PODCAST: “Un-Accountable” Healthcare Quality

BOOK REVIEW

By Dr. Eric Bricker MD

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Why Healthcare Variations are Expensive

The Cost of Medical Quality

By Daniel L. Gee; MD MBA

The cost of medical quality actually goes up when the variation and error rate of a process goes up. For example, the costs of pharmaceutical errors alone, in terms of lives and money, are huge. Consider the legal implications of incorrect procedures to an institution. Coding errors that lead to variability in reimbursements costs physicians and other providers, lost revenue.

Think also of the cost of additional safeguards, such as inspectors, that must be put into place to oversee defective processes. When a process is improved, the cost of quality goes down. There are fewer costs due to redundancy, lost time and lost labor.

A Variations Analogue

The concept of looking at medical variations in a process is analogous to the process of teaching a child to ride a bicycle for the first time. The child will be wobbly when he or she gets on the bicycle, at first and, may even fall, several times. As long as you are watching closely, to help the child back on the bicycle, help steer a little and provide encouragement, the child soon learns to ride smoothly and it appears all so natural. The child soon learns to balance from the feedback gained from you and the internal feedback from the brain. After studying the learning process closer, you may find the child to be more successful learning on a set of training wheels or on a bicycle a little smaller in size.

Regardless, the closed loop feedback, analysis, and monitoring by a teacher or process “champion,” keeps the child from wobbling too much and to stay on a straight and narrow course.

A Closed Feedback Loop

Businesses and medical practices wobble too in their processes and, in Six Sigma terminology, this wobbling is the variation that needs continual feedback to help correct and stabilize. Unlike riding a bike, where when once learned it becomes natural and smooth, businesses continue to wobble in their processes and may fall without ever being able to get back up. The institution of Six Sigma methodology is a closed feedback loop to prevent instability in processes.

More: http://businessofmedicalpractice.com/bonus-e-material/

Assessment

Virtual perfection may not be as easily attainable in an industry – like medicine – as computer chips coming off an assembly line; and the healthcare industry certainly has its share of “wobbliness;”

It is, nonetheless, the desire to constantly improve operations, perfect the way healthcare business is done – and tune in to what the patient needs – that separates the Six Sigma Sx improvement method from those QI techniques that have come before.

Moreover, the benefits of setting high performance goals, is a strategic decision to accelerate improvement, promote continual learning and sustaining efforts to succeed. It is a cultural change in medical mind-set to attain quality at its highest level.

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Conclusion

And so, your thoughts and comments on this ME-P are appreciated. What is your SS experience with medical variations? How should we define cost; in economic or human terms? 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, 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:

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

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Evaluating a Sample Physician Financial Plan I

Stress Testing Our Results a Decade Later

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

By Hope Rachel Hetico; RN, MHA, CPHQ, CMP™dave-and-hope4

We are often asked by physicians and colleagues; medical, nursing and graduate students, and/or prospective clients to see an actual “comprehensive” financial plan. This is a reasonable request. And, although most doctors who are regular readers of this Medical Executive-Post have a general idea of what’s included, many have never seen a professionally crafted financial plan. This not only includes the outcomes, but the actual input data and economic assumptions, as well.

The ME-P Difference

And so, in a departure from our pithy and typically brief journalistic style, we thought it novel to present such a plan for hindsight review. But; we present same in a very unusual manner befitting our iconoclastic and skeptical next-generation Health 2.0 philosophy. And, we challenge all financial advisors to do same and compare results with us.

How so?

By using a real life plan constructed a decade ago and letting ME-P reader’s review, evaluate and critique same.

  • Part I is for a married drug-rep, then medical school student [51 pages] with no children.
  • Part II is for the same, now mid-career practicing physician [28 pages] with 2 children.
  • Part III is for the same experienced practitioner at his professional zenith [56 pages].

Link: Sample Financial Plan I

Fiduciary Advisors?fp-book2

As reformed financial advisors and former licensed insurance agents; and a former certified financial planner – it is now  our professional duty to act as health economists and fiduciaries for our clients and colleagues. In other words; to put client interests above our own. This culture was incumbent in our participatory online educational program in health economics and medical practice management: http://www.CertifiedMedicalPlanner.org

Assessment

And so, as Edward I. Koch famously asked as Mayor of New York City from 1978-1989: “how am I doing”; we sought to ask and answer same. What did we do right or wrong; and how were our assumptions correct or erroneous?  As Certified Professionals in Healthcare Quality this is the question we continually seek to answer in medicine. And, as health economists, this is the financial advisory equivalent of Evidence Based Medicine [EBM] or Evidence Based Dentistry [EBD] etc. It is a query that all curious FAs should ask.

Note: Sample plans II and III to follow; so keep visiting the ME-P.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. As a financial advisor, accountant, financial planner, etc., we challenge you to lay bare your results as we have done. And, be sure to “rant and rave” – and – “teach and preach” about this post in the style of Socrates, with Candor, Intelligence and Goodwill, to all.

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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Sponsors Welcomed

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ASSUMPTIONS

Sample Mega Plan for a New Physician

Joe Good, a 30-year-old pharmaceutical sales representative, and his pregnant wife Susie Good, a 30-year-old accountant, sought the services of a Certified Medical Planner because of a $150,000 inheritance from Joe’s grandfather. The insecurity about what to do with the funds was complicated by their insecurity over future employment prospects, along with Joe’s frustrated boyhood dream of becoming a physician, along with only a fuzzy concept of their financial future.

After several information-gathering meetings with the CMP, concrete goals and objectives were clarified, and a plan was instituted that would assist in financing Joe’s medical education without sacrificing his entire inheritance and current lifestyle. They desired at least one more child, so insurance and other supportive needs would increase and were considered, as well. Their prioritized concerns included the following:

1. What is the proper investment management and asset allocation of the $150,000?

2. Is there enough to pay for medical school and support their lifestyle?

3. Can they indemnify insurance concerns through this transitional phase of life,  including the survivorship concerns of premature death or disability?

4. Can they afford for Susie to be the primary bread winner through Joe’s medical school,   internship, and residency years?

5. Can they afford another child?

Current income was not high, and current assets were below the unified estate tax-credit. Therefore, income and estate-planning concerns were not significant at that time.

After thoroughly discussing the gathered financial data, and determining their risk profile, the CMP™ made the following suggestions:

1. Reallocate the inheritance based on their risk tolerance, from conservative to long-term growth.

2. Maximize group health, life, and disability insurance benefits.

3. Supplement small quantities of whole life insurance with larger amounts of term insurance.

4. Create simple wills, for now.

Sample Mega Plan for a Mid-Life Physician

A second plan was drawn up 10 years later, when Joe Good was 40 years old and a practicing internist. Susan, age 40, had been working as a consultant for the same company for the past decade. She was allowed to telecommunicate between home and office. Daughter Cee is nine years old, and her brother Douglas is seven years old.

The preceding suggestions had been implemented. The family maintained their modest lifestyle, and their investment portfolio grew to $392,220, despite the withdrawal of $10,000 per year for medical school tuition. The financial planning aspects of the family’s life went unaddressed. Educational funding needs for Cee and Douglas prompted another frank dialogue with their CMP. Their prioritized concerns at this point were as follows:

1. Reallocation of the investment portfolio

2. Educational funding for both children

3. Tax reduction strategies

4. Medical partnership buy-in concerns

5. Maximization of their investment portfolio

6. Review of risk management needs and long-term care insurance

7. Retirement considerations

The following suggestions were made:

1. Grow the $392,220 nest egg indefinitely.

2. Project future educational needs with current investment vehicles.

3. Maximize qualified retirement plans with tax efficient investments.

4. Update wills to include bypass marital trust creation, and complete proper testamentary planning, including guardians for Cee and Douglas.

5. Retain a professional medical practice valuation firm for the practice buy-in.

Sample Mega Plan for a Mature Physician

At age 55, Dr. Joseph B. Good was a board-certified and practicing internist and partner of his group. Susan, age 55, was the office manager for Dr. Good’s practice, allowing her to provide professional accounting services to her husband’s office and thereby maximizing benefits to the couple from the practice. Daughter Cee was 24 years old, and her brother Douglas was 22 years old. The preceding suggestions had been implemented.  They upgraded their home and modest lifestyle within the confines of their current earnings. They did not invade their grandfather’s original inheritance, which grew to $1,834,045. Reallocation was needed. The other financial planning aspects of their lives had gone unaddressed. Retirement and estate planning issues prompted another revisit with their original CMP’s junior partner.

Their prioritized concerns at this point were as follows:

1. Long-term care issues

2. Retirement implementation

3. Estate planning

4. Business continuity concerns

The following suggestions were made:

1. Analyze the cost and benefits of long-term case insurance, funded with current income until retirement.

2. Reallocate portfolio assets and  plan for estate tax reduction, with offspring and charitable planning consideration..

3. Retain a professional practice management firm for practice sale, with proceeds to maintain current lifestyle until age 70.

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Ann Miller; RN, MHA

[Executive Director]

Medical Executive-Post

Sample HMO Disenrollment Appeal Letter

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Templates Best When Customized

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

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

[Publisher-in-Chief and Managing Editor]dave-and-hope7

Dear Medical Director,

As a current non-member of your managed car plan, I would like to take this opportunity to inform you of the activities we have pursued during this past year in order to gain acceptance into your plan.

For example, I have received X hours of clinical continuing education, which is X more than the state requires. Topics included recently developed techniques for pain control, non-hospital and non-surgical based therapy, more effective drug utilization, and a host of other methods of practice to reduce costs and increase patient welfare and mobility. Moreover:

  • I have received  X hours of medical business management training aimed at reducing office overhead expenses, increasing office efficiency and capacity, and improving patient flow and communications.  For example, our computerized call-back system is designed to ensure the continuity of patient care.
  • We have completed a patient survey that demonstrates that the average patient can receive a regular appointment within X days and urgent appointment within X days. Of course, we are fully staffed for immediate care of the emergent patients.  Our patient satisfaction rating is high. Most patients spend less than X minutes in the waiting room and are discharged in a timely fashion, with appropriate instructions in order to return them to work efficiently and comfortably.
  • We have expanded our office hours to improve access and enhanced the barrier free design of our office infrastructure. We are OSHA, CLIA, MSDS, PA, Sar-Box and HIPAA compliant, etc.
  • Since we believe in preventative care, our diabetic patients are continually screened and evaluated to reduce the potential for infections and other complications. This includes the liberal use of random accu-check blood sugar readings, with neurologic and circulatory assessment, with prompt reporting of aberrant values and findings to their primary care physicians or endocrinologists.
  • I will be taking my specialty board certification examination on X 2010. Of course, my results will be forwarded to you immediately.
  • I will become ABQAUR (American Board of Quality Assurance and Utilization Review) certified and/or a Certified Physician in Healthcare Quality (CPHQ) this year, after successful completion of all educational requirements and examinations.

Assessment

Although I realize that this is a challenging time for all concerned, we strive to make every patient’s visit to our office a medically and socially positive one. More specific suggestions regarding our practice would be appreciated. Therefore, we hope you will consider the probationary inclusion of our practice into your managed care plan, for the coming enrollment period.

Fraternally,

Joseph A. Smith; MD/DO  

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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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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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

 

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Re-Examining Medical “Do Not Resuscitate” Orders

Information for Financial Planners and Advisors

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

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

[Publisher-in-Chief and Managing Editor]

dave-and-hope11

According to the Rev. Chuck Meyer, former Vice President of Operations and Chaplain at St. David’s Medical Center in Austin, Texas, a new designation for Allowing a Natural Death (“A.N.D.”) would eliminate confusion and suffering when patients are resuscitated against their wishes.

Defining Do Not Resuscitate [DNR] Orders

As medical professionals, we know that a Do Not Resuscitate [DNR] order does not mean that medical care has stopped. It simply means that the goal of treatment has been changed. But, to FAs, patients and family members who are emotionally involved in the situation, this truth may not be apparent www.HealthDictionarySeries.com

Terminal versus Healthy Patients

While a completed DNR tells physicians not to start Cardio Pulmonary Resuscitation [CPR] if the patient suddenly goes into cardiac arrest, the order does not differentiate between a terminally elderly ill patient; and a potentially healthy younger person who may die due to current circumstances. A non-terminal patient may be in a DNR category and continue to receive aggressive or supportive treatment aimed at a cure; or at supporting him through this medical crisis. If symptoms start to respond, then the DNR category might even be changed to a full code.

insurance-book5

Assessment

Should financial advisors become involved in this issue? If not, why not; and if so; to what extent? MD-CFP® subscribers please chime-in with your unique experiences.

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.

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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  or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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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

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Understanding Medical Right-to-Die Terminology

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Need to Know Information for Financial Planners

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

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

[Publisher-in-Chief and Managing Editor]dave-and-hope10

Nothing fans the fire of public awareness more than the language associated with a news report; like Death with Dignity [DwD].

Death with Dignity

Unfortunately, several monikers have become associated with the Death with Dignity [DwD] Act. The public and the media refer to it as ‘physician assisted suicide.’ This in turn has often been confused with euthanasia and the potential for abuse either by physicians, or by family members. Oregon law, for example, allows death-with-dignity, but expressly prohibits euthanasia – wherein a physician or another person intentionally administers medication to end another’s life.

Terms

The actual terms of the Act allow terminally ill Oregon residents to obtain from their physicians, prescription drugs, for use in self administered – lethal doses.  The act states that for those already terminally ill, ending one’s own life in accordance with the law does not constitute suicide

Assessment

The term “physician assisted suicide” is used rather than “Death with Dignity” because [Rx] and prescription drugs are not available without the express prescription of a patient’s physician. Yet, we ask if this is just legal parsing, or a real definitional distinction?

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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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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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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Certified Physician in Healthcare Quality

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About CPHQ

[By Dr. David Edward Marcinko; MBA, CPHQ, CMP™]dr-david-marcinko2

Mission

The mission of the National Association for Healthcare Quality (NAHQ) is to improve healthcare by advancing the theory and practice of quality management in healthcare organizations and by supporting the professional growth and development of Healthcare quality management professionals. The association has about 15,000 members and was established in 1976 www.CPHQ.org

Several Specialties

There are specialties in infection control, medical and staff records, nursing, risk management, utilization review and CQI/TQM. Annual educational conferences are available, along with integrated educational courses, the quarterly newsletter NAHQ News and the bimonthly publication, Journal for Healthcare Quality. The NAHQ certification program, confers the designation Certified Professional in Healthcare Quality to members, and is accredited by the National Organization for Competency and National Commission for Health Certifying Agencies. It has certified more than 8,000 individuals.

Assessment

The NAHQ has liaison relationships with allied organizations, such as the American Hospital Association, JCAHO, National Health Council and the National Association of Medical Staff Services. It has working relationships with the American Health Information Management Association, Healthcare Financial Management Association and the US Department of Health and Human Services. Corporate headquarters are at 5700 Old Orchard Road, first floor, Skokie, Illinois, 60077 (708) 966-9392

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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