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  • David E. Marcinko [Editor-in-Chief]

    As a former Dean and appointed University Professor and Endowed Department Chair, Dr. David Edward Marcinko MBA was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.

    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.

    Professor David Marcinko was a board certified surgical fellow, hospital medical staff President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest drug, DME and pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published academic text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

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

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

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

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

    Marcinko is “ex-officio” and R&D Scholar-on-Sabbatical for iMBA, Inc. who was recently appointed to the MedBlob® [military encrypted medical data warehouse and health information exchange] Advisory Board.

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Off Road Christmas Touring with Dr. Marcinko

City Lights in Baltimore, Maryland

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

I stopped off in Baltimore, Maryland during the recent holidays to visit current clients, prospect for new ones, do a little public speaking and promote our book [Business of Medical Practice, third edition].

Link: www.BusinessofMedicalPractice.wordpress.com

Of course, we stopped by Johns Hopkins University where my sister worked, and promoted the Medical Executive-Post, as well.

Enter Christmas Street

And so, it was with great anticipation that we agreed with our host to visit Baltimore’s Christmas Street, in a section of the city known as Hampden. For 62 years, the residents of Baltimore’s 34th Street have drawn crowds from all over the world to view their display of Christmas lights.

Assessment

Crowd favorites are the motorized robot, the hubcap “Christmas tree”, and “snowmen” made from bicycle tires. The eaves of houses drip with strings of lights that illuminate Nativity scenes, while glowing candy canes light the sidewalks.

And, the hot chocolate and pizza, down the street at Angelo’s Restaurant, was especially delicious on any cold wintry night.

Video link: https://www.youtube.com/watch?v=hwk5N6qBx8Q

Channel Surfing

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register.

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Medicine: A Lesson In Efficient Markets

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MEDICINE: A Lesson In Efficient Markets

dan-snapshot

[By Dan Ariely PhD] http://danariely.com

The market for medicine is incredibly interesting. Almost every day we learn something new about a treatment that we thought would work but does not, or about a treatment that we didn’t think would work but does.

Beyond the particular fascination, I think that the medicine market can also teach us important lessons about rationality … read more:

Medicine: A Lesson In Efficient Markets

More:

Conclusion

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[PRIVATE MEDICAL PRACTICE BUSINESS MANAGEMENT TEXTBOOK – 3rd.  Edition]

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  [Foreword Dr. Hashem MD PhD] *** [Foreword Dr. Silva MD MBA]

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Modern Office Management Skills for Savvy Physicians

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“Learning” about The Business of Medical Practice in Modernity

By Ann Miller RN MHA

www.BusinessofMedicalPractice.com

###

Medical Business Advisors

###

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###

LEXICONS: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
ADVISORS: www.CertifiedMedicalPlanner.org
BLOG: www.MedicalExecutivePost.com

###

Time-Line to Launching a New Medical Practice

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A New Practice Checklist

Dr. David Edward Marcinko MBA CMP™

www.BusinessofMedicalPractice.com

Dr. Marcinko at Emory UniversityIt is important to develop a general checklist that touches some of the most important issues in launching a traditional medical practice; or an extended medical service line.

Link: Chapter 04: Strategic Operations

Once the checklist or “to-do” list is completed, and practically it never will be, a time-line may be developed, accelerated, decelerated or modified depending on circumstances. Just think of it as an overlapping continuum rather than discrete steps using appropriate elements of the checklist below.

Time-Line Milestones to Office Launch

12 Months Out:

  • Determine your strategic competitive advantage
  • Obtain medical license
  • Craft a business plan
  • Secure capital funding and living expenses
  • Secure office location for professional, demographic or lifestyle reasons
  • Retain a practice management consultant, accountant, banker and attorney.

9-11 Months Out:

  • Retain and hire contractor, architect or remodeling firm and build out the office space
  • Obtain certificate of occupancy or appropriate permits
  • Incorporate the business [S Corp, LLC, PC, etc]
  • Obtain state and federal tax ID and EIN, DEA number, NPI, Medicare and Medicaid provider numbers, etc
  • Contact insurance companies for credentialing applications to become a contracted provider
  • Contact local medical professionals, hospitals and ASCs, etc.

7-8 Months Out:

  • Establish a benefit and retirement plan
  • Obtain insurance coverage [life insurance, malpractice insurance, disability and worker’s compensation coverage, etc]
  • Complete Medicare/Medicaid paperwork and from private and commercial insurance companies, hospitals, ASCs, etc.

5-6 Months Out:

  • Complete building out the office
  • Obtain furniture, office equipment, medical and administrative supplies
  • Evaluate and order computerized HIT and eHR systems
  • Begin insurance discussions and obtain policies from agent/broker/counselor

3-4 Months Out:

  • Policy / procedure manuals in place [OSHA, HIPAA, ADA, PA, etc]
  • Interview and start hiring staff, personnel and office manager [FT and PT]
  • Begin marketing and advertising [websites, blogs, yellow pages, TV, radio, etc]
  • Contact drug representatives
  • Retain a CPA, or similar accounting or payroll services professional
  • Secure traditional and electronic “new” yellow page ads
  • Rent a PO box and open a business savings and checking bank account
  • Get a business credit/debt card and unsecured line of credit [LOC], if possible.

1-2 Months Out:

  • Systems check [phone system, answering service, laundry, lawn care, janitorial and cleaning, security, collections, bookkeeping and payroll.
  • Contact clinical laboratory, biopsy, blood analysis, C&S services, etc
  • Contact and set up an account with a medical waste company (unless the landlord includes this in the lease or sub-lease)
  • Secure credit card or similar payment services
  • Prepare for MCO, HMO, CAQH credentialing and walk-thru’s, etc
  • Order office stationary, logos, business cards, etc.
  • Open house parties.

The Road Ahead for New Doctors

Impending Opening

Commence patient care.

Conclusion

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A Guide to Patient Loyalty

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A Multi-Factorial Visual Approach

Link: Chapter 15: I-Doctors I-Patients

Many factors are involved when a patient has a good experience at a hospital, clinic or medical practice. One huge component in patient loyalty and satisfaction is the billing process.

This infographic colorfully shows what factors to consider in gaining and keeping loyal patients.

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patient loyalty

Source:  www.connance.com and www.BusinessofMedicalPractice.com

Conclusion

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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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Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

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Your Private Medical Practice “Game-Plan”

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Get Our “Game-Plan” for Modern Private Medical Practice Success

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Assessment

Link: www.BusinessofMedicalPractice.com Online “live” Social Network Community

Conclusion

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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

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Hospitals: http://www.crcpress.com/product/isbn/9781439879900

Physician Advisors: www.CertifiedMedicalPlanner.org

How Physicians Can Make the Patient Experience a Priority

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By Staff Reporters

Connection Makes the Difference – A Collaborative Shift in Bedside Manner?

Healthcare 2.0 is all about connecting. Take your pick: you can communicate via blogs, tweets, IMs, wikis, or social networks. And then, of course, you can opt for just plain old face-to-face dialogue.

The Communication Explosion

According to ME-P experts and Business of Medical Practice textbook contributors Mario Moussa PhD and Jennifer Tomasik MA, on the face of it, the explosion of communication options seems like a very good thing indeed.

www.BusinessofMedicalPractice.com

In the most basic ways, human beings need connection. Without the give and take of social interaction, our health suffers. In extreme situations—in solitary confinement or similar conditions—the brain almost completely shuts down.

What We Can Learn from Terry Anderson

The journalist Terry Anderson was held hostage in Lebanon from 1985 to 1992, enduring months at a time of almost complete isolation. In his memoir Den of Lions, Anderson described the catastrophic result: “The mind is a blank…. Where are all the things I learned, the books I read, the poems I memorized? There’s nothing there, just a formless, gray-black misery. My mind’s gone dead.”

The Link Between Social Connection and Good Health

On the positive side, studies have established a link between social connection and good health. (Even contact with people you dislike is better than having no contact at all). The same goes for the relationship between doctor and patient: data show that when the relationship is satisfying, it has tangible health benefits.

For example, when patients have a positive emotional connection with their doctors, they remember a higher percentage of care-related information and even experience significantly better physiological outcomes.

The Conversation

And the way doctors converse with patients—apart from the actual content of the conversations—has an equally powerful effect:

Do you want your patient’s nagging headaches to go away?

Discuss their expectations and feelings, in addition to the neurological facts. This is much more effective than sticking to the facts alone, since a strong psychological bond is strong medicine.

Do you want your medical advice to be followed?

Draw your patient into conversations about treatment. The research shows that engagement makes a difference.

Assessment

Is there an analogy here for financial advisors and medical management consultants?

Conclusion

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Succeed with the “Business of Medical Practice” Textbook

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[Transformational Health 2.0 Skills for Doctors]

By Ann Miller RN, MHA

www.BusinessofMedicalPractice.com

December 23rd, 2011 – The Institute of Medical Business Advisors [iMBA] Inc, in Atlanta, GA www.MedicalBusinessAdvisors.com and Springer Publishing Company of New York, just released the third edition of “The Business of Medical Practice” [Transformational Health 2.0 Skills for Doctors] edited by iMBA founder Dr. David Edward Marcinko MBA, CMP™ and President Hope Rachel Hetico RN, MHA, CPHQ, CMP™

Internal Contents

The 37 chapter, 750 page hard-cover textbook provides a comprehensive resource for those physicians, medical professionals, practice managers, nurse executives, health care administrators and graduate students seeking working knowledge on running a private facility or medical clinic.

Three Major Sections

The BoMP is comprised of three enterprise-wide sections: [1] Qualitative Office Operations, [2] Quantitative Aspects of Medical Practice and [3] Health Policies, Ethics and Leadership. Topics like ARRA, HITECH, ACA and the social networking aspects and ramifications of health 2.0 connectivity for all stakeholders are included for modernity.

Tools and Templates

Tools used throughout the book help readers reference and retain complex information. These tools include:

  • Sidebars. Key terms, key concepts, key sources, associations, and factoids all serve to enhance and reinforce the core takeaways from each chapter.
  • Tables. Tables are used to display and reference benchmark data, draw comparisons, and illustrate industry data trends.
  • Figures. Graphical depictions of concepts help you comprehend the material.
  • Charts. Charts allow easily referenced standard industry taxonomies alongside comparisons of related topics.

Assessment

For a further description of the Business of Medical Practice, with online “live’ community, please click: www.BusinessofMedicalPractice.com

To order directly: http://www.springerpub.com/product/9780826105752 

Conclusion

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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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Practice Management ‘Book of the Month’

“Book of the Month”

for

All Medical Professionals

 

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www.BusinessofMedicalPractice.com

 
Sponsor: www.MedicalBusinessAdvisors.com
 

Selecting Practice Management Consultants Wisely

Business Education Needed for Physicians and all Medical Colleagues

By Dr. David Edward Marcinko MBA CMP™

[Publisher-in-Chief]

While the doctors consult, the patient dies

-English Proverb

There are many self-help publications, online resources and management guru’s purporting to impart business information to their physician clients. Within the current managed care climate, economic malaise, and specter of nationalized healthcare following the 2010 health insurance reform legislation, medical business consultants are all the rage.

However, in the same vein, physician bankruptcies are mounting, medical student loan delinquencies are increasing, physician finances are friable and medical and ancillary practices are closing at record numbers. What gives?

Do Doctors Lack Business Knowledge?

Perhaps the answer lies in the lack of real business, accounting, financial and managerial acumen by the average practitioner? This growing concern is prompting more and more doctors to seek the help of a healthcare consultant or financial advisor. But, just what does a practice management consultant do, what credentials are needed to be in the business, and how can a healthcare advisor help you coordinate all aspects of your practice’s life? 

Here are two examples of major practice management fiascos.

Corporate Medicine and Doctor Super-Groups

As the managed and healthcare care crisis exacerbates, and Obama Care [Patient Protection and Affordable Care Act] unfolds over the next eight years, there will be many examples of irrational practice management behavior on the part of physicians, and no specialty is immune.

Just collectively reflect a moment on colleagues willing to securitize their practices a decade ago – and currently with so the so called medical super groups – and cash out to Wall Street for riches that were not rightly deserved. Where are firms such as MedPartners, Phycor, FPA and Coastal Healthcare now? A survey of the Cain Brothers Physician Practice Management Corporation Index of publicly traded PPMCs revealed a market capital loss of more than 99%, since inception; despite their various heath 2.0 re-incarnations. And, how will modern financial regulatory reform, Dodd-Frank, the SEC, insurance company and banking controls resulting from Wall Street’s 2008-09 economic debacles, impact physicians?

A Southern Gentleman and Solo Physician

Or, consider the personal situation of a solo Southern primary care physician who learned an accounting lesson the hard way when he asked his CPA to appraise his business. Upon sale, his attorney brother-in-law drew up the contract, as he was pleased the practice quickly sold for its full asking price. What he didn’t know, but would soon discover, is that accounting value or “book” value — the figure his accountant gave him — is far different than the fair-market value that he could have received for his long years of toil. Was the CPA wrong? Not really. Was the gentleman doctor incorrect? No. Both were merely operating under a different set of practice management terms, and accounting definitions, without communication or knowledge of each other’s perspectives. 

Assessment

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Conclusion

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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

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Some Common Medical Practice Accounting Embezzlement Schemes

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Understanding How to Avoid Office Embezzlement

[By Dr. Gary L. Bode CPA, MSA]

Without proper internal accounting controls, a medical practice, clinic or any health entity would never reach peak efficiency or profitability. Internal controls designed and implemented by the practice physician-owner, help prevent bad things from happening.

Embezzlement protection is the classic example. However, internal controls also help ensure good things happen, at least most of the time. A procedural manual or text like: www.BusinessofMedicalPractice.com that teaches physicians how to deal effectively with, and avoid, common schemes is suggested.

Common Schemes

Here is a list of some embezzlement schemes to avoid; however it is imaginative and endless.

  • The physician-owner pocketing cash “off the books”. To the IRS, this is like embezzlement to intentionally defraud it out of tax money.
  • Employee’s pocketing cash from cash transactions.  This is why you see cashiers following protocol that seems to take forever when you’re in the grocery check out line. This is also why you see signs offering a reward if he/she is not offered a receipt. This is partly why security cameras are installed.
  • Bookkeepers writing checks to themselves.  This is easiest to do in flexible software programs like QuickBooks, Peachtree Accounting and financial software [www.Peachtree.com]. It is one of the hardest schemes to detect. The bookkeeper self-writes and cashes the check to their own name; and then the name on the check is changed in the software program to a vendor’s name.  So a real check exists which looks legitimate on checking statements unless a picture of it is available.
  • Employees ordering personal items on practice credit cards.
  • Bookkeepers receiving patient checks and illegally depositing them in an unauthorized, pseudo practice checking account, set up by themselves, in a bank different from yours. They then withdraw funds at will. If this scheme uses only a few patients, who are billed outside of the practice’s accounting software, this is hard to detect.  Executive-management must have a good knowledge of existing patients to catch the ones “missing” from practice records. Monitoring the bookkeeper’s lifestyle might raise suspicion, but this scheme is generally low profile, but protracted. Checking the accounting software “audit trail”, this shows the required original invoice deletions or credit memos in a less sophisticated version of this scheme.
  • Bookkeepers writing payroll checks to non-existent employees. This scheme works well in larger practices and medical clinics with high seasonal turnover of employees, and practices with multiple locations the physician-owner doesn’t visit often.
  • Bookkeepers writing inflated checks to existing employees, vendors or subcontractors. Physician-owners should beware if romantic relationships between the bookkeeper and other practice related parties.
  • Bookkeepers writing checks to false vendors. This is another low profile, protracted scheme that exploits the physician-owner’s indifference to accounts payable.

Assessment

Operating efficiency, safeguarding assets, quality patient care, compliance with existing laws, and accuracy of financial transactions are common goals of internal controls.

Conclusion

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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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Dr. Marcinko and Prof. Hetico Feted for Literary Works

Top Ten “Must-Have” Reference Books for Doctors;  by BingMed

By Ann Miller RN MHA

[ME-P Executive-Director]

Ever wonder where your most successful colleagues get such great ideas for running an efficient medical office or maximizing profits? Discover tried-and-true business methods from these collaborative works by MDs.

Whether you are opening your first medical practice or just want to stay up to date on your business and passion, BingMed recommends the following books.

Top Ten List

1. The Medical Entrepreneur: Pearls, Pitfalls and Practical Business Advice for Doctors by Steven M. Hacker MD, MS, Daniel Mark Siegel MD, Joseph C. Kvedar MD and Franklin P. Flowers MD

2. Financial Management for the Medical Practice by Max Reiboldt and the American Medical Association

3. Tools for an Efficient Medical Practice: Forms, Templates and Checklists by Kathryn I. Moghadas

4. Starting a Medical Practice by Jeffrey P. Daigrepont, Lauretta Mink and American Medical Association

5. Medical Practice Management in the 21st Century: the Handbook by Marjorie A. Satinsky and Randall T. Curnow Jr.

6. Business of Medical Practice [Advanced Profit Maximization Techniques for Savvy Doctors] by David E. Marcinko

7. Medical Practice Policies and Procedures by Kathryn I. Moghadas

8. Practice Management: a Practical Guide to Starting and Running a Medical Office by Christian Ranier

9. Marketing Your Clinical Practice: Ethically, Effectively, Economically by Neil Baum and Gretchen Henkel

10. Business of Medical Practice [Transformational Health 2.0 Skills for Doctors] Third Edition by David Marcinko and Hope Rachel Hetico

Assessment

Congrats to our ME-P Editor, and Managing Editor, for this accomplishment.

Link: http://bingmed.com/resources/practice-management/top-10-must-have-reference-books-doctors

Book Link: www.BusinessofMedicalPractice.com

Conclusion

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Using Spot Audits to Reduce Internal Medical Practice Fraud

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The Mistrusting Doctor

[By Dr. Gary L. Bode MSA, CPA, LLC]

Spot audits are an important internal medical practice control.  Here, physician-owners use their expertise with the logistics and dynamics of their practice, to devise a series of regular inspections to see if anything is going wrong, and assuring that everything is going right.

Frequent, small spot audits, perhaps different in nature, are best.  These are non disruptive.  Implementation and application of these spot audits can make the difference between them being perceived (by employees, patients and vendors), as prudent and responsible versus petty and mistrusting. Nothing erodes a practice’s efficiency faster than physician indifference.  Nothing demoralizes a practice more than a petty, mistrusting doctor.

Sporadic Audit of Random Employees

Examples of possible spot audit components include:

  • Is the time clock accurate?
  • Can it be manipulated?
  • Is this a real employee?
  • Is there the correct number of employee days being paid?
  • Is there the correct number of employee hours being paid?
  • Is the compensation level accurate?
  • Is petty cash reimbursement fully documented?
  • Are withheld funds appropriate?
  • Do the net pay figures in the accounting software agree with the bank records?
  • Are payroll tax and liability [i.e., child support checks accurate and timely?]
  • Are payroll reports being properly generated and submitted?

Assessment

What else did we miss?

Link: www.BusinessofMedicalPractice.com

TOC: Front Matter BoMP – 3

Channel Surfing the ME-P

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

Conclusion

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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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Understanding MCO-Medical Practice Contract Standards

The Conversion to Negotiated Managed Healthcare is Significant

Dr. David Edward Marcinko, MBA CMP™

Prof. Hope Rachel Hetico, RN MHA CPHQ CMP™

www.BusinessofMedicalPractice.com

The conversion to managed healthcare and capitation financing is a significant marketing force and not merely a temporary business trend. More than 60% of all physicians in the country are now employees of a MCO. Those that embrace these forces will thrive, while those opposed will not.

Developing an Attractive Practice

After you have evaluated the HMOs in your geographic area, you must then make your practice more attractive to them, since there are far too many physicians in most regions today. The following issues are considered by most MCO financial managers and business experts, as they decide whether or not to include you in their network:

General Standards

  • Is there a local or community need for your practice, with a sound patient base that is not too small or large? Remember, practices that already have a significant number of patients have some form of leverage since MCOs know that patients do not like switching their primary care doctors or pediatricians, and women do not want to be forced to change their OB/GYN specialist. If the group leaves the plan, members may complain to their employers and give a negative impression of the plan.
  • A positive return on investment (ROI) from your economically sound practice is important to MCOs because they wish to continue their relationship with you. Often, this means it is difficult for younger practitioners to enter a plan, since plan actuaries realize that there is a high attrition rate among new practitioners. They also realize that more established practices have high overhead costs and may tend to enter into less lucrative contract offerings just to pay the bills.
  • A merger or acquisition is a strategy for the MCO internal business plan that affords a seamless union should a practice decide to sell out or consolidate at a later date. Therefore, a strategy should include things such as: strong managerial and cost accounting principles, a group identity rather than individual mindset, profitability, transferable systems and processes, a corporate form of business, and a vertically integrated organization if the practice is a multi-specialty group.
  • Human resources, capital, and IT service should complement the existing management information system (MIS) framework. This is often difficult for the solo or small group practice and may indicate the need to consolidate with similar groups to achieve needed economies of scale and capital, especially in areas of high MCO penetration.
  • Consolidated financial statements should conform to Generally Accepted Accounting Principles (GAAP), Internal Revenue Code (IRC), Office of the Inspector General (OIG), and other appraisal standards.
  • Strong and respected MD leadership in the medical and business community is an asset. MCOs prefer to deal with physician executives with advanced degrees. You may not need a MBA or CPA, but you should be familiar with basic business, managerial, and financial principles. This includes a conceptual understanding of horizontal and vertical integration, cost principles, cost volume analysis, financial ratio analysis, and cost behavior.
  • The doctors on staff should be willing to treat all conditions and types of patients. The adage “more risk equates to more reward” is still applicable and most groups should take all the full risk contracting they can handle, providing they are not pooled contracts.
  • Are you a team player or solo act? The former personality type might do better in a group or MCO-driven practice, while a fee-for-service market is still possible and may be better suited to the latter personality type.
  • Each member of a physician group, or a solo doctor, should have a valid license, DEA narcotics license, continuing medical education, adequate malpractice insurance, board qualification or certification, hospital privileges, agree with the managed care philosophy, and have partners in a group practice that meet all the same participation criteria. Be available for periodic MCO review by a company representative.

Specific Medical Office Standards

MCOs may require that the following standards are maintained in the medical office setting:

  • It is clean and presentable with a professional appearance.
  • It is readily accessible and has a barrier-free design (see OSHA requirements).
  • There is appropriate medical emergency and resuscitation equipment.
  • The waiting room can accommodate 5 – 7 patients with private changing areas.
  • There is an adequate capacity (e.g., 5,000 – 10,000 member minimum), business plan, and office assistants for the plan.
  • There is an office hour minimum (e.g., 20 hours/week).
  • 24/7 on-call coverage is available, with electronic tracking and eMRs.
  • There are MCO-approved sub-contractors.

Assessment

What have we missed?

Front Matter Link: Front Matter BoMP – 3

 

Conclusion

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Not so Fast – Examining eMR Options and Alternatives

Look Before you Leap

By Shahid N. Shah MS

Because of all the talk about electronic medical records [EMRs] and medical records software, doctors have many reasons to start immediately looking for an EMR vendor.

But, try to resist that urge and look at broader non-EMR solutions that can help remove some of the non-clinical burdens from your staff.

Here are some examples from Chapter 13, in our new book: www.BusinessofMedicalPractice.com

  • Using Microsoft Office Outlook® or an online calendaring system like Google to maintain patient schedules. While most vendors of clinical scheduling will tell you that medical scheduling is too complex to be handled by non-medical scheduling systems, most small and medium sized physician practices can easily get by with free or very inexpensive and non-specialized scheduling tools. By using general-purpose scheduling tools you will find that you can use less expensive consultants or IT help to manage your patient scheduling technology needs.
  • Using off-the-shelf address book software such as those built into Microsoft Office®, the Windows® and Macintosh® operating systems, or online tools such as Google apps you can maintain complete patient and contact registries for managing your patient lists. While a patient registry may not give you all of the features and functions you need immediately they can grow to a system that will meet your needs over time.
  • Using physician practice management systems you can remove much of the financial bookkeeping and insurance record-keeping burdens from your staff. Unlike calendaring or address book functionality which can be adapted from non-medical systems, insurance claims and related bookkeeping is an area where you should choose specific software based on how your practice earns its revenue. For example if a majority of your claims are Medicare related, then you should choose software that is specifically geared towards government claims management. If however your revenue comes less from insurance and more from traditional cash or related means you can easily use small business accounting software like Quicken® or Microsoft accounting.
  • Using computer telephony technology you can integrate automatic call in and call out the services that can be tied to your phone system so that you can track phone calls or send out call reminders.
  • Using integrated medical devices that can capture, collect, and transmit physiological patient data you can reduce paper capture of vital signs and other clinical data so that your staff are freed to do other work.
  • Using e-mail, instant messaging, social networking, and other online advanced tools you can reduce the number of phone calls that your practice receives and needs to return and yet continue to improve the patient physician communication process. One of the most time-consuming parts of any office is the back-and-forth phone calls so any reduction in phone calls will yield significant productivity increases.

Assessment

Any other ideas?

Link: Front Matter BoMP – 3

Conclusion

And so, 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 and http://www.springerpub.com/Search/marcinko

Our Other Print Books and Related Information Sources:

Health Dictionary Series: http://www.springerpub.com/Search/marcinko

Practice Management: http://www.springerpub.com/product/9780826105752

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Some Thoughts on the Marginal Healthcare Dollar

Can this Vital Buck be More Efficiently Used?

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

Recently, healthcare economist Austin Frakt PhD offered these points about healthcare dollars spent on the margin:

1. Spending on health is not without value. It does improve lives [See Cutler]. Yet, we spend much to get that value.

2. Price per QALY is very high [See Aaron’s series on spending and his other on quality).

3. Just staying within the realm of health, the price per QALY on another “service” might be a lot lower [like nutrition, exercise, and healthy habits, etc].

http://theincidentaleconomist.com/wordpress/could-the-marginal-health-care-dollar-be-put-to-better-use/?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+TheIncidentalEconomist+%28The+Incidental+Economist+%28Posts%29%29

Note: The quality-adjusted life year (QALY) is a measure of disease burden, including both the quality and the quantity of life lived. It is most often used in assessing the value for money of a medical intervention. The QALY model requires independent utility, neutral risk and constant proportional tradeoff behavior.

Understanding Marginal Profit

Recalling the equation: Profit = (Price x Volume) – Total Costs

We could amend it and say that:

Total Profit = P x V – (FC + VC) or: Total Profit = Price x Volume – (Fixed Costs + Variable Costs)

However, most medical office or clinic contracts today are based not on total profit, but on additional or marginal profit, because overhead costs always remain and clinic fixed costs are not important in contracted medicine.

And, for other pricing decisions, the equation can again be re-written, to emphasize variable costs, as follows: Marginal Profit = (P x V) – VC.

In other words, the marginal benefit must exceed the marginal cost of practice.

Cost-Volume-Profit Analysis

Now, once a basic understanding of marginal profit and medical cost behavior is achieved, the techniques of cost-volume-profit analysis (CVPA) can be used to further refine the managerial cost and profit aspects of the medical office business unit. CVPA is thus concerned with the relationship among prices of medical services, unit volume, per unit variable costs, total fixed costs, and the mix of services provided.

Assessment

Austin felt that if [*]od were jointly designing all health-related systems and functions of society and government – He’d look at the marginal cost/QALY over all possible ways to spend the next dollar and pick the smallest. How about you?

But, it’s not always going to be on health care services and it probably isn’t given what we’re already spending for those and what we’re getting for that spending.

Conclusion

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Is Primary Care Medicine Toxic?

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Requesting Real-Life Examples of Professional Despair

By Dr. David Edward Marcinko MBA CMP™

www.BusinessofMedicalPractice.com

[Editor-in-Chief]

As you’ve probably heard – and experienced or know from our books, journal and this ME-P – there’s a primary care medical shortage out-there!  Maybe you’ve even read or heard about the Physician’s Foundation study describing the overwhelming number of PCPs who want out of this toxic environment. On one hand, we have patients desperately searching for a PCP, while on the other hand we have good caring doctors being forced out of the profession. Of course, NPs, ANPs, DNPs and other ancillaries are part of the solution; but not entirely.

Link: http://www.physiciansfoundation.org/

Human Anguish

And humanely, as stated by our medical colleague L. Gordon Moore MD, these statistics miss the very real pain and anguish of people who entered primary care to help patients when they find the environment for primary care toxic to the ethical practice of medicine. Even to the point of suicide!

Assessment

These voices need to be heard. And so, we are asking doctors and providers of all stripes to post in the comments section below personal examples of medical practitioners leaving primary, solo or small group practice because they just can’t stand the toxic environment any longer.

Conclusion

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Useful Managed Care Provider, Staffing, Activity and Financial Trends

Part Two

By Dr. David Edward Marcinko MBA

[Publisher-in-Chief]

Dr. DEMIf you read this ME-P regularly or have read my earlier blogs, you know that I am writing a book on practice management for the private medical practitioner.

The Business of Medical Practice [Transformational Health 2.0 Skills for Doctors]; third edition: www.BusinessofMedicalPractice.com

Link: Front Matter BoMP – 3

A recent story in the Chicago Tribune on the difficult business life of private practitioners today reminds me that I need to keep my nose to the grindstone.

For example, according to the sanofi-aventis Pharmaceutical Company Managed Care Digest Series, for 2008-10, the following patterns and comparative trend information has been empirically determined and may provide a basic starting point for medical practitioners to share business management, facilities, personnel, and records information for enhanced success www.managedcaredigest.com

Mid-Level Provider and Staffing Trends

  • Mid-level provider use increased among multi-specialty groups, especially in those with more than half of their revenue from capitated contracts. Use also rose with the size of the practice and was highest with OB/GYN groups.
  • Medical support staff for all multi-specialty groups fell and was lowest in medical groups with less than 10 full-time equivalent (FTE) physicians. However, groups with a large amount of capitated revenue actually added support staff. Smaller groups limited support staff.
  • Compensation costs of support staff increased and the percentages of total operating costs associated with laboratories, professional liability insurance, IT services, and imaging also increased. Support staff costs increase with capitation levels and more than half of all operating costs are tied to support staff endeavors.

Managed Care Activity and Contracting Trends

  • More medical group practices are likely to own interests in preferred provider organizations (PPOs) than in HMOs and the percentages of groups with managed care revenue continues to rise. Multi-specialty and large groups also derive more revenue from MCOs than single specialty or smaller groups.
  • Managed care has little effect on physician payment methods that are still predominantly based on productivity. Physicians were paid differently for at-risk managed care contracts in only a small percentage of cases.
  • Most medical groups (75%) participating in managed care medicine have PPO contracts. Group practices contract with network HMOs more often than solo practices. Single-specialty groups more often have PPO contracts.
  • Capitated lives often raise capitation revenues in large group practices. Group practices are more highly capitated than smaller groups or solo practices. Almost 30% of highly capitated medical groups have more than 15 contracts and 22% have globally capitated contracts.
  • Higher capitation is linked with increased risk contracting. Larger groups have more risk contracting than smaller groups.

Physician Health

Financial Profile Trends

  • Medicare fee-for-service reimbursement is decreasing. Highly capitated groups incur high consulting fees.
  • The share of total gross charges for OB/GYN groups associated with managed care at-risk contracts is rising while non-managed care, or not-at-risk charges are declining.
  • Capitated contracts have little effect on the amount of on-site office non-surgical work. Off-site surgeries are most common for surgery groups, not medical groups.
  • Half of all charges are for on-site non-surgical procedures.
  • Highly capitated medical groups have higher operating costs and lower net profits.
  • Groups without capitation have higher laboratory expenses than those who do.
  • Physician costs are highest in orthopedic surgery group practices. Generally, median costs at most specialty levels are rising and profits shrinking.

Assessment

Obviously, the above information is only a gauge since regional differences, and certain medical sub-specialty practices and carve-outs, do exist.

Part One: Useful Managed Care Patterns and Procedural Utilization Trends

Conclusion

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Useful Managed Care Patterns and Procedural Utilization Trends

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Part One of Two

By Dr. David Edward Marcinko MBA

[Publisher-in-Chief]

If you read this ME-P regularly or have read my earlier blogs, you know that I am writing a book on practice management for the private medical practitioner.

The Business of Medical Practice [Transformational Health 2.0 Skills for Doctors]; third edition: www.BusinessofMedicalPractice.com

Link: Front Matter BoMP – 3

And, a recent story in the Chicago Tribune on the difficult business life of private practitioners today reminds me that I need to keep my nose to the grindstone.

For example, knowing your medical contract negotiation objectives, gathering information on the choices of contracts and discount payment systems, and understanding the pitfalls to watch for when evaluating a contract are the keys to any successful negotiation process.

Reimbursement Contract Negotiations

According to the sanofi-aventis Pharmaceutical Company Managed Care Digest Series, for 2008-10, the following pattern and trend comparative information has been empirically determined and may provide a basic starting point for practitioners to share business management, facilities, personnel, and other records for enhanced contract negotiation success.

www.managedcaredigest.com

hos

Procedural Utilization Trends

  • Among all physicians in a single-specialty group practice, invasive cardiologists averaged the most encounters with total hospital inpatient admissions down from the prior year. However, encounters rose for cardiologists in multispeciality group practices.
  • Echocardiography was the most commonly performed procedure on HMO seniors, followed by coronary artery bypass graft surgery. Group practices performed cardiovascular stress tests for circulatory problems most often.
  • CT studies of the brain and chest were the most common studies for HMO seniors, while MRI head studies were the most common diagnostic test on commercial HMO members.
  • Colonoscopy was the most common digestive system procedure on senior HMO members, while barium enemas were more common on commercial members.
  • Hospital admission volume decreased for allergists, family practitioners, internists, OB/GYNs, pediatricians, and general surgeons.
  • Internists ordered more in-hospital laboratory procedures than any other physicians in single-specialty groups.
  • Non-hospital MD/DOs used in-hospital radiology services most frequently, continuing a three-year upward trend.
  • Pediatricians averaged the most ambulatory encounters, down from the prior year.
  • Non-hospitalist internists ordered a higher number of in-hospital laboratory procedures than any other single medical specialty group, but allergists and immunologists increased their laboratory usage.
  • The number of ambulatory encounters increased for general surgeons, while group surgeons had the most cases. Capitated surgeons, of all types, had a lower mean number of surgical cases than surgeons in groups without capitation. Surgeons in internal medical groups also had more cases than those in multi-specialty groups.
  • The average number of total office visits per commercial and senior HMO visits fell, along with the number of institutional visits for both commercial and senior HMO members.
  • The average length of hospital stay for all commercial HMO members increased to 3.6 days but decreased to 6 days for all HMO members.
  • The total number of births increased for commercial HMO members served by medical group practices, and decreased for solo practitioners.
  • More than one-third of all medical groups use treatment protocols, rising from the year before. Multi-specialty groups were more likely to use them than single-specialty groups, who often develop their own protocols. The use of industry benchmarks to judge the quality of healthcare delivery also increased.
  • Outcome studies are most common at larger medical groups, and multi-specialty groups pursue quality assurance activities more often than single-specialty groups.
  • Provider interaction during office visits is increasingly coming under scrutiny. Patients approve of cardiologists more frequently than allergists and ophthalmologists.

Assessment

Obviously, the above information is only a gauge since regional differences, and certain medical sub-specialty practices and carve-outs, do exist.

Part Two: Useful Managed Care Provider, Staffing, Activity and Financial Trends

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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The Business of Medical Practice

Transformational Health 2.0 Skills for Doctors [third edition]

By Dr. David E. Marcinko MBA, CMP™  [Editor-in-Chief]
By Prof. Hope Rachel Hetico RN, MHA, CPHQ, CMP[Managing Editor]

The third edition of this now classic 775 page textbook, to be released in November 2010 and copyrighted in 2011, seeks to answers questions like these and many others:

The Vital Survival Queries for Savvy Doctors

  • Does Health 2.0 enhance or detract from traditional medical care delivery, and can private practice business models survive?
  • How does transparent business information and reimbursement data impact the modern competitive healthcare scene?
  • How are medical practices, clinics, and physicians evolving as a result of rapid health and non-health related technology change?
  • Does transparent quality information affect the private practice ecosystem?

Answering these questions and more, this newly updated and revised edition by Springer Publishing of NYC is an essential tool for doctors, nurses, and healthcare administrators; management and business consultants; accountants; and medical, dental, business, and healthcare administration graduate and doctoral students.

The Classic Book

A Managerial Discussion for Doctors

Written in plain language using non-technical jargon, the text presents a progressive discussion of management and operation strategies. It incorporates prose, news reports, regulatory and academic perspectives with health 2.0 examples, blog and internet links, as well as charts, tables, diagrams, URL citations, and website references, resulting in an all-encompassing resource. And, it also integrates various medical practice business disciplines—from finance and economics to marketing to the strategic management sciences—to improve patient outcomes and achieve best practices in the healthcare administration field.

The Expert Contributors

With contributions by a world-class team of expert authors from www.MedicalBusinessAdvisors.com among others, the third edition covers brand new information, including:

  • The impact of Web 2.0 technologies on the health care industry
  • Internal office controls for preventing fraud and abuse
  • Physician compensation with pay-for-performance trend analysis
  • Health economics, finance and accounting
  • Human resources and medical practice staffing
  • Medicare compliance, quality improvement and healthcare law and policy
  • Healthcare marketing, advertising, CRM, and public relations
  • eMRs, mobile IT systems, medical devices, and cloud computing,
  • and much more!

Assessment

A core textbook for financial advisors and management consultants:

www.CertifiedMedicalPlanner.com

For more info and to join the “live” discussion:

www.BusinessofMedicalPractice.com

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Be the first to review this book: http://www.springerpub.com/Search/marcinko 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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About the Editor-in-Chief

Dr. David Edward Marcinko, a former residency director, department chairman, and hospital vice-president in Atlanta GA, retired from clinical practice at the age of 45 after selling his Ambulatory Surgery Center to a public company. As a fellow and board certified surgeon, he authored more than two dozen medical and business textbooks in three languages, teaching and operating in the EuroZone, co-founding a pre-IPO PPMC, and forming a series of successful internet ventures while still maintaining a 60 hour work week.  

His companies have created dozens of cognitive products in the last few years that maintain a comfortable lifestyle that started from his home office after retirement. Dr. Marcinko picked up an MBA degree, became a certified financial planner and insurance agent, and developed a cult following thru collaborative on-ground and online education for physicians, financial advisors and management consultants. A social media pioneer and publisher, this Medical Executive-Post is an influential syndicated blog with thousands of content contributions from nationally know experts. 

Dr. Marcinko is a highly sought after futurist and speaker in the areas of health economics, financial planning, medical practice management and related entrepreneurial e-insights for intersecting sectors in the healthcare industrial complex.

Edited with Professor Hope Rachel Hetico of the Institute of Medical Business Advisors [iMBA] Inc www.MedicalBusinessAdvisors.com

Financial Planning and Risk Management Handbooks for Doctors 

Understanding the Medical Records R[e]Volution

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It’s Not All about Electronic Records

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

Introduction

To understand the medical records revolution that has occurred this decade, put your self for a moment in the position of a third-party payer; ie; a private insurance company, Medicare or Medicaid etc.

For example, you want to know if Dr. Joel Brown MD actually gave the care for which he is submitting a [super] bill or invoice. You want to know if that care was needed. You want to know that the care was given to benefit the patient, rather than to provide financial benefit to the provider beyond the value of the services rendered.

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Of Doubts and Uncertainty

Can you send one of your employees to follow Dr. Brown around on his or her office hours and hospital visits?  Of course not! You cannot see what actually happened in Dr. Brown’s office that day or why Dr. Black ordered a PET scan on the patient at the imaging center. What you can do however, is review the medical record that underlies the bill for services rendered from Dr. Blue. Most of all, you can require the doctor to certify that the care was actually rendered and was indicated. You can punish Dr. White severely if an element of a referral of a patient to another health care provider was to obtain a benefit in cash or in kind from the health care provider to whom the referral had been made. You can destroy Dr. Rose financially and put him in jail if his medical records do not document the bases for the bills he submitted for payment.

The Payment Paradigm Shift

This nearly complete change in function of the medical record has precious little to do with the quality of patient care. To illustrate this medical records evolution/revolution point, consider only an office visit in which the care was exactly correct, properly indicated and flawlessly delivered, but not recorded in the office chart. As far as the patient was concerned, everything was correct and beneficial to the patient. As far as the third-party payer is concerned, the bill for those services is completely unsupported by required documentation and could be the basis for a False Claims Act [FCA] charge, a Medicare audit, or a criminal indictment.  We have left the realm of quality of patient care far behind.

mobile EHR health

Provider Attitude Adjustments Required

Instead, medical practitioners must adjust their attitudes to the present function of patient records.  They must document as required under pain of punishment for failure to do so. That reality is infuriating to many since they still cling to the ideal of providing good quality care to their patients and disdain such requirements as hindrances to reaching that goal. They are also aware of the fact that full documentation can be provided without a reality underlying it. “Fine, you want documentation?  I’ll give you documentation!”

Computer Charting and eMRs

Some doctors have given in to the temptation of “cookbook” entries in their charts, canned computer software programs or eMRs listing all the examinations they should have done, all the findings which should be there to justify further treatment.  Many have personally seen, for example, hospital chart notes which describe extensive discussion with the patient of risks, alternatives and benefits in obtaining informed consent when the remainder of the record demonstrates the patient’s complaint that the surgeon has never told her what he planned to do; operative reports of procedures done and findings made in detail which, unfortunately, bear no correlation with the surgery which was actually performed.

Assessment

Whether electronic medical records (eMRs) will be helpful regarding fraud prevention, in the future is still not known. But, it is at best naive and more frequently closer to a death wish to think that a practitioner can beat the system, with handwritten notes, computer generated records, or fabricated eMR documentation.

Conclusion

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On Evidence-Based Clinical Medical Guidelines

About the Institute for Clinical Systems Integration [ICSI] 

By Brent A. Metfessel MD, CMP™

 

The Institute for Clinical Systems Integration (ICSI) is a strong proponent of the value of evidence-based clinical guidelines, and cites the following objections that make their implementation and acceptance more difficult.

 

The Issues

These issues generally apply to technology assessments as well:

  • Guidelines are a legal hazard:  There is a fear that following a guideline that turns out to be wrong increases the risk of litigation.  Good guidelines, however, are evidence-based and not opinion-based drivers of care.  Furthermore, once a review of the literature takes place and is synthesized into a preliminary guideline, multi-specialty physician focus groups review the guidelines prior to finalization.  The strength of evidence supporting each conclusion is usually stated, highlighting areas of remaining scientific uncertainty.  “Evidence hierarchies” are often used as aids to grading recommendations, with meta-analysis, systematic reviews, and randomized controlled trials being at or near the top of the hierarchy in strength, with narrative reviews, case reports, and medical opinion pieces being considered the weakest forms of evidence.  This provides additional checks and balances to guideline development.
  • Guidelines are cookbook medicine:  Guidelines are just that – guidelines.  Each patient should be provided treatment according to his/her individual needs.  Evidence-based clinical guidelines are based on extensive reviews of the literature and are applicable to the vast majority of cases for a particular clinical condition but not necessarily all cases.  In the case of practice pattern evaluation or profiling, comparisons of such patterns to medical guidelines can help identify overall systematic variations from the norm rather than variations due to particular patients with special needs.
  • Guidelines do not work:  When used as the sole basis for practice improvement, this statement contains some truth. However, when incorporated into a systematic continuous quality improvement approach, they have been shown to improve practice patterns and reduce variation.
  • Physicians will not use guidelines:  Once physicians know that the guidelines are based on a sound review of the medical literature, practitioner buy-in greatly increases.  In addition, clinicians need to realize that clinical guidelines are only one part of the total treatment picture since a team approach to patient care is becoming the norm.
  • Guidelines need validation through actual outcomes data:  This is correct when based on a continuous quality improvement approach, but is incorrect if outcomes are based on individual events.  Local implementation of guidelines can be compared to outcomes data one or two years after implementation.  Depending on the actual level of practice pattern improvement, minor alterations can be made to the guidelines to reflect local needs.

Guideline Adaptation

National guidelines in some cases may need adaptation to local patient needs and concerns.  For example, a practice in a major metropolitan area where specialty care is readily available differs in major ways from a rural practice which is based more on primary care.  Practices where many patients are poor or on public assistance also differs from practices in affluent areas.  When used as basic guides to appropriate practice, however, clinical guidelines can significantly decrease practice variation.

Evidence Based Medicine

With the recent emphasis on evidence-based medicine and on decreasing the time lag between evidence publication and its effect on actual patient care, a number of agencies have added clinical guideline and technology assessment development to their task lists.  Such agencies include specialty societies such as the American College of Cardiology (ACC), private companies and non-profit organizations, governmental bodies such as the Agency for Health Care Research and Quality (AHRQ), and MCOs that review the scientific evidence for the purpose of determining coverage policy.

Assessment

MCOs may post medical coverage policies on the Web for physicians to access, and these generally contain narrative justifications (often with evidence grading) in terms of why a particular procedure or diagnostic test may or may not be covered based on level of efficacy shown in scientific studies.  It is important to note that for many high-tech or new procedures, different MCOs may have somewhat different coverage policies based on variation in terms of interpreting the evidence, especially in areas where the science is less certain.

Conclusion

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The Effects of Healthcare Reform Legislation on Physician Compensation

Is a Future Look Predicated on the Past?

By Dr. Brian J. Knabe; CFP® CMP™

By Dr. David Edward Marcinko; MBA CMP™

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

www.BusinessofMedicalPractice.com

With the passage of healthcare reform legislation, officially known as the Patient Protection and Affordable Care Act of 2010, many questions remain regarding its effect upon physicians’ livelihood.

Undoubtedly this bill moves the healthcare system several steps closer to a socialized model, but the effects on physicians’ salaries and compensation models are far from clear.

Other Countries

One way to see the effect that this shift may have on compensation is to look to other countries, many of which already have a more socialized system in place.

According to the CRS Report for Congress, US Health Care Spending:  Comparison with Other OECD Countries http://assets.opencrs.com/rpts/RL34175_20070917.pdf) US specialists rank near the top in compensation compared to these other countries, trailing the Netherlands and Australia.  The average specialist in the US made $230,000 in this survey.  The comparable salary in Canada is $161,000, $150,000 in the UK, and $253,000 in the Netherlands.  Generalists in the US are at the top in terms of compensation with an average of $161,000.  This compares to $107,000 in Canada, $118,000 in the UK, and $117,000 in the Netherlands.

Inflation Adjustments

Another indicator of physician salary trends is the change in compensation adjusted for inflation.  According to the American Medical Association, the inflation-adjusted income for the average patient care physician declined from $180,930 to $168,122 from 1995 to 2003, a 7% decrease. And, the inflation adjusted decrease is more substantial given the low interest rate environment thru 2010, and going forward.

Physician Net Income Chart

  Average net income
  1995 2003 Decrease
All patient care physicians $180,930 $168,122 7%
Primary care physicians $135,036 $121,262 10%
Medical specialists $178,840 $175,011 2%
Surgical specialists $245,162 $224,998 8%

Source: http://www.ama-assn.org/amednews/site/free/prsc0724.htm

Given these trends, as well as the fact that an increasing percentage of healthcare payments are coming from dwindling government sources, it is likely that physician salaries will decline as “healthcare reform” legislation is implemented.  In fact, it is likely that this trend will accelerate.  A 15% to 25% inflation-adjusted decline in salaries over the next decade is a reasonable prediction.

Assessment

It is also important to note that the level of student debt in the US continues to rise, while college and medical education are usually subsidized in other countries.  Many foreign physicians graduate with no student loan debt.  The ratio of debt level to salary in the US continues to become more onerous for new physicians.

Conclusion

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On e-Confidentiality Conflicts in Medicine

Understanding the Potential Role of eMR Compromise

By Render Davis MHA CHE

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Whether it is an employer interested in the results of an employee’s health screening; an insurer attempting to learn more about an enrollee’s prior health history; the media in search of a story; or health planners examining the potential value of national health databases, the confidential nature of the traditional doctor-patient relationship may be compromised through demands for clinical information by parties other than the patient and treating caregivers. 

Impact of eMRs

In addition, without clear safeguards the growth in use of electronic medical records may put personal health information at risk of tampering or unauthorized access.  Clearly, employers and insurers are interested in the status of an individual’s health and ability to work; but does this desire to know, combined with their role as payers for health care, constitute a right to know?  The patient’s right to privacy remains a volatile and unresolved issue.

Assessment

Counter to this concern is the recognition that electronic records may dramatically improve communications by offering greater accessibility of information to clinicians in the hospital or office potentially reducing medical errors through elimination of handwritten notes, increased use of built in prompts and clinically-derived triggers for orders and treatments, and development of pathways for optimal treatments based on clinically valid and tested best practices.

Conclusion

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Essay on Healthcare Leadership

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Versus Healthcare Management

[By Eugene Schmuckler PhD, MBA and Dr. David Edward Marcinko MBA]

Many times, individuals or physicians will use the terms management and leadership synonymously. In actuality the terms have significantly different meanings.

For example, Warren Bennis describes the difference between managers and leaders as “Managers do thing right, Leaders the right thing.”

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leadership

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The Managers

Managers are those individuals who have as their primary function managing a team of people and their activities. In effect, managers are those who have been given their authority by the nature of their role and ensure that the work gets done by focusing on day to day tasks and their activities.

On other hand, a leader’s approach is generally innate in its approach. Good leadership skills are difficult to learn because they are far more behavioral in nature than those skills needed for management. Leaders are also very focused on change recognizing that continual improvement can be achieved in their people and their activities can be a great step towards continued success.

Leadership Development

Perhaps some of the best training grounds for the development of leaders are the military. The Marine Corps slogan is “A Few Good Men” and the military academies at Annapolis (Navy), New London, Connecticut (Coast Guard), Colorado Springs (Air Force), and West Point (Army) all have as their main mission, the development of leaders. This is done by a number of different techniques. At graduation, the new officers, regardless of the branch of service, have been taught, and more importantly, have internalized the following: communicate the missions, sensitivity matters, real respect is earned, trust and challenge your soldiers. It is due to these lessons that many graduates of the military academies go on to positions of leadership in the private sector as well as in government.  Communicating the mission refers to conveying to those who work with us what are practice is hoping to accomplish and the role of each employee in achieving that goal. Given an understanding and awareness of the mission, when confronted with a barrier, employees are able to face hard problems when there is no well-defined approach by which to deal with them.

Sensitivity does matter – A leader treats each employee with respect and dignity, regardless of race, gender, cultural background or particular role they actually perform in the practice. Consider how many legal suits are filed against any type of organization, whether it is a medical practice or a large manufacturing facility due to perceived disparate treatment towards the employee based on race, religion, gender sexual preference or other non-work related issues.

Real respect is earned – Having initials after one’s name and the wearing of a lab coat does not automatically entitle an individual to respect. Formal authority has been found to be one of the least effective forms of influence. Only by earning the respect of your staff as well as your patients can you be sure that your intent will be carried out when you are not present. Setting the example in performance and conduct, rather than ‘do as I say, not as I do,” level of activity enables one to exert influence far greater than titles.

Trust and challenge your employees – How many times have practices sought to hire the best and brightest only to second guess the employee. Eric Schmidt, the CEO of Google, describes his management philosophy as having “… an employee base in which everybody is doing exactly what they want every day.” Obviously there are certain policies and procedures, but at the same time, the leader enables decision making to the lowest possible level. This also enables employees to question why certain policies and procedures are still being followed when more effective and efficient methods are available.  (How the Army Prepared Me to Work at Google, Doug Raymond, Harvard Business)

Internal Faults

The phrase “Physician, heal thyself” (Luke 4:23, King James Version) means that we have to attend to our own faults, in preference to pointing out the faults of others. The phrase alludes to the readiness of physicians to heal sickness in others while sometimes not being able or will to heal themselves.  By the same token, it now is necessary for us to learn how to manage ourselves. It suggests that physicians, while often being able to help the sick, cannot always do so, and when sick themselves are no better placed than anyone else (Gary Martin, phrases.org.uk/meanings/281850.html, 2010).

Self Development

“We will have to learn how to develop ourselves. We will have to place ourselves outside the boundaries where we can make the greatest contribution. And we will have to stay mentally alert and engaged during a 50-year working life, which means knowing how and when to change the work we do” (Managing Oneself, Harvard Business Review – Jan. 2005 – pp 100-109, by Peter Drucker).  Although one’s IQ and certain personality characteristics are more or less innate and appear to remain stable over time there are individual capabilities that enable leadership and can be developed. Enhancement of these capabilities can lead to the individual being able to carry out the leadership tasks of setting direction, gaining commitment, and creating alignment. These capabilities include self-management capabilities, social capabilities and work facilitation capabilities.

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Assessment

Without question, while it is possible to cram for at test and graduate at the top of one’s class, that does not assure   leadership ability. We all know at least one person who scores at the highest levels on cognitive measures but would be incapable of pouring liquid out of a boot if the instructions were written on the heel.

Conclusion

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Benchmarking Study Survey on Physician Sales and Service

ME-P Reader Participation Sought for the Corporate Health Group

By Carolyn Merriman

President, Corporate Health Group

401-886-5588 ext. 201

www.corporatehealthgroup.com

Dear David and ME-P Subscribers, Readers and Visitors

I hope this finds you well and busy. I am sure you are pleased with the publication of the updated text book. Thank you again for allowing me to participate by authoring Chapter 33: Professional Relations.

www.BusinessofMedicalPractice.com

ME-P Reader Participation Requested 

I am sending this along to my fellow consultants asking them to seek their client’s participation. I thought you might be able to post or push out to your ME-P readers.

The CHG 

Corporate Health Group (CHG) is conducting our third benchmarking study on Physician Sales and Service. The success of this study depends on the survey being distributed to the appropriate people to be completed. Because I know that you have many contacts in physician sales and service, I am hopeful that you would forward the survey to those contacts and encourage them to participate. To show CHG’s appreciation you will receive a complimentary copy of the results including the trended data from the 2005 and 2008 studies.

Viral Contacts Sought

If you, or your subscribers and partners, should also happen to have a contact that is a large system or association we have the ability to set up a unique organization code that those completing the survey would enter in the “organization” section. CHG would in return give them a report that shows the overall trended data (2005, 2008, 2010) – compared to their organization’s data. If you want a code, please contact jstratton@corporatehealthgroup.com or 309-647-5456 for this set-up.

Contact Instructions 

Instructions on sending the survey to your contacts:

1. Below you will find a brief description of the survey along with a html message that could be used in your communication to your contacts. In order to use the html embedded in this email you must “forward” the message. It is set-up so that you could “forward” the message and simply delete the top portion of this message.

2. If you are unable to forward this html message, I have created a link to the survey.

The Physician Sales and Service Survey  

Physicians still direct the vast majority of inpatient healthcare in the marketplace – as many as 80% of patients enter the doors of hospitals and facilities at the direction of physicians. Notwithstanding he movement toward a consumer-driven market – many hospitals, health systems and large specialty practices have turned to physician sales or referral development programs to grow their business. Unfortunately, motivating physicians to change referral patterns is a daunting task under the best of circumstances and the lack of industry “best practices” complicates the situation even further.

View image001.png in slide show

Third Benchmarking Study

September 2010 Corporate Health Group (CHG) launched their third benchmarking study of Physician Sales and Service. The National survey will obtain new trends and craft comparisons and a gap analysis of data captured 2005, 2008 and now 2010. The survey (a mix of open and closed ended questions) is available online and respondents will get a free Executive Summary. The results will provide detailed management and benchmarking data for physician sales managers and healthcare executives to benefit their programs for future success!

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Dealing With Uncertainty in Practice Measurement

Understanding Variations in Medical Care Quality

By Brent A. Metfessel MD, CMP™

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Due to high-profile concerns in terms of the variation in quality of care as well as its affordability, practice pattern measurement is here to stay.  And, until further advances in this area are created, physicians with unexpectedly poor performance ratios, especially in the area of cost-efficiency, should review their data to determine if there are opportunities to improve as well as potential outlier cases contributing to an aberrant value, as well as looking at the health plan methodology for statistical analysis and outlier exclusions. 

Communication is Key

It is important for the physician or other provider being measured to communicate any issues to health plan personnel where possible. Physicians need to remember that practice pattern analysis is a continually evolving field. 

Assessment

Given the state of the art, physicians, specialty societies, and other advocacy groups have a responsibility to work with health plans or other practice measurement agencies to make sure quality improvement is at the forefront, that they are active in giving feedback on health plan practice measurement methods, and that as much as possible a collaborative approach is used in working with health plans and other measurement organizations.

Conclusion

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On Ethical Patient Advocacy

Medical Ethics in the Modern Era

By Render S. Davis MHA, CHE

www.BusinessofMedicalPractice.com

Few areas of life are as personal as an individual’s health and people have long relied on a caring and competent physician to be their champion in securing the medical resources needed to retain or restore health and function.

Nevertheless, this philosophy is currently in flux.

Foundation of Medicine

For many physicians, the care of patients was the foundation of their professional calling. However, in the contemporary delivery organization, there may be little opportunity for generalist physician “gatekeepers” or “specialty hospitalists or intensivists” to form a lasting relationship with patients.  These institution-based physicians may be called upon to deliver treatments determined by programmatic protocols or algorithm-based practice guidelines that leave little discretion for their professional judgment.

Personal Values

In addition, the physician’s personal values may be impeded by seemingly perverse financial incentives that may directly conflict with their advocacy role, especially if a patient may be in need of expensive services that may not be covered in their insurance plan, or are beyond the resources of a patient’s HSA or savings account.

Assessment

Marcia Angell, MD., noted during a PBS interview that the “financial incentives directly affecting doctors…put them at odds with the best interests of their patients … and it puts ethical doctors in a terrific quandary.”

Conclusion

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Understanding Disease Management

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How Technology Affects Patient Care

By Brent A. Metfessel MD, CMP™ [Hon]

www.BusinessofMedicalPractice.com

One area where technology assessments, clinical guidelines, and EMR data can make a true difference in patient care is in disease management.

DMAA Definition

The Disease Management Association of America (DMAA) defines disease management as “a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant”.  Disease management supports the physician-patient relationship and places particular significance on the prevention of exacerbations and complications of chronic diseases using evidence-based clinical guidelines and integrating those recommendations into initiatives to empower patients to be active partners with their physicians in managing their conditions.

Usual Conditions

Typically, targets for disease management efforts include chronic conditions such as asthma, diabetes, chronic obstructive pulmonary disease, coronary artery disease, and heart failure, where patients can be active in self-care and where appropriate lifestyle changes can have a significant favorable impact on illness progression.

Outcomes Measurement

The DMAA also emphasizes the importance of process and outcomes measurement and evaluation, along with using the data to influence management of the medical condition.

Assessment

Although claims and administrative data can be used to measure and evaluate selected processes and outcomes, EMRs will be needed to capture the full spectrum of data for analyzing illness response to disease management programs and to support necessary changes in care plans to improve both intermediate outcomes (such as lab values), and long-range goals (such as the prevention of illness exacerbations, managing co-morbidities, and halting the progression of complications).

Channel Surfing the ME-P

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

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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Product Details

The Business of Medical Practice [3rd edition]

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Transformational Health 2.0 Skills for Doctors

By Ann Miller; RN MHA

[Executive Director]

Revised and updated to include the most current information on healthcare administration, the Third Edition of The Business of Medical Practice is an essential business tool for doctors, nurses, and healthcare administrators; management and business consultants; accountants; and medical, dental, podiatry, business, and healthcare administration graduates, managers, and doctoral students.

Journalistic Style

Written in plain language using non-technical jargon, the text presents a comprehensive and progressive discussion of management and operation strategies. It integrates various medical practice business disciplines-from finance to marketing to the strategic management sciences-to improve patient outcomes and achieve best practices in the healthcare administration field.

Returning Contributors

  • Dr. Gary L. Bode; MSA, CPA, CMP™ [Hon]
  • Render S. Davis; MHA, CHE
  • Dr. Charles F. Fenton III; FACFAS, Esquire
  • Eric Galtress
  • Hope R. Hetico; RN, MHA, CMP™
  • Carolyn Merriman; FRSA
  • Dr. Brent A. Metfessel; MS
  • Rachel Pentin-Maki, RN, MHA, CMP[Hon]
  • Eugene Schmuckler; PhD, MBA, CTS
  • Patricia A. Trites; MPA, CHBC, CMP[Hon]

Exciting New Thought-Leaders

And, we seek to breathe additional diversity into this work with these new contributing authors:

  • Suzanne R. Dewey; MBA
  • Dr. Brian J. Knabe; CMP™
  • Parin Kothari; MBA
  • Mario Moussa; PhD, MBA
  • Shahid N. Shah; MS
  • Susan Theuns; PA-C
  • Jennifer Tomasik; MS

Topic Content and Chapters

With 37 chapters, 512 pages, and contributions by a world-class team of expert authors, this new edition – under the direction of Chief Editor Dr. David Edward Marcinko MBA – covers brand new information such as this partial list demonstrates:

  • Web 2.0 Technologies Impact on the Healthcare Industry
  • Office Location, Logistics, Layout and Execution
  • Internal Office Controls for Preventing Waste, Fraud and Abuse
  • Direct-Concierge Medicine and Niche Providers
  • Medical Workplace Violence and Sexual Harassment
  • Office Financial Statements and Analysis
  • Human Resources, Hiring, Firing and Office Staffing
  • Healthcare Marketing, Advertising, and Public Relations
  • Health Economics, Cost and Practice Managerial Accounting
  • Mico-Medical Practice Business Models
  • Incurred but Not Reported [IBNR] Healthcare Claims
  • Revenue Management, Coding and the Cash Conversion Cycle
  • Medical Professional Social Media and Collaborative patient care
  • Healthcare Compliance and Health Law Policies
  • The USA PATRIOT and SAR-BOX Acts
  • Physician Leadership, Communication, and Career Development
  • Patient Service Management and CRM + [plus]
  • Physician Compensation, Micro-Capitation with P-4-P Trend Analysis
  • Office Financial Statements and Analysis
  • Human Resources, Hiring, Firing and Office Staffing
  • Healthcare Marketing, Advertising, and Public Relations
  • EHRs, Mobile IT systems, Medical Devices, SaaS and Cloud Computing
  • Medical Ethics, Participatory Care and Moral Philosophy
  • Health Macro and Micro Economics and Finance
  • Medical Practice Sales and Succession Planning
  • Next-generation Physician Leadership
  • Obama Care American Recovery and Reinvestment Act [ARRA and HITECH]
  • And so much more!

“Live” Website Companion

The “live” online companion for this print textbook is: www.BusinessofMedicalPractice.com

Assessment

So, give em’ a click and tell us what you think.  Be the first to review this book.

Pre-Release Orders Here: www.springerpub.com/shoppingcart

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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Product DetailsProduct DetailsProduct Details

How eMR Vendors May Mislead You

Challenging Assertions

By Shahid N. Shah MS

As the physician executive of your medical practice, it’s your job to challenge any eMR vendors’ assertions about why you need an eMR, especially during the selection and production demonstration phase.

Information Availability [Anytime – Anywhere]

The most important reason for the digitization of medical records is to make patient information available when the physician needs that information to either care for the patient or supply information to another caregiver.

Electronic medical records are not about the technology but about whether or not information is more readily available at the point of need.

Reasons to Purchase?

In no particular order, the major reasons given for the business case of eMRs by vendors include:

• Increase in staff productivity
• Increase of practice revenue and profit
• Reduce costs outright or control cost increases
• Improve clinical decision making
• Enhance documentation
• Improve patient care
• Reduce medical errors

Assessment

So, doctors beware! Challenge vendor “authority.”

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Editor’s Note

Shahid N. Shah is an ME-P thought leader who is writing Chapter 13: “Interoperable e-MRs for the Small-Medium Sized Medical Practice” [On Being the CIO of your Own Office] for the third edition of the best selling book: Business of Medical Practice [Transformational Health 2.0 Skills for Doctors] to be released this fall by Springer Publishers, NY. He is also the CEO of Netspective Communications, LLC.

www.BusinessofMedicalPractice.com

Conclusion

And so, 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, be sure to subscribe. It is fast, free and secure.

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

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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

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

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Product Details

What is M-Health for Physicians?

On “Smart Phones” and Mobiles Devices

By Shahid N. Shah MS

M-Health or “mobile health” is an industry term for collectively defining those tools and technologies that can be used on “smart phones” like iPhone, Blackberry, Android, or on traditional mobile phones from various vendors.

Unlike traditional computers, almost every patient that walks into your medical office, as well as all your own staff, have mobile devices already. If you can find mobile applications that can help your practice you can immediately put to use without large capital expenses, network configuration, and other technical tasks.

www.MedicalBusinessAdvisors.com

The M-Health Initiative

According to the mHealth Initiative, there are 12 major “application clusters” in mobile health: patient communication, access to web-based resources, point of care documentation, disease management, education programs, professional communication, administrative applications, financial applications, emergency care, public health, clinical trials, and body area networks.

www.CertifiedMedicalPlanner.com

The Applications

Almost all of these applications are focused around the patient but most of them will be directly useful to you and your staff as well. Here’s how:

  • Improving physician-patient communications. You can get your staff to send out text messages, e-mails, photos, and other information about your practice to the patient before their visit. You can remind them about appointments, tell them what to expect, ask them for their insurance and check-in information, or let them send you their personal health record link. During the visit you can send them patient education information directly to their phones instead of handing out paper. After the visit you can send medication reminders, additional educational resources, and update to their personal health record, or ask them to join a Health 2.0 social network. PumpOne, GenerationOne, Intouch Clinical, Life:Wire, and Jitterbug phones all have great patient user experiences and you should tell your patients about them.
  • Faster access to information for you and your patients. There are countless web-based resources that are now at your fingertips on a phone. Patients can lookup providers, labs, testing services, etc. that you can refer them to; you can help them join clinical trials, and manage their health records online. None of these require a computer either in your office or in their home, it can all be done on the phone. Check out companies like Healthagen and iSeek.
  • Real-time documentation of office or hospital visits. Most of the things you want to do in your EMR are possible on a smart phone today. You can get your patient profiles, document an encounter with basic order management and lab results review capabilities, and immediate storage into either your own EMR or your hospital’s information system.
  • Help those patients with the most time-consuming treatments. You already know that disease management is an important part of managing the health of chronic patients; diabetes and hypertension are two perfect examples. Help enroll your patients into Diabetes Connect, MediNet, HealthCentral, and similar applications that can help track compliance with your medical treatment guidance. If they use these applications they can simply give you printouts or login credentials so that you can track their progress without doing any data entry yourself. There are patient tools for most common diseases.

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Editor’s Note

Shahid N. Shah is an ME-P thought leader who is writing Chapter 13: “Interoperable e-MRs for the Small-Medium Sized Medical Practice” [On Being the CIO of your Own Office] for the third edition of the best selling book: Business of Medical Practice [Transformational Health 2.0 Skills for Doctors] to be released this fall by Springer Publishing, NY. He is also the CEO of Netspective Communications, LLC.

www.BusinessofMedicalPractice.com

Conclusion

And so, 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, be sure to subscribe. It is fast, free and secure.

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

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Our Other Print Books and 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

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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Sponsors Welcomed: And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

Health 2.0 Empowers Patients – Worries Doctors

Patient 2.0 Collaborative Care Worries Doctors

By Staff Reporters

Writing for Time, Bonnie Rochman digs into the ramifications of patients sharing information and tips online, an “empowerment movement” she calls “Patient 2.0.”

Society of Participatory Medicine

In the piece, she profiles the newly created Society for Participatory Medicine, which “encourages patients to learn as much as they can about their health and also helps doctors support patients on this data-intensive quest,” as well as PatientsLikeMe.com, a free service which makes its money by selling anonymized patient information.

Assessment

Link: http://www.healthjournalism.org/blog/2010/02/patient-20-empowers-patients-worries-doctors/

Our New Book

For more information, please visit our new companion blog for the: Business of Medical Practice [Transformational Health 2.0 Profit Maximizing Skills for Savvy Doctors] – third edition.

Link: www.BusinessofMedicalPractice.com

Conclusion

And so, your comments on this ME-P are appreciated. What are your thoughts on health 2.0? Are doctors worried? 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.

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

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

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

Link: https://healthcarefinancials.wordpress.com/2007/11/11/advertise

***

Meet Shahid N. Shah MS [Our Newest IT Thought-Leader]

Join Our Mailing List

And Textbook Contributor, Too!

By Ann Miller; RN, MHA

[Executive Director]

Shahid N. Shah is an internationally recognized healthcare thought-leader across the Internet. He is a consultant to various federal agencies on technology matters and winner of Federal Computer Week’s coveted “Fed 100” Award, in 2009.

Professional Career

Over a twenty year career, Shahid built multiple clinical solutions and helped design-deploy an electronic health record solution for the American Red Cross and two web-based eMRs used by hundreds of physicians with many large groupware and collaboration sites. As ex-CTO for a billion dollar division of CardinalHealth, he helped design advanced clinical interfaces for medical devices and hospitals. Mr. Shah is senior technology strategy advisor to NIH’s SBIR/STTR program helping small businesses commercialize healthcare applications.

He runs four successful blogs: At http://shahid.shah.org he writes about architecture issues; at http://www.healthcareguy.com he provides valuable insights on applying technology in health care; at http://www.federalarchitect.com he advises senior federal technologists; and at http://www.hitsphere.com he gives a glimpse of HIT as an aggregator.

Industry Awards

Mr. Shah is a Microsoft MVP (Solutions Architect) Award Winner for 2007, and a Microsoft MVP (Solutions Architect) Award Winner for 2006. He also served as a HIMSS Enterprise IT Committee Member. Mr. Shah received a BS in computer science from the Pennsylvania State University and MS in Technology Management from the University of Maryland.

Assessment

Shahid is also contributing the chapter on HIT in the third edition of our book “Business of Medical Practice” [Transformational Health 2.0 Profit Maximization for Savvy Doctors], now in-progress www.BusinessofMedicalPractice.com

Channel Surfing

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register.

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

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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Product Details

ReThinking Medical Professional Autonomy in the Era of Obama Care

Eying Contemporary Medical Ethics in Healthcare Reform

By Render S. Davis; MSA, CHE

And, Staff Reportersbiz-book

Not so long ago, a physician’s clinical judgment was virtually unquestioned. Now with the advent of clinical pathways and case management protocols, many aspects of treatment are outlined in algorithm-based plans that allied health professionals may follow with only minimal direct input from a physician. Much about this change has been good. Physicians have been freed from much tedious routine and are better able to watch more closely for unexpected responses to treatments or unusual outcomes and then utilize their knowledge to chart an appropriate response.  

Restrictive Protocols

What is of special concern, though, is the restrictive nature of protocols in some managed care plans that may unduly limit a physician’s clinical prerogatives to address a patient’s specific needs. Such managed care plans may prove to be the ultimate bad examples of “cook book” medicine. While some may find health care and the practice of medicine an increasingly stressful and unrewarding field, others are continuing to search for ways to assure that caring, compassionate, and ethically rewarding medicine remain at the heart of our health care system.

Assessment

Link: For another opinion: http://healthcareorganizationalethics.blogspot.com/2009/09/obamas-speech-good-ethics-and-good.html

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How does the specter of HR 3200-3400 in the healthcare reform debate impact the concept of medical autonomy and professional ethics? 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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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 

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Our Other Print Books and Related Information Sources:

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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

Appraising a Medical Practice

The “Art of the Deal” for Buyers and Sellers

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chiefdem2

Are you considering selling your practice — or merging it with another? Thinking of buying? If you are, you’re hardly alone. Despite the decline of the big physician practice management companies [PPMCs] of the 1990s, the merger-and-acquisition market remains robust for small, private practices, as they respond to the continuing financial squeeze being placed on them, in 2009.

 

Read: http://www.humana.com/providers/NewsLetters/HumanaWeb1stQ07/articles/CoverStoryOne.html

Assessment

Humana’s YourPractice is a quarterly publication for office staff, physicians and other health care providers within the Humana network, and is produced by Corporate Communications in conjunction with “Physicians Practice”.

biz-book

Note: David Marcinko is also a writer for Physicians Practice 

Conclusion

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

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

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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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

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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Sponsors Welcomed

And, credible sponsors and like-minded advertisers are always welcomed.

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Become a Published Print Author with Us

The Business of Medical Practice [3rd Edition]

By Hope Rachel Hetico RN, MHA, CMP™

[Managing Editor]biz-book7

Dear Colleagues,

As you may know, we are commencing work on the third edition of our best selling book: The Business of Medical Practice

TOC 1st: http://www.amazon.com/Business-Medical-Practice-Maximizing-Doctors/dp/0826113117/ref=sr_1_8?ie=UTF8&s=books&qid=1231111232&sr=1-8

TOC 2nd: http://www.springerpub.com/prod.aspx?prod_id=23759

Invitation to Contribute

Accordingly, we would be honored for you to consider contributing a new or revised chapter, in your area of expertise, for a low-effort but high-yield contribution. Our goal is to help physician colleagues and management executives benefit from nationally known experts, as an essential platform for their success in the healthcare 2.0 business industry. Many topics are still available: [health accounting and costing; law, policy and administration; Medicare fraud and abuse; coding and insurance; HIT, grid and cloud computing; finance and economics, competitive models, collaboration and leadership, etc].

Support Always Available

Editorial support is available, and you would enjoy increasing subject-matter notoriety, exposure and public relations in an erudite and credible fashion. As a reader, or preferably a subscriber to the ME-P, your synergy in this space may be ideal. Time line for submission of a 5,000-7,500 word chapter is ample, and in a prose writing style that is “wide, not deep.” 

A Health 2.0 Initiative

And, be sure to address health 2.0 modernity. Update chapters from the second edition are also available. 

Definition: https://healthcarefinancials.wordpress.com/2008/09/12/emerging-healthcare-20-initiatives

Assessment

Please contact me for more details, if interested. A best selling-book is rare; while a third-edition volume even more so. Join us in this project. Regardless, we trust you will remain apostles of our core ME-P vision, “uniting medical mission and financial profit margin”, promoting it whenever possible.

Front Matter Link: frontmatter1advancedbusinessmedicine4 

Contact Info:

MarcinkoAdvisors@msn.com

770.448.0769

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.

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Wi-Max 2 the Medical-Max

An HIT Report from the Inner City Trenches

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dr-david-marcinko4

While not an IT guru by any means, I am a prudent fan of health IT where appropriate, and have always been a bit on the curious side.

A Bit about Me

OK; I am a member of the American Health Information Management Association (AHIMA) and the Healthcare Information and Management Systems Society (HIMSS). I am also a beta-tester for the Microsoft Corporation, a member of the Microsoft Health User’s Group (MS-HUG) and the Sun Executive Boardroom program sponsored by CEO Jonathan Schwartz; as well as SUNSHINE [Solutions for Healthcare Information, Networking and Education [NASD/FINRA-JAVA]. I also was fortunate to just finish editing the Dictionary of Health Information Technology and Security, with Foreword by Chief Medical Information Officer Richard J. Mata; MD MS MS-CIS of Johns Hopkins University.

And, I was incredibly lucky to have  my colleague Ahmad Hashem; MD PhD, who was the Global Productivity Manager for the Microsoft Healthcare Solutions Group at the time, to pen the Foreword to the second edition of my book, the Business of Medical Practice

And so, it was with the pleasure of potential intellectual satiety that goaded me into testing the airwaves, so to speak, on my recent visit to my home town of Bal’more. Thus, this exclusive ME-P report follows.

Location … Location … Location

If you lived in San Francisco a few years ago, during the ill-fated and costly WiFi experiment, you have my sincere condolences. If you live in Baltimore however, and want to have fast, wireless Internet speeds, then congratulations because you’ve chosen your place of residence wisely. Me, I’m an ex-patriot who was ecstatic when Sprint announced in October 2008, that Baltimore would be the first US city to have access to its new Wi-Max mobile data network; known as Xohm. I visit my home town 3-4 times, annually.

About the Wireless Xohm Data Network

Xohm is a wireless data service which, thanks to its WiMax capability, reportedly provides broadband-like speeds on a wireless PC. With this, as long as you have a WiMAX adapter and can pay for the service, the Internet should be available anywhere within the city. For home use, service for WiMAX costs $25 per month for six months, and $35 per month after that. Laptop access was to be $30 per month for the first six months. If you’re just visiting the city, single day access will cost $10, which is a bit steep, but not bad compared to the price of Wi-Fi access in some airports. Or, their unsecure networks were purported free; anywhere in the city. This was the object of my informal beta-testing activities.

computer-hardware2

City of Baltimore

My neighborhood, in Baltimore, is known as the historic Fell’s Point District. It was founded in 1670 by William Cole who bought 550 acres on the Inner Harbor, downtown. English Quaker, William Fell then bought land he named “Fell’s Prospect”. The land was also known as “Long Island Point” and “Copus Harbor”.

This area was the ideal hostile site for the Wi-Max experiment. The surrounding neighborhoods are composed of many dense, old-brick and stone-masonry buildings, with abundant large expanses of Chesapeake Bay with its related estuaries and inlets. Local gossip about the experiment suggested that if it was successful in this hostile Baltimore environment, it would like be successful in more modern American cities.

Link: http://www.fellspoint.us/history.html

Test-Laptop Specifications

I used my daughter’s [age 12, eighth-grade] Dell Latitude D600 laptop PC, running a Windows XP professional downgrade, with an Intel® P4 micro-processor [1.4 GHZ, 512 MB, 30 GIG CD with 24X CD-RW/DVD] for data only. It was originally purchased used – not new – for a few hundred bucks and badly in need of some upgrades. For the test, we added 512 MB LT DDR PC-3200, and a wireless LINKSYS PCMCIA card [WPC54GX].

Network Results

First, set up was a snap. While the network is expansive, it was not exactly blazingly fast, at least not for unsecure roaming access. The network can provide “download speeds of 2 to 4 megabits per second“. While, it is faster than most cellular networks, the service is nothing compared to some home internet connections. Although, the option to use it on a laptop is useful, the 4 Mbps is good enough for checking email or other smaller, lower bandwidth internet surfing usages. It’s hard to say if these estimates actually hold up with a lot of people using the network at once, especially if you are far from a broadcast tower – or in a funky part of the city – which is everywhere. But, they seemed to work quite well. My daughter, wife and I were suitably impressed.

Of Medical PACS

Of course, we also talked to local town folk about their free unsecured use. All were pleased with the Baltimore experience. We found business, law, nursing and graduate school students who were ferocious users. We even found medical students using open network wireless PCAS. To the uninitiated, picture archiving and communication systems (PACS) are computers or networks dedicated to the storage, retrieval, distribution and presentation of digital radiology images. The medical images are stored in an independent format. The most common format for image storage is Digital Imaging and Communications in Medicine [DICOM].

Roll-Put in Other Cities

Apparently, Sprint plans on releasing Xohm WiMAX networks in Chicago and Washington DC, this year.  While they are both major cities, it is hard to speak for just how well the WiMAX works when you’re sitting in Atlanta, GA. Should these networks actually get some decent use, perhaps the service will be released in more markets. I just don’t know.

About NETGEAR

Local Baltimore provider NETGEAR has been a worldwide leader of technologically advanced, branded networking products since 1996. Their mission is to be the preferred customer-driven provider of innovative networking solutions for small businesses and homes.

Link: federal@netgear.com

Assessment

As an old city, Baltimore has a rich medical heritage. There is the University of Maryland School of Medicine, Dentistry, Nursing and Pharmacy. Up the street from the Inner Harbor are the famed Johns Hospital School of Medicine and the Kennedy School of Public Health. It is here where I played stickball, as a child, in the parking lot. Nevertheless, given the high demands of business networking security and emerging network management in the local, State and Federal space today, NETGEAR is reported to have an end-to-end solution to meet most agency needs. This did seem to be the case in my ad-hoc experiment. We always found an open channel, and dropped links were few and far between; usually while mobile or riding in an automobile, bus, train or high-rail transportation system.

Link: http://www.freewimaxservice.net

Conclusion

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