EMPLOYER’S: Pay for Health Insurance Paradox

By Dr. David Edward Marcinko MBA MEd CMP

SPONSOR: http://www.CertifiedMedicalPlanner.org

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Classic Definition: Employers write checks that cover most health insurance premiums for employees and their dependents. But as the late Princeton health economist Uwe Reinhardt PhD once explained, employer-sponsored insurance is like a pickpocket taking money out of your wallet at a bar and buying you a drink. You appreciate the cocktail until you realize you paid for it yourself.

Modern Circumstance: With health coverage, employers write the check to the insurer, but employees bear the cost of the premium — the entire premium, not just the portion listed as their contribution on their pay stub. The premium money that goes to the insurance company is cash that employers would otherwise deposit in employees’ accounts like the rest of their salary.

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

Paradox Example: The fallacy paradox is in thinking an employer’s contribution comes out of profits. In fact, higher health insurance premiums mean lower wages for workers. Since 1999, health insurance premiums have increased 147 percent and employer profits have increased 148 percent. But in that time, average wages have hardly moved, increasing just 7 percent. Clearly workers’ wages, not corporate profits, have been paying for higher health insurance premiums. Health care costs are one — though not the only — reason wages have stagnated over the last few decades. With health insurance costs rising faster than growth in the economy, more labor costs go to benefits like health insurance and less to take-home pay. Yet the paradox that employees don’t pay for their own health insurance is widespread:

  • The first reason is that individuals cannot be sure what causes their wages to change or remain stagnant for decades.
  • The second reason is that employers want Americans to believe that they pay for their workers’ health insurance.
  • The third reason is that there are those who profit from the employment-based system: drug companies, device manufacturers, specialty physicians and high-income individuals.

And so, they all want you to believe companies are being magnanimous in giving you insurance, but they are not!

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PARADOX: Value Based Care

BY DR. DAVID EDWARD MARCINKO MBA MED CMP

Sponsor: http://www.CertifiedMedicalPlanner.org

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A young clinician representative advising to consider the cost versus value of medicine. Health care concept for economic cost-effectiveness analysis, driving down medical costs, improved access.

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Value Based Care Classic Definition: Value-based care is a type of payment model that pays doctors and hospitals for treating patients in the right place, at the right time and with just the right amount of care. You can look at it as a financial incentive to motivate healthcare providers to meet specific performance measures related to the quality and efficiency of the process. The same way, it penalizes weaker experiences, such as medical errors. The concept is often counter-intuitive.

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

Modern Circumstance: As healthcare costs continue to rise, value-based care has been growing in popularity compared to the traditional fee-for-service method.

Think: HMOs, PPOs, capitation payments and Medicare Advantage [Part C].

Paradox Examples:

  • Payment: A physician paid through fee-for-service compensation might like to see a packed medical office waiting room. More patients and services equate to higher pay. But, the same doctor paid through a VBC contract might wish to see an emptier waiting room as s/he will get the exact same daily pay for seeing fewer patients and working much less.
  • Prospectivity: Traditional Fee-for-Service medicine treats sick patients. VBC medicine seeks to keep patients healthy and out of the doctor’s office. 

Nursing Capitation: https://medicalexecutivepost.com/2024/07/07/on-nursing-capitation-reimbursement/

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DAILY UPDATE: Stock Markets, Netflix and Medicare Part C as CVS Closes Stores

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Markets: The S&P 500 hit an all-time high yesterday, closing out its sixth consecutive week of gains for its longest streak of 2024. The Dow and NASDAQ also closed in the green.

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

The largest Medicare Advantage insurers have prioritized profits over patient care by increasing the use of prior authorization in recent years to frequently deny post-acute care services to older adults, according to a report published Oct. 17th by the Senate Permanent Subcommittee on Investigations.

CITE: https://tinyurl.com/2h47urt5

The drugstore chain CVS is in the process of shuttering “roughly 300” locations across the country in 2024, a spokesperson confirmed to Good Housekeeping. That includes the dozens of pharmacies in Target stores.

CITE: https://tinyurl.com/tj8smmes

Stock spotlight: Netflix stock jumped on Friday, a day after its earnings report beat expectations.

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Do Doctors Use ChatGPT in Clinical Decisions?

By Staff Reporters

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Are doctors using publicly available tools like ChatGPT? The answer, Fierce Healthcare finds, is yes. In the first in-depth look of its kind into physician use of public genAI tools, Fierce Healthcare spoke with nearly two dozen doctors, students, AI experts and regulators, and helped conduct a survey of more than 100 physicians. The reporting confirms that some doctors are turning to tools intended for non-clinical uses to make clinical decisions. 

More: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2804309

A collaborative survey between Fierce Healthcare and physician social network Sermo found that 76% of respondents reported using general-purpose LLMs in clinical decision-making. With no standardized guidelines, lagging physician training and regulators racing to try to keep up with rapidly changing technology, guardrails to protect patients appear to be years behind current rates of utilization.

Source: Fierce Healthcare [10/8/24]

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DAILY UPDATE: Maximum Lifespan as Medicare Part C is Down and Stocks Markets Decline

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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants

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Maximum lifespans. The upper limit of human life expectancy is leveling out, according to a new study published in the journal Nature Aging. Back in 1990, life-extending tech and health measures were increasing the average global lifespan by about 2.5 years per decade, but that dropped to 1.5 years per decade in the 2010s and closer to zero in the US, where there are more drug overdoses, shootings, and medical care inequities.

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

STOCKS UP

Sphere Entertainment popped 6.33% on the news that a second Sphere will be built in Abu Dhabi. London was originally supposed to be the location of a second venue, but they’ve already got the Eye, and didn’t need more circular tourist attractions.

  • Oklo, a Sam Altman-backed nuclear energy startup, rose another 16.04% on the news that Google will purchase nuclear power to turbocharge its AI infrastructure.
  • Charles Schwab climbed 6.10% after the bank announced a top and bottom line beat last quarter, as well as higher revenue projections for the full fiscal year.
  • Boeing somehow gained 2.26% after announcing it is raising $35 billion to support its struggling finances as the machinist union strike enters its second month.
  • Wolfspeed, which sounds like a super power in a YA novel, soared 21.27% on the news that the US government will provide the chipmaker with up to $750 million in government grants.

STOCKS DOWN

  • Semiconductor stocks got a double whammy in the last 48 hours. First, Bloomberg revealed that US officials are considering limiting the sale of AI chips outside the country. Then, ASML missed its Q3 sales estimates (more on that below). Nvidia shares slid 4.52%, AMD fell 5.22%, and Intel dropped 3.33%.
  • Citigroup beat earnings estimates this quarter, but shareholders punished the bank for setting aside more money in case of higher loan losses ahead. Shares dropped 5.11%.
  • Coty, parent company of numerous beauty brands like CoverGirl, fell 10.74% to a new 52-week low after it warned of a sales slowdown in the coming quarters.
  • Enphase Energy tumbled 9.29% after RBC analysts downgraded the solar power stock, citing growing competition from the likes of Tesla as well as slowing demand for solar batteries.
  • Speaking of energy, oil stocks plummeted on news of Israel’s targeting of Iranian military assets rather than crude production facilities. Exxon Mobil fell 3.01%, Chevron dropped 2.67%, and Valero Energy sank 4.62%.

CITE: https://tinyurl.com/2h47urt5

Here’s where the major benchmarks ended yesterday:

  • The S&P 500® index (SPX) fell 44.59 points (–0.76%) to 5,815.26; the Dow Jones Industrial Average® ($DJI) dropped 324.80 points (–0.75%) to 42,740.42; and the NASDAQ Composite® ($COMP) lost 187.09 points (–1.01%) to 18,315.59.
  • The 10-year Treasury note yield (TNX) fell three basis points to 4.04%, the lowest close in a week.
  • The CBOE Volatility Index® (VIX) climbed to 20.72, an elevated level.

CITE: https://tinyurl.com/tj8smmes

Millions of seniors will lose access to their Medicare Advantage plans after major insurer cuts in the aftermath of the Inflation Reduction Act. Experts spoke with Newsweek about what’s going on and what steps seniors can take to get the coverage they need.

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MEDICARE: Open Enrollment Period Commences

By Staff Reporters & The Medicare Team

Medicare open enrollment—which runs from October 15th through December 7th this year—is your chance to check in on your Medicare plan and, if needed, change it.

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Mark your calendars — Medicare Open Enrollment starts October 15th! Did you know new benefits are coming to Medicare drug coverage next year?

Starting in 2025, all Medicare plans will include a $2,000 cap on what you pay out-of-pocket for prescription drugs covered by your plan. So, it’s more important than ever to make sure your drugs are covered.

Also starting next year, you can choose to participate in a program that spreads your out-of-pocket drug costs across the calendar year, instead of paying all at once at the pharmacy. It’s called the Medicare Prescription Payment Plan — and you can opt in with your plan throughout the 2025 plan year. Contact your plan for more details.

Preview Coverage Options

Remember, Medicare plans can change from one year to the next, and so can your health needs. Preview and compare all your health and drug options and see if you can save!

The Medicare Team

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DAILY UPDATE: Exxon Mobil, Medicare Part C, Boeing and UniCredit as Stocks Rise

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Essays, Opinions and Curated News in Health Economics, Investing, Business, Management and Financial Planning for Physician Entrepreneurs and their Savvy Advisors and Consultants

Serving Almost One Million Doctors, Financial Advisors and Medical Management Consultants Daily

A Partner of the Institute of Medical Business Advisors , Inc.

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California state officials filed a lawsuit against one of the world’s top oil giants accusing Exxon Mobil of driving global pollution by running a “decades-long campaign of deception” that dramatically overstated the effectiveness of plastic recycling. The suit seeks “multiple billions of dollars” in civil damages from Exxon Mobil—a main producer of the petrochemicals used to make single-use plastics—California Attorney General Rob Bonta said.

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

What’s up

  • Smartsheet popped 6.47% on the news that Blackstone and Vista Equity Partners will pay $8.4 billion in cash to take the software maker private.
  • Freeport-McMoRan gained 7.95% after the Chinese government announced stimulus plans. Shareholders are hopeful that more economic activity means more business for the copper miner.
  • Liberty Broadband soared 25.92% thanks to its counterproposal to Charter Communications, asking for a higher payout before an acquisition takes place. Charter shares fell 2.49%.
  • Thor Industries rose 6.18% after the RV company announced stronger-than-expected earnings.

What’s down

  • Visa fell 5.36% as the US government sued it over an alleged debit card monopoly.
  • Regeneron Pharmaceuticals dropped 4.21% due to a federal judge’s ruling that it cannot block a new product from rival pharma company Amgen that mimics its eye-care drug Eylea.

CITE: https://tinyurl.com/2h47urt5

Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) added 14.36 points (0.25%) to 5,732.93; the Dow Jones Industrial Average® ($DJI) rose 83.57 points (0.20%) to 42,208.22; the NASDAQ Composite® ($COMP) gained 100.25 points (0.56%) to 18,074.52.
  • The 10-year Treasury note yield (TNX) finished unchanged at 3.74%.
  • The CBOE Volatility Index® (VIX) keeps setting new lows for September, dropping to 15.49.

CITE: https://tinyurl.com/tj8smmes

Boeing offers 30% raise in attempt to end strike. With 30,000 factory workers on strike and 737 production halted for a second week, the embattled aviation company offered to hike wages for union members higher than the original 25% increase over four years they voted to reject.

Seniors could see large increases to their Medicare Advantage costs in 2025 as major changes are underway for prescription plans.

German Chancellor Olaf Scholz warned Italian bank UniCredit against “unfriendly” acts after the bank upped its stake in Germany’s Commerzbank, eclipsing the country as its largest shareholder.

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PODCAST: Accounting for Healthcare Professionals

By Eric Bricker MD

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PODCAST: Economic Cycles in Healthcare

By Eric Bricker MD

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

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RESOURCES: Financial and Economic Essays for Doctors and Healthcare Professionals

https://marcinkoassociates.com

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Informational essays of most current interest to healthcare professionals. Check back periodically for practical updates. Our catalogue library of major books, texts, case models and dictionaries is suggested for additional financial, economic, business and medical practice management information and education.

READ HERE: https://marcinkoassociates.com/articles-essays/

UPDATE: Prior ME-P Topics:

1-The number of balance billing disputes reaching arbitration is far higher than federal projections suggested.


2-Experts worry ACOs could face lasting financial difficulties due to an alleged $2 billion Medicare urinary catheter fraud scheme. 

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INVITE DR. MARCINKO: https://medicalexecutivepost.com/2024/02/05/invite-dr-marcinko-to-speak-at-your-next-seminar-webcast-or-event-in-2024/

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PODCAST: Impact of Education on Employee Health Care

HEALTH INSURANCE DEMOGRAPHICS

By Eric Bricker MD

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DAILY UPDATE: Second Apple Downgrade with Mixed Markets as Investors Await Payroll Data and Lilly Sells Medications Directly to Patients

By Staff Reporters

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SPONSOR: http://www.MarcinkoAssociates.com

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Here’s where the major benchmarks ended:

  • The S&P 500® index (SPX) was down 16.13 points (0.3%) at 4,688.68; the Dow Jones Industrial Average® (DJI) was up 10.15 points at 37,440.34; the NASDAQ Composite was down 81.91 points (0.6%) at 14,510.30.
  • The 10-year Treasury note yield (TNX) was up about 9 basis points at 3.997%.
  • The CBOE® Volatility Index (VIX) was up 0.08 at 14.12.

Oilfield services and consumer discretionary shares were also among the market’s weakest performers Thursday. Banking and health care were among the strongest sectors, illustrating renewed investor interest in stocks that lagged the broader market last year.

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

And, Eli Lilly is poised to sell medicine directly to consumers — with an emphasis on newly popular weight-loss drugs — in a move toward cutting out the controversial middle players in drug distribution.

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EDITOR’S CORNER: Fierce Health-Care’s 10 Most-Read Stories of 2023

By Heather Landi

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READ HERE: http://tinyurl.com/484773vm

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U.S. ECONOMY: Perhaps a “Soft Landing” After All?

YET- HEALTH CARE IS GROWING!

By Staff Reporters

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The US economy is looking like it could avoid a downturn and achieve a soft landing after all. US employers added a more-than-expected 199,000 workers to their payrolls last month, the Bureau of Labor Statistics said recently. The solid result calmed many analysts’ fears that a steeper economic slowdown is imminent due to the Federal Reserve’s earlier interest rate hikes. And, it brings us closer to the coveted “soft landing” scenario, in which the Fed tames inflation on the economy. For example:

  • The unemployment rate unexpectedly ticked down for the first time since July, to 3.7%.
  • Average hourly pay increased by 0.4% and is now up 4% for the year, beating the projected pace of annual price growth.
  • But the job market isn’t quite what it used to be

Last month’s 199-k jobs created were below the average of 240,000 added in the preceding 12 months. Plus, November hiring was confined to just a handful of industries:

  • Healthcare and the government were responsible for two-thirds of the headcount growth, adding 77,000 and 49,000 jobs, respectively.
  • The manufacturing sector gained 28,000 workers—but that was largely due to folks returning to work after striking against the Big Three automakers.
  • CITE: https://www.r2library.com/Resource/Title/082610254

Finally, in another sign that employers might be pulling back from on-boarding new people, the Labor Department reported earlier this week that job openings in late October were at their lowest since March 2021.

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DAILY UPDATE: Health Care, FOMC and the Tepid Markets

By Staff Reporters

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SPONSOR: http://www.MarcinkoAssociates.com

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In healthcare, legislators could vote next week on a major health reform package that includes a ban on spread pricing in Medicaid and a push toward site-neutral payments.


In more news from the Hill, a bipartisan bill was introduced that seeks to cancel a 3.4% Medicare pay cut to docs, which has drawn plenty of ire from the industry.

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The final FOMC meeting of the year will take place this week, and like most work meetings in mid-December, not a whole lot is going to happen. Chair Jerome Powell is widely expected to leave interest rates unchanged as inflation continues its descent to a 2% target. But 2024 planning is in full swing, and investors are desperate to learn when the Federal Reserve thinks it will need to cut rates next year.

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Here is where the major stock index benchmarks ended:

  • The S&P 500 index was up 18.07 points (0.4%) at 4,622.44; the Dow Jones Industrial Average® (DJI) was up 157.06 points (0.4%) at 36,404.93; the NASDAQ Composite was up 28.51 points (0.2%) at 14,432.49.
  • The 10-year Treasury note yield (TNX) was little-changed at 4.239%.
  • The CBOE® Volatility Index (VIX) was up 0.28 at 12.63.

In addition to retailers, semiconductor company shares also posted outsized gains Monday, boosted in part by a jump of nearly 10% in Broadcom (AVGO). The Philadelphia Semiconductor Index (SOX) gained more than 3% and ended near a two-year high. Transportation companies were also strong.

In other markets, Natural Gas futures (/NG) plunged more than 6% to a six-month low, reflecting warmer-than-normal U.S. temperatures and excess supplies.

Finally, the so-called Magnificent Seven stocks of Apple, Microsoft, Alphabet, Amazon.com, Nvidia, Tesla and Meta Platforms each fell at least 0.8%. Meta led the declines, dropping 2.2%. But only one out of 11 S&P 500 sectors fell. Even the information technology sub-index ticked higher, reflecting gains outside of the largest companies in the sector.

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CASE MODELS: Healthcare Business Entities

MARCINKO ASSOCIATES, Inc.

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The Marcinko & Associates case study and white-paper compendium is a teaching vehicle that presents potential clients with a critical management issue that serves as a spring board to lively debate in which participants present and defend their analysis and prescriptions. The average case is 2 to 100 pages long (prose, tables, graphs, charts, spread sheets and figures, etc).

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CASE MODELS: Healthcare Business Entities

MARCINKO ASSOCIATES, Inc.

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The Marcinko & Associates case study and white-paper compendium is a teaching vehicle that presents potential clients with a critical management issue that serves as a spring board to lively debate in which participants present and defend their analysis and prescriptions. The average case is 2 to 100 pages long (prose, tables, graphs, charts, spread sheets and figures, etc).

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AMAZON in Healthcare

By The Medical Futurist

Amazon In Healthcare: Disruption, Data Nightmares And Digital Health Dreams

Amazon’s healthcare ventures present a double-edged sword. On one hand, there’s undeniable promise, but the flip side paints a cautionary tale.

READ: https://tinyurl.com/ydtbvahx

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PODCAST: Poverty in Healthcare Explained

By Eric Bricker MD

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PODCAST: Economic Cycles in Healthcare

By Eric Bricker MD

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

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PHILLIP MORRIS: Healthcare Revenue Down

By Staff Reporters

Philip Morris International Inc. abandoned a goal to get at least $1 billion of revenue from healthcare and wellness products next year following setbacks at companies it has acquired in the sector.

The tobacco company has built a health and wellness unit around the purchases of UK inhaler maker Vectura Group Plc and Fertin Pharma, the producer of a smoking-cessation aid. PMI just took a $680 million impairment charge after unsuccessful clinical trials for an inhalable aspirin product as well as slower-than-expected development of other products.

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PMI paid more than $1 billion for Vectura and about $820 million for Fertin in 2021. Vectura scientists faced a backlash after the acquisition, with the company getting kicked out of a medical conference due to its link to the tobacco industry.

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Hospital Capital Structure

Understanding the Cost of Capital

[By Calvin W. Wiese; MBA, CPA]

[By David Edward Marcinko MBA]

[Staff Writers]

It is critical to understand and to measure the total cost of capital. Lack of understanding and appreciation of the total cost of capital is widespread, particularly among not-for-profit hospital executives.

Capital Structure Defined

The capital structure includes long-term debt and equity; total capital is the sum of these two. Each of these components has cost associated with it. For the long-term debt portion, this cost is explicit: it is the interest rate plus associated costs of placement and servicing. For the equity portion, the cost is not explicit and is widely misunderstood.

Capital Structure of Hospitals

In many cases, hospital capital structures include significant amounts of equity that has accumulated over many years of favorable operations. Too many physician and healthcare executives wrongly attribute zero cost to the equity portion of their capital structure. Although it is correct that generally accepted accounting principles continue to assign a zero cost to equity, there is opportunity cost associated with equity that needs to be considered. This cost is the opportunity available to utilize that capital in alternative ways.

Cost of Capital

In general, the cost attributed to equity is the return expected by the equity markets on hospital equity. This can be observed by evaluating the equity prices of hospital companies whose equity is traded on public stock exchanges. Usually the equity prices will imply cost of equity in the range of 10% to 14%; at least prior to the recent Wall Street meltdown.

Cost of Equity Exceeds Long-Term Debt

Almost always, the cost of equity implied by hospital equity prices traded on public stock exchanges will substantially exceed the cost of long-term debt. Thus, while many hospital executives will view the cost of equity to be substantially less than the cost of debt (i.e., to be zero), in nearly all cases, the appropriate cost of equity will be substantially greater than the cost of debt.

Weighted Average Cost of Capital

Hospitals need to measure their weighted average cost of capital. WACC is the cost of long-term debt multiplied by the ratio of long-term debt to total capital plus the cost of equity multiplied by the ratio of equity to total capital (where total capital is the sum of long-term debt and equity).

Hospital

Assessment

WACC is then used as the basis for capital charges associated with all capital investments. Capital investments should be expected to generate positive returns after applying this capital charge based on the WACC.

Conclusion

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

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

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PODCAST: Venture Capital in Healthcare VS. Boot Strapping

By Eric Bricker MD

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Corporate Moves in Healthcare Continue to Disrupt the Industry

By Health Capital Consultants LLC

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Instead of waiting on regulatory reform, corporate America has sought to disrupt the healthcare industry over the last few years, by streamlining the delivery of healthcare (and associated costs) and taking advantage of technological advancements.

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

This entrepreneurial approach to problem-solving may provide meaningful competition to traditional healthcare organizations, which may result in higher quality, more affordable healthcare. Some of the biggest companies in the U.S. – CVS Health, Walgreens, Amazon, Walmart, and Best Buy – are expanding their healthcare empires through acquisitions and other strategic moves. (Read more…) 

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PODCAST: The Healthcare Eco-System Explained?

By Eric Bricker MD

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

COMMENTS APPRECIATED

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Podcasts: WHAT IS FREE-MARKET “RENT-SEEKING” BEHAVIOR IN HEALTHCARE?

What About “Rent-Seeking” in Banking and Financial Services?

By Dr. David E. Marcinko, MBA

Courtesy: www.CertifiedMedicalPlanner.org

Rent-Seeking is a public choice, and economics, theory that involves methods to increase one’s share of existing wealth without creating new wealth [no added value].

Rent-Seeking results in reduced economic efficiency through misallocation of resources, reduced wealth-creation, lost government revenue, heightened income inequality, and potential national decline.

LINK: https://www.amazon.com/Dictionary-Health-Economics-Finance-Marcinko/dp/0826102549/ref=sr_1_6?ie=UTF8&s=books&qid=1254413315&sr=1-6

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Assessment: But, what about rent-seeking behavior in the healthcare industrial complex, banking and financial services industry, today”

ESSAY: https://pnhp.org/news/the-economist-rent-seeking-in-americas-health-care-system/

MORE: https://www.the-american-interest.com/2014/06/05/health-care-rent-seeking-in-90-seconds/

MORE: https://www.marketwatch.com/story/nobel-economist-takes-aim-at-rent-seeking-banking-and-healthcare-industries-2017-03-06

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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.

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

THANK YOU

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AFFORDABILITY: Healthcare on Notice for Patients

By Staff Reporters

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People living in the US are finding it increasingly difficult to afford needed health services—even with employer-sponsored health insurance, a new analysis suggests.

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

Researchers at the NYU School of Global Public Health (GPH) examined data from the National Health Interview Survey—an annual CDC survey—that was collected from 2000 to 2020 for 230,000+ adults who received health insurance through an employer or union. Both men and women found most healthcare services to be less affordable now compared to the early 2000s, according to the finding of the NYU analysis reported in a December 2022 JAMA abstract. Women, in particular, found all types of health services to be less affordable than men.

From a nationally representative survey which is conducted annually, researchers included data from 5,545 women and 5,353 men sampled in 2020, and found that about 6% of women reported they couldn’t afford needed medical care. This compares to just 3% of slightly larger sample groups from 2000, per the analysis. By contrast, about 3% of men gave that response in 2020, compared to 2% in 2000.

Avni Gupta, a doctoral student in the public health policy and management department at NYU GPH and the lead author of the analysis, offered that “lower incomes and higher healthcare needs among women could be driving these differences in reported affordability.”

And, José Pagán, the department chair and co-author of the JAMA analysis, said people with employer-sponsored coverage—the largest source of health insurance for people living in the US—“generally think they are protected.”

“[B]ut our findings show that health-related benefits have been eroding over time,” he said; according to Healthcare Brew

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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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COMMENTS APPRECIATED

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PODCAST: Podiatric Medicine in the Metaverse!

Closer than You Think?

By Staff Reporters

An interactive look at how the health space — from education to therapeutic support — is evolving with virtual reality.

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When Dr. Linda Ciavarelli tried out her 13-year-old son’s new Quest headset for the first time, she saw the future.

Specifically, the podiatry specialist in Wilmington, Delaware saw a new way to make health information accessible — an idea that is now a functioning Horizon Worlds space called HouseCall VR.

READ HERE: https://technical.ly/software-development/healthcare-virtual-reality-metaverse/

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COMMENTS APPRECIATED

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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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GENERAL ELECTRIC: Intelligent Healthcare Technologies

Limitless possibilities – Compassionate care

By Staff Reporters

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DEFINITION: GE HealthCare is a subsidiary of American multinational conglomerate General Electric incorporated in New York and headquartered in Chicago, Illinois. As of 2017, it is a manufacturer and distributor of diagnostic imaging agents and radio-pharmaceuticals for imaging modalities used in medical imaging procedures

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

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The GE HealthCare team is committed to helping clinicians provide patients with the best possible care.

GEHC’s intelligent technologies are helping clinicians around the world deliver on the promise of patient-focused precision care. Learn how GE HealthCare is working to solve healthcare’s greatest challenges.

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ORDER: 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: 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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ON THE RISE: Healthcare Consumerism!

By Staff Reporters

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As technology continues to rapidly evolve, a corresponding transformation in the healthcare industry is occurring. One of the most significant changes is the shift from traditional healthcare to healthcare consumerism. Patients now have more information available to them than ever before, and they are using this information to make more informed healthcare decisions. Patients are no longer passively accepting the care that is provided to them.

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

Instead, they are actively choosing the care that they receive, and are more selective about the providers that they use. As a result, healthcare providers must now focus on providing a better patient experience to attract and retain patients.

Source: Hari Prasad, Physicians Practice [12/8/22]

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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: Inflation Impact on Healthcare

By Eric Bricker MD

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

COMMENTS APPRECIATED

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PODCAST: Why Healthcare is So Slow to Change

By Eric Bricker MD

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COMMENTS APPRECIATED

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ORDER: 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

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

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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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COMMENTS APPRECIATED

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PODCAST: How To Understand U.S. Healthcare?

Follow The Money!

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By Jonathan Burroughs MD MBA

For those seeking to better understand the US healthcare system, national healthcare consultant Dr. Jonathan Burroughs suggests playing a game of “follow the money.” He asserts that whenever healthcare appears illogical, following the money will make it all rational and clear. The U.S. spends 2x as much money as the rest of the industrialized world, yet its citizens do not live as long as they do in 36 other nations. Dr. Burroughs gives an overview on how to fix the system.

Dr. Burroughs has worked with over 1,100 hospitals across the country to help healthcare leaders navigate the 21st century. He is a popular national speaker, who speaks to the impact of healthcare reform on hospitals, physicians and patients. Jonathan is a healthcare legal expert, who has participated in over 65 cases across the country. He is the winner of the James A Hamilton Award in 2016 awarded by the American College of Healthcare Executives titled “Redesign the Medical Staff Model”. This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at https://www.ted.com/tedx

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What is a DAO [not DOA] in Health Care?

Decentralized Autonomous Organizations in Health Care?

By Staff Reporters

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DEFINITION: A decentralized autonomous organization (DAO), sometimes called a decentralized autonomous corporation (DAC), is an organization represented by rules encoded as a computer program that is transparent, controlled by the organization members and not influenced by a central government. A DAO’s financial transaction record and program rules are maintained on a blockchain.

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

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Overview of Decentralized Autonomous Organization (DAO) | by IOSG | IOSG  Ventures | Medium

BLOCKCHAIN HEALTH: https://medicalexecutivepost.com/2018/11/02/on-blockchain-in-healthcare/

The precise legal status of this type of business organization is unclear. But, in healthcare, today?

DAOs in HEALTH CARE: https://thehealthcareblog.com/blog/2022/01/19/daos-may-rescue-healthcare/?utm_campaign=THCB%20Reader&utm_medium=email&utm_source=Revue%20newsletter

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PODCAST: Future Hospital “Profit Pool” in 2022?

McKinsey Healthcare Industry Analysis – Future Sources of Hospital Profit

BY ERIC BRICKER MD

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Many thanks

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Unable to Afford Health Care?

BRI Board Chairman Sally Pipes Takes a Closer Look

By Richard Walker

Yes, Says Gallup, but Maybe Not!

A recent Gallup poll finds Americans are unable to afford health care. But, a closer look at the data suggests otherwise.

sally_head_shot

What Health-Care Affordability Crisis?

LINK: https://www.nationalreview.com/2021/04/what-health-care-affordability-crisis/

Your thoughts are appreciated.

THANK YOU

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US Healthcare – Giving Doctors a Say

US Healthcare: Giving Doctors a Say

[A Bain infographic]

Doctors that are involved in the decision-making process are more willing to lead change.

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http://www.bain.com/publications/articles/front-line-of-healthcare-2017-doctors-infographic.aspx

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On American Health Care and Financial Services Competitiveness

A MEMORIAL DAY OPINION – EDITORIAL

[Innovation – Not Nationalization – Can Again Lead]

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

[Publisher-in-Chief]

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

[Managing Editor]

Ann Miller; RN, MHA

[Executive-Director]

American Flag

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

Collapse of Command and Control Monopolies and Oligarchies   

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

www.CertifiedMedicalPlanner.com

cmp-logo

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

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

Health Insurance Companies

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

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

Leo F. Mullin, MBA

[Former CEO – Delta Airlines]Shadows

Next-Gen with “Fly”

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

Physician and FA Advocates

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

Flexibility and Virtual Reality

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

[A] Rule No. 1

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

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

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

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

[B] Rule No. 2

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

[C] Rule No 3

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

[D] Rule No 4

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

CP 1

Memorial Day Considerations

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

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

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

Conclusion

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

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

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

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Our Other Print Books and Related Information Sources:

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Health Care and the Economy

The National Governors Association Meeting

By Staff Reporters

The National Governors Association (NGA)—a bipartisan organization of the nation’s governors—promotes visionary state leadership, shares best practices and speaks with a unified voice on national policy.

Healthcare Politics

The nation’s governors gathered this weekend to address critical issues, including health care reform and the economy. The Governors met with President Obama, members of the Administration, business executives and other experts for discussions on a host of issues and challenges facing states.

Opening Session

This 2010 winter meeting began with a robust opening plenary session highlighting the role states can play in improving health care delivery systems to provide cost-efficient and effective health care to all Americans.

http://www.nga.org/portal/site/nga/menuitem.b14a675ba7f89cf9e8ebb856a11010a0

Conclusion

And so, your thoughts and comments on this ME-P are appreciated; especially our colleague Somnath Basu, PhD.  Be sure to visit and watch the online video discussions, as well.

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

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Our Other Print Books and Related Information Sources:

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Sponsors Welcomed

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Off-Road Touring with Dr. Marcinko [Part I]

“Using-Up” Health Insurance

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Dateline: June 18-19th, 2009dem24          

I flew into Marquette Michigan last night on a puddle jumper from Chicago, Illinois. Marquette will be the home base on my current book promotion and public/private  speaking tour. This second leg of our trip, from Atlanta, was delayed for mechanical reasons. So, rather than follow directions from American Airlines regarding new arrangements, and rushing to wait in a long line of humanity for a new boarding pass on a much later flight, I simply called the travel assistance number on my cell phone. We were re-routed by computer from American, to a Delta Airlines flight, that caused no additional time lag as we later learned the other passengers boarded their American flight three hours late. Many of the elderly and slower moving folks even missed connecting flights which necessitated overnight hotel stays, in some cases.

THINK: outside the box independently, and don’t follow directions mindlessly.  

About Marquette, Michigan

The City of Marquette is located in the central region of Michigan’s Upper Peninsula. With a population of 20,714, it is the UP’s largest community. In addition to being a population center, it serves as the regional center for education, health care, recreation, and retail. This regional draw is particularly evident due to Northern Michigan University and Marquette General Hospital, both of which are located in the City of Marquette. Of course, I visited both.

Quality Healthcare for the Upper PeninsulaUPHC

So, the next morning I called some friends who suggested we head over to the Marquette Upper Peninsula  Healthcare Network System, on Washington Street, for an unplanned and unofficial stop on our current “signing and opining” tour. It seemed very busy for a Friday morning; so we gathered some colleagues and ambled over to Viering’s Restaurant where we discussed the local economy, current state of the healthcare industry and the Obama Administration’s ideas for healthcare reform. When I expressed my surprise at the number of patients in the clinic waiting room areas, I was informed that an unexpected corporate layoff resulted in patients “wanting to use their health insurance, before being RIFed [Reduced-in-Force].” Now, as a doctor, and insurance agent, I find this attitude both very strange; yet not uncommon.

“Using-Up” Health Insurance

I can honestly say that after more than three-decades in the business, I have never heard a single soon-to-be unemployed client say,” I need to use up my life insurance”, or “auto insurance”, or “homeowner’s insurance”, etc. So, what gives with health insurance?

Health Insurance IS Different

Insurance of all types is sold to economically protect against catastrophic events like pre-mature death, auto accidents, or home destruction. But life insurance doesn’t pay for non-lethal issues; auto insurance doesn’t pay for new tires, tune-ups or oil changes; and home owner’s insurance doesn’t pay for regular upkeep and maintenance, etc. So, why do some patients believe that health insurance necessarily needs to be used-up? Were they not healthy before the lay-off announcement; or did they suddenly become ill, thereafter? What do you think? Is this just a local phenomenon, or would it be [is it] pandemic in any community given the same or similar circumstances?

AssessmentUPHC-DEM

For me, this scenario clearly demonstrates two things. First, that Health Insurance is thought of as a personal right and/or corporate fringe-benefit; rather than true financial indemnification. Second, it demonstrates the ability of patients to think ahead; unlike the airline customers on my initial trip here. So, if patients can be forward thinking about their health insurance needs, why don’t they think ahead about their personal health care needs? Why don’t more of us exercise regularly, watch our blood pressure and weight, and/or avoid drugs, alcohol and promiscuous sex, etc.  If we can monitor and pay for routine auto and home maintenance ourselves; why not our routine health needs?  Isn’t good health our most important personal asset? Aren’t we worth it? Do we really want to abrogate our very lives to others? Do we want to concede our responsibilities to a third party, ie, a national [single-payer] governmental controlled healthcare? Those patients wanting to “use their health insurance”, before unemployment, certainly seem to think so.

About Off Road with Dr. Marcinko

These sporadic off-road segments will continue through-out my 2009 summer promotional tour. On the one hand, formal attendance at several engagements was initially a bit sparse because of the death of several recent celebrities and entertainer types. On the other hand, local book stores and sponsors noted a spike in our CD and book sales, as well as interest in our online www.CertifiedMedicalPlanner.com program and premier quarterly guide: Healthcare Organizations [Journal of Financial Management Strategies] www.HealthcareFinancials.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post 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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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Our Other Print Books and Related Information Sources:

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Sponsors Welcomed

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

Understanding the Emergency Medical Treatment and Active Labor Act

An Important and Contemporary Issue – Once Again

[By Patricia Trites; MPA, CHBC, CMP™ (Hon) with Staff Reporters]

tritesThe Emergency Medical Treatment and Active Labor Act (EMTALA) is receiving increasing scrutiny from prosecutors during these times of financials stress and credit tightening. The statute is intended to ensure that all patients who come to the emergency department of a hospital receive care, regardless of their insurance or ability to pay. Both hospitals and physicians need to work together to ensure compliance with the provisions of this law.

Triad of Requirements

EMTALA imposes three fundamental requirements upon hospitals that participate in the Medicare program with regard to patients requesting emergency care.

First, the hospital must conduct an appropriate medical screening examination to determine if an emergency medical condition exists.

Second, if the hospital determines that an emergency medical condition exists, it must either provide the treatment necessary to stabilize the emergency medical condition or comply with the statute’s requirements to affect a proper transfer of a patient whose condition has not been stabilized. A hospital is considered to have met this second requirement if an individual refuses the hospital’s offer of additional examination or treatment, or refuses to consent to a transfer, after having been informed of the risks and benefits of treatment.

Third, EMTALA’s requirement is activated if an individual’s emergency medical condition has not been stabilized.

Hospital Transfers

A hospital may not transfer an individual with an unstable emergency medical condition unless:

(1) the individual or his or her representative makes a written request for transfer to another medical facility after being informed of the risk of transfer and the transferring hospital’s obligation under the statute to provide additional examination or treatment;

(2) a physician has signed a certification summarizing the medical risks and benefits of a transfer and certifying that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the transfer outweigh the increased risks; or

(3) a qualified medical person signs the certification after the physician, in consultation with the qualified medical person, has made the determination that the benefits of transfer outweigh the increased risks, if a physician is not physically present when the transfer decision is made. The physician must later countersign the certification.dhimc-book21

On-Call Responsibilities

One area of particular concern is physician on-call responsibilities. Physician practices whose members serve as on-call hospital emergency room physicians are advised to familiarize themselves with the hospital’s policies regarding on-call physicians. This can be done by reviewing the medical staff bylaws or policies and procedures of the hospital that must define the responsibility of on-call physicians to respond to, examine, and treat patients with emergency medical conditions. Physicians should also be aware of the requirement that, when medically indicated, on-call physicians must generally come to the hospital to examine the patient. Patients may be sent to see the on-call physician at a hospital-owned contiguous or on-campus facility to conduct or complete the medical screening examination due to the following reasons:

  • all persons with the same medical condition are moved to this location;
  • there is a bona fide medical reason to move the patient;
  • qualified medical personnel accompany the patient; and
  • teaching physicians may participate.

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Meet Dr. Gary L. Bode CPA MSA CMP™ [Hon]

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Introducing our Newest Thought-Leader

Dr. Gary Bode; CPA, MSA, CMP

[By Ann Miller RN MHA]

The Medical Executive-Post is proud to introduce Dr. Gary L. Bode as our newest thought-leader for healthcare financial modernity. Dr. Bode was the Chief Financial Officer [CFO] for a private mental healthcare facility, and previously the Chief Executive Officer [CEO] of Comprehensive Practice Accounting, Inc, in Wilmington, NC. The firm specialized in providing tax solution to medical professionals. Dr. Bode was a board certified practitioner and managing partner of a multi-office medical group practice for a decade before earning his Master’s of Science degree in Accounting [MSA] from the University of North Carolina. He is a nationally known forensic health accountant, financial author, educator and speaker.

A Multi-Faceted Healthcare Financial Expert

Areas of expertise include producing customized managerial accounting reports, practice appraisals and valuations, restructurings and innovative financial accounting, as well as proactive tax positioning and tax return preparation for healthcare facilities. Currently, Dr. Bode is Chief Accounting and Valuation Officer (CAVO) for the Institute of Medical Business Advisors, Inc. He is also a Certified Medical Planner™ http://www.CertifiedMedicalPlanner.org  He provides litigation support in his areas of expertise and has been previously accepted as a legal expert witness www.MedicalBusinessAdvisors.com

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Gary has promised to publish his most exciting ideas and innovative work on our blog. He is also available for private consulting engagements and related professional work on an ad-hoc, or interim basis. So, let’s give a warm ME-P “shout-out” to Dr. Gary L Bode; our newest thought-leader.   

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