PODCASTS: Corporate Practice of Medicine Laws

Private Equity Owning Doctor Practices

LEGALITY?

By Eric Bricker MD

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PODCAST: https://www.youtube.com/watch?v=2epmk4_-kUI

These Laws Were Put Into Place So That Doctors Would Not Put Shareholders Before Patients and So That Corporations Would Not Interfere with Doctor Judgement.

Corporate Practice of Medicine Laws are at the State Level, NOT the Federal Level.

Each State Has Its Own Exceptions Such as 1) Doctors Can Work for Companies That Are Owned by Other Doctors and 2) Doctors Can Work for Hospitals.

Accordingly, Private Equity Firms Have Been on a Physician Practice Buying Binge.

Private Equity Firms Bought 355 Physician Practices from 2013 – 2016.

Two of the Largest Purchases Were KKR’s Purchase of Envision’s 25,000 Doctors for Almost $10 Billion and Blackstone’s Purchase of Team Health’s 20,000 Doctors for $6 Billion.

If Corporate Practice of Medicine Laws Say that Doctors Cannot Work for a Corporation, How are Private Equity Purchases of Physician Practices Legal?

CITE: https://www.r2library.com/Resource/Title/0826102549

PODCAST: https://www.youtube.com/watch?v=DgWEybUSiuo

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PODCAST: How Doctors are Really Paid?

Learn the Incentives in Physician Compensation

BY ERIC BRICKER MD

RAND and Harvard University Researchers Recently Published a Study in the Journal of the American Medical Association Examining How Doctors are Paid by Hospital System-Owned Practices. The Study Found that only 9% of Primary Care Physician Compensation was Based on Value (Quality and Cost-Effectiveness) and only 5.3% of Specialist Compensation was Based on Value.

The Study Concluded: “The results of this cross-sectional study suggest that PCPs and specialists despite receiving value-based reimbursement incentives from payers, the compensation of health system PCPs and specialists was dominated by volume-based incentives designed to maximize health systems revenue.”

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MORE: https://medicalexecutivepost.com/2020/09/19/what-doctors-must-do-to-file-an-aetna-claim-to-get-paid/?preview_id=237387&preview_nonce=44f9028974&preview=true

RELATED: https://medicalexecutivepost.com/2008/09/12/how-doctors-get-paid/

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BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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HOSPITALS: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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PODCAST: Medicare Advantage Plan Over Payments

A SYNOPSIS

By Eric Bricker

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PODCAST: Government Overpayments to Medicare Advantage Plans are a major problem.

CMS pays Medicare Advantage Plans per member based on a risk score. The more chronic conditions the person has, the larger the payments CMS makes to the Medicare Advantage Plan.

Medicare Advantage Plans may be overexaggerating how sick their members are in order to increase their payments from CMS.

The Department of Justice is currently suing Cigna and Elevance (Anthem) for such over exaggerations.

However there is a deeper problem… CMS itself had performed its own audits, but has not done so in 10 years. CMS identified $650M in overpayments and did nothing about them.

When the Kaiser Family Foundation (KFF) requested information on the audits, CMS refused. KFF had to sue CMS to obtain the audit information and it took 3 years for KFF to win the case.

Perhaps it is incompetence on the part of CMS or perhaps CMS does not want to reveal the audits or do anything about them due to political pressure.

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ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books& qid=1275315485&sr=1-4

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PODCAST: Hospital Money Problems 2023

INFLATION AND COMPETITION

By Eric Bricker MD

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ORDER: https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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PODCAST: Medicare Traditional [A and B] v. Advantage [C] v. Part [D] v. Supplements

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCAST: “Sage Transparency” on Hospital Prices

EMPLOYER SPONSORED HEALTH INSURANCE PLANS

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: Employee Engagement and Health Plans

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCASTS: The Physician-Patient Population Health Mis-Match

By Eric Bricker MD

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PODCAST: https://medicalexecutivepost.com/2022/10/23/podcast-help-your-medical-practice-embrace-population-health/

Population Health: https://medicalexecutivepost.com/2022/07/12/enter-population-health-management/

CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: History Applied to Health Economics

Divining the Future?

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: Hospital Financial Cross – Subsidization

By Eric Bricker MD

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Hospital Profit Margin from Employers = 57%

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PODCAST: “All OR Nothing” Hospital Contracts

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCAST: Industrial Revolution – Healthcare Revolution

SEE THE FUTURE BY LOOKING BACK

By Eric Bricer MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Financial Deception in Healthcare

THIRTY EXAMPLES

By Eric Bricker MD

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Citation: https://www.r2library.com/Resource/Title/0826102549

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ORDER: https://www.routledge.com/Risk-Management-Liability-Insurance-and-Asset-Protection-Strategies-for/Marcinko-Hetico/p/book/9781498725989

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PODCAST: Doctor’s Don’t Disclose Conflicts of Interest

C.O.I.

By Eric Bricker MD

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MORE: https://medicalexecutivepost.com/2022/10/05/video-on-doctors-money-and-conflicts-of-interest/

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCASTS: Direct Primary Care Medicine

NO HEALTH INSURANCE – NOT FEE for SERVICE

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PODCAST: Never Pay Your First Medical Bill?

Marshall Allen Has a New Healthcare Book Out Called Never Pay the First Bill.”

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BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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PODCAST: Healthcare is Great for People with Medicare.

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Greater than 90% of Medicare Beneficiaries Are Satisfied with Their Care

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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ORGANIZATIONS: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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PODCAST: Drugs AVERAGE WHOLESALE PRICE

AWP EXPLAINED

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCAST: Hospital Debt and Tax Exempt Bonds

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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ORDER: https://www.routledge.com/Comprehensive-Financial-Planning-Strategies-for-Doctors-and-Advisors-Best/Marcinko-Hetico/p/book/9781482240283

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PODCAST: CMS Over-Payments to Medicare Advantage [Part C] Plans

By Eric Bricker MD

RISK ADJUSTMENTS EXPLAINED

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ORDER: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCAST: Healthcare Finance [Recorded Live] Q and A Session

By Eric Bricker MD

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INSURANCE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCAST: Medical Billing Charge Abuse by Radiologists

By Staff Reporters

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PODCAST[s]: Medicare Re-Admission Penalties

UPDATE 83% Penalized!

By Eric Bricker MD

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HRRP PODCAST: https://www.youtube.com/watch?v=mwRrKM83CVQ

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PODCAST: Hospital-Insurance Contracting [“Carve-Out” Prices Explained]

By Eric Bricker MD

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PODCAST: Inflation Impact on Healthcare

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: Accounting Deception in Health Care

Examples of Exploitation and Deception?

BY ERIC BRICKER MD

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TERMS: https://medicalexecutivepost.com/2021/11/02/financial-terms-and-definitions-all-physician-should-know/

Triple Entry Accounting: https://medicalexecutivepost.com/2020/12/28/triple-entry-accounting/

HEALTH ECONOMICS CITE: https://www.r2library.com/Resource/Title/0826102549

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PODCAST: Health Insurance Carrier Contracting

By Eric Bricker MD

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PODCAST: Why Healthcare is So Slow to Change

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Hospital Insurance Contracting [Prices]

Percent-of-Charge Discounts”

By Eric Bricker MD

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PODCAST: Nine [9] Ways to Pay Doctors

“Behavioral Economic Strategies”

By Eric Bricker MD

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As Published in the Annals of Internal Medicine by an All-Star Cast of Researchers:

1) Limitations of Information
2) Inertia/Status Quo Bias
3) Choice Overload
4) Immediacy
5) Loss Aversion
6) Relative Social Ranking
7) Threshold Effect
8) Limits of Willpower
9) Mental Accounting

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PODCAST: Private Equity in Healthcare Explained

By Eric Bricker MD

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Private Equity is a Newer Name for Leveraged-Buyout Firms that were Popular in the 1980s.

These Companies Use Investor Money and Debt to Buy Companies and Often Use Additional Debt to Accelerate Growth.

The Private Equity Firm then ‘Flips’ or Sells the Company for a Profit.

The Private Equity Firm KKR’s Acquisition of the Physician Staffing Firm Envision is a Great Example of This Strategy.

However, Private Equity Firms May Be Contributing to the Rising Cost of Healthcare Through Their Activities.

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BUSINESS OF MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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PODCAST: Top Five Healthcare Consulting Firms

By Eric Bricker MD

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HOSPITALS: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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PODCAST: See the Future of Healthcare?

By Eric Bricker MD

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HOSPITALS: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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PODCAST: Technology Adoption in Healthcare

The Technology Adoption Lifecycle Applied to Healthcare

By Eric Bricker MD

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DHITS: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5
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PODCAST: EMRs are a MESS!

By Eric Bricker MD

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HIT: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

MORE: https://medicalexecutivepost.com/2022/03/28/emrs-laugh-or-cry/

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PODCAST: Healthcare Machine Learning Can Self Create / Improve Algorithms?

Machine Learning is a Subset of Artificial Intelligence (AI) Where Computer Software Can Create and Improve on Algorithms on Its Own.

Machine Learning for Population Health

PODCAST: 'Hacking of the American Mind' | The Leading ...

By Eric Bricker MD

Healthcare Machine Learning Company ClosedLoop.ai is One of the Best at Applying Machine Learning to Population Health Data.

ClosedLoop.ai is So Good, They Won the CMS AI Challenge … Beating Out 300 Other Organizations Including IBM, the Mayo Clinic and Deloitte.

The Promise of Machine Learning in Population Health is to Better Predict Which People Will Benefit From an Intervention Because They Are at Greater Risk of a Complication of a Disease or an ER Visit or a Hospitalization.

ClosedLoop.ai Beautifully Applied Their Machine Learning Abilities to Create a Pandemic Risk Model That Helped a New York City Health Insurance Plan Identify Which Members Would Be Most Likely to Have Severe Complications of COVID-19.

As a Result, the Insurance Company Helped These Individuals Have Groceries and Prescription Medication Delivered to Them So They Could Stay at Home and Avoid Exposure to COVID.

There You Have It!  A Practical, Real-World Example of Machine Learning in Population Health That Literally Saved Some People’s Lives.

Disclaimer: Dr. Bricker is the Chief Medical Officer of Virtual Care Company First Stop Health.

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HIT: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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PODCAST: Artificial Intelligence in Medicine

MACHINE LEARNING AND NATURAL LANGUAGE PROCESSING

By Eric Bricker MD

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DHIT: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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PODCAST: The AWS Model for Healthcare Change?

By Eric Bricker MD

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BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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PODCAST: IC-HRA [Individual Coverage – Health Reimbursement Arrangement] Explained

Health Insurance Job Options

By Eric Bricker MD

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DEFINITION: ICHRA (we pronounce it “ick-rah”) stands for “Individual Coverage Health Reimbursement Arrangement” (not the common misnomer of individual coverage health reimbursement accounts)  and is available for employers to start using as of January 2020. ICHRA is an evolution of another type of HRA, called a QSEHRA, that was created in 2017. Both allow employers to reimburse employees tax-free for individual health insurance, but ICHRA represents a “super-charged” version of QSEHRA with higher limits and greater design flexibility that will appeal.

More: https://www.takecommandhealth.com/ichra-guide

CITE: https://www.r2library.com/Resource/Title/082610254

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HEALTH INSURANCE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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HOSPITALS: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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PODCAST: The “Value Hole” in Health Insurance Plan Design

By Eric Bricker MD

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HEALTH INSURANCE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCAST: The MEDICARE COST REPORT Explained

Not For DoctorsNot Managerial Cost Accounting

By Eric Bricker MD

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HOSPITALS: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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PODCAST: High Medical Debt Yet Hospitals Still Thrive!

By Eric Bricker MD

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PODCAST: Hospital Executives Confess Fee-For-Service Care Drives Costs

By Eric Bricker MD

1) Fee-for-Services Motivates Hospitals to Increase Costs.
2) Medicare and Commercial Insurance Companies Have Not Changed That Motivation with ‘Value-Based’ Payments.
3) Hospital Prices Have NO Connection to the Underlying Cost of a Test or Procedure.
4) Most Don’t Even Know What the Underlying Test or Procedure Cost Is in the First Place.

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HOSPITALS: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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PODCAST: Healthcare Selling Strategies

By Eric Bricker MD

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DICTIONARY: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCAST: Inflation Reduction Act [IRA] and Healthcare

THE AGENDA 2022 AND BEYOND!

By Eric Bricker MD

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RELATED: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCAST: What Hospital CEOs Should Do?

TOP 4 PRESUMPTIONS!

BY ERIC BRICKER, MD

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YOUR COMMENTS APPRECIATED.

HOSPITALS:

https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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HEALTHCARE:

https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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PODCAST: Medical Specialties with High Margin Hospital Power

By Eric Bricker MD

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HOSPITALS: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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PODCAST: Investing in Digital Health Sales and Marketing

By Eric Bricker MD

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DHITS: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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PODCAST: United Health Group Acquisition of “Change Healthcare”

A DATA GOLDMINE

By Eric Bricker MD

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HIT: https://www.amazon.com/Dictionary-Health-Information-Technology-Security/dp/0826149952/ref=sr_1_5?ie=UTF8&s=books&qid=1254413315&sr=1-5

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PODCAST: Reference Based Pricing for Medical Facility Fees

By Eric Bricker MD

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CITE: https://www.r2library.com/Resource/Title/082610254

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HOSPITALS: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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