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Keeping the CORONA VIRUS Out of Dental Offices?

Opinion-Editorial

[By Darrell K. Pruitt DDS]

The ONLY way to protect dentists, staff, patients and their families from the risk of fatal COVID-19 infections is to keep the virus out of dental offices. (See graph from the New York Times).

***

Prediction: If quick and reliable testing is not available soon, within weeks after dental offices re-open for routine dental care – creating aerosols with high speed hand pieces, air/water syringes and ultrasonic scalers – dental offices will justifiably become known as reliable sources of COVID-19 infections, before being closed down again by the state.

Assessment: Your thoughts are appreciated.

***

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USN&WR – Meet the ADA President

Dr. Raymond Gist

By Kellus Pruitt DDS

I just found a US News Health article by Angela Haupt titled, “The Era of Electronic Medical Records.”

http://health.usnews.com/health-news/most-connected-hospitals/articles/2011/07/18/most-connected-hospitals?PageNr=1 

Even though dentistry wasn’t mentioned even once, I took liberties with the comment I posted. Besides, dentistry is never mentioned anywhere in the healthcare press, and that’s just not healthy. That is the point I hope I got across to Angela Haupt when I suggested she become Dr. Gist’s 7th Facebook friend.

 

Dear US News and World Report:

Last year, President Barack Obama promised that digitizing America’s health records will go beyond just improving care. He said transforming from paper to digital is a “panacea for the economy.” Somehow, illness became a renewable national resource.

I’m pretty sure neither the President nor US News have a clue about the business of dentistry.

Defying your common, misinformed bias for EHRs over paper records, here is a bite of reality from a dentist who actually treats patients: Other than me, the nation’s other 170,000 dentists are stone-silent about adoption of electronic dental records. Don’t you find that odd? What’s more, stakeholders inside and outside the American Dental Association, including even software vendors, avoid public discussions of EDRs. Dr. Oz’s Sharecare.com won’t even touch the topic. Why?…  a reporter might ask.

Do you trust that the widely-respected ADA always represents first and foremost the safety of dental care for both dentists and their patients? Let me fix that for you: ADA President Dr. Raymond Gist recently opened a Facebook, and two days ago, I was fortunate enough to be his second fan and the first to post a comment.

https://www.facebook.com/pages/Raymond-F-Gist/165275266868843

I took advantage of an unprecedented opportunity to speak directly to a vetted ADA official and asked the President, “Are electronic dental records more or less dangerous for dentists and patients than paper records?” I’m disappointed that Dr. Gist still has not responded. Why did he even bother opening a Facebook, one might ask.

Here’s what I think:

Because of the cost and safety issues with digital records that I warned each ADA President about since 2006, EDRs, and especially HIPAA, have become so difficult to defend in a free-market that nobody even tries any more. I think a handful of ADA leaders expected pigs to fly much sooner than this.

Assessment 

Want to do some real reporting, US News? Become Dr. Raymond F. Gist’s 7th Facebook fan and ask him on behalf of your publisher if EDRs are safer than paper dental records. Sure. It’s unconventional, and as far as journalism goes, it’s kind of kinky to post a question on someone’s Facebook. Nevertheless, it could be fun to watch a USN&WR reporter be treated with the same level of respect ADA officials offer dues-paying members.

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“The ADA Practical Guide to HIPAA Compliance”

Book Review – Dark, Dark Reading

By Darrell K. Pruitt DDS

Complying with HIPAA is an investment in the future of your dental practice. HIPAA Privacy sets forth requirements regarding the proper protection, use, and disclosure of patient information. HIPAA Security addresses using and protecting electronic patient information and the electronic technology that can save time, increase revenues, and improve workflow.” So are those evidence-based claims or an advertisement in the $250 ADA publication I purchased?

On Being Leary 

I’ve learned to be wary when dentalcare stakeholders like authors Ed Jones and Carolyn P. Hartley call HIPAA an “investment in the future of your practice” much like I would advise people to be wary of a dentist who sells cosmetic veneers by calling it an “investment in your smile!” All too often it turns out to be an investment in the dentist’s smile.

Unsupported Claims

Contrary to the authors’ unsupported claims in the Introduction of “The ADA Practical Guide to HIPAA Compliance,” there is no evidence that electronic technology saves time, increases revenues or improves workflow in dental offices. And even though Jones and Hartley mention “investment” numerous times in their HIPAA guide, how smart is it for a dentist to sink money into expensive electronic technology that demands mind-numbing documentation (even if it’s done on a computer); that exposes a practice to government inspections which carry liabilities up to $1.5 million even before state attorneys general get involved; that endangers the long-term welfare of both the dental practice as well as dental patients, and that promises no financial return? So just how smart is a HIPAA investment in the future of one’s practice?

Disaster Recovery 

I wasn’t far into Jones and Hartley’s imaginative guide to HIPAA compliance before reading other long-since rejected selling points that are so lame that even rookie eDR vendors know better than to attempt them. The authors’ naïve claim of the digital advantage of easier “disaster recovery” from a fire or hurricane is a good example of ADA-approved HIT fiction. Just ask yourself why disaster recovery was hardly a concern throughout the history of dentistry until the ADA leadership mindlessly bought in to promoting paperless practices and suddenly needed selling points in the worst way.

ADA Slogan

“Dentistry is healthcare that works”.

Beware

Any time dentalcare stakeholders trot out solutions, before asking the price, dentists should determine that there is indeed a corresponding problem that needs to be solved. Here is a simple marketplace test of Jones and Hartley’s disaster recovery claim: Which is cheaper: Disaster recovery insurance or data breach insurance? Common sense says that dentists’ offices are much more likely to be hit by burglars than fires and hurricanes. When burglars break into dentists’ offices, they don’t go for filing cabinets and ledger cards. They steal computers that can contain thousands of patients’ identities. As for the small percentage of US dentists whose offices are located in coastal cities and vulnerable to hurricanes, perhaps those dentists should maintain both digital and paper patient records. After all, which kind is easier to read during power failures that are common with hurricanes as well as ice storms – which occur much more frequently and throughout the nation?  What’s more, pegboards and ledger card boxes in a paper-based practice are not only hack-proof, but their use is unaffected when Internet servers go down, or are hacked. Confused yet? 

“You may decide to engage a technology consultant at some point, but after reading this book, you’ll have specific reasons for that engagement.”

Still Not a Fan

I’m not a fan of creative writers Ed Jones and Carolyn P. Hartley’s style of humor, but I needed a few continuing education credits and decided to pick up 8 easy hours through the ADA by purchasing their HIPAA guide and accompanying test. After finally conquering the first 2 bureaucratic-tedious chapters, it’s a pretty sure bet that I’ll try to wing it on the test long before getting through all 360 pages – many with footnotes even.

In the Minority 

I think studying for a CPA exam would be more riveting reading for me, as well as perhaps more meaningful for my dental patients – even if I were a HIPAA-covered entity. But since I’m one of the 4% of dentists in the nation who still doesn’t store or transmit patients’ protected health information (PHI) in slippery digital form, I never have to worry about attracting a subjective inspection because of my highly visible opinions about the absurdity of HIPAA in dentistry. Fines for being “willfully negligent” start at $50,000, and my transparent lack of respect for the Law would understandably trigger an inspection if I were a HIPAA-covered entity.

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HIPAA Flexibility 

On the other hand, since the HIPAA Rule is “flexible” by design, and HIPAA-covered dentists can be charged with huge fines – the other 96% of dentists in the nation who use computers in the business office have good reason to be careful about exercising their basic freedoms in the land of the free. It’s easy to see why covered entities aren’t complaining. Not to worry. As always, Proots has your six, good buddy. Are flexible laws really in American citizen’s best interest?

Although authors Jones and Hartley repeatedly point out that the HIPAA Rule’s flexibility is its beauty – even to the extent of allowing dentists to decide whether or not to notify their patients of a breach – dentists simply must be warned of the dangers that are inherent in vague laws: Flexibility for the dentist always means subjectivity for the inspector. History has shown us that subjectivity is dangerous in the hands of poorly-trained people with badges working on commission. The odds of fair treatment following even a self-reported data breach are not in a dentist’s favor. Even the simplest investigation by HHS representatives will cost a dentist at least $100 – even if the dentist is determined to be innocent of a baseless complaint – perhaps filed by a disappointed patient or employee.

Investigations and Violations 

“Violation Category (A) Did Not Know:  For a violation in which it is established that the Covered Entity did not know and, by exercising reasonable diligence, would not have known the Covered Entity violated such provision [$100-$50,000 per violation]. Chapter 2, page 20. HHS Secretary Kathleen Sebelius promised Congress that she intends to efficiently investigate every complaint against providers and vows to stop data breaches through stricter enforcement of the (hazy) HIPAA Rule – starting real soon. How is that not tyranny?

HITECH Subjectivity?

The ADA’s guide to HIPAA compliance has reaffirmed to me that HITECH HIPAA is a subjective law designed for abuse by those who created it. What’s more, eDRs provide NOTHING to dental care that has not been adequately and safely handled by conventional means of communication for decades at far lower costs. Sooner or later, the sudden news about HIPAA’s absurdity in dentistry is going to hit the HIT market like a brick. Following that flash of honesty, anyone who doesn’t agree that HIPAA is absurd in dentistry will do so at risk of snickers. So how complicated is compliance?

Chapter One: Dentist’s Obligations 

Chapter 1, page 1: “This book is concerned with only a portion of [Public Law 104-191]: Subtitle F — Administrative Simplification, hereinafter referred to as ‘HIPAA.’” Later in Chapter 1, Jones and Hartley use a paragraph to describe dentists’ obligations.

“Adopting Health IT presents challenges as well. For example, a dental practice must research and evaluate available systems, assess the current and foreseeable needs of the practice, negotiate the terms of the contract for the system and related services, including items such as the cost and availability of tech support, the number of licenses and authorized users that the contract will include, and the hardware and software features that enable HIPAA and HITECH compliance. Time and energy must be devoted to training staff to use the electronic health record system. A dental practice adopting an electronic health record should consult its attorney both with regard to the acquisition itself (including any contracts, licenses, and other legal documents) as well as with regard to the legal implications of using an electronic health record (for example, the dental practice should understand what will constitute the legal record and how the electronic health record would affect document retention requirements). A dental practice that intends to take advantage of the HITECH Act Medicare or Medicaid reimbursement incentives must understand and stay abreast of developments regarding the incentives, such as the qualifications of an “eligible provider,” how to demonstrate compliance with the “meaningful use” criteria,  how reimbursement incentives will be structured, and certification criteria of dental information systems.” 

Now do you see why the name “HIPAA” works better for stakeholders than “Administrative Simplification”?

HIT Rot 

As another illustration of how effectively stakeholders have hidden rot in HIT, the most common misspelling of HIPAA is “HIPPA,” and most consumers trustingly assume at least one of the Ps stands for “Privacy.” HIPAA hasn’t been about patient privacy since it was amended 8 years ago, and the P stands for “Portability.” And boy-howdy are digital records ever portable! HIPAA has ceased to be a benevolent law for Americans. It’s become instead a bi-partisan plan to take control of healthcare from healthcare principals and award it to healthcare stakeholders such as the HIT industry.

Assessment

You’ll spend a good amount of time implementing the Security Rule in your dental practice, but it’s the maintenance measures that will keep you in compliance.” This is a beautiful, meaningless point, Ed Jones and Carolyn P. Hartley.

Conclusion

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On American Health Care and Financial Services Competitiveness

A MEMORIAL DAY OPINION – EDITORIAL

[Innovation – Not Nationalization – Can Again Lead]

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

[Publisher-in-Chief]

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

[Managing Editor]

Ann Miller; RN, MHA

[Executive-Director]

American Flag

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

Collapse of Command and Control Monopolies and Oligarchies   

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

www.CertifiedMedicalPlanner.com

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

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

Health Insurance Companies

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

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

Leo F. Mullin, MBA

[Former CEO – Delta Airlines]Shadows

Next-Gen with “Fly”

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

Physician and FA Advocates

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

Flexibility and Virtual Reality

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

[A] Rule No. 1

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

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

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

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

[B] Rule No. 2

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

[C] Rule No 3

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

[D] Rule No 4

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

CP 1

Memorial Day Considerations

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

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

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

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Queries for the ADA Member Service Center

Four Questions for Consideration

[By Darrell K. Pruitt; DDS]

Dear ME-P Readers

I’m considering these four questions for the ADA Member Service Center to break the ice. What do you think?

Question 1 – The FTC’s Red Flags Rule is due to be enforced on June 10. If the Rule is not delayed for a fifth time and a dentist has a contractual relationship with CareCredit/GE or similar healthcare financing service, will that mean he or she will become a covered entity obligated to additional paperwork, liability and expense?

Question 2 – According to the “ADA National Oral Health Agenda” found on the Advocacy page, it states that one of the ways the ADA intends to reduce the cost of dental care is to promote health information technology. This goal was first posted several years ago. Considering the ever increasing liability of data breaches in healthcare, can consumers still expect to save money in dental care by visiting a paperless practice?

Question 3 – Am I correct to assume that soon the ADA.org Website will include the capability for direct discussions between members and leadership?

Question 4 – If interactive functions are indeed to be included in the new ADA Website, will there be any topics concerning ADA policy that will be closed to questions from membership?

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Editors Note: The incredible power of the internet is illustrated with this post relative to the phenomenon of “crowd-sourcing.” In this context, the term means to harvest the reach of social networking, like this ME-P, to solve a problem, or ask for input or opinions.

IOW: A knowledge seeker asks a question and participants respond.  PeerClip.com is an example of how “wisdom of the crowds” allows you to follow the latest opinions on interesting topics. In the medical practice management arena, you can also participate at the: www.BusinessofMedicalPractice.com, our newest 850 page book available this Fall.

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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How You Can Investigate Your State’s Oversight of Its Nurses

Reporting Recipe

By Charles Ornstein and Tracy Weber, ProPublica – March 3, 2010 5:38 pm EDT

cropped-me-p-mast-head-nurses.jpg

Nursing boards – and other agencies that oversee such professionals as pharmacists, dentists and mortgage brokers – do not get nearly enough scrutiny. These boards are charged with protecting consumers from unscrupulous or incompetent professionals, but some provide almost no public information about what they do or how they’re run. They are sometimes led by ill-qualified political appointees and lack sufficient personnel. But should these boring bureaucracies fail, the implications for your health, finances, and home can be dire.

Assessment

We realize that many newsrooms face competing priorities and limited resources, so we’re making our reporting recipe public.

Visit our special site with our complete how-to investigation guide [1], with information on all 50 states.

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Electronic Medical Records and Dentistry

A Note to Diane Rehm

[By Darrell K. Pruitt; DDS]

Dear Diane Rehm,

I always enjoy your show.

You add value to my drive to work.

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

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

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

Small and Mid Sized Practices

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

Marginal Benefits May Not Exceed Marginal Costs 

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

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

Assessment 

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

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

Conclusion

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Kathleen Sebelius Please Pay Attention to Dr. Darrell Pruitt

Deferred Investment [An Incentive to Access]

By D. Kellus Pruitt; DDS

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

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

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

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

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

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

To HHS Secretary Kathleen Sebelius

Pay attention. You only think you run the show.

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

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

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

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

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

Of Face Book Accounts

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

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

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

Assessment

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

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

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

Conclusion

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

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When Will Costs Outweigh Health Information Technololgy?

[By Darrell K. Pruitt; DDS]pruitt

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

Senate Judiciary Committee

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

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

Two Hundred Ten Dollars Cost – Per Record – for Notification

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

Personal Data Privacy and Security Act 

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

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

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

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

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

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

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

Assessment

ADA President Dr. Ron Tankersley is already irrelevant.

Conclusion

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Ask an Advisor about “Meaningful-Use”

Do dentists qualify for “meaningful use” incentives under ARRA?

By Ann Miller; RN, MHA

[Executive Director]

Chairman's Seat

A simple and direct query asked by an ME-P subscriber.

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A Doctor – Economist’s Solution for Health Reform

My Laundry Wish List for all US Healthcare Stakeholders

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]Fox News

As President Obama speaks, prods and cajoles, and Congress returns to session to begin work again on HR 3200-3400 or similar, I believe that for any healthcare reform effort to work successfully for the American people – not necessarily be adopted – we need to consider the following in no particular prioritized order:

  • Insurance portability uncoupled from patient employment
  • Health insurance regional exchanges with inter-state purchase competition
  • Doctor, drug, DME and hospital pricing and payment transparency for HSAs, and all of us
  • Modifying or eliminating AMA owned CPT Codes®; a huge money maker for them
  • Abandoning ala’ carte medicine for values-based outcomes
  • Reduce JCAHO influence; encourage competition from Norwegian Det Norske Veritas [DNV]
  • Reduce big-pharma influence thru-out the entire medical education, career and care pipeline
  • End DTC advertising from big-pharma
  • Promote wholesale drug purchase competition, MC bidding and generic drugs
  • Encourage evidence-based medicine, not expert-based medicine
  • Less pay for medical specialists with a  re-evaluation of the hospitalist concept
  • Advance the dying art of physical diagnosis, teach and embrace Paretto’s 80/20 rule for clinic issues
  • Reduce lab test, diagnostic imaging and testing
  • Encourage private 24/7/365 medical offices and clinics; and on-site and retail clinics
  • Abandon P4P, medical homes and disease management ideas
  • Give more economic skin-in-game to patients relative to health benchmarks
  • Concretize the “never-event” prohibitions and include a list of patient health responsibilities
  • More pay for primary care docs and internists
  • Adopt digital records and cloud computing for patients
  • Phase in true eHRs incrementally; and abandon CCHIT for open source SaaS
  • Promote Health 2.0 social media.
  • Augmented scope of practice, numbers and pay for NPs and DNPs, etc
  • Reduce pay for CRNAs and increase it for staff RNs
  • Develop step down triage and treatment units to reduce the number of full service ERs
  • Increase medical, osteopathic, dental, optometric and podiatric medical school classes
  • Increased practice scope for dentists, podiatrists and optometrists
  • Make some sort of catastrophic HI mandatory, much like auto insurance for all
  • End pre-existing conditon health insurance contract clauses
  • More choice  and end of life control for the terminally ill patient
  • Increase marketplace competition with fewer political and financial “externalities”.
  • Teach basic healthcare topics in school and encourage physical exercise
  • Health and insurance education should be, but is not, the “answer” for Americans
  • Protect borders and discourage undocumented illegals
  • Adopt medical malpractice tort reform
  • Make all stakeholders fiduciaries 
  • No public “option” unless you like food stamps, Section 8 housing, public transportation and schools
  • Budget deficit neutrality
  • Joe Wilson is both a bright guy – and a jerk
  • Slow down!

Assessment

Recently, while in the Baltimore/Washing area, I was asked by several reporters to opine on the healthcare debate; which I did so freely having never been known as the shy type. And, regular readers will note that many of these items have been used as posts or comments on this ME-P. Unfortunately, my “laundry list” interview was pre-empted by two local but boisterous town-hall meetings with respective passionate politicians. It was redacted no doubt, but never broadcast. Thus, I missed the potential for my “five minutes” of fame. C’est la vive!

Conclusion

There you have it; direct and straight forward. 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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BCBS-TX Reverses NPI Policy

Victory at Last

[By Darrell K. Pruitt; DDS]pruitt

Every now and then, I enjoy little victories. My war with BCBS-TX started when they began declining to pay their clients’ claims if they originated in my office. Since I’m not a HIPAA-covered entity, I didn’t volunteer for an arbitrary National Provider Identification number.

The behemoth insurance company not only successfully drove away some of my long term patients, but their clever policy blocked my access to their pool of clients who were led to believe their dental insurance was good everywhere – until my office manager had to tell them otherwise. BCBSTX is a sleazy company simply because it lies to its clients as policy. 

Successful Claims

In the last two weeks, my office manager has successfully filed a couple of claims and it appears that unless payment is blocked in the next day or so, BCBSTX no longer requires Texas dentists to have NPI numbers.

Asessment

That’s nice, but I want more. I want the state CHIP program to drop its NPI requirement as well. Why limit access to dental care to the poor because of a number that only helps insurers. I’m just getting started, Texas.

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Janis Oshensky Lobbies Congress – Not Dentists

Show Me the Math

By Darrell K. Pruitt; DDSpruitt 

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

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

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

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

Dear POLITICO.com Editor:

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

Hello – It’s Me

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

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

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

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

Allow Me to Show-You the Math

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

Free Markets 

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

Value Comparisons

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

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

Assessment

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

Conclusion

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ADA / IDM Breakup – You Heard it Here First

Will CareCredit be the Next ADA Subsidiary to Fail?

I saw a warning sign last week.

By Darrell K. Pruitt; DDS pruitt

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

http://www.dentalblogs.com

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

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

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

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

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

Dear Dentalblogs.com moderator:

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

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More about Healthcare Organizations [Financial Management Strategies]

Our Print-Journal Preface

By Hope Rachel Hetico; RN, MHA, CMP™hetico1

As Managing Editor of a two volume – 1,200 pages – premium quarterly print journal, I am often asked about our Preface.

A Two-Volume Guide

As so, our hope is that Healthcare Organizations: [Financial Management Strategies] will shape the hospital management landscape by following three important principles.

What it is – How it works

1. First, we have assembled a world-class editorial advisory board and independent team of contributors and asked them to draw on their experience in economic thought leadership and managerial decision making in the healthcare industrial complex. Like many readers, each struggles mightily with the decreasing revenues, increasing costs, and high consumer expectations in today’s competitive healthcare marketplace. Yet, their practical experience and applied operating vision is a source of objective information, informed opinion, and crucial information for this manual and its quarterly updates.

2. Second, our writing style allows us to condense a great deal of information into each quarterly issue.  We integrate prose, applications and regulatory perspectives with real-world case models, as well as charts, tables, diagrams, sample contracts, and checklists.  The result is a comprehensive oeuvre of financial management and operation strategies, vital to all healthcare facility administrators, comptrollers, physician-executives, and consulting business advisors.

3. Third, as editors, we prefer engaged readers who demand compelling content. According to conventional wisdom, printed manuals like this one should be a relic of the past, from an era before instant messaging and high-speed connectivity. Our experience shows just the opposite.  Applied healthcare economics and management literature has grown exponentially in the past decade and the plethora of Internet information makes updates that sort through the clutter and provide strategic analysis all the more valuable. Oh, it should provide some personality and wit, too! Don’t forget, beneath the spreadsheets, profit and loss statements, and financial models are patients, colleagues and investors who depend on you.ho-journal9

www.HealthcareFinancials.com

Assessment

Rest assured, Healthcare Organizations: [Financial Management Strategies] will become an important peer-reviewed vehicle for the advancement of working knowledge and the dissemination of research information and best practices in our field. In the years ahead, we trust these principles will enhance utility and add value to your subscription. Most importantly, we hope to increase your return on investment [ROI] in some small increment.

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1-800-251-0381

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TOC: http://www.stpub.com/pdfs/toc_ho.pdf

Conclusion

And so, your thoughts and comments on this Medical Executive-Post, complimentary e-companion are appreciated. If you would like to contribute material or suggest topics for a future update, please contact me. Subscribers, have we attained our goals and objectives, as a work-in-progress in this preface statement?

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Developing a Financial – Management – Advisory Practice for Doctors

Deep Knowledge and Personalized Marketing Brings in New Clients

By Dr. David Edward Marcinko; MBA, CMP™

BY Professor Hope Rachel Hetico; RN, MHA, CMP™

[ME-P Publisher and Managing Editordave-and-hope]

In any marketing situation, the more you know about your target audience, the more successful you will be. Accordingly, all of the old rules still hold true, such as “do your homework.” Unfortunately, for some financial advisors and management consultants, homework means researching broad (i.e., vague) demographic information such as zip codes, income, and age. This broadband approach to marketing is insufficient and unlikely to succeed. For example, SWOT analysis is best done in-house, while related medical marketing information can be obtained from the Institute of Medical Business Advisors, Inc.

www.MedicalBusinessAdvisors.com

Focus like a Laser Beam

An absolute of communication is to focus on the person receiving your message. If you don’t know anything about the person, you can’t focus on what is important to him or her, and you end up placing too much emphasis on yourself. Your message then carries less weight and has less impact.

Defining Your Niche

Instead of approaching all people in a certain neighborhood or age group, look for people within professional subcategories—people who use their talents in a specific way. Primary care physicians, dentists, podiatrists and optometrists apply their talents differently than surgeons or pediatricians. And, private management consultants and entrepreneurs use their talents differently than large corporate managers.

Develop a Profile

Let’s look at the medical entrepreneur niche space. Perhaps you regularly work with such entrepreneurs who manufacture or deal in medical gadgets, Durable Medical Equipment [DME], healthcare IT devices, instruments etc., and would like to increase the number of clients you serve in this niche.biz-book

The Process

First, you need to develop a profile that gives you specific information about those who manufacture said medical widgets in your area (i.e., more than just their zip codes), bearing in mind of course, that the profile is a point of departure. The general profile is then divided into several subsets based upon their specialty sales-type, devices, locations, market size, gender, etc. Concentrate on developing niches in which you have existing clients. Next, consider the attitudes, values, and mental processes common to all of your clients within a given niche. Knowing (or at least being able to project) what those qualities are will make your marketing efforts more successful because you already are familiar with who they are, their values, and how they want to receive information.

Client Values

How do you find out what someone’s values are? Just watch the person work. Ask questions. What do you want? Why do you do that? What’s important to you? To what words and phrases do you relate? What words and phrases do you resent? What does your desk look like? How do you prefer to receive information? Do you prefer a structured or a more relaxed environment?

The Value of Profiles

Developing profiles of specific groups within any given niche helps you establish rapport with people who are not yet clients. Many marketers make their initial contact through a letter. That’s dangerous, unless you are able to establish rapport in the letter. If not, you have diminished your reputation and accomplished little.

Mirroring

If you understand the concept of mirroring, you know it is important to mimic the other person’s breathing, vocal tonality and body language. That works amazingly well in meetings or even during telephone conversations.

Beware Letters

However, you can’t mimic in a letter, so you have to mirror the other person’s mentality. You have to match his or her attitudes, values, and mental processes in your marketing. Again, to consider sending a marketing letter – without first developing a profile – may be a foolish gamble.

Assessment

In short, relationship niche marketing can work to increase your practice without diminishing your reputation.

fp-book

Enter the Certified Medical Planner™

For those fiduciaries interested in the medical management and the healthcare financial advisory deep-space, for doctors and medical professionals, please visit www.CertifiedMedicalPlanner.com for more information.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? Despite the CFP imbroglio, how do you niche market, or attract physicians or other “high-value” clients, to your advisory practice? Do you possess any special deep-knowledge or “gravitational pull?” 

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Direct Reimbursement [DR] and RiskManagers.Us

Join Our Mailing List

Transparent Dental Benefits versus Confusion

[By Darrell K. Pruitt; DDS]

pruitt

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

Company slogan- www.riskmanagers.us

Meet Mr. William Rusteberg

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

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

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

Defining RiskManagers.Us 

Here is how RiskManagers.us describes itself: 

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

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

·         Self Funding – Need a second opinion?

·         Texas leads in transparency issues

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

·         Medical Stop Loss Through a Captive

·         PPO Discounts – Games People Play

·         PPO Networks – Shell Game

·         Can Hospitals waive Deductibles in Texas?

“What is a NPI number?” 

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

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

Thanks for your reply.

My Response:

I like you, William; 

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

http://www.directreimbursement.com/

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

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

Little Management Needed

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

Assessment

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

Conclusion

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Don’t Rush Into eHRs

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Address Medical ID Theft

1-darrellpruitt

[By Darrell Pruitt; DDS]

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

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

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

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

Reasons to Go Slow 

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

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

Conclusion

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Discount Dentistry Brokers

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More … on Sleazy Defenseless Companies

By Darrell K. Pruitt; DDS

I just came across a deceptive advertisement for a discount dentistry broker.

Yea, I know! What’s new? 

Why do we as healthcare providers silently allow naïve consumers to be so brazenly misled by sleazy businesses like Universal Benefit Plans and Universal Dental Plan, when we know they cheat their clients out of healthcare dollars?

Massachusetts Non-Profits

In a press release that announces their joint outreach initiative to aid Massachusetts nonprofits, it says Universal Dental Plan provides “… guaranteed rate discounts of 20-50% on all procedures.”

http://news.prnewswire.com/DisplayReleaseContent.aspx?ACCT=104&STORY=/www/story/01-06-2009/0004949991&EDATE=

Off the Top 

Just think – 20-50% off what – a super-inflated “retail” price? Dentists’ overhead easily tops 60%. If a dentist is losing 10% of his or her retirement just to do an intricate procedure for a gullible and trusting consumer who has no idea what is happening, how well do you think that work of art will chew? 

A Madoff Investment

Universal Dental Plan sounds almost as good as a Bernard L Madoff Investment, except that Ponzi tycoon Madoff accidentally promised quality before the wheels fell off. Universal Benefit Plans and Universal Dental Plan are sleazy companies who will never attempt to defend themselves on the Internet. They know better.

Assessment

This has been fun. Let’s do it again. And, if sleazy attorneys don’t like what I have to say about these two sleazy clients, come and get me.  But you better bring a ladder and a sack lunch. I’m not worried. I’ve said the same thing about Delta Dental, and they haven’t the guts to face me either [“Such a ‘Sleazy’ Company” on this Medical Executive-Post].

https://healthcarefinancials.wordpress.com/2008/09/19/%E2%80%9Csuch-a-sleazy-company%E2%80%9D/

Note: Dr. Pruitt blogs at PenWell and other dental sites, where this post first appeared.

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Conclusion

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ADA – Can You Hear Me Now?

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The Sounds of Institutional Silence 

[By Darrell K. Pruitt DDS]

pruitt2

Hey you, American Dental Association.

What do you have against talking with us members?

Do you fear the questions we might ask, or something?

Who I Am 

I am one of a growing number of dentists who believes that our profession, as well as all US health care, urgently needs transparency through communications – hair and all – bottom to top.  That means accountability from leadership.

Government Similarity 

President-elect Barack Obama has the same idea about government. Over a year ago, candidate Obama promised that all his Cabinet Secretaries would maintain weblogs to promote two way communication with all citizens. Even before he takes office, his website has been busy for weeks with interactive conversations with average citizens … yet I cannot get an official from my own professional association to respond to me online at all. I pay dues to the non-profit organization. How good is that?

The Naked Conversations 

Over two years ago, I read about weblogs in “Naked Conversations,” written by Robert Scoble and Shel Israel. I quickly became a fan of networks. A few months later, I offered to help start an ADA weblog – in a conversation with ADA Senior Vice President Dr. John R. Luther. I suggested that if ADA members could interact online with ADA officials or their representatives in real time, the transparency would empower the organization like never before in history. He was not interested.

An ADA Weblog 

Dr. Luther dismissed my idea outright and refused to discuss it further. He specifically told me that when the ADA was ready for a weblog, “the ADA leadership would let me know.” If you don’t recognize it, his was a variation of a typical conversation-ending response often used by leaders of traditional top-to-bottom, command-and-control business models like the ADA’s. Other door-closers are “Just because,” and “Anyway, it’s mandated so we have no choice.”  In my opinion, the ADA and in turn, the dental profession, are hobbled by an archaic model that no longer works and is recently vulnerable to trouble-makers like me who not only don’t play by their self-serving rules – but have a hell of a good time flaunting them. 

So-Called Authoritarian Dismissals 

By the summer of ’06, I was already accustomed to authoritarian dismissals from Dr. Luther.  On a separate issue I had raised earlier concerning the NPI number, he used a nuclear door-closer when he suggested that I write a letter to the editor if his committee-approved non-answer didn’t satisfy me … which he knew didn’t come close. If I had gone through my ADA publications with my question, the turnaround – if it were even considered for publication – would have been at least six weeks. 

Chain of Command 

That is how the leaders of the ADA used to conveniently handle those who didn’t respect proper chain-of-command representation, which normally shelves tricky questions on local dental society levels long before they reach Headquarters in Chicago. Very soon, officials in the ADA will be demanded to explain what’s wrong with responding to members immediately, or their silence will look more and more suspicious. It is not a good time in history to be a dinosaur. Barack Obama’s team finds the time to talk to underlings. What makes the leaders of the American Dental Association so special?

Internal Rules

Oh yea! Here is another internal ADA rule. “Let’s not wash our laundry in public.”  That means laundry never gets washed. Now, Dr. Luther isn’t the only ADA official who won’t venture onto the Internet.  I have tried to attract past Presidents, current Presidents and future Presidents as well.

For example, when one Google searches “Dr. Ron Tankersley,” who will be our next President of the ADA, my article on the PennWell forum titled “An invitation to Dr. Ron Tankersley, President-elect of the ADA” – appears on his first page.

http://community.pennwelldentalgroup.com/forum/topics/an-invitation-to-dr-ron

Here is the invitation that has been ignored for two months

Dear Dr. Tankersley,

I too am a member of the ADA. Congratulations on your election to the highest post in our professional organization. It is an esteemed compliment when so many colleagues put so much faith in a fellow professional, especially in these challenging times for dentistry.

As a dentist, I am excited about the miracles of discovery that will become possible when we begin applying Evidence-Based Dentistry to a vast network of interoperable computers in dentists’ offices across the nation – creating real-time research.

  • How soon do you foresee this happening?
  • Can we expect to see the beginning of it during your reign?

Your response is appreciated by dentists and patients alike.

Assessment

Does anyone else found institutional silence odd these days? Or, am I unprofessional to demand information that I consider is owed me?

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The Great eHR Debate

Another IT Challenge for Dentists

By Darrell K. Pruitt; DDS

I posted this on my surrogate blog (Baltimore Sun). I’m hoping to gather a crowd of town-folks to witness me send a collection of door-to-door scoundrels on down the road. 

http://www.topix.net/forum/source/baltimore-sun/T0GLLJEPSJAJJDBCJ/p5#lastPost

“EHR Debate of the Century – Pruitt vs. All Comers”

Allow me to invite you to the “EHR Debate of the Century – Pruitt vs. All Comers”

Kevin Henry, editor for Dental Economics, has invited healthcare IT experts other than me to a debate concerning electronic health records in dentistry.  I posted my acceptance of the challenge here.

http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14917

Dental Economics

http://community.pennwelldentalgroup.com/forum/topic/show?id=2013420%3ATopic%3A14859

When I read that he was entertaining questions for a panel of experts, I hammered out twenty or so questions in less than five minutes and posted them below his comment.  Every one of my questions is a subterranean stinker except for the last two.  Those two are as sweet as honey. 

This Could be Fun

I have to assume that the other unnamed and unarmed experts are healthcare IT stakeholders, not principals like me.  Since I’m defending my patients’ turf instead of the price of a company’s stock, I cannot and will not lose.  This could get exciting.  Wake the kids.  I’ll also do my best to spread the word about the train wreck in my own way.

I must take this opportunity to acknowledge the courage of PennWell and specifically Mr. Henry for stepping out in front of the vast silent, lost crowd to offer consumers transparency at last, and perhaps just in time.  I will never forget your help in my efforts to salvage evidence-based miracles that my future grandchildren might still be able to enjoy, if we’re lucky.

“The events going on right now are the seeds of a unification of faith and honor of all thirteen colonies on our continent.  The smallest fracture between us now will be like a tiny carving into a small oak sapling, which will grow large over time, and future generations will be able to read our failure in giant letters.” 

Thomas Paine, Chapter III, “Common Sense.”  1776

OSEBD

If we are to reap miracles from Open Source Evidence-Based Dentistry [OSEBD], we cannot afford to disappoint our patients the first time out with a loser EHR that ADA President Dr. John Findley says dentists will have to accept – regardless of the Hippocratic Oath.  The interoperability that Findley does not understand but nevertheless promises the nation will never be realized if leadership continues with this reckless, parasite-infested course in healthcare IT adoption.

Open-Source EBD using trustworthy data will only get one chance at trust.  Contrary to what Findley says, EHRs are not inevitable.  It is abysmally foolish for a bureaucrat to suggest that the nation’s dentists, 85% of whom are sole-proprietor small business owners, will abandon their own Constitutional Rights for the common good.  That is being far too generous with others’ rights, Dr. Findley.

Bribing the Doctors

Until both dentists and patients trust EDRs, interoperability simply will not happen anywhere.  Consider this:  EMR adoption by physicians is going so badly that HHS Secretary Michael Leavitt had to bribe 1,200 physicians just to try EMRs.  Do you know the difference between EMRs and EDRs?  EMRs make tremendous sense. 

Bribing the Dentists?

How many dentists will the next Secretary have to bribe?  Taxpayers should be warned that investing in EHRs in dentistry is a waste of healthcare dollars until Personal Identification Information (PII) is removed from them.  What, I ask you, could be simpler than that?  “And, what about the interoperability with physicians’ records?” a deeply-rooted healthcare IT stakeholder might timidly ask.  Forget the MDs.  Forget Newt Gingrich.  Forget ONCHIT.  And especially, with extreme prejudice, forget the National Association of Dental Plans (NADP).  Let’s set up our own system, with or without the ADA, collectively fine tune it to our own needs which only practicing dentists truly understand, and make the opportunists come to us for once, damn it.  Just because physicians’ practices are so terribly infested with parasites that they cannot move into the future should not stop dentists from leading the way using precedent-setting innovation in a free market.

Assessment 

Even before Secretary Leavitt addressed the ADA House of Delegates in 2006, which Kevin Henry mentioned in the invitation to the coming debate, I wrote that maintaining EDRs with personal information is like storing bombs with fuses.  It is still earthly stupid.  So are we, the nation’s dentists, going to sit back in our lawn chairs and watch for the muddy explosion?    Not me.  I’m going to defuse the sucker.  You just sit back and watch. 

Conclusion

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HIPAA Rules and Dentistry

A Survey of Dentists [Pilot Study]

By Darrell Pruitt; DDS

A survey of 18 dentists was performed using the Internet as a platform. The dentists were presented with ten HIPAA compliancy requirements followed by a series of questions concerning their compliancy as well as the importance of the requirements in dental practices.

Frustration with the tenets of the mandate, as well as open defiance is evident by the written responses.  In addition, it appears that a dentist’s likelihood of satisfying a requirement is related to the dentist’s perceived importance of the requirement.

Even though this is a limited pilot study, there is convincing evidence that more thorough investigation concerning the cost and benefits of the requirements need to be performed before enforcement of the HIPAA mandate is considered for the nation’s dental practices.

Excerpt:

Dr. Gerald Daniel seems to have captured many of the dentists’ feelings about the HIPAA Rule when he lamented, “We try to comply, however many times I feel every government agency in the country wants to run my practice without regard to the problems, expense or aggravation it causes the health provider.”

READ IT HERE: hipaa-survey-dentists4

GRAPHS: hipaa-survey-graphs1

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