your social network?

This is good. The new restriction on oral communications with government officials for both registered and non-registered lobbyists (everyone in the nation) is terrible news for organizations which depend on store-bought secretive representation. On the other hand, it’s wonderful news for English majors, speech writers and special bastards with no shame.

ADA Lobbyists

I would never attempt to persuade you to take on my personal issues as your own, but please roll this development over in your mind and decide for yourself if the information I’m sharing might become an advantage for dental patients in the nation if dentists are mobilized for a more democratic form of representation long before the insurance industry can react. And that shouldn’t be too hard. Committees move oh so slowly, including ADA committees. If I am correct, if we work unconventionally, dentistry could be way ahead of the curve by preparing for independent written representation using informal social networks and Internet blogs. No planning or financing is needed. Face it, the money the ADA has paid to lobbyists starting a few years ago was wasted, and there is no way they can help the organization now. Dump them.

PR Assistance

Here is some powerful PR help I offer for free that cannot be purchased at any price, anywhere: If a dentist posts something that parallels my goals, on any blog, I will easily boost the exposure of the article more effectively than any SEO genius in the nation. I’ve proven so many times how I can do this by merely mentioning someone’s name. And I can help again, and again. All I have to do is discover someone who has confidence in good ideas for protecting our patients from harm. Put it out there and sit back. I’ll do the rest.

Assessment

I wonder if Obama knew anything about special bastards and unconventional PR when he chose transparency as a goal for his administration. Maybe I can teach him a thing or two. I have faith that if one’s goals are noble, nothing can hurt you in the land of the free. Come on out. The air is fine.

http://www.whitehouse.gov/blog/Update-on-Recovery-Act-Lobbying-Rules-New-Limits-on-Special-Interest-Influence/

FRIDAY, MAY 29TH, 2009 AT 5:35 PM

Update on Recovery Act Lobbying Rules: New Limits on Special Interest Influence

Posted by Jesse Lee

THE BRIEFING ROOM • THE BLOG

Another update from Norm Eisen, special counsel to the president for ethics and government reform, in the spirit of transparency as always:

I am writing with an update on the President’s March 20, 2009 Memorandum on Ensuring Responsible Spending of Recovery Act Funds. Section 3 of the Memorandum required all oral communications between federally registered lobbyists and government officials concerning Recovery Act policy to be disclosed on the Internet; barred registered lobbyists from having oral communications with government officials about specific Recovery Act projects or applications and instead required those communications to be in writing; and also required those written communications to be posted on the Internet. That Memorandum instructed the Office of Management and Budget (OMB) to review the initial 60 days of implementation of the stimulus lobbying restrictions, to evaluate the data, and to recommend modifications.

Following OMB’s review, the Administration has decided to make a number of changes to the rules that we think make them even tougher on special interests and more focused on merits-based decision making.

First, we will expand the restriction on oral communications to cover all persons, not just federally registered lobbyists. For the first time, we will reach contacts not only by registered lobbyists but also by unregistered ones, as well as anyone else exerting influence on the process. We concluded this was necessary under the unique circumstances of the stimulus program.

Second, we will focus the restriction on oral communications to target the scenario where concerns about merit-based decision-making are greatest –after competitive grant applications are submitted and before awards are made. Once such applications are on file, the competition should be strictly on the merits. To that end, comments (unless initiated by an agency official) must be in writing and will be posted on the Internet for every American to see.

Third, we will continue to require immediate internet disclosure of all other communications with registered lobbyists. If registered lobbyists have conversations or meetings before an application is filed, a form must be completed and posted to each agency’s website documenting the contact.

OMB will be consulting with agencies, outside experts and others about these principles and will publish detailed guidance, but we wanted to update interested parties on the outcome of the initial review. We consulted very broadly both within and outside of government (including as reflected in previous posts on the White House blog) and we are grateful to all those who participated in the process.

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Filed under: Alerts Sign-Up, Career Development, Ethics, Health Law & Policy, Information Technology, Op-Editorials, Research & Development | Tagged: ADA, Allscripts, American Dental Association, “Update on Recovery Act Lobbying Rules: New Limits on Special Interest Influence”, CCHIT, DDPA, delta dental, EHRs, EMRs, Glen Tullman, HIMMS, HIT, Insurance & Financial Advisor, IT, Janis Oshensky, Jesse Lee, lobbyists, Norm Eisen, obama, OMB | 11 Comments »

Economic Facts your Dentist Doesn’t Want You to Know

Posted on May 25, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Some Office Visit Schedules Linked to Insurance Payment

By D. Kellus Pruitt; DDS

http://thebulletin.us/articles/2009/05/21/herb_denenberg/doc4a15404e56e5f308210565.txt

Here is the link to an article written by Herb Denenberg titled: “Some Facts Your Dentist Doesn’t Want You to Know”. In it, he shared with his readers some information about dentistry that is hard to find. I submitted the following comment.

Dear Herb Denenberg,

Yours was a great article, and as a dentist with 27 years in a comfortable practice and 32 years in an expensive marriage, I find your cost-saving points oh so painfully accurate. Nevertheless, I must honestly agree that not only can some patients safely go a year or more between check-ups (ouch!), but many don’t need bitewing x-rays every year either (Good thing neither my patients nor my wife read the stuff I write).

Of BiteWing X-Rays

Readers who are hopefully from places other than the east side of Fort Worth can easily understand that the more treatment and x-rays I recommend, the more money I make. I must honestly add that my devoted and trusting dental patients, like most Fort Worth dentists’ patients, are reliably willing to accept my recommendations for these kinds of procedures without questioning the need. Let me put it this way: Annual bitewings are an easy $56 sale, mostly because fee-for-service insurance pays for them at 100% anyway. (If an angry dentist should ask who told you that, it wasn’t me). That is why it should not be taken lightly my approval of the advice about dentistry published in the book “1,001 Things They Won’t Tell You.” And; they won’t, sometimes.

Ethics and EBD

True to ethics I learned at the University of Texas dental school, in San Antonio (UTHSC), in the last six months, my hygienists and I have been determining which patients are safe to go a year and a half without routine bitewing x-rays. They are commonly taken every year simply because it has always been that way, and that interval was adopted as the minimum time most insurers allow. As readers can see, not a hint of Evidence-Based Dentistry [EBD] was involved in that determination. It was just a 1950’s guess.

Extended Prophylactic Schedules

This week we found four candidates in our practice for extended schedules. Our honesty will save these patients (their insurance companies) money by eliminating unnecessary care. And I really, really hate saving insurance companies money, on principle alone.

In My Defense

In my defense of continuing to maintain a large number of my patients on 6 month prophys and 12 month x-rays – and with the hope of restraining local dentists from throwing rocks through my windows – let me say up front that most people still need the old-school schedule in order to prevent disease. And, a few of the more fragile cases need x-rays and cleanings even more often than insurance allows.

Assessment

My patients and I are fortunate that I can freely charge the prices I deem necessary in order to put my patients’ interests above my wife’s. Let’s face it. Ethics are invisible to dental patients and they are not free. Ethics are a precious courtesy that dentists who accept managed care insurance find themselves forced to eliminate because contracts prevent them from raising fees as the market demands. Managed care dentistry is dentistry by the lowest bidder with no quality control. I only wish that someone would have pointed out that chunk of information in the book. Now, I’d better have my wife go ahead and start my car in the morning when she grabs the paper.

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Filed under: "Doctors Only", Career Development, Ethics, Health Economics, Health Insurance, Managed Care, Practice Management | Tagged: ADA, bite wing X-rays, cavities, Darrell Pruitt, DDS, dental visits, DMD, EBD, evidence based dentistry, Herb Denenberg, UTHSC | 7 Comments »

Red Flag Rules in Dentistry

Posted on May 1, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Mayday for Identity Theft Provisions 2009

By Darrell K. Pruitt; DDS

On October 22, 2008, the FTC announced that it would delay the enforcement of the Red Flags Rule for healthcare providers for six months – until May 1, 2009. A handful of attentive dentists, as well as ADA Chief Legal Counsel, Tamara Kempf, released a sigh of relief. Ms. Kempf immediately went to work to persuade the FTC to delay enforcement “indefinitely.”

The FTC Delay

Four days later, Kempf caught the mood of the few who were paying attention in her quote for an article on DentalCompare.com:

“We are very pleased that the Federal Trade Commission has postponed for six months its implementation of the ‘Red Flags Rules.’”

http://www.dentalcompare.com/news.asp?newsid=250078

The DentalCompare article continues:

“If the FTC persists in its position that dentists are covered by the rule as creditors, the ADA will make available a sample compliance plan or program well in advance of the new enforcement date. Dentists will have sufficient time to consult with their personal attorneys and to put an appropriate identity theft prevention program into place, according to the ADA’s Legal Division.”

The ADA Legal Division

Did the ADA’s Legal Division follow through with its promise? If information about the Red Flags Rule is posted on the ADA News Online Website early tomorrow morning, is a 24 day warning considered by the ADA to be “well in advance”? (Emphasis mine) As reassuring as Kempf’s words sounded five months ago, it can be argued that the ADA’s intentions were misrepresented to DentalCompare. I checked the ADA Online Website and found nothing at all about preparation for the Red Flags Rule – at least not yet.

http://www.ada.org/prof/resources/pubs/adanews/index.asp

ADA Archives

When I searched the ADA archives for “Red Flags Rule,” I was provided seven links to the topic, but none included “a sample compliance plan or a program.” Three of the links are irrelevant, three are to articles about the delay of the FTC enforcement, and one is a link to a hopeful letter dated November 24, 2008 and addressed to William E. Kovacic, Chairman of the Federal Trade Commission. In other words, I found nothing that will help dentists become FTC compliant well ahead of time.

HIPAA

If the ADA’s help in preparing members for the 1996 HIPAA Rule is any indication of the help members can expect with Red Flags Rule, it will take the ADA at least 13 years to start on the Red Flags. The leaders of the otherwise conservative ADA seem to have bet a huge chunk of membership trust that Kempf and the Legal Affairs department would succeed in delaying Red Flags enforcement indefinitely, and that the Department of Dental Informatics would not have to admit that contrary to what they led members to believe, computers in dental offices are rapidly becoming too dangerous and too expensive for the profession. For many dentists, pegboards, carbon paper and ledger cards are looking better and better. You can forget about paperless practices. What happened, ADA?

The groveling November 24 letter to the FTC chairman that was signed by Kempf and cc’d to ADA President Dr. Johns S. Findley and President-elect Dr. Ronald L. Tankersley, officially begs for forgiveness and appeals for bureaucratic mercy to allow dentists to be excluded from becoming Red Flags-covered entities.

http://www.ada.org/prof/advocacy/let_081124_redflags.pdf

Since the fines for non-compliance of both HIPAA and the Red Flags Rule are obscene, and since the leaders of the ADA continue to fail to inform members what they should do to prepare for unannounced inspections from either HHS or the FTC, I will once again do the Department of Dental Informatics job for them, and let readers in on the secret.

An Economic Threat

If you wish to continue to accept assignment from insurance companies, and/or otherwise extend credit to your patients, the FTC recently posted a helpful pdf document titled “Fighting Fraud with the Red Flags Rule – A How to Guide for Business.”

http://www.ftc.gov/bcp/edu/pubs/business/idtheft/bus23.pdf

Dentists have become the nation’s unpaid fraud inspectors. And if a dentist’s practice is computerized, the more will be expected, or rather, demanded of the dentist, by law.

Here is a brief description of dentists’ Red Flags obligations lifted from the FTC document:

An Overview

The Red Flags Rule sets out how certain businesses and organizations must develop, implement, and administer their Identity Theft Prevention Programs. Your Program must include four basic elements, which together create a framework to address the threat of identity theft:

First: Your Program must include reasonable policies and procedures to identify the “red flags” of identity theft you may run across in the day-to-day operation of your business. Red flags are suspicious patterns or practices, or specific activities that indicate the possibility of identity theft. For example, if a customer has to provide some form of identification to open an account with your company, an ID that looks like it might be fake would be a “red flag” for your business.

Second: Your Program must be designed to detect the red flags you’ve identified. For example, if you’ve identified fake IDs as a red flag, you must have procedures in place to detect possible fake, forged, or altered identification.

Third: Your Program must spell out appropriate actions you’ll take when you detect red flags.

Fourth: Because identity theft is an ever-changing threat, you must address how you will re-evaluate your Program periodically to reflect new risks from this crime.

Note: More “red-flag” information may be obtained from the 2 volume, 1,200 pages, premium print guide: Healthcare Organizations [Financial Management Strategies].

www.HealthcareFinancials.com

Assessment

Since my business office still uses the pegboard, and no patients’ identifiers are on any computer, my official Red Flags policy is simple:

“Staff; if you notice anything unusual in relation to our patients’ accounts; or if you are handed an unusual-looking drivers license, notify me immediately”.

-The Management

My official notice will be fastened with thumb tacks to my wall of safety posters by May 1, 2008, and I will be in full compliance with not only HIPAA, but the Red Flags Rule as well. If the government continues its reckless, heavy-handed, one-size-fits-all laws, it won’t be long before I’ll be able to further undercut the fees charged by all computerized dental offices, and still make more profit. I say bring out the Department of Agriculture.

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On Continuity of Medical Care and HIMSS

Posted on April 13, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Considering Pay-for-Retention [P-4-R]

By Darrell K Pruitt; DDS

Here is the question on lots of minds these days; how can we change the way medical providers are paid so they are both incentivized and adequately compensated to provide consistent, high-quality, patient-centered medical homes?

My Novel Idea

Here is a solid, common sense idea; increase providers’ pay gradually according to how long the doctors retain patients – who are free to choose any doctor they wish. Consistency is the mortar of a medical home [i.e., pay-4-retention].

An Ounce of Prevention

If prevention, which predates eHRs by thousands of years, is more than just a modern buzzword, the nation can still shave much more expense from health care by promoting continual, personalized care for consumers than from digital health records alone – void of prevention incentives. Who in the audience still cannot understand that concept? Think of it this way. How do business leaders in the land of the free retain the best employees? They pay bonuses. Even waiters get tips to encourage interest in providing service consumers will return for. What do US physicians get? Guaranteed cuts in their Medicaid payments over the next decade. Physicians no longer encourage their children to become doctors. Surprised? Scared?

Consumers Should Rule

In place of consumers ruling their healthcare in the US, well-positioned, giant stakeholders have persuaded lawmakers to offer physicians bonus money (that will later be taken away), not for curing patients, but for using digital records “in a meaningful manner.” It’s called “Mark and Michael Leavitts’ Clicking for Cash.” Since the rules are made up along the way, they change like the weather. That is why the larger and more progressive medical facilities pay bonuses to retain their best “Coders” and other informatics specialists who keep up with the current Ingenix-styled games in order to maximize profits. It is my opinion that health care IT’s complexity works well with the economic stimulus plan to improve employment in the nation. Entrepreneurial stakeholders will continue to be movie-star popular right up until the complete collapse of Medicare. Then they’ll be impossible to find www.HealthDictionarySeries.com

HIMSS

Have you ever heard of HIMSS?

“The Healthcare Information and Management Systems Society (HIMSS) is the healthcare industry’s membership organization exclusively focused on providing leadership for the optimal use of healthcare information technology (IT) and management systems for the betterment of healthcare.”

– From the HIMSS Web site.

HIMSS Annual Meeting

A week ago, HIMSS convened its annual convention in Chicago. The keynote speakers for the four day event were actor Dennis Quaid; followed by the Chairman and CEO of Kaiser Foundation Health Plan, George C. Halvorson; then the economist and former Chairman, Board of Governors of the Federal Reserve, Alan Greenspan, and finally; Jerry M. Linenger, MD, MSSM, MPH, PhD, Captain, Medical Corps, USN (Ret.), NASA Astronaut, and Space Analyst, NBC News. As one can tell, healthcare IT has lots of momentum. In fact, Dave Roberts, the HIMSS vice president for government relations confidently told Bob Brewin on NextGov.com

“The e-records initiative is an entitlement program like Social Security.”

http://www.nextgov.com/nextgov/ng_20090406_1509.php

Another Entitlement Program – Entitlement for Whom

In Regina Herzlinger’s 2007 book “Who Killed Health Care?” the Harvard School of Business professor argues that entitled stakeholders, including a few ambitious members of HIMSS, are destroying health care in the name of reform. In the first half of her 260 page book, she spells out entrepreneurial malfeasance in simple well-annotated terms. In the last half, she describes why Consumer-Driven Health Care [CDHC] makes sense to her. Professor Herzlinger does not specifically mention the words “medical home” in her book, yet she emphasizes the importance of continuity of care. To promote continuity, she suggests that managed care insurance policies be extended to three years duration and longer. Although she also does not mention dentistry, it is obvious to me that since chronic illnesses like diabetes are exacerbated by poor oral health, continuity of care in dentistry is of special importance. It occasionally takes years to improve some patients’ oral health care. And sometimes we fail.

Assessment

If these assumptions about continuity of care are accurate, it follows that the physical and economic health of the nation depends on long-term medical insurance contracts with employers and freedom-of-choice in providers. So is prevention worth holding ourselves accountable to consumers for once? Maybe it is just me, but I think unprecedented truth in healthcare will soon emerge regardless of stakeholders’ needs for confusion and obscurity. It is called consumerism. And it goes hand-in-hand with the Hippocratic Oath, the free-market and common sense.

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Direct Reimbursement [DR] and RiskManagers.Us

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

Transparent Dental Benefits versus Confusion

[By Darrell K. Pruitt; DDS]

“If you are not a part of the solution, there is good money to be made prolonging the problem.”

Company slogan- www.riskmanagers.us

Meet Mr. William Rusteberg

Today, I met William Rusteberg on the PennWell forum when he replied to the thread, “Why the long NPI, BCBS-TX?” which I copied below, along with my response which includes a plug for Direct Reimbursement [DR].

http://community.pennwelldentalgroup.com/forum/topics/why-the-long-npi-bcbstx?page=1&commentId=2013420%3AComment%3A26976&x=1#2013420Comment26976

Mr. Rusteberg represents a company called RiskManagers.Us, whose specialty involves the benefits market, yet it is not exactly an insurance company – just like there is no such thing as true dental insurance. RiskManagers.us is a firm that works directly with businesses to identify and develop cost-effective benefits packages – emphasizing transparency and fairness. Now that is refreshing, friends!

Defining RiskManagers.Us

Here is how RiskManagers.us describes itself:

“We do not work for an insurance company, we work for you. As an independent brokerage, and consulting firm we can represent any licensed insurance company in Texas, Colorado, Mississippi, Louisiana, Alabama, Illinois & Florida.”

If one visits the Web site’s “Reference Library,” here are some of the topics offered:

· Self Funding – Need a second opinion?

· Texas leads in transparency issues

· Can’t get claim information? HB 2015 May Solve Your Problem

· Medical Stop Loss Through a Captive

· PPO Discounts – Games People Play

· PPO Networks – Shell Game

· Can Hospitals waive Deductibles in Texas?

“What is a NPI number?”

Mr. Rusteberg’s initial question on the PennWell forum simply asked, “What is a NPI number?” Following my explanation, he wrote:

“It seems that many of those in your profession would do well in accepting cash only, or directly working with employer groups who sponsor dental/medical plans on a direct pay basis. We have had good success in doing this for our clients – we have one employer in San Antonio who pays medical care providers directly and quickly – providers like it and the plan pays a fair and reasonable rate, not relying on a PPO network to “re-price” claims. We have done the same on dental plans, eliminating the insurance company, PPO network and paying dental care providers submitted charges directly and quickly. We see little or no trend increases on dental charges using this method. In my view, insurance companies interfere in patient – provider relationships in a financially detrimental way.”

Thanks for your reply.

My Response:

I like you, William;

What you describe sounds like my all-time, personal favorite dental benefits plan. It is called Direct Reimbursement {DR}, and it not only gives the employer the unlimited capability to design a plan which reflects the level of commitment desired by the company, but most importantly, it naturally preserves quality of care by allowing employees unlimited freedom of choice in dentists. And that’s as good as the market gets.

http://www.directreimbursement.com/

In addition, since there are no NPI requirements for DR, employees are also permitted see dentists who decline NPI numbers for ethical reasons. That increases employees’ choice by 50% over BCBS-TX clients, according to recent information provided by the Healthcare IT Transition Group.

http://www.npidentify.com/stats.htm#states

Little Management Needed

Just like the benefits plans you mention, with DR, very little money is spent on management because such policies are so simple and transparent that there is no room for profit-enhancing (wasteful) confusion used by unethical companies like BCBSTX, Aetna, Cigna, UnitedHealth, Delta Dental, United Concordia, and so many other members of the National Association of Dental Plans (NADP).

Assessment

Without transparency and the invisible hand of freedom-of-choice, free-market competition for healthcare dollars disappears as fast as executive bonuses rise. We’ll see where it goes from here. It would sure be swell if a Direct Reimbursement representative takes interest in the conversation; anyone home?

Conclusion

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Defining Current Dental Terminology [CDT®] Codes

Posted on April 5, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

What they Are – How they Work

By Staff Reporters

OMAP Unique Procedure Codes*

The HHS [Health and Human Services] Office of Medical Assistance Program’s [OMAP] unique procedure codes were originally listed in the appropriate service guides. The maintenance of these codes was the responsibility of OMAP. These procedure codes were reviewed as needed and deleted either when a program no longer exists or when other Healthcare Common Procedure Coding System [HCPCS] codes are created which fully describe the service. Most of the unique codes were created to meet the needs of specialized services or programs. OMAP’s unique procedure codes were all five character configurations with the following alpha/numeric combinations: four numeric/one alpha (e.g., 7300Y); three numeric, two alpha (e.g., 206EP); two alpha/three numeric (e.g., BA311); or three alpha/two numeric (e.g., VIS01).

Current Dental Terminology (CDT procedure codes)

The American Dental Association’s (ADA) Code on Dental Procedures and Nomenclature is contained in the CDT-3 user guide. The maintenance of these codes is the responsibility of the Council on Dental Benefit Programs with consultation from: Blue Cross and Blue Shield Association, the Health Insurance Association of America, the Health Care Financing Association, National Electronic Information Corporation, and the American Dental Association recognized dental specialty organizations. The ADA updates the user guide approximately every five years. CDT codes are five-character, alpha-numeric configurations (e.g., D2110). Contact the American Dental Association to obtain a current copy of the CDT-3 Users Manual.

* Note: Due to HIPAA (Health Insurance Portability and Accountability Act) requirements, Medicare Local codes and OMAP Unique codes were replaced with national standard procedure codes.

www.HealthcareFinancials.com

Assessment

For more terminology information, please refer to the Dictionary of Health Economics and Finance.

www.HealthDictionarySeries.com

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Blindsiding Delta Dental

Posted on April 3, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Delta Dental Sends More Easy Prey My Way

By Darrell K. Pruitt; DDS

When it comes to blindsiding witless PR departments, what good is Schadenfreude if it can’t be shared for the entertainment of my large collection of quirky, unshaven sports fans – a special class of readers who would stick around to watch the sequelae of an ignited paper bag on a front porch … even if from a safe distance.

Devoted and Abandoned Employees

The rumor is, watching PR professionals silently vanish from the Internet is becoming a popular spectator sport – especially when it’s the more expensive hacks for sleazy discount dental companies like Delta Dental. I intend to show you that when someone writes really nasty things about their most devoted employees – employees who publicly donate their name and reputation to Internet branding for the interests of Delta Dental – Delta Dental will still not come to their defense (No wagering, please). The devoted and abandoned, whose objectives in life are to take hits for some team, make easy prey.

Thinking of Ari Adler

Remember Ari Adler? He heads Delta’s Corporate and Public Affairs division, and was quoted in DrBicuspid Assistant Editor Rabia Mughal’s article, “Dentists or patients: Who should get the insurance check?”

http://www.drbicuspid.com/index.aspx?d=1&sec=sup&sub=pmt&pag=dis&ItemID=301436&wf=34

It was on DrBicuspid that Adler broke the news to the nation that Delta Dental now guarantees the fillings done by their preferred providers. When confronted by a special bastard to explain Delta’s unprecedented sales pitch, Adler immediately sat his butt down and shut up. (See “I will hurt you Delta Dental”)

http://community.pennwelldentalgroup.com/forum/topics/i-will-hurt-you-delta-dental

Lost in Web Space

That was two months ago, and Adler still hasn’t uttered another peep on behalf of Delta Dental. Now doesn’t that make the air in the land of the free just a little more pleasant? And yesterday, Rabia Mughal posted another article illustrating managed care dentistry’s level of ethics titled “Study: Insurers’ market power lowers dentists’ income.”

http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=301668&wf=34

Mughal describes the findings of a study titled “The effects of insurance carrier market power on dentists and patients” that appeared in the January edition of the JADA. Here is the abstract of the study:

http://jada.ada.org/cgi/content/abstract/140/1/90

The effects of insurance carrier market power on dentists and patients

By L. Jackson Brown; DDS, PhD

By Albert H. Guay; DMD

By Donald R. House; PhD

Background

Market power among dental insurance carriers is a carrier’s ability to reimburse dentists at rates below what would exist in more competitive areas. Competition among carriers for dentists’ participation in their networks protects dentists from highly discounted fees. The authors examined the extent to which dental insurance carriers facing less competition increase fee discounts.

Methods

The authors selected a sample of dentists from listings of general practitioners. They identified 219 metropolitan areas and contacted 11,542 dentists in those areas by mail, telephone or both. A total of 8,017 dentists completed surveys (a response rate of 69.46 percent). The authors’ key focus was the possible relationship between carrier market power and the size of the fee discount. The authors compared discounts across metropolitan areas with their differing levels of insurance coverage and carrier market shares.

Results

Carrier market power was directly related to the sizes of fee discounts. The larger discounts were found where there was significant dental insurance coverage and few carriers providing this coverage. Dentists’ net incomes were significantly less in areas with larger fee discounts.

Conclusions and Practice Implications

Dental insurance carrier market power leads to increased fee discounts. These higher discounts reduce dentists’ earnings. Although the larger discounts may result in lower overall patient costs, this patient benefit is temporary. Ultimately, the number of practicing dentists in these communities will decrease as dentists seek improved practicing conditions elsewhere. This reduction will lead to overall fee increases until the earning potential of dentists is restored.

Abbreviations: IPAs: Independent practice associations. • PPO: Preferred provider organization. • UCR: Usual, customary and reasonable.

####################

As one can imagine, Delta Dental, the largest dental discount service in America, did not like what both the ADA study and Mughal had to say about discount dentistry brokers. This time though, instead of sending Ari Adler into the wide open spaces once more, Delta sacrificed a new, unsuspecting traditional-type of PR executive whose feelings have never been hurt. Her name is Janis Oshensky, and she is the vice president of professional relations for Delta Dental Plans Association.

Enter Again Ms. Janis Oshensky

Ms. Oshensky confidently said that it is her opinion that the study is flawed. Here is what Ms. Oshensky told Mughal:

“The study speculates that dentists will leave markets dominated by a few large carriers, which would lead to higher fees for uninsured patients and reduced access to care. In fact, the miniscule effect of concentration on the fees paid to dentists — as they are reported in the study — is unlikely to trigger a mass exodus of dentists from concentrated areas.”

Ms. Oshensky further states – on dentists’ behalf – that we actually realize that discounts do not necessarily mean less pay, and that network participation increases dental visits (for the same pay). Now that woman deserves a company wristwatch!

Devoted to Delta

To show you how devoted Oshensky is to Delta Dental, her act almost fooled me into believing that she believes the NPI number makes sense. That’s no joke. Look at what she posted on the Delta Dental Website celebrating Delta’s success, and you will see what I mean:

“Thanks to all of the dentists and health professionals who have applied for NPIs and who have notified us of their new identifiers. While we’re not ready to completely replace the current identifiers with NPIs, we’re making great progress and will work to keep dentists and their office staff informed about our NPI readiness.”

http://www.deltadentalnj.com/npi/PrepareToAccept.shtml

Now that’s talent. I would imagine that she probably charges more than Adler ever will. Her name is all over the Internet on behalf of Delta Dental, and she sounds even more enthusiastic about the NPI number than Patrick Cannady of the ADA Department of Dental Informatics did a couple of years ago when his department was still telling ADA members to quickly volunteer for the ten digit identifier. You know, come to think of it, Delta Dental’s Website closely resembles the ADA’s. How do you think that happened?

Re-Enter Rabia Mughal

My hat goes off to author Rabia Mughal. How he can successfully lure another Delta Dental slow-mover into the open following the ambush of Ari Adler is pure genius in a mis-match of wits.

Assessment

So here we go again, sports fans. Come on out, Janis Oshensky, I can make you famous. Please bring everything you know about the NPI number with you as well because I have a few questions to ask … or not. Schadenfreude macht Freude.

Conclusion

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Usual and Customary UnitedHealthcare?

Posted on March 30, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

More on “Sleazy” Healthcare Stakeholders

[By Darrell K. Pruitt; DDS]

If the leaders of the American Dental Association have the power and stoic determination to casually sweep aside trouble-making members who might tarnish their image, one would think that they could certainly avoid associating with sleazy healthcare stakeholders; such as UnitedHealthcare.

The Insurance Giants

Have you ever suspected that insurance giants like UnitedHealthcare, WellPoint, Aetna and Cigna (and other members of the National Association of Dental Plans) lie to patients when the say a dentist’s fees are above “usual, customary and reasonable” levels? You could be correct. NY Attorney General Andrew Cuomo says UnitedHealthcare, WellPoint, Aetna and Cigna lie to physicians’ patients – understating New York state physician’s fees up to 28 percent. Why would the crooks treat dentists’ patients any differently?

Employing Tapeworms to Control Fat

Cuomo caught UHC and others cheating their customers with smoke, mirrors and Ingenix – its wholly-owned data mining and consulting subsidiary. Who would have guessed that UHC would tweak Ingenix to manipulate claims data to favor UHC and other insurance companies who subscribe to their services? These are the same parasites who want to run the nation’s Pay-For-Performance (P4P) mandate – a cornerstone of President Bush’s healthcare reform ideas. They want to tweak professional reputations for healthcare reform and the common good.

And of Ingenix

Ingenix is a full-service consulting business for insurers, backed with the credibility of 14 years of accumulated health claims it is privy to. The “friend in the business” not only cooks the data to produce profit-enhancing Usual, Customary and Reasonable (UCR) fee schedules, Ingenix is also active in “pay-for-performance program assessment, strategy, planning, design, implementation, evaluation and improvement.”

http://www.ingenixconsulting.com/about_history.html

So if you like the way UnitedHealthcare dental consultants treat you now, just wait until they are given authority to determine your worth to society using Ingenix leveraging tools.

P-4-P

I first read about pay-for-performance [P4P] in dentistry in February 2006 in an email from Patrick Cannady who is an employee in the ADA Department of Dental Informatics. He told me that nation-wide quality control in dentistry is an important benefit of having a HIPAA-compliant, paperless dental practice – and that the Department of Dental Informatics is very excited about the opportunity to help prepare US dentists for the future. A month or so later, I learned that the NPI number the ADA still pushes on membership is the crucial legal link to government-approved P4P data-mills like Ingenix – a wholly-owned UnitedHealthcare profit center. Do you think it is odd that the NPI is “voluntary,” yet irreversible?

AMA’s Award

In January, the AMA was awarded $350 million in a lawsuit against UnitedHealthcare and Ingenix on behalf of physicians, and they plan to sue other major insurance companies as well. So what has the ADA done to discourage UnitedHealthcare’s and other NADP members’ atrocious behavior that undeniably harms dental patients? You won’t believe it when I tell you. Here’s more: In a recent Associated Press interview, Sen. Jay Rockefeller, chairman of the Senate Commerce, Science and Transportation Committee, said UnitedHealthcare is nothing but a company of cheats. He says, “They’re lowballing deliberately. They deliberately cut the numbers so the consumer has to pay more of the cost.”

http://www.google.com/hostednews/ap/article/ALeqM5gL4XFckx9sah3eFEMuHYD3V2WGhQD97763800

So if Cannady’s department is all for P4P and other benefits from interoperable digital records, the question on most ADA members’ minds should be: What does the ADA think of UnitedHealthcare?

ADA News Online

Two weeks ago the ADA News Online posted an advertisement that looks like an article (with no byline) for the spring meeting of the American Association of Dental Consultants (AADC) on May 7-9 in Scottsdale, Arizona.

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3493

Since it is so well known that UnitedHealthcare is the major funding sponsor of the AADC, the word in the neighborhood says AADC, like Ingenix, is another UnitedHealthcare profit center awaiting the wrecking-ball.

Link: http://www.google.com/hostednews/ap/article/ALeqM5gL4XFckx9sah3eFEMuHYD3V2WGhQD97763800

Assessment

Last year’s annual meeting of the dental consultants – who deny dental claims to protect the ethics in dentistry – featured ADA Senior Vice-President Dr. John Luther as a guest speaker. Dr. Luther is Cannady’s boss. He oversees the Department of Dental Informatics. Yep. The ADA is tight with UnitedHealthcare. One can tell a person’s character by the company he or she keeps.

Conclusion

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Filed under: Breaking News, Career Development, Ethics, Health Insurance, Health Law & Policy, Managed Care, Op-Editorials | Tagged: AADC, ADA, Aetna and Cigna, AMA, American Association of Dental Consultants, Department of Dental Informatics, Ingenix, Jay Rockefeller, John Luther, National Association of Dental Plans, NPA, NY Attorney General Andrew Cuomo, P4P, Patrick Cannady, Science and Transportation Committee, Senate Commerce, UCR, UHC, UnitedHealthcare, WellPoint | 3 Comments »

BCBS-TX Dental Insurance is Rude to Everyone

Posted on March 27, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Why the Long NPI – BCBSTX?

[By Darrell Pruitt; DDS]

More than a year ago, Dr. Robert Ahlstrom, an ADA [American Dental Association] and NHII (National Healthcare Information Infrastructure) task force member, told attendees to the ADA’s 3rd International Evidence-Based Dentistry Conference that the NPI number is

“Critical to the future of dentistry.”

But, to this day, he refuses to reveal why. Even though I have learned that he is a very shy man on the Internet; on that Sunday in May in ADA Headquarters, he confidently added,

“It is only voluntary unless you want to get paid.”

His case-closed proclamation shut down discussion cold in a Soviet manner. Did I mention that this occurred at an “Evidence-Based Dentistry” conference? Soviet East Germany was also called the German Democratic Republic.

NPI Harmful to Dentists and Patients

There is nothing evidence-based or otherwise about the NPI number – that benefits anyone but healthcare stakeholders. In fact, the number actually harms both dentists and patients. Like Ahlstrom, the irreversible NPI number is simply un-American. However, the NPI means profit for sleazy dental insurance companies like BCBS of Texas – especially when dentists’ reimbursements for work done long ago are delayed by NPI-NPPES screw-ups. Some physicians’ payments have been delayed for a year or more because of NPPES crosswalk difficulties. Who needs that?

Veteran’s Example Scenario

A new patient called my office this week wanting an appointment to start a crown. We don’t normally block off two and one-half hours for a patient on the first visit, but the Veteran told my office manager that before he was recently discharged, they did a root canal, post build-up and temporary on a tooth that still needs a crown. I like to think other dentists would also risk big holes in their schedules for Veterans. We owe them at least that much.

BCBSTX Dental Insurance

When he showed up with his BCBSTX dental insurance information, my office manager had to tell him that even though his boss was promised by the BCBSTX sales representative that the dental benefits package he bought for his employees was good anywhere, it cannot be used in my office because I do not have an NPI number. I am licensed to practice dentistry in the state of Texas, but that is not enough for BCBSTX. Capricious qualifications are certainly their choice if they prefer to do business that way in Texas, but why does BCBSTX leave it to my office manager to inform their clients about their deception? If a client who pays premiums to BCBSTX likes a dentist who does not have an NPI number, those premiums are pure profit for BCBSTX. It is easy to understand that the more obstacles BCBSTX can put between their clients and obligations to cover their dental bills, the bigger are the bonuses for executives. What’s more, BCBSTX’s leaders’ lousy work ethic permeates the entire dental insurance industry. Compared to BCBSTX executives, AIG executives who kept bonus money should be honored as national heroes.

BCBSTX Rude to Everyone

As the Veteran who almost became my patient works to fit him-self back into society, perhaps the next opportunity he has to break away from work for a few hours, he will be lucky enough to come across a dentist who has an NPI number. If things go well, BCBSTX will not have wasted a Veteran’s time twice – and wrecked a dentist’s schedule – for what? BCBSTX has nothing against Veterans in particular, they are rude to everyone. Since nobody from the company can be held personally accountable, tyranny is as natural as Ponzi schemes.

Attention Texas Employers:

I wish deceptive business practices which insurance companies use to cheat their clients were against the law in Texas. Attention Texas employers; as a dentist who has witnessed harm from BCBSTX, I warn you not to waste money on their dental plan. BCBSTX’s sales reps cannot be trusted to tell the truth and will aggravate your employees as well as neighborhood dentists.

Assessment

If BCBSTX gets away with this dishonesty, what other senseless, but profit-enhancing hoops will they demand next year? How many more dentists and patients can an Attorney General allow them to cheat before speaking up? Come out and fight for your honor, BCBSTX … or not. I bring more than your best attorney can handle and I am waiting.

Conclusion

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Filed under: "Doctors Only", Career Development, Health Insurance, Information Technology, Military Medicine, Quality Initiatives, Risk Management | Tagged: ADA, BCBSTX, Blue Cross, Blue Shield, dental benefits, dental insurane, evidence based dentristy, evidence based medicine, Health Insurance, insurance fringe benefits, National Healthcare Information Infrastructure, NPI Number, NPPES, Robert Ahlstrom, Veterans | 22 Comments »

Independent Medical Practitioner as Solo Primary Care Surrogate

Posted on March 24, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Doctors Facing a Bleak Future Business and Financial Planning Model

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

According to Physicians News, on March 19, 2009, the demand for family physicians is growing. Proposals for health system reform focus on increasing the number of primary care physicians in America. Yet, despite these trends, the number of future physicians who chose family medicine dipped this year, according to the 2009 National Resident Matching Program. What gives?

NRMP

The National Resident Matching Program [NRMP] recently announced that a total of 2,329 graduating medical students matched to family medicine training programs. This is a decrease in total student matches from 2008, when 2,404 family medicine residency positions were filled.

Primary Care Demand Explodes

Meanwhile, demand for primary care physicians continues to skyrocket. For example, in its most recent recruitment survey, Merritt Hawkins, a national physician recruiting company, reported primary care physician search assignments had more than doubled from 341 in 2003 to 848 last year.

The Decline of Solo Medical Practitioners

Regular readers and subscribers to this Medical Executive- Post are aware of the declining number of solo medical practitioners; we have been sounding the alarm here, in our books, journal, speaking engagements and elsewhere for years now.

In fact, the statistic that we often cite is that more than 40% of the nation’s physicians are employed doctors; not employers as in the past. This business model shift has occurred over the past decade or so, and has accelerated of late. The decline in solo and independent doctors has occurred elsewhere as well, but much more slowly [i.e., dentistry, podiatry and osteopathy] as these specialties have been somewhat isolated from the traditional allopathic mainstream.

Going forward, this solitary model seems to be a good thing, and a fortunate result of the un-intended consequence of previously keeping these folks out of the healthcare mainstream.

The Decline of Independent Medical Practitioners

Now, in the March 2009 issue of Healthcare Finance News, we learn that the number of hospital owned physician practices has been climbing over the last four years, according to the Medical Group Management Association [MGMA]. Think: PHOs back-in-the-day.

And, while this trend only marginally affects patients and patient care, it is quite disruptive to physicians, their families, personal wealth accumulation, retirement and estate planning endeavors.

For example, according to Professor Hope Rachel Hetico, RN, MHA, CMP™ of our firm www.MedicalBusinessAdvisors.com

“The professional good-will valuation component of a medical practice is being decimated. Today, some practices are being bought and sold for tangible asset value, only.

Assessment

Therefore, allow me to identify this emerging trend which suggests independent medical practice as reflective of solo primary medical care. In other words, as independence goes the way of the “dodo-bird”, so goes primary care practitioners precisely at a time when the later is needed more than the former.

Why? Employed doctors stay that way by making money for their employer and hospital-bosses. Specialists make more money than primary care doctors. So, if you want to stay an employed doctor; which specialty would you pursue?

Answer: The NRMP class this year spoke out loud and clear. Any specialty but primary care!

Channel Surfing the ME-P

Conclusion

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Filed under: "Doctors Only", Career Development, Estate Planning, Financial Planning, iMBA, Inc., Managed Care, Op-Editorials, Practice Management, Practice Worth, Retirement and Benefits | Tagged: ADA, allopath, AMA, APMA, david marcinko, DDS, dentist, DO, doctor, DPM, family practitioner, hope hetico, iMBA, Inc., internist, MD, National Resident Matching Program, OD, optometrist, osteopath, pho, physician, podiatrist, primary care, residency match, www.healthcarefinancials.com, www.healthdictionaryseries.com, www.medicalbusinessadvisors.com | 15 Comments »

Reflections on Evidence Based Dentistry

Posted on March 23, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

My Search for Truth – 2009

[By Darrell Kellus Pruitt; DDS]

Do the leaders of the American Dental Association [ADA] encourage critical thinking by membership? Or; do they fear my opinion of what appears to be destructive and self-serving institutional bias in my ADA that favors businesses peripheral to the care of dental patients, and at patients’ expense? I think it is clear that there are a few good ol’ boys imbedded in the fat ADA who prefer to hide behind a comfortable, but obsolete command-and-control ADA business model. The mighty ostrich stuck its head in the sand. Then along came a noisy, gasoline-powered weed-whacker. Never saw it coming.

Evidence-Based Dentistry Champion Conference

On May 29-30, the First Annual “Evidence-Based Dentistry (EBD) Champion Conference” will be convened in ADA Headquarters in Chicago. Just like last year, the meeting with a brand-new name is sponsored by Procter & Gamble and The Journal of Evidence-Based Dental Practice with Dr. Michael G. Newman as its Editor and Chief. Even though this effort is enthusiastically supported by large corporations with products to sell, like P&G, managed care insurance companies such as Delta Dental, and electronic health records vendors such as Allscripts, the power of the reclusive stakeholders is further amplified by bureaucrats inside and outside the ADA – siphoning off my professional organization’s credibility. That is my opinion based on actual contact with a few characters in this group.

Evidence-Based Dentistry: 3rd International Conference

I attended the meeting last year when it was called “Evidence-Based Dentistry: 3rd International Conference” – I assume that in the last year, it lost its “international” status, and now caters only to “EBD Champions” (cheerleaders). Last year, they were also looking for Champions for their EBD ideas, but the bias was better concealed. I reported on the meeting in an article called “Evidence-Based Dentistry – My search for truth.”

http://community.pennwelldentalgroup.com/forum/topics/evidencebased-dentistry-my

Shortly into the meeting on May 4, 2008, I could tell by a show of hands from attendees that as a dentist who actually puts his hands in patients’ mouths as a regular part of his job; I was virtually alone in the auditorium. This was confirmed by the volume of “Boo” directed at me later that day. The Champions who had been selected months before the conference had already met that week and they were pumped. One could smell the zeal for EBD – whatever it means.

Journal of Evidence-Based Dental Practice

In his introduction to last year’s conference, Dr. Michael G. Newman, Editor in Chief of the Journal of Evidence-Based Dental Practice, told attendees that P&G is providing all the information about EBD to all the dental schools in the nation. I will be honest with you. Being booed last year for addressing what I think is the inferior quality of managed care dentistry during the final discussion period may have affected my attitude about EBD. In addition, being subsequently blocked from responding to a hurt and angry managed care discount dentistry broker by an ADA employee named Dr. Ron Zentz also disappointed me in my ADA. Dr. Zentz told me “This is not the place for this” as he stood between me and the microphone. Later I could not get Zentz to concede the indisputable fact that quality is proportional to reward. When I pressed him for an answer to the managed care question, he stoically repeated exactly what the insurance representative said: “Whether the dentistry is managed care or not, it makes no difference in the quality of care.” Here is something cute: The event was an “Evidence-Based” conference on the second floor of the Headquarters of the ADA, and Dr. Zentz is employed in the ADA’s “unbiased” science department. Get it? Now that’s funny!

Trouble-Makers Don’t Get Invited Back

My bad behavior last year may have something to do with why I was not invited to attend this year, even though I worked hard on the prerequisite essays which I will share with you later. Nevertheless, I have to warn that ADA-approved propaganda from P&G doesn’t strengthen this dentist’s confidence that our leaders are protecting the future of dentistry, friends. Take a look at what healthcare parasites have quietly done over the last decade or so to physicians’ practices with the blessing of the AMA, and counter to the interests of patients. Those same parasites were in ADA Headquarters on May 4, 2008. Our house at 211 East Chicago Avenue reeked.

EDB Vagueness

Like the HIPAA Rule on which Newman’s favorite interpretation of EBD leans hard, the beauty of EBD is in its vagueness. Both HIPAA and EBD can mean damn well anything one needs them to mean, and stakeholders with lots of influence have their fingerprints and drool all over the plans. For example, Dr. Robert Ahlstrom, a stakeholder and one of the speakers at last year’s conference uses HIPAA to support EBD and vice-versa according to closed-circuit, cause-I-said-so science that he evidently makes up as he goes. It is difficult for me to imagine that Ahlstrom’s eleven reasons that HIPAA benefit dentistry – which he presented as testimony for HHS Secretary Michael Leavitt over a year ago – were approved by a committee. I think Ahlstrom made up his reasons while waiting in the hall for the NCVHS meeting to begin. If the reasons were indeed approved by an ADA committee, I extend my sympathy. It must be difficult for challenged people like that to safely find their way home from work every day.

(See “HIPAA and Dentistry – About Ahlstrom’s Controversial HIPAA Testimony”)

https://healthcarefinancials.wordpress.com/2009/01/08/hipaa-and-dentistry/

Where is the Evidence?

A few hours before Dr. Ahlstrom, an ADA NHII (National Health Information Infrastructure) Task Force member, took the podium, Dr. Newman pleaded with dentists to always ask, “Where is the evidence?” I know Dr. Ahlstrom heard Dr. Newman’s words because Ahlstrom was sitting on the first row, next to ADA Senior VP Dr. John Luther, who is in charge of the ADA Department of Dental Informatics – a major beneficiary of EBD and HIPAA.

***

Buzzwords

I have come to the conclusion that EBD is a buzzword for a scheme supported by avaricious stakeholders who seek to regulate dentistry using healthcare IT. I assume it will be left to Dr. Robert Ahlstrom to present the plan to the next administration in his special, fanciful way. It is clear to me that the ADA is using Ahlstrom to lead American dentists down a computerized, cook-book path initially promoted several years ago at ADA Headquarters by none other than Newt Gingrich. The path ends with the NPI, NPPES and Ingenix-style Pay-for-Performance instead of free-market competition and consumers’ desires. Like Ahlstrom, EBD is little more than a tool.

Living with Rejection

I learned a couple of days ago that my application for this year’s conference was rejected. A PDF letter signed by Dr. Michael Newman, Editor and Chief of the Journal of Evidence-Based Dental Practice stated that the competition for seats was intense this year, and that I just didn’t have what the selection committee was looking for in a “champion” – even though one can see by their essay questions that the EBD stakeholders desire dentists who can draw audiences.

My Responses

Below are my responses to this year’s questions that I posted on September 23, even before I hooked up with PennWell, and the ME-P. I’m even more widely read now.

Q: Are you involved in the treatment of populations with limited access to care?

Counseling people who have big problems and little money is part of the job. Almost every day I help patients make hard decisions that affect their appearance as well as health. Compromises are always difficult, especially when it involves children. I do my best to provide my patients with the information they need concerning their specific problems in a personal manner. In that respect, I am no different than almost all other dentists I know.

Q: Given the opportunity, how do you plan to disseminate the information and knowledge of EBD?

For dentistry-related news, I am arguably the most popular commentator on the Internet. If I am convinced that EBD is in patients’ best interest, I can promote the concept to a wider audience than anyone else in dentistry and it will not cost a thing. I can use any number of websites in addition to a private network of colleagues that has been in place for almost three years.

If I leave the conference suspecting that stakeholders ambushed EBD to manipulate dentist-patient relationships for selfish reasons, I will work even more effectively to undermine it. Fair is fair.

Q: Are there any specific examples that demonstrate your ability to be a good disseminator?

Apart from having an increasingly popular column about healthcare matters on this ME-P https://healthcarefinancials.wordpress.com/?s=darrell+pruitt+dds ), I am always seeking new and innovative ways to attract attention to dentistry. I am very good at what I do.

Here is a simple demonstration of my talent: Googlesearch “Darrell Pruitt DDS.” You will discover that I’ve got what they call “googlejuice.” I create interesting content. People you need to reach read me.

The question is; does the ADA have the confidence to subject EBD to my critique? On the other hand, does the ADA have the courage not to?

Since I will not be allowed to keep colleagues in my neighborhood as informed in real-time and in detail as they should be, I invite one or more “EBD Champions” to describe what they learned following the Conference in May right here on this ME-P and PennWell forums. And as always, I invite Dr. Robert Ahlstrom to discuss what he plans to do with my dental practice.

Assessment

Tomorrow, as part of “Transparency and the ADA – a dissecting experiment,” I intend to post another question on the EBD link following my weekly report. I will ask if Dr. Robert H. Ahlstrom will be addressing the audience before having my name put on a short-call list to replace late-cancellations. Depending on the answer, I may go camping instead.

Channel Surfing the ME-P

Conclusion

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Filed under: "Doctors Only", Career Development, Ethics, Op-Editorials, Quality Initiatives, Research & Development | Tagged: ADA, Allscripts, American Dental Association, delta dental, Dr. John Luther, Dr. Michael G. Newman, Dr. Robert Ahlstrom, Dr. Ron Zentz, EBD, eDRs, evidence based dentistry, Evidence-Based Dentistry: 3rd International Conference, HIPAA, Ingenix, National Health Information Infrastructure, Newt Gingrich, NHII, NPI, NPPES, P&G, P4P, Pay-for-Performance, PennWell, Procter & Gamble, The Journal of Evidence-Based Dental Practice | 7 Comments »

On the HITECH Act of 2009

Posted on March 10, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

The American Recovery and Reinvestment Act

By Staff Reporters

On February 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act [ARRA]. According to some, the law provides an opportunity to transform healthcare in the United States.

HIT

The law also provides $19 billion in health information technology [HIT] funding to ensure widespread adoption and use of interoperable HIT systems like the electronic health records funding provision. But, as ME-P readers are aware; this is not apparently for electronic Dental Records [eDRs]; and CCHIT is no advocate of professional diversity.

Link: https://healthcarefinancials.wordpress.com/2009/03/02/cchit-is-prejudiced-and-lacks-diversity-%e2%80%93-an-indictment

HITECH

Obama’s signing of the Health Information Technology for Economic and Clinical Health (HITECH) Act [a portion of the stimulus package] recognized the importance of HIT as the foundation for health care reform and cost savings.

Assessment

Is this report correct? Read all 187 pages and decide.

Link: HITECH http://democrats.science.house.gov/Media/File/Commdocs/HealthIT%20Bill.pdf

Conclusion

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Filed under: Health Law & Policy, Information Technology | Tagged: ADA, American Recovery and Reinvestment Act, ARRA, CCHIT, Darrell Pruitt, dentistry, eDRs, EHRs, EMRs, Health I.T., Health Information Technology for Economic and Clinical Health, HIT, HITECH, obama | 6 Comments »

Problems with HIT in Minnesota

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

The Continuing eHR Saga

By Darrell K. Pruitt; DDS

If you were one of fifty governors who decide to jump off a cliff because flying looks so cool, would you proudly race to be the first to grab the air? Blissfully, Minnesota Governor Tim Pawlenty is way ahead of the pack. He’s so confident in healthcare information technology [IT] that he doesn’t even have to watch where he’s going – leaving him free to smile for the cameras. Now that’s cool.

Initial Ambitious Plans

Attention ME-P readers! Please gather around to watch a world-class belly-flop of a gutsy statewide eHR mandate. A few years ago, Governor Pawlenty had ambitious plans to lead the nation with an interoperable eHR system that was touted to include all providers – that means Minnesota dentists as well. Your landing could be vertical and abrupt, Pawlenty.

CCHIT Approved?

In fairness to a brick, back in 2005 Pawlenty could not have predicted the economic collapse that began three years later, nor could he have known about the subsequent $19 billion eHR money that would be made available to providers – but only if they purchase healthcare IT software that is approved by the Certification Commission for Healthcare Information Technology (CCHIT).

CCHIT Laggards

Even if the descending Pawlenty could have predicted the recent changes in the terrain, including the CCHIT qualification, he would have never guessed that to this day in March of 2009, the certifying commission would still be yet to certify even one single electronic dental record – thereby blocking Minnesota dentists from copious federal help in their efforts to become compliant in Pawlenty’s brave new state.

“The government is actually looking for places to spend the money where there is a strong likelihood of success stories”.

–Mike Ubl

Executive Director Minnesota Health Information Exchange

[Owned by Blue Cross Blue Shield of Minnesota, HealthPartners, Medica, Fairview Health Services, UCare and the Minnesota Department of Health].

Link: http://www.twincities.com/ci_11830085

“And that after this is accomplished, and the brave new world begins – When all men are paid for existing and no man must pay for his sins”.

-Rudyard Kipling

The CCHIT qualification was incredibly bad luck for Pawlenty’s nifty ideas of interoperability with all providers. When Minnesota dentists discover that they must pay $30 thousand for software they don’t want in order to practice in paradise, some may just swallow their pride, sell the portable ice-fishing house, and move to slow-moving Iowa.

Dentists, MDA and the ADA News

Why the surprisingly quick landing? If Pawlenty actually gave any consideration for dentistry at all, just like everyone else, he must have assumed that dentists’ concerns about digital records would be adequately attended to by the Minnesota Dental Association [MDA] and the American Dental Association. It was easy to make that mistake because of the enthusiasm for eDRs radiating from ADA Headquarters and expressed in confident terms in ADA News Online articles that have since stopped appearing. Most eDR enthusiasts naturally assumed that by now the majority of dentists in the nation would be saving money, lives and trees with paperless practices. However, the ADA has been nowhere to be found for a long time. As it turns out, the professional organization has still not yet even contacted the certifying commission. We know this, because when I personally contacted CCHIT a few weeks ago, it caught them off guard. I was told that I was one of the first to ever mention dentistry.

Link: https://healthcarefinancials.wordpress.com/2009/03/02/cchit-is-prejudiced-and-lacks-diversity-%e2%80%93-an-indictmen

No Endorsements

To show how far the ADA has slipped, and as an example of its flagging influence on membership, I doubt that more than 5% of American dentists have made the ADA-endorsed leap from paper to digital. Why should they? It makes good business sense to wait, and most dentists are not techno-silly. Consider this; Even if a dentist is happy with a costly eDR system that demanded unanticipated time and effort to learn, in less than a year, CCHIT could determine that his or her favorite system is not worthy of certification because it does not integrate with physicians’ one-size-fits-all, CCHIT-certified eMRs. Tough luck, Minnesota dentists! Uncertified eDRs will be outlawed, while favored, large healthcare IT companies in Madison and Chicago will profit and pay more state taxes with Twin-Cities’ dollars. By then, all the stimulus money will be gone and lawmakers will no longer be giddy about eHRs due to the imminent explosion of data breaches everywhere caused by moving too fast. No return on investment [ROI] there.

Assessment

Still, Tim Pawlenty could have never known, yet away he sails with a stupid grin on his face.

Conclusion

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Filed under: Career Development, Health Insurance, Information Technology, Op-Editorials | Tagged: ADA, American Dental Association, Blue Cross, Blue Shield of Minnesota, CCHIT, Certification Commission for Healthcare Information Technology, Darrell Pruitt, david marcinko, DDS, DMS, eDRs, EHRs, EMRs, HealthPartners, HIPAA, HIT, IT, MDA, Medica, Mike Ubl, Minnesota Department of Health, ROI, Tim Pawlenty, UCare | 1 Comment »

Don’t Rush Into eHRs

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

Address Medical ID Theft

[By Darrell Pruitt; DDS]

Yesterday, an important message titled “Don’t Rush eHRs Without Addressing Medical ID Theft” was posted on ModernHealthcare.com by Martin Ethridgehill, a provider training specialist with Blue Cross and Blue Shield of New Mexico.

Link: http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090302/REG/303029965

Mr. Ethridgehill points out that if a patient’s electronic medical identity is stolen by someone for health insurance benefits, critical information about the patient can be imperceptibly altered, leading to accidental death in an emergency room for any number of reasons. Furthermore, he points out that even if the real patient is aware that his or her record is tainted by a false patient’s data, it is very difficult to get the comingled record cleared up.

I have also read elsewhere that HIPAA actually impedes resolution of the nightmare because the Rule also protects the privacy of the false patient – prohibiting the real patient from examining his or her own health record.

Reasons to Go Slow

Ethridgehill is particularly critical of the EHR industry which lately has downplayed the importance of patient privacy in order to sell dangerous products. He gives these reasons for the need to slow down in the rush for interoperability:

“Adding safety and records mitigation protocols ensures patient safety as an ongoing concept and practice.”
“No industry would be allowed to operate, where the officials in charge of it stated that the market or other bodies would be responsible for creating safety procedures. Can you imagine if the auto industry stated, “We make cars, let the market figure out how to regulate safety”? I doubt that Congress or any other body would consider these people as remotely credible, yet I hear time and time again these statements being made in public and private forums by executives, lobbyists, and even so-called healthcare leaders.”
“For the public and providers to embrace a product that has no regulation, no built-in safeguards and obviously no importance to safety from the makers of these products, why would Congress expect the American public or healthcare providers to embrace a product or concept that involves the unregulated risk of injury, death, or staggering liability opportunities, let alone without any hope of remedy or proper relief?”

Conclusion

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Filed under: Health Law & Policy, Information Technology, Research & Development | Tagged: ADA, CCHIT, Darrell Pruitt, david marcinko, dentists, eDRs, EHRs, EMRs, HIPAA, HIT, IT, Martin Ethridgehill, ModernHealthcare | 20 Comments »

Avi Baumstein and HIPAA Compliancy

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

A Ten-Step Process

By Darrell K. Pruitt; DDS

HIPAA inspections are coming. Are you still computerized? If so, are you prepared? The fines are steep if a dentist’s [optometrist, podiatrist, allopath or osteopath’s] computer is hacked and he or she is found to be not in compliance.

About Avi Baumstein

Avi Baumstein is an information security analyst at the University of Florida’s Health Science Center in Gainesville. He posted an article recently; on InformationWeek titled “Time to Get Serious about HIPAA.” Baumstein is one expert who should know.

Link: Ten Step Process

http://www.informationweek.com/news/industry/health-care/showArticle.jhtml?articleID=214600332&pgno=1&queryText=&isPrev=

Mr. Baumstein notes that in October, the HHS inspector general issued a report that was sharply critical of CMS (Medicare and Medicaid) for not enforcing HIPAA security. The embarrassing dope-slap of CMS leadership causes Baumstein and other experts in the security industry to anticipate more “proactive enforcement” (unannounced inspections) in the next year.

From his article, I am led to believe that the last prerequisite for meaningful action to enforce security is a tax-paying and otherwise acceptable nominee for Secretary of Health and Human Services. Whoever Obama finally digs up [Kathy Sibelius] I think providers are in for significant changes.

For example, it will be the Secretary who will ultimately decide if HIPAA inspections will be performed by new federal employees or PriceWaterhouseCoopers personnel – which was the former President’s administration’s “market approach” to helping the GDP by outsourcing policing duties, as well as accountability, to favored big businesses. (For those who are sensitive about political affiliations and become upset with me for saying unflattering things about your heroes, please don’t feel too hurt. I’m a bi-partisan critic for natural reasons).

The ADA’s imaginary playing field and toy soldiers

ADA President-Elect Dr. John S. Findley,

In-house interview ADA News

October 7, 2008

In spite of President Findley’s manicured and traditional cause-I-say-so sound bite, the actual invisibility of ADA leadership in healthcare IT matters clearly hints that whatever happens in Obama’s healthcare reform, dentists’ and patients’ concerns stand little hope of being adequately represented by ADA representatives.

For example, when I recently contacted CCHIT to ask about EHRs in dentistry, I was told that I was one of the first to even mention dentistry to the private and reclusive non-profit EHR certification club. I think that chunk of unexpected news blows a huge hole in President Findley’s boat. Want to see something hilariously scary in a darkly humorous way? The President’s campaign motto this time last year was “Findley for the future.” Get it?

In spite of the silent neglect of dentists’ interests by dental leaders from the top down, I would like to proclaim that there is accidental hope that future HIPAA inspectors will know more about dentistry than the jobless OSHA hired in the late 1980s during the HIV panic. I heard a rumor back then that OSHA sent an inspector to a dental office who didn’t know the difference between a microwave and an autoclave.

Panic and Urgency

Panic, a favored US government bureaucratic response, occurred when OSHA leaders found themselves suddenly under pressure from Congress over a mysterious disease that was raging out of control. Since immediate action was demanded, even if it was irrelevant and wasteful, OSHA leadership was so busy chasing shadows that it was hiring almost anyone just to cover their lower backs. Eventually, the panic subsided and yielded to a low level of common sense, thanks in large part to the intervention of the late Rep. Dr. Charlie Norwood of Georgia – a dentist and a courageous statesman. Nevertheless, because of the momentum of institutional panic, millions of healthcare dollars have been wasted on 99% superstition; incredible? Consider this.

In the last two decades, how many lives have been saved by covering dental chairs with plastic between patients? Now, how much does the effort raise dentists’ fees – thereby lowering accessibility and increasing disease and suffering among Americans? Furthermore, after each dental patient is released, the “contaminated” sheet of petroleum-based polyethylene is thrown away. I ask this: Are the reasons for inevitable environmental problems caused by regularly adding non-biodegradable plastic to the city dump based on evidence-based science?

Of course not! This and other related acts of foolishness are nothing but lingering, costly superstition – now accepted as standard of care without proof of effectiveness. Here is how such absurdity happens: Some of those weekend miracles quickly hired by OSHA in the ‘80s went on to become prosperous and influential consultants with lots of ideas.

Since the US government is prone to panic followed much too quickly by careless and expensive overkill, national responses to adversity often stimulate lots of employment – evidence of need be damned. The OSHA surge of the 80s followed the AIDS scare. More recently, coming on the heels of the banking collapse, auditing has become one of the fastest growing fields in the industry. The feds cannot hire people with accounting skills fast enough. I contend that one should expect that for reasons and attitudes similar to those surrounding the increased funding for OSHA, it follows that news of frightening breaches of EHRs by the hundreds of thousands at a time has created a new nidus of power in a fresh, enthusiastic administration, as well as an enormous employment opportunity for anyone with knowledge of dentistry – like super-hygienists.

A hazy glimpse of the future and a promise to tie all this together soon

This brings us to a fanciful peek over the edge of the event horizon in dentistry. At the same time that HIPAA inspections of dental offices appear unavoidable, there is currently a turf war between fully licensed dentists and expanded duty “super-hygienists” who wish to be able to practice independently – limiting their invasive work to only easy fillings and simple extractions that in their assessment will not turn complicated.

Link: www.HealthcareFinancials.com

Turf Wars

This kind of war has been fought before, and physicians lost. Nurse-practitioners annexed physician turf like Sudetenland, and they are still grabbing lebensraum. CMS loves it.

However, dentistry is different. It is my opinion that because of dental patients’ very personal reasons that include under-rated motivation from primal fear and terror, they will shun almost-dentists almost immediately – leaving graduates with huge student loan payments and lots of unused knowledge about dentistry.

Furthermore, I predict that when super-hygienists consider the expense of finishing out and leasing space at a shopping mall or department store, in addition to monthly loan payments to cover the price of dental equipment, or perhaps even the buy-in price to an insurance-sponsored dental franchise, a few will be discouraged from their initial intention to increase accessibility to dental care by lowering cost and quality.

I think reality will cause a few super-hygienists to be readily lured from their initial goals upon entering two-year junior college programs that taught them nomenclature and the easy parts of doing dentistry. Unless they agreed to work in underserved areas in exchange for paid tuition, some will consider the benefits of working for commission for the US government as HIPAA inspectors. And later, the most successful of these will have the opportunity to continue their careers as HIPAA consultants with lots of ideas.

Are you following me so far? In conclusion, within two years, instead of real-dentists and almost-dentists being faced with uninformed HIPAA inspectors like OSHA’s shock-and-awe weekend miracle crews of the ‘80s, there will accidentally be thousands of nomenclature-savvy super-hygienists graduating across the nation looking for work about the time an acceptable HHS nominee finds his or her stride. What a story!

Did I ever tell you that I once did a short stint as a screenplay writer?

I guess I am being a little bit silly concerning super-hygienists, but do you see how all these pieces of history can conceivably come together at a time when the nation couldn’t be more vulnerable to wasting money on foolishness? Common sense about patients’ security is just not that common in Washington DC, and the absurdity of HIPAA is so great that the stunned silence it evokes actually causes the enforcement of folly to fit in well with the traditional Democratic tendencies of using big government to handle all possible contingencies caused by human frailties – even if that means micromanaging everyone. Who needs that?

Every day, I am increasingly thankful that my office is not computerized. The sheet-metal box that contains my patients’ ledger cards does not have a USB port. Preparation for inspection is tricky by design.

Link: www.MedicalBusinessAdvisors.com

Assessment

Baumstein concedes that preparing for a HIPAA inspection is difficult because the law is intentionally vague:

“One goal of HIPAA was to be a one-size-fits-all, technology-neutral regulation.”

Incredible; when you read the ten obligations Baumstein says a dentist must complete to be compliant with a vague mandate, you too may want to go back to a pegboard system – carbon paper and all.

It seems to me that in 2003 or so, someone in the ADA Department of Dental Informatics should have warned ADA leadership about the obvious fact that as long as there is a dependable supply of cheap carbon paper in the nation, HIPAA enforcement has the potential to drive computers smoothly out of dentistry. Instead, there was silence followed by increased funding for the department’s budget, and the game was on. By 2005, at the urging of the former administration and healthcare IT stakeholder Newt Gingrich, the ADA News was posting articles pushing ADA members to quickly volunteer for irreversible NPI numbers for no good reason. A trusting majority of members dutifully followed the tainted command. I am saddened by the loss few yet comprehend.

Link: www.HealthDictionarySeries.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. In bringing a close to this contiguous, here is something some may find interesting about the University of Florida, where Avi Baumstein works. Do you remember the 330,000 dental patient records that were hacked this fall from the Dental School located in Gainesville, Florida? You guessed it; same college town – same health science center.

And, as of last week that the dental school was still hemorrhaging patient data to who knows where. I bet by now, Baumstein knows more about HIPAA and dentistry than anyone in the nation How about you?

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Filed under: Career Development, Health Law & Policy, iMBA, Inc., Information Technology | Tagged: ADA, ADA News, AMA, AOA, APMA, Avi Baumstein, CCHIT, Darrell Pruitt, EMRs, HHS, HIPAA, InformationWeek, John S. Findley, Kathy Sibelius, Newt Gingrich, NPI Numbers, obama, OSHA, Rep. Dr. Charlie Norwood | 6 Comments »

The Future of Hospitals

Posted on February 28, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

Between a “Rock and Hard Place”

By Dr. David Edward Marcinko; MBA, CMP™

By Hope Rachel Hetico; RN, MHA, CMP™

A recent white paper by the Joint Commission suggests that hospitals must respond in new ways to meet the increasing complexity of patient care and to address rising health care costs. Duh! What an insight. Why did it take so long for them to declare same?

The Hospital Accreditation Competition Heats-Up

Was it because of competition from DNV Healthcare Inc? Was it their new ability to determine if hospitals are in compliance with Medicare Conditions of Participation [COP]? DNV joins the Joint Commission on the Accreditation of Healthcare Organizations [JCAHO], and the American Osteopathic Association [AOA], as the only national hospital accrediting agency approved by the Centers for Medicare and Medicaid Services [CMS].

Link: https://healthcarefinancials.wordpress.com/2008/10/03/hospital-accreditation

Recommendations

Nevertheless, the JCAHO report recommends action in five areas:

Economic viability and ROI
Technology adoption and use
Patient-centered collaborative care
Medical and human resources staffing
Hospital architectural design

Patient Centered-Philosophy

Of course, it is no surprise that patient-centered care should be philosophically at the core of any partnership between a patient and his/her hospital and medical providers. Yet, just think of the last time you saw your HMO doctor and tried to engage in a collaborative health 2.0 discussion with him/her? Na-da!

Health Information Technology

The Joint Commission, despite the interoperable eHR controversy often presented on this blog, suggests that technology adoption can play a major role in improving patient care, safety and quality.

Link: https://healthcarefinancials.wordpress.com/2008/12/19/the-case-against-inter-operable-ehrs

This transformation from paper to electronic records, according to the report, will involve:

Making the business case for ROI and funding
Redesigning business processes with HIT implementation
Extending the digital footprint to the “medical-home”
Engaging IT leaders for guidance on prior mistakes
Improve workflow – minimize labor intensive activities

Of Hospital “Insider” Administrators

One local hospital administrator insider, here in Atlanta, confidentially tells us that a single hospital bed is currently worth about a million bucks a year to the institution; private or public. And, the mantra of most hospital CEOs to staff doctors, is: “fill the beds”; “schedule the procedures”; and/or “book the operating rooms.” So, the priorities outlined in the report really don’t seem appropriate; do they?

IOW: Put the hospital first; not the patient? And, this echoed our experience in hospital administration two decades ago. Has anything changed?

Assessment

Nevertheless, it may be refreshing to see an approach to healthcare technology implementation that seems to leverage the experience and knowledge of other industries. Privacy concerns however, are the biggest obstacle to HIT and true inter-operable eMRs, in our opinion. Yet, it doesn’t need to be. Who cares if grandma has a bunion, or dad had his cataracts repaired. They aren’t running for public office; are they?

The road to the Hospital of the Future will be bumpy, but we are hopeful enough to trust the benefits will be great once we arrive.

Full report: hosptals-future

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Are hospitals today “between a rock and hard place?” Is technology and business process reorganization being offered as a substitute for critical thinking and true collaborative medicine? Especially, in light of the healthcare capitalistic thrust to: “do more – in order to earn more.”

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Filed under: Health Economics, Health Insurance, Healthcare Finance, Information Technology, Research & Development | Tagged: ADA, AMA, AOA, CMS, DNV Healthcare, Hetico, JCAHO, Kenneth A. Powers, Marcinko | 3 Comments »

Collaborative Dental Health 2.0 [Upcoming Three Part Series]

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

Hippocratic Dental Consumerism

By Darrell K. Pruitt; DDS

Even before the downturn in the economy sent dentists scrambling for new sources of patients, these were already times of revolutionary changes in the marketing of dental care. To those who are alert, the Internet-enabled chaos signals a rare opportunity if one sides with consumers rather than tradition. It takes confidence to welcome transparency, and it looks increasingly bad when dentists resist accountability in traditional ways – like suing. Yelp; because of a bad review that was posted on the patient referral site. That is the second stupidest thing one can do. Being perhaps a geeky student of the Internet, and sort of nosey, I have been tracking the popularity of dentists’ comments on a few Internet venues for quite a while, because of my own curiosity. I also get ornery enjoyment from reporting to my friends my opinion of what is really happening in my profession that nobody else talks about. My hobby could be called fuzzy data mining based on a platform of precise subjectivity.

For more intricate and dependable real-time information, I choose the surveys reported on The Wealthy Dentist Blog, hosted by Jim Du Molin. They are the best around.

Link: http://www.thewealthydentist.com/blog/

American Dental Association

The ADA also provides nice, formal presentations of even more accurate information, but it is often dated and not ground-level relevant like Du Molin’s studies. Until the Internet came along, gathering useful information about dentists’ prevailing attitudes outside one’s professional circle was virtually impossible, and dentists are well aware that even within these circles, colleagues’ opinions at dental meetings are sometimes intentionally misleading – perhaps mine are less reliable as well at social gatherings. I never talk this frankly in real life.

Dental Information Silos

Talk about information silos! No less that 85% of dentists in the nation are owners of solo private practices (ADA News), and only 2% have bubbly personalities (my guess). Dentists’ quiet isolation, which is arguably favored by what I would guess would be around 85% of dentists in the nation, is a unique characteristic in modern healthcare that is part of a unique labor-intensive art – performed to exacting tolerances in an unpredictable environment – intricate work that most consumers know little about. Yet the ultra-personal accountability welcomed by almost all solo dentists is the way even neighborhood physicians once practiced their trade for thousands of years before modern stakeholders became involved.

Hippocratic Oath

Is working alone with one’s chosen staff the most efficient way to provide dental care? No way. But for me personally, maintaining complete control of the care I provide from start-to-finish for those who depend on me is safer for them and a better business model for me than any alternative I have seen yet. In my opinion, there is no room in the Hippocratic Oath for less than 100% devotion to the patients’ interests. More than two thousand years later, it is called consumerism, and it is 180 degrees counter to stakeholders’ interests, preferred provider lists and universal healthcare. And, it probably comes as no surprise that last October I observed that the most popular comments that were posted shifted from news about the benefits of high-tech inventions in dentistry to advice for how to survive in a tough economy. The whole nation is concerned about finances, and getting one’s teeth cleaned is commonly sacrificed when things get tough. Don’t even mention implants and crowns.

2009 Recession

At the risk of sounding ostentatious as well as pedantic, I will offer that (for the time being) my practice is not suffering from a downturn that many of my local colleagues are enduring. In fact, I am actually busier than I was this time last year – and I made more profit in 2008 than ever before in 26 years of practice. I am also discovering that patients I lost long ago are returning now that they no longer have provider lists. They are also finding that my prices are not so high after all (in fairness, I should add that it has been longer than usual since I have raised fees – except for full gold restorations, of course). Since I am not in the business of selling advice, I am not afraid to also admit that my practice still experienced a couple of slow periods in the late fall – directly attributable to the initial shock of the downturn. But I cannot say that the slowdown was any worse than other times in the last few years, and it certainly hasn’t been as bad as what dentists in Michigan must endure. My sympathy and best wishes go out to my colleagues up north. Things could all turn for the worse for me tomorrow, but for right now, I’m somewhere between surviving and thriving, for what that is worth; nothing spectacular, but solid.

Three Part Series

This posting, which I hope some readers find useful, will be a multi-part series. I haven’t worked everything out yet, and my outline is subject to change, but here is what I have in mind.

In Part One, I’ll describe how my active participation in DR. Oogle (doctoroogle.com) has not only kept my name off of preferred provider lists, but it has also improved the quality of care my staff and I provide, as well as improved the working atmosphere in the office. Transparency will do that.

Then, in Part Two, I will offer my suggestion how one can use DR. Oogle or similar patient referral site to “graduate” from managed care into fee-for-service dentistry without losing patients or profit. As a naughty teaser, let me hint that over three years ago, I offered the idea as an article for the monthly newsletter of my local dental society, only to be refused publication for the first time in over two decades of submissions. I was told that an official nixed it as a transparent “scheme” to harm managed care dental companies, and was therefore below the standards of ADA publications.

“Image is everything”

-ADA/Intelligent Dental Marketing

Finally, in Part Three, I’ll describe how a good offense is also a handy defense – perhaps even in defense against malpractice litigation. Hopefully, a few sincere readers will consider playing to win rather than playing not to lose. And, for those who still don’t see my point, I will reveal how to play not to lose. Fair is fair. It costs from $625 to $1995 per year, and in my opinion, is the stupidest thing one can do. Hope you enjoy this three part series.

Assessment

Editor’s Note: This post was first published on PennWell. Dr. Pruitt blogs here and at others sites. His insights are applicable to most all medical specialties.

Conclusion

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

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Maintenance of Medical Board Certification

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

Status Growing in Importance – or Sham

Dr. David Edward Marcinko; MBA, CMP™

And Staff Reporters

Increasingly, efforts to boost quality and gain better value from the world’s most costly healthcare system are including attention to Maintenance of Board Certification [BOBC], a little-understood but rigorous process by which physicians maintain board certification status and then keep it.

Hillary-Care Redeux

Back in the day, circa late 1970s – early 1980s, medical board certification was indeed a rigorous process; and still is to a very large extent. For example, Democratic presidential candidate Hillary Rodham Clinton, in laying out the quality portion of her three-part healthcare reform plan last year, specifically touted these programs as a key step in enhancing quality. From the presidential campaign trail to hospital and health plan board rooms, Board Certification and the Maintenance of Board Certification is a growing force in the industry.

But, is maintaining recertification status another matter of true quality import?

Major Health Plans On-Board

Several of the nation’s biggest health plans—including Aetna, Cigna, Humana, UnitedHealth Group and national and regional Blue Cross and Blue Shield organizations—are embracing Maintenance of Certification as part of their recognition and reward programs. Physicians who do not participate are not highlighted in plan directories and miss out on higher plan reimbursements.

Yet, why do we have “red flag” issues, “never-events” policies and/or the rise of “checklist-medicine” for risk reduction if these continuing education programs are so effective?

Allow me to cite the raging over-treatment epidemic, especially in specialties like arthroscopic orthopedics, radiology imaging [CT and MRI scans] and invasive cardiology, etc. Not to mention recent, and not so recent, Institute of Medicine [IOM] quality chasm reports for in-hospital patient deaths, complications and infections, etc.

Assessment

Of course, savvy hospital administrators and physician executives, of all stripes, are examining ways to use elements of board certification maintenance to respond to the Joint Commission’s new requirements for physician credentialing and privileging. Furthermore, the National Quality Forum [NQF] and the AQA quality alliance will be considering Maintenance of Certification for quality measurement endorsement.

Source: Cary Sennett and Christine Cassel, Modern Healthcare

Joint Commission Relevance in Modernity

But, is the Joint Commission itself even as relevant today, as in the past? Or – is its [political, quality and economic] status, might and swagger being reduced in favor of modern new-wave insights from health 2.0 collaboration activities and emerging formal organizations like DNV Healthcare Inc., a division of the Norwegian company.

As subscribers and Medical Executive-Post readers are aware, Det Norske Veritas [DNV] has recently been charged with immediately determining if hospitals are in compliance with the Medicare Conditions of Participation [COP]. The company’s authority to accredit hospitals runs through September 26, 2012. DNV joins the American Osteopathic Association [AOA] as the only other national hospital accrediting agency approved by the Centers for Medicare and Medicaid Servicers [CMS].

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Is medical board certification and maintenance status of real value – or just fluff – much like the continuing education and licensure requirements of insurance agents, stock-brokers and financial advisors, etc? Is it less for medical education – and more for liability risk reduction – or PR – you decide?

Disclosure: I am a reformed insurance agent, stock-broker, board certified quality review physician and Certified Financial Planner®.

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A Review of Elder Housing Protections

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

Home Equity Resources, Housing and Care Options

Staff Reporters

According to Stephanie Edelstein JD; Charles P. Sabatino JD and Nancy M. Coleman MSW MA; opining in the ElderLaw Series, until relatively recently most people in this country followed a rather typical housing pattern in their later years. They either rented or owned their homes and lived alone until they were no longer physically or economically able to manage independently, at which time they moved in with family members or into nursing homes or board-and-care homes.

Elderly Housing

Housing, particularly rental housing, provided the proverbial bricks and mortar, and, with the exception of a few facilities that offered meals and some light housekeeping, little opportunity existed for older persons to receive services in their homes. Elderly tenants who were perceived by a landlord or housing manager as unable to manage on their own were evicted, frequently without due process protections, and just as frequently would end up in a nursing home. While disabled tenants in federally assisted housing programs were accorded protections against discrimination on the basis of disability, no such protections existed for residents of private housing. Few members of the legal, healthcare or aging communities, and even fewer among the elderly, were aware of those protections that did exist.

Emerging Changes

Much has changed during the last few years, in large part due to the increasing emphasis on retaining autonomy, the trend towards aging in place, and the passage of civil rights statutes, which have raised public awareness of the legal rights of persons with disabilities.

For example, for frail or disabled older persons, including medical professionals, protection against discrimination in housing can be found in three federal statutes: [1] the Americans with Disabilities Act, [2] the Rehabilitation Act of 1973 and the [3] Fair Housing Amendments Act of 1988. Of the three, only the Fair Housing Amendments Act (FHAA) is targeted exclusively to housing and within the housing area is arguably the most far-reaching.

Rehabilitation Act

The Rehabilitation Act of 1973 (the antidiscrimination provisions of which are commonly referred to as §504) is a general civil rights statute that prohibits discrimination against any “otherwise qualified individual with handicaps” in a wide variety of programs or activities receiving federal financial assistance, including housing.

FHAA

The scope of the FHAA, as it applies to housing is broader, and it covers virtually any housing activity or transaction, including both private and subsidized, apartments and single family dwellings, and prohibits discrimination against all individuals with handicaps, even if the discrimination cannot be attributed directly to the disability.

ADA

The Americans with Disabilities Act (ADA), which is having a profound effect on all elements of society, can be seen as complementing the other statutes. The ADA extends to all state and local programs the protections of §504, and also prohibits discrimination against people with disabilities in public accommodations.

Disability Defined

All three statutes use virtually the same definition of “handicap” or “disability.” Protection is extended to persons with a “physical or mental impairment which substantially limits one or more major life activities,” such as performing manual tasks, personal care, walking, seeing, hearing, speaking, etc. The definition includes persons “having a record of such an impairment”, whether or not the impairment still exists; and a person “regarded” as having such an impairment,” whether or not the perception is accurate. While age alone does not equate with disability, the symptoms and conditions of the aging process are likely to cause impairments that meet these definitions.

Addition Exempted

“Handicap” or “disability” does not include current illegal use of or addiction to a “controlled substance.” Moreover, none of the statutes require a housing provider to make housing available to an individual “whose presence would constitute a direct threat to the health or safety of other individuals or whose tenancy would result in substantial physical damage to the property of others.”

Legal Purposes

The intent of these laws is to provide persons with disabilities access to and enjoyment of housing and services to the same degree as if they were not disabled. They apply from point of application throughout the tenancy. Housing providers may not maintain separate admissions standards for people who are frail or disabled, nor may they inquire about an applicant’s health or ability to live independently, unless those questions are to establish eligibility for particular programs or services.

For example, the decision to lease to a particular individual must be based on program eligibility (if appropriate) and the ability of the applicant to comply with the terms of the lease, whether independently, with the assistance of a third party, or as a result of a reasonable accommodation by the provider. A prospective property owner may not require an older person to have a “sponsor,” or “guarantor,” a practice common to many senior housing programs.

Assessment

In recent years, courts have found the following policies to be discriminatory: requiring residents who must use walkers or wheelchairs to transfer to regular chairs when eating in the common dining room; failing to provide accessible parking spaces for disabled tenants; and refusing to modify a “no pet” rule for tenants with disabilities who need guide dogs or service animals.

Link: www.HealthDictionarySeries.com

Conclusion

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

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

Filed under: Financial Planning, Health Insurance, Health Law & Policy, Insurance Matters, Risk Management | Tagged: ADA, Americans with Disabilities Act, charles sabatino, elder housing, elder law, eldercare, Fair Housing Amendment, FHAA, nancy coleman, Rehabilitation Act of 1973, stephanie edelstein | 1 Comment »

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