Clinical Information Systems

More than Hospital Administration Technology 

Staff Reporters

In contrast to hospital administration systems [HASs], according to Richard Mata MD MIS, clinical information systems [CISs] deal directly with patient care processes and results. Clinical system sophistication varies widely from hospital to hospital and has the strongest presence in tertiary care centers. And, some hospitals have become nearly “paperless” due to the installation of leading edge clinical information systems.

Leading Edge Hospitals

Several leaders have emerged in the field of clinical informatics, most of which are tertiary care centers and teaching hospitals. Whereas the typical hospital only has about 3 to 5% of its budget allocated toward information systems, these medical centers often have a much greater percentage earmarked for such systems.

Functions and Functions

Hospital clinical information systems [CISs] encompass a wide range of features and functions, and modules may include the following:

  • pharmacy information systems which may include bar coding and drug interaction checking;
  • computer physician order entry [CPOE] systems allowing clinicians to directly order tests and treatments on line. These systems can also check for selected appropriateness of care parameters;
  • other departmental systems such as laboratory information systems [LISs], radiology systems, and intensive care clinical computing; and
  • electronic medical record (eMR) systems, which allow physician orders, free text clinical notes, decision support, radiology images, and other areas to be nearly fully computerized, allowing a “paperless” medical institution.

High Start-Up Costs

Both budget outlays and implementation strategies for these systems are highly variable and require much deliberation and foresight. The start-up costs of these systems can vary from several hundred thousand dollars for a departmental system in a community hospital to tens of millions of dollars for EMR systems in large centers.

Assessment

In addition, ROI calculations become more subjective, as ROI is more dependent on cost avoidance (e.g., from fewer medical errors, more efficient work processes) rather than revenue generation. However, improvements in quality of care from well thought-out development and implementation can still provide significant financial returns.

More info: www.HealthcareFinancials.com

Conclusion

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

Related Information Sources:

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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Exposing Medicare and Insurance Sales Commission Scams

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Some Agents and Brokers May Be Cashing-In

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

According to the Associated Press, on October 25, 2008, Medicare Advantage’s agents stand to make $500 to $550 this year. This happens by enrolling a beneficiary into one of their HMO type managed care type plans, while the agents could make another $500 for every year the beneficiary stays with the plan. It represents a financial reward that is raising concerns that agents and brokers will work too aggressively to enroll people into HMO plans that don’t meet their health needs; or where traditional Medicare may be a better personal fit.

CMS to Take Action

Representative Peter Stark (D-California) has urged the Centers for Medicare and Medicaid Services [CMS] to consider capping the commissions, while Kerry Weems, the acting administrator for CMS, said the agency plans to take action soon.

Insurance Policy “Twisting” and “Churning”

According to the Dictionary of Health Insurance and Managed Care, and others:www.HealthDictionarySeries.com:

  • Policy Twisting is the use of trickery to get someone to lapse an insurance policy and purchase a new one; usually in another company.

  • Policy Churning is a related fraudulent practice where an agent tricks a policy holder to fund a new one with the same insurer. Important information about the full consequences of their action is dishonestly withheld.

Both tactics are typically done to increase sales agent/broker commission income.

Scam Alerts

Although much more common with life insurance policies, each state has an insurance department that will help you if you think you’ve been scammed. Visit their website or office and you’ll get help on what to do. Many reputable insurance companies will quickly compensate you once it’s established that you were a victim of such fraud. Make sure you don’t waste you time by complaining to an insurer’s branch office. Contact the main office for swift response.

Assessment

America‘s Health Insurance Plans [AHIPs], the trade group representing insurers, encouraged CMS to develop clear and consistent standards, while two of the major players in the program, Humana Corporation and UnitedHealth Group both said that they welcomed regulation of insurance agent commissions. WellPoint and Cigna are the two other major health insurance companies in this country.

Conclusion

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Paging Doctor Oogle

Patient Driven Referral Sites [PDRSs]

By Dr. Darrell K. Pruitt; DDS

By Staff Writers

It is clear to some practitioners that Internet-based consumerism is the future of medicine; as well as dentistry. 

Regardless of the increasing number of complaints about managed care’s malevolent business model, managed care medical and dental plans are already wilting under the heat of transparency as well as the stifling economy. Market share continues to fall because of Adam Smith-like competition. 

These days, consumers are talking like a small town. Dentistry is no exception in the healthcare space. 

Enter Doctor Oogle

Doctor Oogle is a web 2.0 platform, built on a social architecture of national participation where patients post comments and opine about participating providers; nice or nasty. According to the site, it also offers a public database of dentists with patient feedback about dental practitioners. One can also read reviews, ratings, and recommendations; select a practitioner or schedule an appointment.

Ad-Driven Contrast of PDRSs

In contrast to WebMD, Servicegrades.com or other Patient-Driven Referral Sites (PDRS), which sell dentists ad space, DR. Oogle is completely uninfluenced by paid advertisements because there are none.  Participating dentists pay a flat monthly fee.

Defining Dental Quality 

If we can agree that in dentistry [perhaps more than medicine] patient satisfaction is an important measurement of quality care, DR. Oogle is a natural measuring tool just begging to be used by patients holding preferred provider lists.  In addition, DR. Oogle has the largest database of patient ratings of any other PDRS.

Dollar-Based Dental Benefits 

As businesses pull-back from expensive dental and medical insurance, some providers encourage owners to replace it with a fair and simple dollar-based benefit system; like Direct Reimbursement [DR] instead of intentionally confusing procedure-based benefits. This is akin to a concierge medical practice.

And, dentistry may be more susceptible to consumer influences, than whole-body medicine for a variety of reasons; for example:

  • costs of dental treatment are a small fraction of hospitalization,
  • emergencies are not generally life threatening, even if painful, and,
  • patients readily recognize bad dentistry [sometimes even as it is being performed].

Welcomed Transparency

Some dentists – and doctors – opine that managed care dentistry [medicine] is simply dentistry [medicine] provided by the lowest bidder – with little to no quality control – an unethical/specious business foundation that ultimately leads to the abandonment of patients’ interests.  Of course, this is not a new hue and cry against managed care precepts. 

DIY Studies

And so, in a recently received, and anonymous, do-it-yourself DR. Oogle study; one researcher was shocked at how much the listed dentists were disliked by their customers [patients]. Of course, there are statistical wrinkles: 

  • Maybe these lower rated dentists are not as bad as the reviews describe.
  • Is it possible that a few vocal people who expect discounts are impossible to satisfy?
  • How fair is that to a young dentist – just trying to scrape by anyway possible?
  • What dentist can maintain professionalism indefinitely in the financially thank-less environment of managed care? 
  • What about the future? 

Even if a preferred provider goes bankrupt trying to maintain professional standards, he or she remains sadly unappreciated.  Discount dentistry [medicine] comes at a tremendous price.

Assessment:

Collaborative healthcare 2.0 is the philosophy where patients, providers, and payers interact collaboratively and competitively in order to enhance quality medical services at value-driven prices in the most appropriate venue and time.

Dr. Oogle is an imperfect tool that in many respects seeks to further this goal.

Nevertheless, although metering tools will undoubtedly improve going forward, caring and competent dental professionals need not fear them. All others beware of patient empowerment and transparency.  

Conclusion:

You thoughts and opinions are appreciated. Please comment on Dr. Oogle and/or related doctor evaluation methods. [PDRSs].  Or, discourse on the increasingly transparent healthcare ecosystem in general.

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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SEC Rule 151-A and Insurance Agents

NAFA Criticizes the SEC

Staff Reportersinsurance-book

Insurance agents without securities licenses won’t be able to sell index annuities under this new proposed rule.

NAFA Opines

The National Association of Fixed Annuities (NAFA) recently took a firm stand against the Security & Exchange Commission’s (SEC) proposed Rule 151A, which would regulate index annuities as securities rather than as insurance products.

Insurance-Securities Hybrid Product

NAFA said in a statement issued in July that it “strongly disagrees with the SEC proposal and will pursue all available avenues of recourse,” including taking legal recourse, if required.

Assessment

NAFA Says Nix SEC Rule 151A.

Conclusion

In other words, if Rule 151A is adopted, insurance agents without securities licenses would not be able to sell Index Annuities [IAs].  IAs are investment products that combine both fixed income investments and equity index options so as to be able to leverage opportunities in both.

Please comment and opine; especially insurance agents, investment advisors and financial planners.

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

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IT Start-Up QWAQ

Introducing QWAQ Forums

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

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

What It Is?

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

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

The Healthcare Connection

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

Assessment

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

Link: www.QWAQ.com

Conclusion

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

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

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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Patients Challenging Medical Invoices and Bills

Root Cause is Money, Failure-to-Disclose and Frustration

[By Staff Reporters]

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Patients are challenging their medical bills with lawyers and lawsuits, out of frustration about the lack of up-front disclosure over costs by doctors and hospitals.

Involve More than a Few Cases

For example, after being charged $82,282 for a 23-hour stay in doctor-owned Westfield Hospital for two operations on her abdomen, a 56-year-old West Penn Township woman called the hospital and her insurer for an explanation.

Not satisfied with the response, she hired a lawyer and notified a reporter, after which Westfield officials said she was overcharged due to human error.

In another 2006 class-action Seattle lawsuit that was expected to have a ripple effect on consumers and hospitals, two patients of the Virginia Mason Medical Center filed suit against the center and won, after which Virginia Mason agreed to pay back an estimated $60 million to more than 3,200 patients who over six years had been charged ”overhead” for procedures performed in hospital-owned clinics – in some cases adding 60 percent to the price patients would have been charged for the same procedure performed by the same doctors in their offices.

Assessment

Although private legal action over medical bills is hard to track, the number of billing and coverage complaints filed with the Pennsylvania Attorney General’s health care unit has risen steadily, with the 2,000 or more complaints so far this year representing a five or six percent increase over last year; according to Morning Call, July 13, 2008.

Conclusion

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

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Doctors Unite!

On the “Open Letter from America’s Physicians”

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

As we have seen in this healthcare-charged election season, almost every form of political activism or debate has moved online. So, it is no surprise that a coalition of disgruntled physicians would electronically socialize and network together, as seen with www.sermo.com

About Sermo – Peer 2 Peer Doctor Network

First billed as a physician’s only online community, where 65,000 doctors around the nation exchanged the latest medical insights with each other to improve patient clinical outcomes, some portions of the Sermo community have morphed into a kind of political action committee [PAC] representing a particular flavor of zealot doctor activist.

Political Activism

And, not to miss out on a marketing opportunity, Sermo has allowed itself to be used as a vehicle for an open letter signed by physicians, decrying the state of domestic healthcare, that’s only going to get more public.

According to Mr. Matthew Arnold of Medical Marketing & Media, the letter is a physicians’ manifesto of sorts, composed by selected Sermo doctors demanding an end to intrusive insurers and overzealous regulators. To date it has garnered 5,200 signatures in the several weeks since it was posted on www.mmm-online.com

So, You Want a Revolution?

According to Arnold, “There’s a sense of revolution in this,” said Dr. Daniel Palestrant, founder and CEO of the physician social networking site, which boasts around 70,000 members. “It’s doctors coming together for the first time, voicing discontent with the representation they’ve had to date, and making it clear to the public that the quality of care is going to be suffering based on some of these outside forces.” http://www.mmm-online.com/Fed-up-Sermo-docs-draft-manifesto/article/112006

Doctors Unite

The “Open Letter from America’s Physicians,” hosted at www.doctorsunite.org blames “The insurance industry’s undue authority and oppressive control over healthcare processes,” “Excessive and misguided government regulation” and “The practice of defensive medicine in response to a harmful and costly legal environment” for America’s healthcare crisis, and vows: “We, the physicians of the United States, will no longer remain silent. We will not tolerate a healthcare system where those without medical expertise or genuine interest in our patients’ health have absolute control.”

Assessment

As almost every other form of political activism has moved online, don’t be surprised to see more websites, blogs, wikis or social e-communities like this. Of course, if the details get specific, it’s tricky to know whether the coalition of disgruntled doctors will stay together, and/or whether Sermo will emerge as representing a new breed of doctor “turned-political-pundit.”

Conclusion

And so, is political activism an appropriate initiative for the medical community; why or why not?

Might it be considered more self-serving; or more patient centric? Your thoughts and comments are appreciated.

Related Information Sources:

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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About Tax Record Retention

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Which Ones to Keep—How Long?

[By Staff Writers]fp-book2

By law, we are all required to keep records the IRS could use to determine our tax liability accurately. And doctors, more than most, know what it’s like to keep records. So you should retain whatever papers and documents support or clarify your calculations. If the IRS thinks you owe it money, you—both as an individual taxpayer and as a medical business owner—must prove it wrong. Your records are your only real protection if the IRS sets its sights on you for an audit.

Query: But what papers? And how long does the IRS have to determine your taxes for any given year? Do you have to keep everything forever? He following information may provide some clarity to this query.

Individual Tax Records

Accuracy means more to the IRS than the form of recordkeeping you use. Even more important is thoroughness. While certain papers are more significant than others, all of them together build your case for stated adjusted gross income, taxable income, deductions, exemptions, etc. For example:

Income:

Your medical, and other, employment-related records are top priority. The basic ones are W-2s from your hospital, clinic or medial practice, W-2P (for recipients of pensions, annuities, and IRA payouts), and 1099s for freelance income, speaking and pharmaceutical fees, and royalties, etc. You will also need 1099s that show interest and dividend income, as well as stock brokerage statements and any other documents that contain information pertaining to the amount you report as income.

Deductions

Generally, to back up your various deductions, the records you keep should include all related canceled checks and receipts. Here are some specific deductions and their requirements:

Medical expenses:

Keep all canceled checks and receipts. Keep records of any expense reimbursed or paid directly by medical insurance and medical insurance policies on which you deduct the premium cost. The person on whose behalf payments were made should be noted on every check, bill, and receipt.

Mortgage interest:

Keep bank (or mortgage company) statements, notes, and canceled checks.

Child-care credit:

Maintain a record of the name and address of the person or center providing the care, copies of canceled checks, and receipts to verify costs, and amounts paid for household services during the year. The latter will allow you to differentiate costs if the IRS tries to claim your child-care payments were really for a housekeeper. If you pay an individual to provide child care, keep a record of his or her taxpayer ID number, since you need that to get the credit.

Alimony:

You should maintain a copy of the divorce decree, separate maintenance agreement, or other document that specified the basis for the payments; name and address of the ex-spouse to whom you made payments; and canceled alimony checks. If you made payments indirectly through insurance policies, annuity contracts, or endowments, keep the documents showing the source of the payments.

Charitable contributions:

To prove charitable contributions, keep canceled checks and receipts showing the donee’s name, plus the date and amount of the contributions. If you don’t have a check, you need other reliable records showing the same information. If contributions are made by credit card, keep the receipt, the bill, and a statement from the charity with the required information. If you make a contribution of above certain periodically indexed thresholds, or more, to a particular charity, you must get a written acknowledgment from the charity (letter, postcard, etc.). A canceled check is not enough. Generally speaking, if you make separate deminimus contributions each year, the written acknowledgment rule may not apply.

A donation of property will complicate recordkeeping. You need the same items as above, plus a description of the property and the place you made the contribution. You should also keep documents showing the method you used to determine the fair market value of the property, with a signed copy of appraisal reports, if any. If you have an agreement with the charitable organization regarding the use of the donated property, hang on to a copy of that as well.

For property, you will also need documents showing how and why you acquired the property and your cost or other basis (except for publicly traded securities) if you held it for less than one year. For property valued over certain thresholds, you must get a qualifying appraisal and keep a copy of the report

IRS

Business Tax Records

As a medical business owner, your recordkeeping requirements are more substantial. There are so many more soft spots where the IRS can probe. The following areas are of particular importance:

Depreciation:

Keep any records needed to establish the reasonableness of a depreciation deduction, such as the original sales receipt showing what you paid for the property. Records must show the yearly depreciation claimed.

Withholding:

Keep all compensation records. For each employee, show name, address, job, and Social Security number, total amount and date of each wage payment, and any other type or form of payment; amount of wages subject to withholding; amount of tax collected; employee W-4 forms; and any agreement with employees regarding additional withholding.

Travel and entertainment:

The IRS does not accept estimates. You must keep itemized bills and receipts, Back them up with a diary showing cost, time, place of travel or entertainment, business purpose, and business relationship of guests.

Also, you must keep a log of your business use of items, such as a car, pager, computer, or server; or PDA, ipod or cell phone, etc., that you use partly for business and partly for personal purposes. For travel, your diary should show the date of departure and return, plus how many days of the total trip were spent on business. If you are an independent medical contractor, keep a diary of your daily work activities. This will reinforce the specific items and pull them together.

How Long to Retain Records?

By law, you have to keep tax records “as long as material” to the administration of the tax law. Since the statute of limitations runs for three years from the time you file your return or the due date of the return (whichever is later), and the IRS is free to audit your return during this time, you want to keep the records at least that long. After an assessment, the IRS has six years to begin collecting, so you are up to nine years. But you then have two years to claim a refund after payment, giving you a grand total of 11 years.

This may seem extreme, and not everyone keeps records that long. Many individuals keep records for six years—the amount of time the IRS has to audit if it suspects a gross error—an underreporting of 25% or more of the gross income shown on your return.

The 11-year time frame is the maximum time frame for assessment, collection, and refund claim. Business owners would be wise to use that period as a rule of thumb, even if individual taxpayers don’t.

Homeowners—

Keep any documents connected to home ownership that have a bearing on your taxes, if any, for the entire time you own your home. If you sell your home, keep the documents as long after the last tax filing as they have a bearing on your tax records. Remember the newer rules for homeowner tax exemption.

Withholding—

These records are subject to a special four-year retention rule. Most doctors and medical business owners keep them longer.

Fraud

In the case of fraud, there is no limit on the time the IRS has to charge you. But here, the burden of proof shifts to the IRS, and you get the presumption of innocence. So you need not feel you have to keep records forever to protect yourself against such an accusation. 

Conclusion

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

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

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