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

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

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

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

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

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

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Uninsurance Rates and Coverage Gains for 2017

Racial Disparities in 2017

By http://www.MCOL.com

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Book of Month

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 Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Percentage of US Adults Without Health Insurance

UPDATE: Circa 2008- 2018

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Conclusion

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements.

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IS HEALTHCARE [REALLY] DIFFERENT -OR- NOT?

A Particle Physics Analogy

By Dr. David Edward Marcinko MBA

http://www.CertifiedMedicalPlanner.org

Some folks, here and elsewhere, often opine that banking is more progressive than healthcare. And, by inference many, if not most, other industries may be included as well.

Unfortunately, this is a ridiculous reality.

WHY: Sorry – Like Heisenberg – You can’t have it both ways.

Health insurance is becoming less like real, pro-active insurance and more like a taxpayer “pay-as-you-go” system. Hence, the two current societal opinions:

HI AS A RIGHT: On the one hand, we opine that you can’t buy car or home owners insurance after the accident or fire. But, you can buy Obamacare after the cancer diagnosis. Not insurance at all; but a right.

HI AS A PRIVILEGE: On the other hand, others opine that HI is for the privileged few.

Now, here is my third option:

HI AS A RESPONSIBILITY: Well, I suggest HI is a responsibility. We do need catastrophic insurance but not for routine health maintenance. The better we are at pro-active responsibility – the less expensive HI should be, with patient skin-in-the-game. And, I have written about Health Savings Accounts [HSAs] before, here and elsewhere.

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Assessment

So, decide which and proceed accordingly. But, just like the Werner Heisenberg Uncertainty Principle; it can’t be both.

NOTE: In quantum mechanics, the Heisenberg uncertainty principle is any of a variety of mathematical inequalities asserting a fundamental limit to the precision with which certain pairs of physical properties of a particle, known as complementary variables, such as position x and momentum p, can be known simultaneously.

IOW: I can tell you where you are -OR- how fast you are going; but not both.

Conclusion

Your thoughts are appreciated. http://www.BusinessofMedicalPractice.com

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Racial Disparities in UnInsured Rates

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On Health Insurance [PP- ACA]

By http://www.MCOL.com

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graphoid111616

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™8Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Comparing “Best-in-Class” Blue Cross Blue Shield Plans Against Their Peers

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Plan Management Navigator

thoughtSherlock

By Douglas B. Sherlock CFA

sherlock@sherlockco.com

This issue of Plan Management Navigator contains a summary of our analysis comparing “Best-in-Class” Blue Cross Blue Shield Plans and the other Plans that we refer to as “Peer” Plans.

Best-in-Class Plans operated with costs, excluding Sales and Marketing and Medical Management that were 32% lower than their Peers.

Low Staffing Ratios was the primary driver in the Best-in-Class cost advantage, while Staffing Costs per FTE and Non-Labor Costs per FTE were also lower.

The functional area of Information Systems was key in superior Best-in-Class performance. Economies of scale played no role in the ranking.

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Invitation to Participate in the 2016 Sherlock Benchmarking Study

Our highly valid, well-populated Benchmarks provide an unbiased ranking and helps prioritize activities that will have the greatest impact on improving your health plan’s overall operating performance.

The overwhelming proportion of health plans participating last year are participating this year, and we have added several plans. Please follow this link to see what last year’s participation looked like.

We will meet to finalize the content of the survey in February, distribute the survey forms in March, collect the completed surveys in May and publish beginning in late June or early July. Participation entails efforts on your part since useful outputs require relatively granular inputs. The cost is relatively modest.

Because of the calendar, if you are considering participation, please contact me as soon as convenient. We can answer questions and help get the paperwork out of the way.

Assessment

Thank you again for your continuing interest in the Sherlock Benchmarks. Please visit this link to find the January 2016 Plan Management Navigator.

Conclusion

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OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

HEALTH INSURANCE, MANAGED CARE, ECONOMICS, FINANCE AND HEALTH INFORMATION TECHNOLOGY COMPANION DICTIONARY SET

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Health Insurance Costs [circa 2016]

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The most devious tax increases in modern history? 

Rick Kahler MS CFP

By Rick Kahler MS CFP®

http://www.KahlerFinancuial.com  

A few months ago I scoffed when my wife told me about a report from CNN that the average individual, unsubsidized health insurance premium was going up over 60%.

After receiving my 2016 premium notice from Wellmark Blue Cross and Blue Shield, I’m no longer scoffing. My monthly premium for family coverage went from $1,400 to $2,140, an increase of $740, or 53%. According to healthcare.gov, the average Wellmark increase in South Dakota is 43%.

I immediately started looking for ways to decrease my premiums. This has become an annual ritual ever since Obamacare was pushed through Congress in 2010. Back then, my family health insurance policy (now considered a Platinum plan) had a low deductible with a maximum out-of-pocket of $3,500 and cost $660 a month.

Despite the President’s promise that “If you like your plan you can keep your plan,” I can’t even purchase that same plan today. If I could, I estimate it would cost over $3,500 a month. In order to keep health insurance affordable, each year I’ve reduced my coverage, increased my deductibles, and paid a higher premium than the year before.

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kidney

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I set out to analyze my options for 2016. After spending six hours crunching numbers and pouring over online calculators, I admitted defeat. There is no simple way to analyze plans to determine whether, based on your personal health care expenditures, you are better served to go with a copay or a deductible plan, a Bronze or a Silver plan, or if a Health Savings Account is preferable to a plan with coinsurance. All the online calculators I found were limited in scope and woefully generic. My health insurance agent didn’t know of any better ones, either.

Adding to my angst, while Wellmark makes policyholders’ year-to-date healthcare expenses available on its website, it doesn’t provide any breakdown of costs. You must figure out for yourself how many drug or doctor co-pays you had, the average cost of a copay visit, the average total costs of those visits, and any other information you need for any type of analysis.

This task was daunting for me, a financial planner and numbers guy. How are average consumers supposed to navigate it? The need for this information is so obvious, one wonders what the insurance companies are hiding by not providing it.

Ultimately, I selected a Bronze plan with no copays and an out-of-pocket cap of $11,900 on in-network providers and $18,500 on out-of-network providers. Based on my family’s average health care costs for the last three years, my out-of-pocket spending for premiums, covered drugs, and approved in-network medical providers will be $2,612 per month, or $31,344, in 2016. It was $11,420 in 2010. That’s an increase of 273%, or 18.3% a year.

By comparison, during the same time period medical costs only increased 16.0%, or 2.7% a year. The increase in premiums is clearly not about increasing health costs.

The $1,660 extra per month I had available to spend on consumer goods and services in 2010 is now going to insurance companies to subsidize the health care of others. This is a clear-cut example of a massive transfer of wealth.

Based on my family’s needs, if I earned $97,000 a year I would qualify for a subsidy of $912 a month. But since I earn over $98,000, I pay the full premium.

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incontinence

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Assessment

Clearly, the only people who find the Affordable Care Act affordable are those who receive a subsidy or who have preexisting conditions. For them, Obamacare was a godsend. For the rest of us, it turned out to be one of the most devious tax increases in modern history. 

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Health Plan Premium Increases for 2016

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Projections for 2016

By http://www.MCOL.com

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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dollar-1029742_640

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

 ***

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™   Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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ME-P Health Economics, Financial Planning & Investing, Medical Practice, Risk Management and Insurance Textbooksfor Doctors and Advisors

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  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Product Details

http://www.BusinessofMedicalPractice.com

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Dr. David Edward Marcinko, editor-in-chief, is a next-generation apostle of Nobel Laureate Kenneth Joseph Arrow, PhD, as a health-care economist, insurance advisor, financial advisor, risk manager, and board-certified surgeon from Temple University in Philadelphia. In the past, he edited eight practice-management books, three medical textbooks and manuals in four languages, five financial planning yearbooks, dozens of interactive CD-ROMs, and three comprehensive health-care administration dictionaries. Internationally recognized for his clinical work, he is a distinguished visiting professor of surgery and a recipient of an honorary Bachelor of Medicine–Bachelor of Surgery (MBBS) degree from Marien Hospital in Aachen, Germany. He provides litigation support and expert witness testimony in state and federal court, with medical publications archived in the Library of Congress and the Library of Medicine at the National Institutes of Health.

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A primer to tonight’s GOP debate

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Health Entitlements & the Deficit

By Nancy Chockley PhD

NIHCM.org

Congress is poised to pass a budget plan that will raise funding levels for the next two years. While these changes are paid for, the plan does not include structural changes to the health entitlement programs that are a leading driver of our budget deficits and mounting debt.

The GOP presidential candidates are likely to discuss a variety of proposals for structural reforms to these programs during tonight’s debate.

As a primer to this important conversation, this chart story presents essential facts about spending for Medicare, Medicaid and the Affordable Care Act and the impact of these programs on the deficit.

http://www.nihcm.org/health-entitlement-spending-a-growing-threat#one

business-valuation1

See the rest of the story

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[HEALTH INSURANCE, MANAGED CARE, ECONOMICS, FINANCE AND HEALTH INFORMATION TECHNOLOGY COMPANION DICTIONARY SET]

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[Mike Stahl PhD MBA] *** [Foreword Dr.Mata MD CIS] *** [Dr. Getzen PhD]

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It’s open enrollment season for health insurance – Now What!

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How do I compare my health insurance options during open enrollment?

Daniel J. Antokal MBA
[Financial Advisor]

daniel

The decisions you make during open enrollment season regarding health insurance are especially important, since you generally must stick with the options you choose until the next open enrollment season, unless you experience a “qualifying” event such as marriage or the birth of a child. As a result, you should take the time to carefully review the types of plans offered by your employer and consider all the costs associated with each plan.

With most health insurance plans, your employer will pay a portion of the premium and require you to pay the remainder through payroll deductions. When comparing different plans, keep in mind that even though a plan with a lower premium may seem like the most attractive option, it could have higher potential out-of-pocket costs.

You’ll want to review the copayments, deductibles, and coinsurance associated with each plan. This is an important step because these costs can greatly affect what you end up paying out-of-pocket.

When reviewing the costs of each plan, consider the following:

  • Does the plan have an individual or family deductible? If so, what is the amount that will have to be satisfied before your insurance coverage kicks in?
  • Are there copayments? If so what amounts are charged for doctor visits, specialists, hospital visits, and prescription drugs?
  • Will you have to pay any coinsurance once you’ve satisfied the deductible?

Specific features

You should also assess each plan’s coverage and specific features. For example, are there coverage exclusions or limitations that apply? Which expenses are fully or partially covered? Do you have the option to go to doctors who are outside your plan’s provider network? Does the plan offer additional types of coverage for vision, dental, or prescription drugs?

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healthcare

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Assessment

In the end, when reviewing your options, you’ll want to balance the coverage and features offered under each plan against the plan’s overall cost to determine which plan offers you the best value for your money. 

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

***

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

***

Mid-Year 2015 Un-Insured Rates

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Health Insurance by US State

By http://www.MCOL.com

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Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

[HOSPITAL OPERATIONS, ORGANIZATIONAL BEHAVIOR AND FINANCIAL MANAGEMENT COMPANION TEXTBOOK SET]

Product DetailsProduct Details

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On Getting Health Insurance [A Personal Journey]

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A Former Teacher Engages Reality

[By Jeffrey M. Hartman]                   

jhIn late 2014, I did something many teachers never have to consider doing. I sought my own health insurance. After leaving my teaching career, I opted to work for myself. My plan was to live off my savings while getting started. This meant I was going to have to buy insurance rather than rely on a school to provide it. The misadventure that unfolded provided unsurprising but unsettling insights.

Bubble-Boy

I lived in a bubble during my teaching career. The comforts my job afforded me affected my perspective. How did people in other fields work so late each day? Why did anyone agree to work during the summer? I had a salary that kept me more than comfortable and health insurance that most people would have envied. Although I frequently reminded myself how fortunate I was, I still took too much of my situation for granted. When I decided to up and leave, reality poured into my bubble.

Great Coverage

Health insurance had never concerned me. Working in schools my entire adult life, I didn’t fret over having coverage. It was a given; an amount taken out of each check. If anything, I felt guilty for having such great coverage. I rarely used it. I happened to be a healthy person and I infrequently visited my doctor. Being so cavalier about my coverage while other people suffered without it made me feel like some kind of heel. My wife used it occasionally, so it wasn’t completely wasted.

A Career Abandoned

By abandoning my career, I forced myself to face a sudden and real need for coverage. I’ll admit resenting the need to have something I wasn’t likely to use, but I accepted the situation and proceeded. I had left other teaching jobs. After each departure, I replaced the job quickly, moving to a better job each time. This was another example of my chosen field distorting reality. Not many people enjoy that kind of mobility. Benefits had come along with each new job. With no intention of taking a new job last fall and no immediate income from working for myself, I was on deck to try HealthCare.gov.

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Healthcare Gov Search

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Enter HealthCare.gov

Prior to any of this, most of my experience in dealing with health insurance involved my mother. I helped her get Supplemental Security Income and Medical Assistance. The process was arduous, but after an appeal, she got what she needed. More recently, I assisted my grandmother in connecting with a home health care aide through her insurance. This was tricky as well, but perseverance paid off. Having to deal with these systems gave me a notion of what to expect when navigating a massive health insurance bureaucracy.

Experienced as I was, working through HealthCare.gov tested my patience. The site achieved infamy in early 2014 following its beleaguered launch. I expected the site administrators to have fixed most of the bugs for the second year. Perhaps they had. What I found was convoluted, nonetheless. I managed, but not without incident.

Registration

The first hiccup came during registration. I followed the directions on the screen and provided the requested information, but the site couldn’t verify my identification. I’d never had a problem like this registering for anything else. It prompted me to upload registration documents, but I found no way to do this. I called customer service and a helpful but disaffected person verified my identification simply by asking for my address and Social Security number.

I completed the application and was eager to see my results. Before I registered, I had investigated what coverage might be available. I expected to be eligible for one of several seemingly suitable plans. Upon seeing my results, I was shocked to find my wife and I only qualified for Medicaid. Nothing else was available. I knew Medicaid had a resource limit in my state. I also knew my savings were approximately thirty times that limit. The site never asked about resources. It only asked for income, which was zero at the time. My wife’s income didn’t put us over the Medicaid income limit, but this was irrelevant.

I realized my situation was an anomaly. Most people don’t go from my former income to nothing by choice while not having any solid replacement. At the time, I was paying a high premium for continuing coverage from my former employer. I was determined to get something less costly through the Marketplace for the start of 2015. My state was going to deny me Medicaid. I had to appeal.

Non-Appeals

I couldn’t find a way to appeal online, at least not in my state. I had to mail the completed appeal form. After several weeks, I got no response. The deadline approached for having coverage by the first of the year. I called customer service. The representative told me I’d have to apply for Medicaid and get rejected before appealing. This was going to take too long. I called my state Department of Health and Welfare. A representative confirmed I’d be denied. He urged me to call HealthCare.gov again and simply state I’d been denied instead of going through the process. I did. I handled the appeal over the phone. An hour later, I had new insurance. I had even paid my first premium, which definitely stung.

Over the next month, HealthCare.gov sent me three letters and called me twice to remind me my identification had yet to be verified and my appeal had been denied. I politely informed them I had handled each issue. No one I spoke with could tell that I had, nor could they tell I’d selected and paid for coverage, even though I had.

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New Coverage

Dealing with the new coverage was almost comical. I’d selected the same provider I had while teaching, but a different plan. My wife and I selected the same physicians we had seen for years. Despite our history with each, making appointments or filling prescriptions required us to provide detailed proof of our existence and needs through phone calls, faxes, and emails. This was necessary for the first several interactions. Inquiries and referrals were much more tedious than what we had known. Over four months, the provider sent us a total of ten new insurance cards. All the inefficiency with both systems prompted some reflection.

One could expect such confusion within large systems. However, I’ve thought of what difficulty others users might face. I’d like to think I’m relatively literate, tech-savvy, and patient. I have family members who would have been stumped after the first few screens of the on-line HealthCare.gov site. The parents of some of the students I taught would have had similar difficulty. People in such situations might have the greatest need for coverage. The complicated and buggy nature of Healthcare.gov requires a small army of customer service operators to help befuddled applicants through problems. I shiver thinking about the resources spent maintaining this backup system in lieu of having a more functional interface, but I guess this creates jobs. Similarly, my actual provider requires a maddening degree of redundancy that might strain the coping skills of needy clients. I wonder how many people just give up when pursing complicated but necessary claims.

Assessment

Perhaps by 2016 HealthCare.gov will be streamlined and smart enough to not confound its users. My provider might be as streamlined and smart as it’s going to get. I’ve rarely seen such bloated systems. Maybe I’ve been ignorant to what other people endure. Having outstanding coverage handed to me while teaching and being healthy my whole life kept me out of touch. My new experiences were mild inconveniences, but I fear how similar complications could stifle those really needing help. I suppose I’ve emerged from my bubble.

More:

ABOUT

Jeffrey M. Hartman is a former teacher who blogs at http://jeffreymhartman.com/

Conclusion

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Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

Update on US Health Insurance Coverage

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Census Bureau 2013 Data

By http://www.MCOL.com

kkkkkkkk

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State Uninsured Patient Rate Reductions

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Five State with Highest Percentage Change for 2013-14

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uninsured

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Appreciating the Highest Rates of Uninsured or Underinsured‏ Americans

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For the Five States with the Highest Percent of People Under Age 65

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Uninsured

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Enrollment, Coverage and the PP-ACA

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For Medicaid

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Assessment

1. Aetna CEO: Only 11% Of ObamaCare Signups Have Been Uninsured 
2. The Individual Mandate for Health Insurance in the U.S.
3. Survey of Americans’ Preparations for Health Care in Retirement
4. Medi-Cal at a Crossroads: What Enrollees Say About the Program 
5. The Affordable Care Act: The Exchanges Go Live

Conclusion

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INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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My Experience with ObamaCare

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Not a Unique Story – to Date

Rick Kahler CFPBy Rick Kahler CFP® http://www.KahlerFinancial.com

Like millions of Americans, I jumped on Healthcare.gov on October 1 to view the long-anticipated plans on the insurance exchanges mandated by the Affordable Healthcare Act, known as Obamacare. I needed a new healthcare plan and purposely held off buying one in September to compare the coverage and prices of an Exchange plan.

My disappointment paralleled that of thousands of other Americans wanting to do the same. After six tries that day, I gave up. I tried the site multiple times for each of the next six days. No luck.

The Short Form

Finally, on the seventh day, the site actually let me start an application. I chose to go with the “short” form since I was certain I would not qualify for a subsidy.

The short form application took 30 minutes to fill out. There were very few questions about health, just whether anyone in the household smoked. A number of questions had me wondering if I was applying for a passport. These included my Social Security number, race, citizenship, relationships to everyone in the family, and whether I was ever incarcerated.

When I reached the end of the form, I hit “submit,” anticipating that plan options and costs would appear. Instead, I was sent back to the starting page of the form. After 60 minutes of trying to get out of this endless loop, I gave up.

Three More Weeks of Trying

For the next three weeks, I went to the site at least once a day. I was never able to get past the endless loop to view plans or prices. I took a two-week break.

On November 14, I tried again. Success! Well, sort of. No endless loop. Instead, the site said it lost my original application and I needed to complete a new one. After another 60 minutes filling out the application, I ended up stuck in a loop again, unable to view plans or prices, much less choose one.

Giving Up

Frustrated, I decided to give it a rest until the site re-launched on December 1. I figured I would still have plenty of time to meet the December 15 deadline for enrollment.

On December 1, I eagerly popped onto the site. Not only was the site not functional, it had lost my application for the third time.

I gave up.

Enter the Insurance Broker

I phoned my insurance broker. She was able to give me all the information I had tried to get out of healthcare.gov for the past 60 days. She also said my insurance company was canceling my current plan. Obamacare deemed the coverage substandard because it did not cover pregnancy, mental health costs, and pediatric dental and vision costs. Although I don’t want or need any of that coverage, Obamacare gives me no choice.

Prices

My old policy cost $1,192 a month. The new one costs $1,506, which includes $59 a month in mandated surcharges on non-exchange policies to help fund Obamacare. My maximum family out-of-pocket expenses must also increase $208 a month. The total potential increase is a staggering $524 a month.

###

Obama Care

###

A Skeptic

As someone who listened with great skepticism as politician after politician promised that Obamacare would lower health care costs, lower our deficit, and guarantee we could keep any existing plan, I feel sadly vindicated. In March 2010, when Congress passed Obamacare, I paid $660 a month for health care that had better coverage than I have now. For that same coverage today, my premium would be $2,450 a month.

Assessment

Unfortunately, my story is not unique. It is ubiquitous to the average American who has health insurance. Our elected officials and government agencies failed us miserably. So far, there appears to be no relief in sight.

More

Conclusion

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ME-P Picks [Public Viewpoints on Health Reform and Policy]

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By Staff Reporters and related sources

By http://www.MCOL.com

 Delolitte Employer Poll Gives Grades From 500 employers Regearding Healthcare Reform

  1. 33%  would give a grade of an A or B
  2. 38% say a C is an appropriate letter grade
  3. 29% believe a D or F would be more appropriate
  4. 22% of employers say the ACA will reduce costs by the year 2019
  5. 19% said it will improve quality of care by the year 2019
  6. 50% of respondents said it will widen access to health insurance.

Source: Deloitte

Some more new Lists:

Health Insurance

Assessment

Visit: www.CertifiedMedicalPlanner.org

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Should HHS Secretary Kathleen Sebelius be Replaced?

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A Voting and Opinion Poll

[By Ann Miller RN MHA]

We are all aware that critics are calling for the head of Kathleen Sebelius after the clumsy online rollout of the PP-ACA.

And so, we ask:

Assessment

After you vote; please leave a cogent opinion, too.

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Percentages of Patients Experiencing Cost-Related Healthcare Access Problems

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An Infographic by Country

By www.MCOL.com

dem

Assessment

Now, compare this to healthcare access difficulties in the USA.

Conclusion

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

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Artistic Occupations without Health Insurance

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Health Insurance Cost Update

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BLOG: www.MedicalExecutivePost.com

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Top 12 Articles [Health Administration Reading List]

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By Staff Reporters via Austin Frakt PhD

On Health Economics, Finance and Insurance, Quality Care and Organizational Behavior

1. Substantial Health And Economic Returns From Delayed Aging May Warrant A New Focus For Medical Research

By Dana Goldman and others (Health Affairs)

2. Trends Underlying Employer Sponsored Health Insurance Growth For Americans Younger Than Age Sixty-Five

By Carolina-Nicole Herrera and others (Health Affairs)

3. Accountable Care Organization Formation Is Associated With Integrated Systems But Not High Medical Spending

By David Auerbach, Hangsheng Liu, Peter Hussey, Christopher Lau, and Ateev Mehrotra (Health Affairs)

4. The Quality Of Care Delivered To Patients Within The Same Hospital Varies By Insurance Type

By Christine S. Spencer, Darrell J. Gaskin, and Eric T. Roberts  (Health Affairs)

5. Understanding State Variation In Health Insurance Dynamics Can Help Tailor Enrollment Strategies For ACA Expansion

By John Graves and Katherine Swartz (Health Affairs)

6. When Medicare Cuts Hospital Prices, Seniors Use Less Inpatient Care

By Chapin White and Tracy Yee (Health Affairs)

7. More Americans Living Longer With Cardiovascular Disease Will Increase Costs While Lowering Quality Of Life

By Ankur Pandya, Thomas Gaziano, Milton Weinstein, and David Cutler (Health Affairs)

8. Surgical Skill and Complication Rates after Bariatric Surgery

By John Birkmeyer and others (New England Journal of Medicine)

Reading list

9. Who Is in Control? The Determinants of Patient Adherence with Medication Therapy

By Sergei Koulayev, Niels Skipper and Emilia Simeonova (National Bureau of Economic Research)

10. Fifty Years of Family Planning: New Evidence on the Long-Run Effects of Increasing Access to Contraception

By Martha Bailey (National Bureau of Economic Research)

11. Identifying the Health Production Function: The Case of Hospitals

By John Romley and Neeraj Sood (National Bureau of Economic Research)

12. ACA Standoff

By Jeffrey Drazen and Gregory Curfman (New England Journal of Medicine)

Assessment

Feel free to send us links to your own hot topic reading list so that we may share.

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Marketplace HIE Enrollment Update

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In Selected States

[By www.MCOL.com]

###

enrollment

###

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

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Purchase ME-P Textbooks, Handbooks and Dictionaries to Thrive

 Our Library is Growing … thanks to you

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[ME-P Executive-Director]

We have been publishing the Medical Executive-Post for more than eight years now. And, with almost 3,000 formal posts, by the nation’s brightest experts, we have a treasure trove of information available to you.

So now, for the first time, all this information – and more – has been codified, updated, copy-righted and copy-protected in print form for your purchase and use. All have been edited by our Publisher – Dr. David Edward Marcinko and Professor Hope Rachel Hetico.

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Assessment

Purchase our white papers, too: https://medicalexecutivepost.com/white-papers/

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Business%20Optimization

How to Handle Incurred But Not Reported Health Insurance Claims [Webinar]

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Event Information
[Live Audio Conference – Webinar]
Dr. David E. Marcinko MBA
Presenter: Dr. David Edward Marcinko; MBA CMP™
###
Conference Date: Tue, Apr 02, 2013
Aired Time: 1 pm ET | 12 pm CT | 11 am MT | 10 am PT
Length: 60 Minutes
Product Description
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Here’s How to Augment Bottom-Line Revenues by Understanding IBNR Healthcare Claims

One of most relevant financial issues of the PP-ACA and contemporary healthcare and medical reimbursement is known as Incurred But Not Reported (IBNR) healthcare claims. IBNR claims are an indirect result of prospective payments systems, the insurance industry and commercial risk contracts, and to some extent fee-for-service medicine. IBNR claims represent a risk and an opportunity for managed care companies, healthcare organizations, clinics, physicians and related medical providers alike.

Join this enlightening event presented by expert speaker Dr. David Edward Marcinko MBA CMP™ who will provide you detailed insights on IBNR claims so that you do not face any compliance risk and optimize your organization’s bottom line.

Here is a brief sample of some details you may learn:

  • Historical Review
  • What Is an IBNR Claim?
  • IBNR Problems for Healthcare Organizations
  • IBNR Claims — Management Volume and Consequences
  • Inadequate Cash Flows
  • Reserve Shortfalls and Fiscal Instability
  • Inaccurate Pricing
  • Administrative Cost Increases
  • Regulatory Sanctions
  • Managed Care Organization Exacerbation of IBNR Claims
  • IBNR from a Net Present Value Perspective
  • Tax Strategies for IBNRs
  1. IRS Rules and Regulations
  2. IBNR Tax Qualifications for Managed Care Organizations
  3. How Managed Care Organizations Intensify IBNRs
  4. How Does IBNR Affect Net Present Value?
  • IBNR Challenges and Solutions

1. Tax and Court Penalties

  • IRC Section 4958
  • Excess Benefit Definition
  • Taxes under Section 4958

2.  Tax Deductibility

  • Potential Solutions to the IBNR Challenge
  • IBNR Calculations and Methodology
  1. Actuarial Data Analysis
  2. Open Referral Analysis
  3. Historic Cost Analysis

Ask a question at the Q&A session following the live event and get advice unique to your situation, directly from our expert speaker.

Who should attend? All charge-master coordinators, coding personnel, billing and claims transaction personnel, internal auditing personnel; and financial and compliance personnel! And, all administrators, accountants, comptrollers, office managers, billing clerks and physician-executives, CFOs, CXOs and other interested parties.

IBNRs

###

http://www.audioeducator.com/medical-coding-billing/ibnr_problems-040213.html

ORDER HERE FOR WEBINAR

Understanding the “Language” of Healthcare Finance, IT, Economics and Insurance

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By Ann Miller RN MHA

The ME-P is Doing Its’ Part with Comprehensive Dictionaries and Glossaries

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Books for Savvy Doctors and their Financial Advisors and Management Consultants

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Assessment

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The Monetary Value of Human Life

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How Much are We Worth?
By Matthew Pelletier
[Director of Public Relations]
Compliance and Safety LLC

###

Monetary-Value-of-a-Human-Life
 Assessment

• Japan places the highest value on a human life, spending $11,728,000 to save a single life through improvements in public safety.
• South Korea spent the least, at a measly $878,000.00 per life saved.
• Health insurance companies value life at $50,000 per year of quality life, a depressingly low number compared to what government entities will pay. Keep your workforce healthy with proper Health & Wellness training.
• The families of suicide bombers receive just $25,000 per suicide.
• While the families that lossed a loved one on 9/11 received an average of $2.1 million per death, families of fallen soldiers receive a maximum of just $400,000. Rush Limbaugh did an interesting piece about this huge disparity back in 2002.

Conclusion

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

  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™ Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Taxes and the SCOTUS ACA Decision

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My Synopsis for Physician Investors

By Dr. David Edward Marcinko FACFAS MBA CMP™

www.CertifiedMedicalPlanner.org

[Publisher-in-Chief]

I was at Emory University this past weekend for an unrelated colloquium. But all the chatter, of course, was about SCOTUS, taxes and the just announced ACA decision.

Most doctors I know – just don’t like paying needless taxes. So, what’s the buzz for physicians and other medical professional investors, and their financial advisors [FAs]?

The Synopsis

The taxes to pay for the Affordable Care Act include a new tax on medical devices that will increase costs to individuals and healthcare providers.

There also is a new 3.8% Medicare tax. It applies in 2013 to income and capital gains.

If the expected post-election tax bill extends the current 15% capital gain rate, then the capital gains tax rate will be 18.8% in 2013. However, if the 15% federal capital gains tax rate is increased to 20%, then the new rate in January of 2013 will be 23.8%.

In addition to dividend seeking investors, the increase in capital gains rate may also influence charitable gifts of appreciated property in 2013.

Assessment

Please weigh-in all you FAs and healthcare focused CPAs. What is a physician investor supposed to do, now?

Conclusion

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Community Rating and Guaranteed Issue in the Individual Health Insurance Market

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Expert Voices

[By Staff Reporters]

In this essay Dr. Anthony Lo Sasso provides empirical evidence of the adverse selection that resulted when states adopted community rating and guaranteed issue requirements in their individual health insurance markets but did not implement complementary mechanisms to keep lower risk individuals in the insurance risk pools.

Results of Adverse Selection

Such adverse selection can raise premiums, destabilize markets and even lead to market failure through the following cycle of events:

  • Community rating prohibits differential premiums based on health status, effectively lowering premiums for individuals in poorer health and increasing them for healthier individuals.
  • Guaranteed issue allows people to purchase coverage when they get sick, decreasing the need to maintain insurance coverage.
  • Healthy individuals respond by dropping coverage and entering the market only when they need coverage, thus the pool of enrollees becomes increasingly older and sicker.
  • This adverse selection pushes premiums for all remaining enrollees higher, provoking further departures by those at the healthier end of the spectrum.
  • Premiums increase again to reflect the ever-worsening risk pool of enrollees.
  • The cycles continue, further destabilizing the market and potentially leading to complete market collapse.

Assessment

Dr. Lo Sasso’s findings highlight the importance of providing effective mechanisms to protect the integrity of the risk pool in conjunction with the community rating and guaranteed issue provisions contained in the SCOTUS upheld Patient Protection and Affordable Care Act.

Link: EV-LoSassoFINAL

Conclusion

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Anatomy of Health Insurance

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An Overview

Health insurance is a hotly debated topic in this year’s presidential elections. Obama-care has some doctors and citizens fuming over the possibility of universal healthcare. But, before preaching, one should get a full grasp of what health insurance entails for a typical buyer.

This infographic gives an overview of how the health insurance industry works. One thing for sure, the health insurance industry is a booming business, as the typical 22-year old will pay $400,000 for health care and insurance in his or her lifetime.

Assessment

So study up with our handbooks, textbooks, dictionaries and this ME-P so you can responsibly select an insurance plan that is right for you.

Conclusion

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The Best, Most Revealing Reporting on Our Healthcare System

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Reading and Reviewing

By Blair Hickman and Cora Currier

ProPublica,  March 30, 2012, 1:44 pm

As we wait for the Supreme Court to issue its verdict on the health-care reform law  we rounded up some of the most revealing reporting on the issues.

They’re grouped roughly into articles on high costs and those on insurance.

Assesment

Link: http://www.propublica.org/article/top-muckreads-the-best-most-revealing-reporting-on-our-healthcare-system

Conclusion

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

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

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

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

Physician Advisors: www.CertifiedMedicalPlanner.org

Hospitals & Healthcare Organizations: Management Strategies, Operational Techniques, Tools, Templates and Case Studies

Hospitals & Healthcare Organizations: Management Strategies, Operational Techniques, Tools, Templates and Case Studies

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Celebrating Our One/Third Millionth ME-P Reader

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Join the ME-P Celebration

By Ann Miller RN MHA

By Hope Hetico RN MHA

[ME-P Management and Staff]

Oh – good morning doctors, financial advisors, nurse-executives, HIT experts, healthcare CXOs and all medical management consultants, readers, subscribers, visitors and devotees of the Medical Executive-Post professional ecosystem.

We are reporting this “breaking-news” ME-P event live from an Institute of Medical Business Advisors, Inc. corporate retreat in seclusion up North.

The Breaking News!

We just wanted you to know that the Medical Executive-Post just served up content to its one / third millionth reader sometime this weekend, according to iMBA Inc statistics: www.MedicalBusinessAdvisors.com

It seems our text books, white papers and hand books are best sellers, too! And, our growing online education and certification program for financial advisors, CPAs, management consultants and medical professionals is gaining in popularity and stature, as well www.CertifiedMedicalPlanner.com

Thank you!

Celebrate Appropriately!

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The ACA and Rising Healthcare Costs?

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Effects of Affordable Care Act on Private Health Care Costs Remain to be Seen
[By Staff Reporters]
###
The latest data on economic growth shows the American economy spent the last quarter growing at a rate equal to 2.5 percent a year. That’s neither recession-level bad nor full employment recovery-level good, but it’s worth diving into the numbers to see exactly what’s driving this slow expansion.
###
A significant part of the growth came from personal spending on health care as insurance premiums continue to rise, meaning a lot of that growth wasn’t very productive. That health care costs are rising—and rising faster than most other expenses—is a problem that businesses and policymakers have struggled with for years: It’s the major cause of federal budget deficits and the reason behind the health care law passed in 2010. While the effects of the Affordable Care Act on private health care costs remain to be seen—many of its provisions will not go into affect for another two years—health care economists like Harvard’s David Cutler say it draws on nearly every idea that exists to lower costs.
###
But, Cutler adds that while we wait for pilot programs to succeed and scale or fail, more changes to the system—including a public insurance option and further incentives for health providers to reform delivery—should be on the table.While policymakers in Washington and state capitals wait on politics and legal challenges to the 2010 law, consumers can take action themselves to lower costs. Innovative health care companies are coming up with new ways to make cost savings easier to find.

infographic, healthcare, politics, business, cost, transparency, GOOD

Source: Simplee

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

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Do Doctors have an Obligation to Bill their Patients for Co-Payments?

Ask an Advisor – Query

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I have read about pro-bono care on the ME-P. But, as doctors, are we required to bill our patients their co-pay amount by law, or can it be written off at our discretion? In other words, if we decide not to bill them, will we be penalized by Medicare.

Conclusion

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Healthcare Organizations: www.HealthcareFinancials.com

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On Health Insurance in America

Just how bad is it –  economically?

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QUESTION: How bad is the health insurance problem in America?

ANSWER: 4% of Americans are uninsured with many more under-insured, 75% of all bankruptcies are from the result of medical bills and 60% of insured individuals are in debt from health related expenses.

The cost of healthcare is no longer affordable to many middle class families, even with health insurance, so some would say it is pretty bad.

But, are these figures correct?

Assessment

Brought to you by: lowcosthealthinsurance.com

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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A Nutrition Label for Health Insurance Plans?

Appreciating “Search Frictions”

By Dr. David Edward Marcinko MBA CMP™

[Editor-in-Chief]

Because products vary so much across many characteristics, health insurance is not easy to shop for. Comparing plans is an apples-to-oranges problem.

Of Search Frictions and Economic Externalities

As a former insurance agent for more than a decade, this is a situation by design – to obfuscate the patient and consumer.  

The challenges of comparison – health insurance plan – shopping then, creates what economist and colleague Austin Frakt PhD calls “search frictions” or inefficiencies in the ability to wisely choose. This may be likened to economic “externalities” and perhaps even motivated the recent development of (draft) standards for health plan labeling.

Beginning March 2012

So, how much will the new health plan labels, required starting next March, help consumers in their search for plans? How much grease will they add to the otherwise highly frictional process? I sure don’t know.

A good place to start however, is an examination of those frictions. What are they and how much do they matter?

Link: http://www.healthcare.gov/news/factsheets/labels08172011b.pdf

Assessment

Did food nutrition labeling, and the old food pyramid help – or confuse – consumers? What about the old and new cigarette warning label warnings? Or – the prohibition of alcohol for pregnant women – helpful or not! Any labeling for that matter?

Conclusion

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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America’s One-Stop Shop for Healthcare [HIEs]

Health Insurance Exchanges [HIEs]

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Brought to you by ACS a Xerox Company

For some Americans, selecting a health insurance plan will soon feel a bit like shopping. As part of healthcare reform, each state is required to have a Health Insurance Exchange (HIE or HIX) in operation by Jan. 1, 2014.

Given the complexity of the topic, we’ve created the attached infographic that visually represents the process Americans will experience when participating. If you’re planning to write about HIXs in the near future – we hope you’ll consider using this graphic to help explain the process to your readers.

Here is additional information on HIXs to support the infographic:

  • Q:  How will states develop a HIX? A: States can either build their own HIX structure or buy a platform from the federal government.
  • Q:  Who can participate in a HIX? A: Only individuals without other coverage, individuals from whom coverage is unaffordable or inadequate, or small employers can participate in the exchange in 2014. Large employers can join the exchange in 2017.
  • Q:  How many people are expected to participate? A: The Exchanges are expected to cover as many as 29 million people by 2019, including five million with employment-based coverage.

Conclusion

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Who Can’t Afford Health Care?

Expensive Even with Insurance

By Thomas Porostock

Health Care, even with insurance can be expensive, but what if you actually can’t afford medical care?

 

Conclusion

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Should Health Insurance Pay for Patient Exercise Programs?

Or – Enough with the “Benefits” Already!

By Dr. David Edward Marcinko MBA, CMP™

[Former Licensed Insurance Agent]

[ME-P Editor-in-Chief]

An editorial just published in the Journal of the American Medical Association says research supports consideration of a wider policy of reimbursing for structured exercise programs, particularly in high-risk groups, such as diabetics.

Link: http://jama.ama-assn.org/content/305/17/1808.full

Present Status

Currently, health-insurance plans don’t treat exercise as medicine; only some plans offer a fitness benefit, usually a partial reimbursement for gym membership.

Link: http://blogs.wsj.com/health/2011/05/04/reader-consult-should-insurance-reimburse-for-exercise-programs/

Yet, the push for this benefit does seem to be growing.

My Opinion

And yes, as a doctor and surgeon who treated diabetic bone and soft tissue infections, ulcers and related necrotic gangrene for two decades, there’s something to this philosophy in-theory. But, this “theory” is not grounded in risk-management principles or economic sense; and it does seem counter-intuitive to most insurance models that I know.

Note: Most adult diabetics are Type II, maturity onset and controllable.

Examples

For example, auto insurance does not pay for routine car maintenance, nor does home owner’s insurance or most other standard insurance policy types.

Question: Why should health insurance be any different?

Answer: Because it is a public good.

Oh, come on now!  Obeying moral codes and legal boundaries is also a public good for civility; but we don’t mitigate the risk of breaking them with insurance policies; do we?

Why? They would be too expensive. Believe me, if insurance companies thought they could make a buck this way, they surely would!

Assessment

Aren’t these types of benefits already in place in some Flexible Spending Accounts, High Deductible Medical [Health] Savings Accounts , and employee cafeteria plans, etc.

Moreover, don’t we all know that we aren’t supposed to smoke, use street drugs, drink excessively, pig-out, or have promiscuous sex? Yet – we still do – like the diabetic who excessively indulges.

If you want to get-or-stay healthy[ier]; exercise more and eat less. A simple – understandable – and free healthcare Rx; but no best selling book, “breaking news” or JAMA report, here.

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Why Your Stitches Cost $1,500 [Part I]

InfoGraphics – Part 1

Courtesy Medical Billing and Coding

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The United State has fallen behind other nations, failing to provide affordable health care to its citizens. Americans spend $477 billion a year MORE on health care than other advanced countries.

So why do we pay so much compared to other wealthy nations?

Part 1 of 2 in a Series

This Infographic is part one in a two part series which dissects the state of our health care system and presents some alarming numbers.

Link: http://www.medicalbillingandcoding.org/medical-costs-1/

Part 2: https://medicalexecutivepost.com/?p=30972&preview=true

Conclusion

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

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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About HealthCareAndYou.org

What it is – How it works?

By Staff Reporters

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At a time when many Americans are confused about the healthcare overhaul law, a coalition of groups representing doctors, nurses, pharmacists and consumers has launched a website to answer questions about the Affordable Care Act.

The new website – HealthCareandYou.org – doesn’t delve into the politics behind the law, but spells out what the law means to consumers, depending on the state they live in and their age. The website also provides a timeline, telling consumers when different parts of the law go into effect.

The Site

According to the site, The Affordable Care Act is a health care law that aims to improve our current health care system by increasing access to health coverage for Americans and introducing new protections for people who have health insurance.

If you have health insurance, you will benefit from steps to stop insurance companies from cancelling your coverage if you get sick. The law will also require insurance plans to cover your out-of-pocket costs for many proven preventive and screening services, such as colonoscopies and mammograms, to catch problems at their earliest, most treatable stages.

Your job might not offer health insurance. Or, maybe you have been denied coverage because of a pre-existing condition such as asthma or cancer. The law now offers health plans for people with pre-existing conditions who have had trouble finding care. And it will increase access to coverage for more Americans in 2014.

The law helps small businesses pay for health insurance for their employees. And it supports programs that will help increase the number of primary care physicians, nurses, physician assistants and other health care professionals.

Assessment

It is important to understand what the law means for you. Check out what changes have already taken place and learn more about what is happening in your state.

Link: http://www.healthcareandyou.org

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

Our Other Print Books and Related Information Sources:

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

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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Update on How Physicians Get Paid in 2010-11 [A slide show]

Part 2: [A Visual .ppt Presentation]

By Dr. David Edward Marcinko; MBA

[Editor-in-Chief]

From prior posts and comments on this ME-P, we know that most patients don’t have a clue about how doctors get paid in the real world of health insurance reimbursement.

A Popular Topic

We know this because prior posts on the topic have consistently been among the most popular on this platform. For example:

Part 1: https://healthcarefinancials.wordpress.com/2008/09/12/how-doctors-get-paid

Assessment

And so, we have taken the liberty of drilling down the topic, to a more granular level, in this attached .ppt presentation.

Link: How Doctors Get Paid in 2010 

Conclusion

And so, your thoughts and comments on this ME-P special presentation are appreciated. Tell us what you think?

Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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

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

Our Other Print Books and Related Information Sources:

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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

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

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

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[Health] Plan Management Navigator

January 2011

By Douglas B. Sherlock, CFA
Senior Health Care Analyst

Dear ME-P Readers and Subscribers,

 Join Our Mailing List 

At the risk of appearing overwhelmed with New Year’s enthusiasm, we think this edition of Plan Management Navigator is especially interesting:

1. We report on the cost decisions made by low cost Blue Cross Blue Shield plans. Low cost plans make decisions that differ from their higher cost peers. Hallmarks of these decisions include levels and distributions of expenses between functions, the levels and distribution of staff between functions, the levels of compensation and its distribution between functions and the distribution between functions, and levels of, non-labor expenses. Overall, low cost Blue Cross Blue Shield Plans have “tactical” administrative expenses that are $5.75 PMPM, or 30%, lower than their higher cost counterparts. These tactical expenses are all administrative expenses excluding medical management and sales and marketing.

Last month we published a similar study of the choices of low cost Independent / Provider-Sponsored Plans. Low cost health plans had tactical costs that were 36% lower than their peers, or by $6.39.

A more detailed version of either of these analyses is available to licensed users of each of our benchmarks. Please call us for further information if you have an interest.

2. We introduce a new service on our website that will enable you to determine how a health plan is doing relative to the 2010 benchmarks. You can select your universe and then determine whether you are high or low and, if so, by how much.

3. We invite you to participate in the 2011 benchmarking study. We are now forming universes. We think that, under pending MLR rules, participation is very timely.

Link: Navigator January 2011

Thank you for your continued interest in our research.

Assessment

sherlock@sherlockco.com
Ph:  215-628-2289
Fax: 215-542-0690

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

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Our Other Print Books and Related Information Sources:

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

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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

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

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

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The ME-P Recommends: Financial Planning and Risk Management Handbooks

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ADVERTISEMENT

A Funny [Poignant] Video about Health Insurance

What Exactly Do Patients Know and Understand?

By Staff Reporters

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This video illustrates the current state-of-the-art regarding patient understanding of health insurance reimbursement and physician income. But, should it be played in all doctors offices’ and waiting rooms?

Title

It is titled: “What the public does not know about doctors and insurance.”

Link: http://www.youtube.com/watch?v=Y00kxCn7m0s

Assessment

The movie was made and uploaded with Xtranormal’s State. To make your own movie just visit: http://xtranormal.com

Source: Dr. Jon Purdy

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

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

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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

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

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

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About the Healthcare Blue Book Consumer Website

Establishing Price Transparency for Medical Goods and Services

By Staff Reporters

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The website Healthcare Blue Book http://www.healthcarebluebook.com is provided free to consumers. The site presents a reported fair price to pay for a healthcare service or medical product when the patient is paying cash at the time of treatment; adjusted for geography and zip codes. It reports to represent a payment amount that many high-quality providers accept from insurance companies as payment in full, and it is usually less than the stated “billed charges” amount.

Comparison Shopping

Unfortunately, it is difficult for consumers to determine fair pricing for healthcare. Prices are not generally published and the list prices (or billed charges) are higher than providers typically charge most of their patients with insurance. The Healthcare Blue Book is a free resource that shows a fair price for healthcare products and services to consumers.

The Consumer Need to Know

Consumers with traditional health insurance frequently need to know how much healthcare services will cost. Average deductibles are increasing and can be $1,000 or higher. Coinsurance rates, which are the percentage of the bill that the consumer must pay, range from 20 to 40%. Many consumers would prefer to use the doctor of their choice, instead of the one selected as “in-network” by their insurance company, as long as they knew they wouldn’t have to pay higher prices.

Assessment

There are also “non-covered services” that may not be covered by insurance. As health insurance companies shift more of the cost to consumers, consumers need to be able to choose healthcare services at fair prices.

Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Give em’ a click http://www.healthcarebluebook.com and tell us what you think? As a physician or medical provider are you intimidated by this site and resulting price transparency? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

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

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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

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

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

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About HealthCareTownHall.com

Informed Healthcare Reform Dialogue

By Staff Reporters

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Milliman is the host of this blog to encourage an informed dialogue about healthcare reform.

Complications

Healthcare is complicated, and there is no single, silver-bullet answer to the question of “How do we best improve the current system?”  

Assessment

But, thoughtful discussions will help move reform in the right direction and mend the fractured system; especially in terms of entitlements, costs and spending, etc.

  Conclusion

And so, your thoughts and comments on this ME-P are appreciated. Visit www.HealthCareTownHall.com and tell us what you think? Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

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

Get our Widget: Get this widget!

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

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

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

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

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