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

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The AMA says “Power to the Patient” … Finally!

The American Medical Association Recognizes Shared Decision Making

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Some readers of the ME-P may be surprised to learn that the American Medical Association [AMA] now “recognizes” shared decision making.  A document recommending precisely that is available for your reading pleasure here.

Assessment

The AMA also recognizes that shared decision making can make the physician-patient relationship stronger, opposes any effort to link it to insurance coverage and supports more pilot programs.

Of course, with AMA influence waning at less than 18% of allopathic members, and health 2.0 strategic initiatives rising along with a plethora of other related medical professionals, was there even a choice? 

As one doctor we interviewed said:Congratulations AMA for recognizing the obvious and abandoning your command-control philosophy … and welcome to Y 2012.” 

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On American Health Care and Financial Services Competitiveness

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]

American Flag

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.

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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]Shadows

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].

CP 1

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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Conclusion

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Independent Medical Practitioner as Solo Primary Care Surrogate

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Doctors Facing a Bleak Future Business and Financial Planning Model

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dem2

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.dhimc-book4

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. ho-journal3

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!

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Avi Baumstein and HIPAA Compliancy

A Ten-Step Process

By Darrell K. Pruitt; DDSpruitt

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

“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.”

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.

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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? 

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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