Health Information Technology Security and Encryption

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Understanding the Risks of eMRs and Internet Connectivity

[By Carol S. Miller; RN, MBA]Sun Micro

E-mails, PDA data, and Internet connectivity, unless encrypted, can be read by anyone.  Therefore, if these items are not encrypted, physicians should be careful of what they say and how they say it, especially when discussing any patient information with other providers, vendors, or managed care organizations. In addition, just because you deleted e-mail from the system does not mean that you have deleted it from the server or from the computers that maintain copies of your server’s data.  HIPAA regulations set forth the criteria in electronically transferring patient related data via the Internet.

Secure and Encrypt Messages and Health Information

If you want secure messages, an encryption program should be used. If the message is intercepted the text will be scrambled to anyone other than your intended recipient.  Most physicians feel encryption is too time consuming; however, programs such as Pretty Good Privacy at www.pgp.com provides an easy and nearly seamless integration into e-mail and operating systems, encrypting the sensitive files but still allowing ease of communication.  PCP software developed by MIT and endorsed by HIPAA, uses privacy and strong authentication.  Only the intended recipient can read the data.  If files were intercepted, they would be completely unreadable.  Other software programs are available in the marketplace that will work using a private key – similar to a password.  Tell the program the name of the file you want to encrypt and the private key, and the program uses a mathematical algorithm to encrypt the file.  For reference material on various encryption and security software programs, search the web under “encryption” or go to one of the following sites:  www.zixit.com, www.cisco.com, www.aspencrypt.com, or www.verisgn.com.  

Assessment

In addition to encryption, the office needs a good anti-virus program that is designed to detect and prevent viruses, such as Norton Anti Virus at www.symantec.com and McAfee VirusScan at www.mcafee.com 

Conclusion

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The Business of Medical Practice: Transformational Health 2.0 Skills for Doctors, Third Edition

Physician [Fee] Schedule Augmentation

Organizing and Analyzing Financial Data

[By Christy Clodwick; MHA]

biz-book1After all medical practice management data has been gathered, organize it onto a spreadsheet or chart.  This analysis report will help to determine the codes and/or health plans that should be targeted for process improvement.

Focus … Focus … Focus

The focus should be on the highest volume and dollar value codes. Does this mean patients with unusual conditions or low dollar value codes are not treated? Hopefully it will not; but it will push this process forward and the practice will see the greatest benefit from these categories. When you review the report and find that a fee is being paid at a much lower rate, this would be indicative of a necessary negotiation with the payer for an increase for that procedure. Most health plans are committed to preventing disease. Maybe, but they are still actually aimed at treating diseases; not preventing them. If this is true of many payers then they should be willing to provide the incentives for those services to be carried out. You will find that some payers’ fee schedules are very much out of line with a percentage of Medicare payments, therefore the practice administrator should focus on those payers and bring evidence of the inadequacies to their attention.

The Specialists

Specialists are, for the most part, paid at a higher rate than primary care physicians not usually for the same service! And, with GPs as gatekeepers, the specialty doc incomes may have actually decreased in some instances, while the GPs may have increased. There was a time when Medicare had two conversion factors, and this was the result. This inequity could also be used as a tool for better reimbursement rates.

Finalizing the Fee and Revenue Analysis

When the final preparations of the fee analysis have been completed, it is time to react to the results of the findings. There are several options to choose from when it has been determined that a health plans fee schedule is not in tune with the practice’s financial growth. The practice should act on these results as soon as they are discovered, to avoid the loss of any more revenue.

No longer Accepting Health Plans

During the analysis phase, you may determine that a health plan’s payment levels are extremely low. You will have to determine whether the plan is worth negotiating or the practice administrator should consider dropping out of the plan altogether at the end of the contract period. It will have to be carefully determined by the local market. If the practice is in a highly competitive market, this process should not be considered as first choice. However, if the market is very slim, the health care purchaser will be responsible for complaining to the health insurance plan provider that there is simply not enough physician coverage for their employees for the area. This could be a very effective way to force a negotiation with the health care company. If this were the case, the area would have less managed care and more MC/MD.

Not Accepting New Patients from Low Paying Health Plans

One option would be to not accept any more patients from the health plan that is reimbursing the practice with low rates. Although this may initially lower your patient count, over time the practice will benefit from new patients with health plans that have a better reimbursement policy. Include snapshot of what the final analysis or report should look like and the details of what it should include. This can be used in any specialty to assist in putting together the individual practice analysis to achieve the same results. But is it noble or ethical? What about any willing provider laws?

dhimc-book1The Future for Health Care Reimbursement

The health care purchasers who pay most of the bills, such as employers and the government, will soon be challenging the annual increase and the overall cost of health care. The cost increases of the hospital and pharmacy sectors of healthcare are far higher than that of the physician. However, the pressure for cost containment is being felt across the board. This will eventually depress future reimbursement for all healthcare providers.  In the future it will be hard for practices to keep up with the demands of labor, malpractice and supply cost increase. All medical providers need to plan for this future paradigm. To offset this trend, physicians will need to get the most out of the work that they are doing today as well as look to new revenue generating procedures for their practice that will be cheaper and more convenient to the patient.

Process Improvement

The biggest benefits will come from continually improving the process of the daily operations of the practice, as well as ensuring accurate diagnostic coding. This will enable a practice to keep up with charge capturing through the explanation of benefits (EOB) when the charge has been processed and paid by the health insurance provider. When this process identifies that there is room for negotiation, the provider should proceed for a better reimbursement rate. If the provider is in a dominant market, the payers will be more likely to issue sweeping fee increases and so can you give me an example of this ever happening? By completing a Practice Fee Analysis, any practice should be able to use this tool to demonstrate the inequities and negotiate a better reimbursement rate for the practice.

Assessment

The first step in the negotiation process would be to contact a representative of the health insurance company that is in question. If you can produce compelling evidence to the representative, the negotiation process should be the next meeting. These folks may be fired if they do what you suggest, too frequently. Continually updating the practice fee schedule will help the practice stay on top of the contracts that it practices under. Practices that present a well-documented argument may (almost never) be rewarded with positive payer response. Again, proper planning will make for great future performance in any health care practice.

Conclusion

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Business Property and Liability Insurance Coverage for MDs

General Commercial Property Insurance for Physicians

By Gary A Cook; MSFS, CLU, ChFC, RHU, CFP® CMP™ (Hon)

insurance-book8

One category of property and casualty coverage is commercial or business coverage.  Commercial Insurance protects against those perils and losses that a medical practitioner routinely faces in their practice of healthcare. These exposures are both wide and varied and include aspects that may never affect most practitioners, such as the explosion of boilers, or aviation mishaps, or ship’s hulls failing. However, many risk exposures should be considered.  This post will outline the covered property, covered perils, and a little known area titled Loss Settlement.

Covered Property

  • Buildings
  • Business personal property of the policyowner (which, remember, may be the practice)
  • Property and equipment used in the business
  • Personal property of others in the care and custody of the policyowner.

Covered Perils

This topic defies clear summarization because it usually defines the exposures unique to the healthcare practice. The risks of loss for a radiology practice are different from those of an obstetrician / gynecology office. Within numerous policy forms, “named perils” are identified in addition to the “all-risks” form that generally cover common perils such as crime or fire. In addition, just like with the individual Homeowners policies, endorsements can be obtained to cover unique and specific risks, such as earthquakes in California and hurricanes in Florida.

Loss Settlement

This special provision of commercial policies provides for the settle of losses on a cash value basis.  Most policies are subject to a deductible amount, although “Full loss replacement value” coverage is usually available. Typically, the deductible is 20 percent of the covered value, with the insurance company only covering the balance. As with personal lines of coverage, the amount of the deductible effects the premium charged.

www.HealthDictionarySeries.com

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Commercial General Liability Insurance

Commercial general liability (CGL) provides coverage for a wide variety of risks that a medical/healthcare facility may face.  In brief, these exposures will include (there are others in a general liability policy that may be “endorsed out” for the particular practice):

 

  • Premises liability – injuries on the property owned or occupied by the policy-owner
  • Business operations liability – losses caused by business activities of employees
  • Contractual liability – litigation arising from oral or written contracts assumed by the organization.

Unfortunately, for the medical practitioner, as with many property and liability contracts, liabilities that occur “from the rendering or failure to render professional services” are standard exclusions from this section of liability coverage.

BOP

Often, insurance companies offer “packaged” programs or, Businessowners Policy (BOP) especially for small to medium medical practices.  These policies include “all–risks” coverages for the property and limited liability. Most BOP programs include such coverages as:

  • Debris removal  
  • Fire department service charges
  • Pollutant cleanup and removal                
  • Water damage.

Most importantly, BOP contracts will cover:

  • Loss of Business Income (it is difficult to run the practice if half of it was destroyed by water damage from the fire in the office upstairs);
  • Extra Expense Coverage (the cost of renting substitute property while the covered property is being repaired); and
  • Payroll Expense (the need to retain specialists or key employees while the property is being rehabilitated).

Although the latter is limited in amounts and period of coverage, it is valuable coverage, especially for professional practices.

biz-book3

Assessment

Finally, the Businessowners Policy will cover losses due to crime (such as, forgery and alteration). As with Commercial Liability coverage, professional liability is excluded from Businessowner policies. 

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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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Securing Medical Professional Liability Insurance Coverage

Tips for Doctors Looking for Malpractice Insurance

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

dem2The following are buying tips for healthcare professionals who are shopping for medical professional liability insurance coverage:

** Shop well in advance of your renewal or expiration date. Your agent should have all of the necessary information to the insurer at least six to eight weeks before your coverage expires.  See below for more tips and  the type of information your agent will need.

** If you do not know an agent who can place your coverage, the Bureau of Insurance has a list of agencies that are licensed and appointed with at least one of the insurers on the Bureau’s list of “Insurers Writing New Business for Physicians and Surgeons.”

  • Contact one or two agents and be sure to ask each agent which insurer will be contacted for a quote. Ask the agent if an application will also be submitted to a surplus lines broker.  If so, ask for the name of the surplus lines broker and ask which surplus lines insurers will be contacted.  Provide this information to the other agent to avoid multiple applications being submitted to one insurer from different agents.  If the application is being submitted to a surplus lines broker, be sure to ask the agent for information on the coverage provided and specifically request information on exclusions.
  • If the agent recommends coverage through an unlicensed company (such as a surplus lines insurer or a risk retention group), be aware that, in the case of insolvency, the insured will not have coverage through the [State] Property and Casualty Insurance Guaranty Association.  However, if the healthcare professional has had several claims or an open claim, they may only be able to obtain coverage through a company not licensed in their state.
  • Ask the agent for information on the financial rating of the company and if the surplus lines insurer has its own guaranty fund.  Also, if shopping, the medical professional should feel free to check with the Insurance Bureau of their respective state to see if the company and agent are licensed or authorized to do business.
  • The agent should fully understand the healthcare professional’s business.  If incorporated, ask the agent what coverage is needed to protect the corporation as well as any individual doctors.
  • Ask the agent about the availability of “tail coverage” or if the new insurer will provide coverage for “prior acts.”  If coverage is offered with two insurers, ask the agent what each insurer charges for “tail coverage.”  This information may help in deciding which insurer has the most competitive price.
  • Complete the application for coverage in its entirety.  Don’t omit any information and be sure to provide as much detail as possible, especially about prior claims.  Many insurance companies want 10 years of information.  They may also request information about any risk management practices and procedures.
  • Discuss deductible options with your agent.  These may help lower your premium.
  • Find out if the insurance company offers any risk management or loss prevention programs.  Such programs may lower the premium and help reduce exposure to losses.

insurance-book

Assessment

The author has been an expert medical witness in both state and federal court. He is a former licensed insurance agent and certified financial planner, advisor and consultant.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Have you ever considered a more modern liability coverage method, such as an RRG, etc?

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Negotiating Physician Fee Schedules

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Better Data for Improved Fixed Compensation

[By Christy Clodwick; MHA]

[By Dr. David E. Marcinko MBA]

biz-book1It is known that most health plans operate with fixed fee schedules. While these fee schedules have little or nothing to do with RBRVS, and most are based on a percentage of what Medicare pays, the question is: “are they tied to levels that are more than 3 or 4 years old?”  Physicians who have no negotiating tools or a plan in place, and who question the methodology that the payers are using, are (too casual-left) with a ‘take it or leave it’ response from the health insurance provider.

Gathering the Data

A good solid foundation of data is necessary to negotiate better reimbursement rates successfully. The practice administrator or accountant (not 1 in 100 accountants can actually do this) should have this information readily available, especially if the office has an automated billing system.

Steps to Preparing a Fee Analysis

First and foremost, the medical management team in charge of this project will need to determine the most commonly used CPT® codes for the practice.  The bulk of primary care or family practice physician fees should be derived from the revenue of the office visit, hospital and preventive medicine codes. This in turn may limit the number of codes for the study. The frequency of each CPT code should be listed over a 12 month period.  If applicable, laboratory fees should also be included to see if there are fluctuating reimbursement schemes for these services. The codes on the list should account for at least 75% of the total practice charges.

Determining Top Payers and Reimbursement by Payer

It is known that Medicare and Medicaid use established fee schedules and do not negotiate, therefore the focus should be on the other major payers that make up the bulk of the reimbursement. In this process, make sure that the payers in the report are the practice’s top payers. The practice administrator will also need to determine the reimbursement for each code that is sent to the various payers’ list in the report. The administrator or team leader (the average GP has 3-4 employees, so I don’t think there would be a team leader, here). For this project we can use the Explanation of Benefits EOB that is received from each payer that has been selected for the report.  When including this data, make sure the allowed amount, not the paid amount, is referenced. After this information has been gathered, each payer’s reimbursement rate will need to be calculated as a percentage of Medicare’s reimbursement rate. Medicare’s current rates for any geographical area can be found through the “Medicare Physician Fee Schedule Look-up” tool at:

Link: https://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?p_sid=1reSKuxj

This site also provides a reference to Relative Value Unit, (RVU) that Medicare assigns to each code.

RVU Conversion Factors

It is important for the practice administrator or manager to understand the RVU conversion factors and how they work, simply because most payers are in the beginning stages of using this method. To calculate a payment for service you multiply a particular CPT Code by the Medicare conversion factor for that code. For an example we will use the code 99214 – office visit. The Relative Value Unit for that Code is 2.2. The Medicare conversion factor for the same code is $37.34.  The calculation would result in a rate of $82.15.  Geographical adjustments must be taken into account when performing these calculations. The next step in this process would be to review the fees for each code listed in the report. Calculate each fee as a percentage of Medicare’s rates. You will find different statistics for each payer.

dhimc-book1

Apply the Rules and Process

Follow these basic rules when applying this new process:

First, if the charges are being reimbursed at 100%, the fee may be too low. At this point, raising the fee for that code would be acceptable (Usually not the case). Next, If several fees are in this category, the practice should just set all its fees to a percentage of Medicare reimbursement across the board, such as 125 percent (many managed care plans pay at less than MC, i.e., 80% MC). Finally, a tiered fee schedule would be applicable if the payers seem to pay more for certain procedures or diagnostic studies. That would set evaluation and management codes at 125 percent of Medicare reimbursement while charging 150 of Medicare reimbursement for other procedures and diagnostic tests.

Assessment

The medical practice administrator should make sure that, no matter which fee schedule is best suited for the practice, it is updated annually to prevent loss of any increases that may occur per payer.

Conclusion

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Physician Use of the Internet

The Slow Evolution of a Healthcare Tool

[By Carol S. Miller; RN, MBA]biz-book15

The Internet is a constantly evolving service that continues to grow at an exponential rate, especially in physician practices. Primarily, the Internet is used as a means to electronically and expeditiously transfer data via e-mail as well as obtain information from a variety of sites.  Initially, in the physician’s office, the primary use was e-mail communications with peers, hospitals and others. Next providers linked to hospitals and managed care organizations to obtain more direct connectivity for clinical information and benefit coverage. Today physicians are finding other beneficial avenues to expand their utilization of the Internet. Several examples include:

 

  • Direct e-mail inquiries from the patient to the physician.
  • Patient educational newsletters and links to other healthcare educational web sites.
  • Continuing medical education (CME).
  • Chat room consultations, conferences or presentations with other providers.
  • Nurse to patient e-mail connectivity.
  • Immediate data on lab results with alerts for abnormal high or low values.
  • CPOEs (Computerized Purchase Order Entry Systems).
  • Radiology images.
  • EMR (Electronic Medical Records).
  • Monitoring of patients blood sugars or EKGs via the Internet.
  • Appointment scheduling on-line by patients.
  • Patient appointment reminders via the Internet.
  • Secure physician portals such as Medicity, located at www.medicity.com, which allows access to pertinent and prioritized data from a wide range of sources and vendors to include, labs, imaging centers, hospitals, payers and others.
  • HIPAA compliant Application Service Providers (ASP) for dictation, recording, routing and speech recognition and transcription services, such as Speech Machines at http://www.speechmachines.com.

Access Management

Besides the value to the patient and the physician, the physician can utilize his or her Internet connection with software firms such as NextGen to automate the registration, scheduling, eligibility verification, billing and “clean” claims processing via innovative Web-base solutions in real-time scenarios. All the physician’s office needs is a PC, a standard Internet browser, and a connection to the Internet to take advantage of this service.

Assessment

snow-highway1These resources and more, via the Internet super highway, enable physicians to have quicker and easier access to clinical information and improve productivity. Furthermore, these tools will quickly assist providers with accurate and timely medical decision making, thus improving patient care and outcomes.

Conclusion

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***

Non-Traditional Property and Liability Insurance Coverage for Doctors

Review of Other Insurance Forms for Medical Providers

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chief

dem23Obviously, not all forms of P and L insurance coverage can be described in detail on this post. However, the healthcare professional or medical practitioner should consider these other forms of commercial property and liability coverage.

Directors and Officers Liability Insurance

The officers and directors of large practices, or healthcare facilities can be held personally accountable, and thus liable, for breaches of their duties by a number of parties.

Commercial Automobile / Vehicle Insurance

As the name suggests, this coverage provides protection for any commercial vehicles owned and operated by the healthcare corporation. If the practice or facility owns automobiles or other vehicles that are used in the “usual and customary” business activities, this coverage is required.  The policy-owner should be aware of the nine classifications of automobiles insured to ensure that coverage is appropriate.

Commercial Umbrella Liability Insurance

This coverage is very similar to the umbrella coverage that falls under the personal coverage area. Again, risks above the limits established by the underlying commercial liability coverage trigger the umbrella policy. The word of caution for this coverage is “Read the Provisions Carefully” as there is little standardization among insurance companies. Make sure the umbrella policy covers what you want it to cover, with the right limits of benefits and “trigger” points, with proper exclusions, and proper endorsements (if being used specifically for a medical practice.)

Employee Benefits Liability Insurance

Virtually each medical practice or healthcare facility has employee non-cash benefits in addition to their payroll. These benefits usually include group insurance and some form of retirement plan (a 401(k), for example). Nevertheless, each of these benefit packages expose the employer to liabilities under state and federal statutes. Employee Benefits Liability Insurance covers an employer, or if so stipulated by some policies, the employees who act on behalf of the employer, against liability claims involving alleged errors or omissions, or improper advice or administration of the employee fringe benefit plans.  For example, an employer may be liable for not enrolling an employee on a timely manner resulting in no medical coverage. Frequent litigation also arises out of violations of the Employee Retirement Income Security Act (ERISA) of 1974.  Since 1974, the provisions and reach of this Act has become massive and errors can occur.insurance-book3

Disclaimer: The author is a former licensed insurance agent and certified financial planner and advisor.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. What have we missed, and who might wish to update this post?

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:

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ADSL – DSL Primer for Physicians

Asynchronous Data Subscriber Line versus Digital Subscriber Loop

By Carol S. Miller; RN, MBAbiz-book20

Asynchronous Data Subscriber Lines

ADSL is a very fast digital line provided by the telephone company. If available in your area, the ADSL provides fast connections, but generally not as fast as cable. There are various choices, beginning around 256 kbps (about five to six times the speed of a fast modem) going up to 7 Mbps.  Prices begin around $60 per month (including Internet service). There is also a set-up charge and a card needs to be inserted in your computer.

Digital Subscriber Lines

DSL is a high-speed direct line that can be 20-100 times faster in communication over the modem, depending on the type selected. Prices for the DSL begin at approximately $30-$40 per month and that includes Internet access. In addition, there is a set-up charge and a network card will need to be installed into the computer. Office workstations can usually share DSL circuits over their existing local area network (LAN).

Internet Connection

To connect with the Internet, as a rule of thumb, the faster the better; therefore, the office should have at least 56 kbps.  DSL normally runs over the same line as a basic telephone voice circuit and provides Internet access from speeds of 384 kbps all the way up to 1.54 mbps (megabits per second). The advantage of this configuration is you not only have high-speed access to the Internet, your telephone is still free to make and receive calls at the same time.

Integrated Services Digital Network   

A digital telephone line that allows voice and data to be transmitted on the same line in a digital format – instead of analog – and at a relatively high speed, usually around 64 to 128 kbps.  When reviewing this service, make sure the ISP has an ISDN connection. If not, you will be charge more by both the telephone company and the ISP. Prices for the ISDN average around $300 plus, with an extra fee to install the telephone line and a monthly service charge of $25 to $100 plus to maintain.

Wireless Network (WiFi – 802.11b)

The biggest change to happen to computers in the last ten years has undoubtedly been the Internet. Close on its heels in importance may just be the adoption of the wireless network access.  Wireless Fidelity, or Wi-Fi, is now cost effective and available at the computer store.  It is no longer necessary to re-wire buildings with Category 5 wire to provide LAN connectivity and resource sharing to multiple computers. Wi-Fi, or IEE standard 802.11b, enables small offices to connect up to four computers to a single network for less than the cost of a single computer.  This means the days of multiple analog lines to offer Internet access to every computer, or a printer on every desktop, are going away. Now a single cable modem or DSL line and a centralized printer can service four users. This can save a small business hundreds of dollars a year.

www.HealthDictionarySeries.comdhimc-book28

Limited Connectivity

For limited connectivity, computer stores are stocked with wireless vendor products that are cost effective, easy to install, and very robust that will push even the most cautious computer user to take the leap to wireless computing.  Not only does it make the initial cost to install a network cheaper than it has ever been before, it eliminates the cost to remodel or move computers within a building since instead of requiring data wiring at each proposed desktop all you need now is an electrical outlet to power the PC itself. 

Satellite

This is a more modern device. In the past, satellite connections were at 400K bps or fourteen times faster than the average modem.  As an example, a 2MB file would be downloaded in 30-40 seconds.  Benefits of the satellite connection are:  The connection is always on; it is reliable; there is a secure connection; office can have multiple e-mail addresses; the web space is free; and there is tech support coverage nationwide.  Costs include around $300 for the equipment, $150 plus to install the equipment, and around $30 to $50 per month for service.  Web site reference is satcast.com (DirecWay Satellite Dish).

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? Who can update the above post for modernity?

Link: https://healthcarefinancials.wordpress.com/2009/03/13/rip-retail-financial-services-industry/

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Understanding Automobile Insurance

A Review for Physicians

By Gary A Cook; MSFS, CLU, ChFC, RHU, CFP® CMP™ (Hon)

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Like the Home Owners policy, automobile insurance comes in a package (commonly called a Personal Auto Policy, or PAP) containing declarations, forms and endorsements.

These are: Liability Coverage, Medical Payments coverage, Uninsured Motorist coverage, and Coverage for Damage to your auto.

Important Elements

The important elements of automobile coverage are:

  • The vehicle or vehicles is covered, whether owned or leased
  • The insured – the covered driver
  • What is covered?
  • What are the limits of coverage – for both property and liability?

Exclusions

What are the exclusions – for example, the business use of a vehicle may not be covered under the personal policy? Other coverage for example includes a friend driving your car, or, coverage driving a rental vehicle. The medical payments coverage outlines the limits of liability for medical services needed as the result of an accident.

PULP

The final area of common personal coverages is the Personal Umbrella Liability Policy. To say that our society has become very litigious may be a gross understatement. The umbrella liability policy transfers the risk of losing substantial assets or future personal income to pay legal obligations resulting from an adverse judgment. The umbrella policy originated to provide risk protection against catastrophic legal claims or judgments. Typically, coverage limits begin at $1 million with upper limits of $10 million, and some unique situations, more. The term “umbrella” arises from the contract language that reflects that the individual carries the appropriate underlying basic coverages (homeowners or automobile) and that this coverage is triggered after the limits of the base contracts are exhausted.

Provided Coverage

An important element of this policy is that coverage provides for protection for the named insured, spouse, and family members living in the household.  This coverage should be very important to those households with teenage drivers.  Organizations may also obtain the protection of an umbrella policy, with certain limitations and exclusions. Unfortunately, “failure to render proper professional services” is very frequently a common exclusion, though some insurance companies will cover this loss exposure with an increased premium.

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Other Policies

Other common policies available include: Watercraft and Airplane coverage, Title Insurance, Flood Insurance (offered by very few private insurance companies), Renters Insurance (which covers the contents), and Condominium protection (like homeowners, but has language for common wall risks).

Personal Legal Expense Protection

Finally, there is the issue of the taxation of premiums and claim payments. Premiums for personal property and casualty coverage are not deductible. Therefore, only under unusual circumstances will any benefits received from the coverage be considered taxable income.

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Assessment

However, the benefit payments may be considered capital gain if they happen to exceed the insured’s basis in the property. Uninsured losses are generally deductible under the current Internal Revenue Code.

As usual, specific questions concerning the taxation of premiums or benefits should be directed to your professional advisors.

Conclusion

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Physician Property, Casualty and Liability Protection

Essentials of Risk Management

By Gary A Cook; MSFS, CLU, ChFC, RHU, CFP® CMP™ (Hon)

Medical professionals may not be familiar with the unique differences between the terms – property, casualty and liability.  Property insurance is coverage for the loss of, or damage to, real and personal property caused by fire, theft, explosion, riot, vandalism and a host of other risks.  Casualty and liability are generally interchangeable terms for the coverage of legal liability due to injury to others or damage to their property.

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Personal Liability Coverage

One of the most common of all personal liability coverages is the Homeowner’s policy. This is not one policy, but several policy declarations (what is insured – the location), forms, endorsements, and “floaters,” which protect the structure of the home against loss, as well as the personal property (contents) to various degrees. Risks for homeowners need not be consistent across the country and the rates generally reflect the differences. For example, homes in the Midwest need protection from tornados, while homes along the East, West and Southern coasts need coverage for hurricanes and flood risks. 

Policy Form

The Home Owners Policy Form contains five categories of coverage for property:

  • The dwelling
  • Other structures
  • Personal property
  • Loss of use
  • Additional coverages, such as debris removal, trees, shrubs, and plants, or now, electronic theft (credit card, checking account theft).

The Contract

The contract contains three areas of Liability Coverage:

  • Personal liability
  • Medical payments to others
  • Miscellaneous liability benefits.

The Endorsements

Endorsements are an important aspect of the Homeowners coverage because they permit the customization of the coverage to the unique requirements of the individual. Two examples:

We noted that the West coast does not have tornados, however, they do have earthquakes and therefore, an endorsement can be added which will transfer the risk for earthquakes – or even volcanic eruptions. If the individual doctor has a home business, the business property can be protected against such perils as loss of business records due to fire or water damage. There is, however, no coverage for liability for providing poor professional services.

The Floaters

Finally, the Homeowners policy may contain “floaters” (named because the articles covered are moveable, thus “float around.”). The use of floaters can be very beneficial for coverage of unique or expensive electronic equipment and most commonly, jewelry. The other common personal coverage is Automobile Insurance. Forty-two states have compulsory insurance laws that require insurance on automobiles before it is registered. Various states have unique laws pertaining to:

  • Financial Responsibility, or proof of responsibility, by carrying insurance, a cash deposit, bond or security for future liability effective after an accident, which is the major criticism of these laws. 
  • Unsatisfied Judgment Funds that compensate individuals who are unable to collect from a judgment resulting from an automobile accident.
  • Uninsured Motorist Coverage is required in most states as mandated by state insurance regulators.  In essence, the insured’s own insurance company acts as the insurance company for the uninsured motorist.
  • No-fault Automobile Insurance stems from the problems associated with today’s tort law.  These policy forms, however, vary dramatically by state and a full discussion is not possible here.  Information and advice from a professional insurance agent is always recommended.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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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Product Details

Long-Term Care Insurance

A Review for Doctors and Advisors

By Gary A. Cook; MSFS, CLU, ChFC, LUTC, RHU, CFP®, CMP™ (Hon)

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Long-term care (LTC) insurance is considered one of the newest forms of personal coverage insurance.  LTC insurance is designed to transfer the financial risk associated with the inability to care for oneself because of a prolonged illness, disability, or the effects of old age.  In particular, it is designed to insure against the financial cost of an extended stay in a nursing home, assisted living facility, Adult Day Care Center, hospice or home health care.  It has been estimated that two out of every five Americans now over the age of 65 will spend time in a nursing home.  As life expectancy increases, so does the potential need for LTC. One unfortunate consequence of being the “new kid on the block” is the lack of actuarial data specifically collected for this style of policy.  This results in policy premiums being underpriced to sustain the claims currently being experienced.  During the first half of 2003, at least three insurance companies stopped writing these policies because of their losses.  Those insurers remaining in this market are expected to increase premiums quickly.  Unless these policies can be profitable for the company, their future will be an uncertain one.

Medicare

Any discussion of LTC must begin with an understanding of what Medicare is designed to cover.  Currently, the only nursing home care that Medicare covers is skilled nursing care and it must be provided in a Medicare-certified skilled nursing facility.  Custodial care is not covered. Most LTC policies have been designed with these types of coverage, or the lack thereof, in mind. To qualify for Medicare Skilled Nursing Care, an individual must meet the following conditions: 

  • Be hospitalized for at least three days within the 30 days preceding the nursing home admission;
  • Be admitted for the same medical condition which required the hospitalization; and
  • The skilled nursing home care must be deemed rehabilitative.

Once these requirements are met, Medicare will pay 100 percent of the costs for the first 20 days.  Medicare covers days 21 to 100 along with a daily co-payment, which is indexed annually.  After the initial 100 days, there is no additional Medicare coverage. Medicare Home Health Services cover part-time or intermittent skilled nursing care, physical therapy, medical supplies and some rehabilitative equipment.  These are generally paid for in full and do not require a hospital stay prior to home health service coverage.

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Critical LTC Policy Features

According to the U.S. Department of Health and Human Services and the Health Insurance Association of America, there are seven features that should always be included in a good long LTC policy: 

  • Guaranteed renewable (as long as premiums are paid, the policy cannot be canceled).
  • Covers all levels of nursing care (skilled, intermediate and custodial care).
  • Premiums remain level (individual premiums cannot be raised due to health or age, but can be raised only if all other LTC policies as a group are increased).
  • Benefits never reduced.
  • Offers inflation protection.
  • Full coverage for Alzheimer’s Disease (earlier contracts tried to eliminate this coverage).
  • Waiver of premium (during a claim period, further premium payments will not be required).

In addition, there are another seven features considered to be worthwhile and are included in the better LTC policies: 

  • Home health care benefits
  • Adult day care and hospice care
  • Assisted living facility care
  • No prior hospital stay required
  • Optional elimination periods
  • Premium discounts when both spouses are covered
  • Medicare approval not a prerequisite for coverage.

ADLs

Most LTC policies provide benefits for covered insured’s with a cognitive impairment or the inability to perform a specified number of Activities of Daily Living (ADLs). These ADLs generally include those listed below and the inability to perform two of six is generally sufficient to file a claim:

1. Bathing:  Washing oneself in either a tub or shower, or by sponge bath, and includes the task the getting into and out of the tub or shower without hands-on assistance of another person.

2. Dressing:  Putting on or taking off all necessary and appropriate items of clothing and/or any necessary braces or artificial limbs without hands-on assistance of another person.

3. Toileting:  Getting to and from the toilet, getting on and off the toilet, and performing associated personal hygiene without hands-on assistance of another person.

4. Transferring:  Moving in and out of a bed, chair or wheelchair without hands-on assistance of another person.

5. Eating:  The ability to get nourishment into the body without hands-on assistance of another person once it has been prepared and made available.       

6. Continence:  The ability to voluntarily maintain control of bowel and/or bladder function, or in the event of incontinence, the ability to maintain a reasonable level of personal hygiene without hands-on assistance of another person.

Other Issues

Another issue concerning ADLs is whether the covered insured requires “hands-on” assistance or merely needs someone to “stand-by” in the event of difficulty.  Obviously, LTC policies that read the latter are considered more liberal.

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Long-Term Care Taxation

Some LTC policies have been designed to meet the required provisions of the Kassenbaum-Kennedy health reform bill, passed in 1996, and subsequently are “Tax Qualified Policies”.  Insured’s who own policies meeting the requirements are permitted to tax deduct some of the policy’s premium, based on age, income and the amount of total itemized medical expenses.  The major benefit of the tax-qualified LTC policy is that the benefit, when received, is not considered taxable income.  There are several initiatives in Congress, however, which would expand and simplify these deductibility rules. 

Assessment

Regardless, the medical professional or financial advisor [FA] should investigate the opportunity afforded them through their current form of business, or client use, for any purchase of a LTC policy. And, small businesses may be permitted to deduct LTC premiums on a discriminatory basis.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. What have we missed, and who might wish to update this post?

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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ISP Primer for Physicians

Understanding Basic Access and Connectivity

By Carol S. Miller; RN, MBAbiz-book18

To connect with an Internet service, the medical office will need a computer, modem, telephone line and software.  The modem, either external via a connection or internal via a built-in or slot card, takes the digital signals from your computer and converts them to analog signals that your phone line uses.  As a rule of thumb, the faster the better; therefore, the office should have at least a 56 bps or use a DSL line.

Accessing the Internet

To access the Internet, the office must obtain an Internet Service Provider (ISP) such as America Online (AOL), Earthlink, ATT Worldnet, Microsoft Network Premiere (MSN), Hot Link, or others.  The cost varies on the plan selected but usually averages in the range of $10 to $25 per month.  In selecting an ISP, several guidelines need to be considered:

 

  • The major online services often make it very easy to connect to the Internet, but may be more expensive;
  • Many low-priced ISPs may have customer service that matches their prices;
  • In selecting the ISP, make sure the provider has a toll-free or local support telephone line;
  • For a nationwide directory list of ISP providers, go to the Internet site of www.isp.com.

Besides the POTS (plain old telephone service), the physician may wish to have a faster connection to the Internet.  Several options are available.

Cable Modems

Cable connection is very fast, providing a lot of bandwidth (the amount of information that can be sent through a particular communication channel).  As an example, in the time it takes to transfer a half page across a 56K connection, the cable connection can transfer over 25 pages.  As is suggested by the name, the local cable TV provider or community antennae TV (CATV) deliver this service.

www.HealthDictionarySeries.com

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Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? Who can update the above for modernity?

Link: https://healthcarefinancials.wordpress.com/2009/03/13/rip-retail-financial-services-industry/

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Essential Insights on Successful Physician Budgeting

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Avoiding Common Cash Flow Budget Mistakes

[By Dr. David Edward Marcinko; MBA, CMP™]

[By Hope Rachel Hetico; RN, MHA, CMP™]

[Publisher-in-Chief and Managing Editor]dave-and-hope4

Although some doctors might view a budget as unnecessarily restrictive, sticking to a spending plan can be a useful tool in enhancing the wealth of a practice. We emphasize the keys to smart budgeting and how to track spending and savings in these tough economic times.

Money and Happiness

There is an aphorism that suggests, “Money cannot buy happiness.” Well, this may be true enough but there is also a corollary that states, “Having a little sure reduces the unhappiness.” Unfortunately, today there is more than a little financial unhappiness in all medical specialties; not just the specialty of podiatry – where this article first appeared as a free-lance writing project. The challenges range from the commoditization of medicine, aging demographics, Medicare reimbursement cutbacks and increased competition to floundering equity markets, the home mortgage crisis, the squeeze on credit and declines in the value of a practice. Few doctors seem immune to this “perfect storm” of economic woes.biz-book2

Most Doctors Financially Hurting Today

Far too many physicians, dentists and other medical providers are hurting and it is not limited to these above-average earning professionals. However, one can strive to reduce the pain by following some basic budgeting principles. By adhering to these principles, most physicians can eliminate the “too many days at the end of the month” syndrome and instead develop a foundation for building real wealth and security, even in difficult economic climates like we face today.

Three Budget Types

There are at least three major budget types. [1] A flexible budget is an expenditure cap that adjusts for changes in the volume of expense items. [2] A fixed budget does not. [3] Advancing to the next level of rigor, a zero-based budget starts with essential expenses and adds items until the money is gone. Regardless of type, budgets can be extremely effective if one uses them at home or the office in order to spot money troubles before they develop.

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Assessment

For the purpose of wealth building, medical professionals may think of a budget as a quantitative expression of an action plan. It is an integral part of the overall cost-control process for the individual, his or her family unit or one’s medical practice.

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Conclusion

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Selecting an Assisted-Living Facility

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Checklist for Financial Planners

[By Staff Reporters]

Thousands of boarding homes cater to the elderly. Their operators promise to provide at least a place to sleep and food to eat. Beyond that, the services and assistance offered will vary from facility to facility. This checklist will help the financial planner or his or her client find a facility that is appropriate in all respects to the client’s resources and needs. Unlike nursing homes, assisted-living facilities often operate without any scrutiny from public agencies. Furthermore, Medicaid often will not be a source of funds.

The Checklist

The items the financial planner and client should consider when selecting a facility are listed below.

      1.   Determine the client’s willingness to live in a group environment.

      2.   Avoid unlicensed facilities, particularly if Medicaid-provided services may be needed in the future.

      3.   Review the facility’s inspection report.

      4.   Review the facility’s service contract and house rules. Look for answers to the following questions:

            a.         Where will the resident live?

                        Are there any types of ownership rights?

                        What flexibility is there with respect to furnishings?

                        Will the same unit be available after a hospital stay?

            b.         What meals are included?

                        Will the facility provide appropriate meals and a special diet?

            c.         What form of transportation does the resident currently use?

                        What transportation is provided by the facility?

                        Can residents shop, dine, attend services or visit doctors?

            d.         What help does the facility provide during a medical emergency?

                        What type of staff training is provided or required? Is there 24-                        hour-a-day staffing?

            e.         What provisions are there for privacy? When are rooms cleaned and when can staff access the rooms?

            f.          What is the basic cost and what are the costs for extras?

                        What is included in each?

                        What provisions for fee increases are there?

            g.         Can a resident see his or her own doctor?

                        Does the facility offer transportation for appointments?

            h.         Who’s in charge of administering and scheduling medication?

                        Can medication and other supplies be purchased at the facility?

            i.          What happens if the resident’s health begins to fail?

                        Does the facility provide additional services to help with ADLs?

            j.          What is the procedure for transfers from one unit to another?

                        Does the resident have any opportunity to express an opinion?

            k.         What’s required if a contract is terminated by facility or resident?

                        What is the provision with respect to refunded fees?

                        Is there a required minimum stay?

Assessment

What have we missed?

Conclusion

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Advisor’s Checklist for Physicians Seeking Insurance

Background, Education, and Certifications

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chiefdem22

The following are sample questions and information gathered for Professional Liability Coverage

The Checklist

**Medical specialty information by percentage of practice.

**Information on medical education, including information on medical school, internship information, residency information, and fellowship information, if any.

**Information on medical experience, including information on military discharge (DD214), public health service, moonlighting, ‘locum tenens’, and private practice information. Have dates and locations available. Other information includes:

  • Information on completed continuing education hours in the past two years.
  • Publications, speeches, instruction, etc.
  • Information on medical licenses, including state, license number, expiration dates, and current status.
  • Information on board certifications.
  • The above information may be contained in a Curriculum Vita, if you have one.
  • On an “as applicable” basis:
  • Complete details including dates and outcomes of any board certification revocations or suspensions, license revocations or suspensions, alcohol or drug addictions and treatments, criminal or sexual misconduct charges, or Medicare or Medicaid charges.
  • Previous Insurance Information
  • Insurance history, including the name, policy number, whether the coverage form was occurrence or claims made, policy period, limits of liability, deductible amount, and prior acts date, for your current carrier, and your first, second, third, and fourth prior carrier, if applicable.
  • Information on any insurance company cancellations or non-renewals.
  • If your current policy is a claims-made policy, whether you are obtaining tail coverage from your current insurance company.
  • Copies of prior policies, if available.

Current Medical Practice Information

  • Information on supervision and employment of residents, physician assistants, nurse practitioners, CRNAs, nurse midwives and other physicians;
  • Information on networks or managed care organizations associated with (IPA, PHO, MSO, etc.), including group name, type of organization, and relationship;
  • Information on other contractual relationships other than PPOs, HMOs, IPA, etc;
  • Full information on all hospital privileges, including hospital name, location, and type of privilege.
  • Information on any suspension, denial, revocation, restriction, or other sanctioning of hospital privileges.

Classification and Specialty Identification

Full information on procedures performed, including details of surgeries, average number of patients seen weekly, specialty practice areas, etc.

Prior Claims History (if any)

For each claim, patient’s name; date of occurrence; insurance carrier; location of occurrence; date claim was reported; date claim was closed (if applicable); copies of subpoenas, pleadings, or judgments; amount reserved on your behalf; and amount paid on your behalf.  Provide as complete a description of the allegations as possible.

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Important Note

This checklist is provided as a guide to assist the Healthcare Professional in gathering the information that insurance companies typically request.  Discuss this checklist with your agent to identify additional information as needed.

Assessment

The author has been an expert medical witness in both state and federal court. He is also a former licensed insurance agent and certified financial planner.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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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Reviewing Medical PDAs

Physician Use Growing Slowly

By Carol S. Miller; RN, MBAbiz-book10

Handheld personal digital assistants (PDAs), such as Palm Pilot M130, 500 or 515, Sony Clie, Visor Prism or Pro, Psion, RIM Blackberry, Zaurus, iPhone, Zune and other comparable PDA OS platforms, have revolutionized the communication world this past decade. PDAs and their future counterparts are becoming the catalyst for physicians to use information technology, are becoming the intro for physicians into the world of the electronic medical record software, and becoming the virtual office tool, enabling providers to communicate away from the desktop as well as away from his office practice. The reasons for increased utilization with physicians are portability, pocket-size, provides easy access to information at point of care and regardless of location, improves practice efficiency and workflow, improves drug related decisions and decreases adverse drug events.  

PDA Components

The common uses of PDAs by physician practices are:

 

  • Personal applications such as scheduling, telephone directories, dictionary, “to-do lists” and others
  • Drug databases
  • Clinic suite that ties into the hospital information system
  • Charge and procedure capture
  • Communications, from provider to provider, provider to hospital, provider to office, and vice versa

Palm Operating System

Palm OS still represents the standard in handheld computing, assisting individuals to manage and access information at any time, at any location.  Handhelds are easy to use.  Physicians are using the Palm OS and/or compatible PDAs to access their office schedules, receive downloads of clinical information on their patients, and enter clinical services and charges when performing services at remote locations.

PDA Selection

In selecting not only the PDA but also the software, the physician needs to answer the following questions:

 

  • What would you like to use the PDA for – clinical reference data, patient information, non-clinical applications, personal data, etc.?
  • What information do you need to know about the patient that the PDA can simplify?
  • What is the connection route between the hospital, managed care, or lab and your practice? In other words, how do you get access to the data?
  • What are your price considerations?
  • Do you need a color or black and white screen?
  • What is the system support and warranty?
  • How do you plan to connect to the office or hospital? 
  • Do you want to go wireless or obtain information via a telephone connection?
  • Do you plan to render care outside of your office practice, such as in the home, a clinic, hospital setting, etc?  If so, what would you like included on the PDA that would improve communication with the office and save time at point-of-service in documentation?

HIPAA

HIPAA regulations do not specifically address the specific term PDA, but the regulations do include guidelines for protecting patient information and transmission of this data that can impact the use of PDAs.  Physicians are utilizing handheld digital assistants whether they contain clinical information; or just resource data, may be or not are password protected, and may or may not be officially supported by hospitals or clinics.  Providers as they prepare for future applications and usage of PDAs involving patient information must understand the scope of the new HIPAA regulations as it impacts on patient data collected, stored or transmitted.  Any application involving patient identifiable data must be HIPAA compliant.  The key issues are how to protect the patient information stored on the device, i.e., if lost or stolen, and second how to protect patient information transmitted during a synchronization or wireless transaction.  Probably the most vulnerable aspect is the loss rate with recent studies indicating at least 30%.

Security

Most providers using PDAs for patient data utilize a user ID or password level of security. To maintain security, the provider should be required to re-enter their user ID or password every time they enter the application. Likewise, each PDA should have a “time out” feature, requiring a provider to re-enter his ID or password again. This feature will not prevent individuals with technical skills from accessing this information – the only mechanism is encryption.

Synchronization versus Wireless Applications

1. Synchronization transfers information from the enterprise database to the PDA, i.e., hospital lab or x-ray results, patient demographics, consultative notes, and others.  It is important that the hospital or hospital system authorize and approve the physician for using and transmitting this information and in turn, the provider authenticates and validates his agreement with the hospital before data is transmitted.  In addition for protection, an audit trail of who synchronized and what data was transmitted should be maintained by the hospital system.

2. Wireless providers have immediate real time access to patient data; however this process of transmission is more vulnerable than synchronization.  Wireless solutions can utilize a public or private network. HIPAA require encryption for the transmission of data over the public networks – Encryption is optional for others. Sharing data from a wireless over the Internet represents potential security issues; however, more and more technical firms and providers are using a wireless VPN that allows PDA users to connect securely from remote locations just as laptop users do today.

Other Issues

The other issues are who owns the PDA. If the provider does, he or she should be responsible for the security; however if the hospital does, the hospital should be responsible.  More current applications of Palm OS will include built-in modems for easier wireless communication, improved secure transactions, and ability of greater resolution for graphics, and other Web-based services. In addition, current and future applications will include refined voice dictation.  As an example, MDEverywhere’s package called Everynote allows the provider to digitally record notes and in turn links with MDEverywhere’s coded patient encounter.

The Blackberry

A very versatile product is the Blackberry.  It has web browsing capabilities, embedded wireless modem and can (1) write, send receive and respond to messages right from the unit, (2) access web information, (3) has nationwide coverage with no roaming fees, (4) has voice mail message capabilities, and (5) can be the size of a pager or PDA. The next feature with Blackberry will be its text messages to cell telephones.  New units start around $150-$300 with monthly service charges of $20-$50 depending on the plan.  The wireless Internet connection can be accomplished through Go.Web. 

Assessment

The typical cost for a PDA averages between $300 and $600 – depending on color or black and white – plus the cost of additional software and accessories.  For wireless connectivity, the physician will need to connect with a communication partner. Reference sites for PDAs are: www.handheldmed.com (for clinical, reviews, and news), www.pdamd.com (PDA resources), www.freewarepalm.com (free software programs), www.palmpilot.com, www.handspring.com.  The active shopper can refer to www.zdnet.com or www.palmblvd.com

Conclusion

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Networks Basics for Medical Professionals

Defining WANs and LANs

By Carol S. Miller; RN, MBAbiz-book13

Depending on whether the practice is housed in one or multiple-office locations and there is a need to connect multiple computers, either a local area network (LAN) or wide are network (WAN) should be part of the package consideration.

The LAN

The LAN is a computer network that covers only a small area (often a single office or building).  The advantage of a LAN (besides connecting several computers to a network system) is the ability to configure one printer for multiple stations.  The same may be said for sharing administrative, clinical, financial and operational data in real-time manner to support smooth office function.

The WAN

The WAN provides the ability to link data on one network for multiple office site locations.

www.HealthDictionarySeries.comdhimc-book25

Conclusion

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How to Select a Nursing Home

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Checklist for Financial Planners

[By Staff Reporters]fp-book6

The following will enable the financial planner to assist the client in choosing a nursing home.

The Checklist

1.   Review the client’s requirements. An assisted-living facility may suffice instead of a true nursing home, which is required by the frail and elderly needing daily medical care.

2.   Pick a location close to home and relatives. Frequent visits are crucial, not only to combat loneliness but also to ensure resident receives proper attention.

3.   Read inspection report (state survey). If the financial planner encounters difficulties in obtaining a current report, he or she should assume that the home has something to hide. Don’t expect perfection. Nursing homes provide a difficult service for difficult residents. If a home is unresponsive to inquiry regarding items in a report, assume a similar response to concerns about the quality of care being provided in the future.

4.   Tour the facility on an unannounced basis at different times on different days. Stroll through corridors and look and listen. Trust senses and instincts. Items to consider should include:

·         Appearance of residents’ rooms. Outward decor of facility can be misleading, so the planner should inspect the residents’ rooms. To what extent can the rooms be personalized? If rooms are shared, how are good roommate matches made?

·         Smells. High-quality homes have no lingering stench of urine or air freshener to cover up bad care and unusually high incidences of incontinence due to lack of attention by staff.

·         Safety hazards. Be especially aware of items in corridors that can be obstacles to those with unsteady gait and poor eyesight.

·         Sufficient staff members who are pleasant and respectful to residents. Are staff members responsive to residents’ needs? Are staff members warm in their interactions with all residents, even those requiring the heaviest supervision? Are aides helping residents with walking or exercise of their arms and legs?

·         Residents’ attitudes toward facility’s service. Talk with residents and staff to determine attitudes toward the facility’s service. Does the facility have a family counsel to provide it with input?

·         Grooming. A clear sign of neglect is failure to keep residents clean, well dressed, and well groomed.

·         Physical restraints. Nursing homes that have eliminated restraints also have improved quality of life and more social contact among residents. Ties, belts, vests, and high bed rails are an easy but unsatisfactory solution to managing residents. Count number of residents that are restrained; ask what percentage are restrained and why.

·         Food. Visit at meal time and sample the food to make sure it is palatable. The setting for meals should be attractive and pleasant, and food should be served at the proper temperature. Staff should be available to help residents who are not able to feed themselves. Review menus and determine the amount of concern for nutrition.

·         Activities. A wide variety of activities should be provided, and the participation level should be high. Bored residents in front of a television may be a sign of a home’s failure to stimulate its residents.

·         Dignity. Residents should be handled in ways that respect their dignity. For example, are residents properly clothed in public?

·         Bed sores. Bed sores are a sign of poor care. Review inspection reports and see if they are mentioned, or talk to residents or their families about this topic.

·         Special care units. Such units are often used as an expensive marketing device. The special care units may not be designed well and may indicate a lack of outdoor facilities.

5.   Review the facility’s policy on medical care. Will residents be seen by their personal doctors or by staff physicians? Does the home have good infection control and immunization plans? What sort of access to dentists and eye doctors is there?insurance-book9

6.   Perform financial analysis. The planner should gain a complete understanding of what the client’s and/or his or her family’s financial commitments are and how they will be met.

·         Determine the financial strength of the nursing home, particularly if client funds are to be advanced.

·         Consider a single lifetime payment in lieu of monthly rental payments.

·         Consider exclusions in contract. For example, nursing home insurance coverage should include loss of personal property and personal injury.

·         Determine what services the client will require, what is covered under the facility’s general fee, and what services are provided for an extra fee. Determine what the extra fee will be for each additional service that will be required. Family members should not agree to pay these charges because this could delay Medicaid funding.

·         Analyze pricing structure in general and what the pattern of increases in fees has been.

·         Determine residents’ rights in eviction proceedings for nonpayment of rent, in returning to nursing home after hospital stay, and in having Medicaid make payments on behalf of resident.

·         Determine residents’ rights to appeal decisions and what the appeal procedures are.

7.   Obtain and check references, including families of current residents, local hospitals, doctors, and government agencies, particularly the ombudsman at state departments for aging.

Assessment

What have we missed?

Conclusion

In any case, early planning is the key to supporting both your kids’ futures and your retirement. Making logical college funding decisions, rather than emotional ones, creates a win/win for everyone.

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On Baseline Medical Practice Compliance Audits

Establishing a Reference Point is Key to Success

Submitted by Pati Trites; MPA, CHBC with Staff Reporters 

www.HealthcareFinancials.comho-journal11

There are several types of compliance audits that a medical practice, clinic or healthcare organization might need to perform. The starting point is to obtain a baseline audit. The next step, discussed elsewhere on this ME-P, is periodic audits or reviews that are performed after information is obtained from the baseline audit.

Baseline Audits

Baseline audits are preliminary assessments to develop a reference point. Until a medical practice or healthcare organization establishes a track record with items such as coding accuracy or documentation to support medical necessity, it is difficult to determine any performance issues. In the spirit of Total Quality Management [TQM], the information that is shared should be done in a non-punitive manner to demonstrate that the intent of the process is to create a positive environment geared towards fixing the problems. A baseline audit can help any organization understand where the program is and establish a reference for future activities.

Assessment

Additional audits can also be performed whenever new employees are added, or if there are complaints, or issues that arise in the course of business.

Conclusion

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Defining and Understanding “Boutique Medicine”

What it is – How it Works

img_0566

By Dr. David Edward Marcinko MBA 

http://www.CertifiedMedicalPlanner.org

According to colleague Robert James Cimasi of Health Capital Consultants LLC in St. Louis MO, concierge or boutique medical practices began in the mid-1970s, and are now in many major metropolitan areas. Concierge medicine is described as a “return to old-fashioned medicine,” where physicians limit their client base and devote more time to each patient. Patients can usually get in to see their physician within a day, and most have 24-hour access to their physician by beeper or cell phone.

The Doctor’s Perspective

Physicians who turn to concierge medicine are typically tired of not having enough time with their patients and dealing with overbooked caseloads, and are looking for a way of balancing their lives while still providing quality care for their patients. Patients who have physicians in this type of practice appreciate the “perks” they get for paying a yearly fee — similar to “annual membership dues.” These fees can range anywhere from $1,000 per year to $10,000 per year depending on the patient’s age, benefits received, area of the country, and practice.

Patient Amenities

Amenities vary by practice, but some include longer physician office visits, increased access to physicians, e-mailed “newsletters” or condition-specific information, physicians accompanying patients on visits to specialists, and house calls. In order to provide more attentive care and amenities to patients, physicians often decrease their patient load to approximately 10-25% of their managed care load. Thus, most of their patients must find other physicians, leading to potential increases in the patient load of managed care physicians.

Elitist Patients

Although concierge medicine may provide many benefits for patients (including more, and in some cases, nearly unlimited access to their physicians), it has been met with some scrutiny. Some say that this type of medicine is elitist, that it is available only to wealthy patients who can pay the annual fees. Medicare beneficiaries who are members of a concierge practice have received political attention, because many politicians have said that the annual fees patients pay is a lot more than the Medicare rate and thus is illegal billing.

dhimc-book23

Critics

Critics also emphasize that healthcare needs to be first-rate for everyone, something that the current managed care system prevents. The implication that managed care means second-class medicine has also been a fear cited by critics.

Assessment

However, concierge physicians portray their clients as mostly middle-income people who are willing to pay more for this kind of care. Concierge medicine is not a substitute for health insurance. Patients typically keep their traditional insurance to pay for any tests or scans ordered by the physician.

MORE: https://medicalexecutivepost.com/2009/10/26/customer-relationship-management-and-the-nascent-concierge-medical-practice/

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Paradigm Shift to “Defined Health Contributions” from “Defined Health Benefits” Plans

What it is – How it Works

By Staff Reporters

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In the past, according to Robert James Cimasi MHA AVA CMP™ of Health Capital Consultants LLC in St. Louis MO, many employers had defined retirement benefits for employees. Today, most retirement benefits are in the form of 401K plans where companies make defined contributions, effectively shifting the financial risk of paying for retirement to employees.

Defined Health Contributions

Defined health contributions are similar to employer-funded defined retirement contributions like 401K plans. Currently, employers pay for some portion of about half of Americans’ health insurance. Traditional employer-funded plans are those for which the employee simply fills out a form; that is, an employer will offer one or possibly two health insurance plans, and the employee fills out application paperwork. The employer administers the plan and may charge the employee a portion of the monthly premium or pay the entire premium themselves. A defined contribution plan allows companies to shift the financial risk of paying for rising health insurance costs.

Defined Health Benefits

Although part of the “benefit” of a health benefit plan is that the employer also takes care of all the administrative paperwork related to the insurance, companies are increasingly uninvolved in the administration process, opting instead to let the employee decide which plan out of many choices suits them best. For example, if an employer typically spends about $5,000 per employee per year on health benefits, the employer would use that money as a “defined contribution.” The employee then has $5,000 to spend per year on benefits, but instead of using the employer-defined health plan, the employee may choose from a variety of HMOs, preferred provider organizations PPOs, or other health plans. If the insurance premiums rise above this amount, the employee must make up the difference.

dhimc-book24Defined Contribution Package

Many employers are currently offering a defined contribution package to their employees. The definition of “defined contributions,” however, can range from one in which employers are completely uninvolved in the administration of benefits and simply give their employees cash or vouchers for the amount contributed that they can use to buy coverage, to a more “defined choice model” where employers offer a variety of health options at differing price levels along with a premium dollar contribution, and a variety of other options in between.

Risk Shifting

Thus, defined contributions shift the financial risk from the employer to the employee. Defined care is not a replacement for managed care, but will probably cause managed care to adapt under these new systems. That is, HMOs, PPOs and other managed care plans still appear to be the main choices in a defined care environment, so they are in fact a part of the system.

Assessment

Another challenge with a defined health benefit program is that the concept of risk-pooling becomes more difficult. In traditional employer-sponsored plans, rates are usually based on the pool of employees; a chronically ill employee who tries to find insurance independently may face rates drastically higher than if they had participated in an employer-sponsored plan.

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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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Conclusion

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Understanding Modern Health Plan Delivery Models

By Defining Terms and Concepts

Staff Writers

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Here are four important health care delivery models that should be understood by all financial advisors, their clients, patients and the public:

1. PHYSICIAN ORGANIZATION (PO)

A PO is a group of physicians banding together, usually for the purpose of contracting with managed care entities, or to represent the physician component in a Physician Hospital Organization. The PO is a managed care contracting entity owned by and composed exclusively of physicians. The PO tends to be more tightly controlled in terms of members and adherence to treatment protocols than an Independent Physician Association. POs typically share information systems, claims-processing procedures, financial data, medical records, and other technical support functions.

2. PHYSICIAN PRACTICE MANAGEMENT CORPORATION (PPMC)

A firm that purchases physicians’ practices in exchange for a percentage of the gross receivables. The PPMC leases the office back to the doctor or employs the doctor on a salaried basis. The PPMC then contracts with the areas MCOs.

3. POINT OF SERVICE PLAN (POSP)

A type of managed care plan that allows members to choose whether to seek medical care within the plan’s network or seek medical care out of network at the point of service (i.e., at the time services are rendered). It allows members to pay little or nothing, if they stay within the established HMO delivery system. But, it also permits members to choose and receive services from an outside doctor, any time, if they are willing to pay higher co-payments, deductibles and possibly monthly premiums. It is also called an “open-ended” plan.

4. PREFERRED PROVIDER ORGANIZATION (PPO)

A PPO is a select, approved panel of physicians, hospitals, and other providers who agree to accept a discounted fee schedule for patients and to follow utilization review and pre-authorization protocols for certain treatments. It is a system in which a payer negotiates lower prices with certain doctors and hospitals. Patients who go to a preferred provider get a higher benefit — for example, 90% or 100% coverage of their costs — than patients who go outside the network.

Assessmentdhimc-book20

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Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated?

Link: https://healthcarefinancials.wordpress.com/2009/03/13/rip-retail-financial-services-industry/

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Understanding the Health Maintenance Organization Delivery Model

ho-journal8Defining Terms and Concepts

By Staff Writers

www.HealthcareFinancials.com

An HMO is a legal corporation that offers health insurance and medical care. It is a health care delivery system that provides comprehensive services for subscribing members in a particular geographic area. Most HMO care is provided through a managed network made up of MD/DOs, hospitals, and other allopathic/osteopathic professionals selected by the HMO. HMO enrollees are required to obtain care from this network of providers in order for their care to be covered, except in cases of emergency. All the care the members may need is paid for by the single monthly fee, plus nominal co-payments. HMOs typically offer a range of health care services at a fixed price (capitation).

Different Types

The types of HMOs are:

1. STAFF MODEL: Organization owns its clinics and employs its doctors.

2. GROUP MODEL: Contract with medical groups for services.

3. INDEPENDENT PHYSICIAN ASSOCIATION (IPA) MODEL: IPA contract that in turn contracts with individual physicians.

4. DIRECT CONTRACT or NETWORK MODEL: Contracts directly with individual physicians.

5. MIXED MODEL: Members get options ranging from staff to IPA models.

6. OPEN-PANEL MODEL: A managed care plan or HMO where members can see any provider for an extra premium cost.

Assessmentdhimc-book18

Link: www.HealthDictionarySeries.com

Conclusion

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Understanding Collateralized Mortgage Obligations

Defining Terms and Concepts for Medical Professionals

By Staff Reporters

www.HealthcareFinancials.comho-journal9

A CMO is a debt security backed by mortgages. These mortgage pools are usually separated into different maturity classes called tranches (from the French word for “slice”). The securities were issued by private issuers, as well as the Federal Home Loan Mortgage Corporation (Freddie Mac). As the mortgages were usually government-guaranteed, CMOs usually carried AAA ratings until their current financial meltdown. The early versions of CMOs were known as “plain vanilla,” but recent developments gave us PACs (planned amortization certificates) and TACs (targeted amortization certificates); among too many others. They were all variations on how principal repayments in advance of maturity date were treated.

Assessmentdhimc-book19

Link: www.HealthDictionarySeries.com

Conclusion

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Product DetailsProduct DetailsProduct Details

Become a Published Print Author with Us

The Business of Medical Practice [3rd Edition]

By Hope Rachel Hetico RN, MHA, CMP™

[Managing Editor]biz-book7

Dear Colleagues,

As you may know, we are commencing work on the third edition of our best selling book: The Business of Medical Practice

TOC 1st: http://www.amazon.com/Business-Medical-Practice-Maximizing-Doctors/dp/0826113117/ref=sr_1_8?ie=UTF8&s=books&qid=1231111232&sr=1-8

TOC 2nd: http://www.springerpub.com/prod.aspx?prod_id=23759

Invitation to Contribute

Accordingly, we would be honored for you to consider contributing a new or revised chapter, in your area of expertise, for a low-effort but high-yield contribution. Our goal is to help physician colleagues and management executives benefit from nationally known experts, as an essential platform for their success in the healthcare 2.0 business industry. Many topics are still available: [health accounting and costing; law, policy and administration; Medicare fraud and abuse; coding and insurance; HIT, grid and cloud computing; finance and economics, competitive models, collaboration and leadership, etc].

Support Always Available

Editorial support is available, and you would enjoy increasing subject-matter notoriety, exposure and public relations in an erudite and credible fashion. As a reader, or preferably a subscriber to the ME-P, your synergy in this space may be ideal. Time line for submission of a 5,000-7,500 word chapter is ample, and in a prose writing style that is “wide, not deep.” 

A Health 2.0 Initiative

And, be sure to address health 2.0 modernity. Update chapters from the second edition are also available. 

Definition: https://healthcarefinancials.wordpress.com/2008/09/12/emerging-healthcare-20-initiatives

Assessment

Please contact me for more details, if interested. A best selling-book is rare; while a third-edition volume even more so. Join us in this project. Regardless, we trust you will remain apostles of our core ME-P vision, “uniting medical mission and financial profit margin”, promoting it whenever possible.

Front Matter Link: frontmatter1advancedbusinessmedicine4 

Contact Info:

MarcinkoAdvisors@msn.com

770.448.0769

Conclusion

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More about Healthcare Organizations [Financial Management Strategies]

Our Print-Journal Preface

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

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

A Two-Volume Guide

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

What it is – How it works

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

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

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

www.HealthcareFinancials.com

Assessment

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

Visit and Order Now

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8 – 14th Street

Blaine, WA 98230

1-800-251-0381

orders@stpub.com

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Conclusion

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

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I Jealously “Shake my Fist” at Somnath Basu PhD

On CFP® Mis [Trust] – One Doctor’s Painful Personal Experience

[“So Sorry to Say it … but I Told You So”]

By: Dr David Edward Marcinko; FACFAS, MBA, CMP™

[Publisher-in-Chief]dem21

According to Somnath Basu, writing on April 6, 2009 in Financial Advisor a trade magazine, the painful truth is that many financial practitioners are merely sales people masquerading, as financial planners [FPs] and/or financial advisors [FAs] in an industry whose ethical practices have a shameful track record. Well, I agree, and completely. This includes some who hold the Certified Financial Planner® designation, as well as the more than 98 other lesser related organizations, logo marks and credentialing agencies [none of which demand ERISA-like fiduciary responsibility]. For more on this topic, the ME-P went right to the source last month, in an exclusive interview with Ben Aiken; AIF® of Fi360.com  

fp-book4

The CFP® Credential – What Credential?

Basu further writes that stockbrokers and insurance agents who earn commissions from buying and selling stocks, insurance and other financial products realize that a Certified Financial Planner® credential will help grow the volume of their business or branch them into other related and lucrative products and services. After all, there are more than 55,000 of these “credentialed” folks. And, this marketing designation seems to have won the cultural wars in the hearts and minds of an unsuspecting – i.e., duped public; probably because of sheer numbers. Didn’t a CFP Board CEO state that its’ primary goal was growth, a few years ago? Can you say “masses of asses”, as the oft quoted Bill Gates of Microsoft used to say when only 2,000 micro-softies defeated 400,000 IBMers during the PC operating system wars of the early 1980’s. Quantity, and marketing money, can trump quality in the public-relations business; ya’ know … if you repeat the lie often enough … yada … yada … yada! Yet, as the so-called leading industry designation, the CFP® entry-barrier standard is woefully low. Moreover, the SEC’s [FINRA] Series #7 general securities licensure sales examination is not worth much more than a weekend’s study attention, even to the uninitiated.

insurance-book2

Easy In – Worth Less Out

In our experience, we agree with Basu and others who suggest that scores of lightly educated, and sometimes wholly in-articulate and impatient individuals are zipping through the CFP® Board of Standards approved curriculum in three to six months of online, on-ground, or “self-study”. But, that some can do so without a bachelor’s degree when they join wire-houses and financial institutions, which cannot be trusted to adequately train them, is an abomination. And, even more sadly, some of these CFP™ mark-holders, and other folks, believe they have actually received an “education” from same. Of course, their writing skills are often non-existent and I have cringed when told that, in their opinion, advertiser-driven trade magazines constitute “peer-reviewed” and academic publications. Incidentally, have you noticed how thin these trade-rags are getting lately? Much like the print newspaper industry, are they becoming dinosaurs? One agent even told me, point-blank, that his CLU designation was the equivalent of an “academic PhD in insurance.” This was at an industry seminar, where he thought I was a lay insurance prospect.

THINK: No critical thinking skills.

biz-book4

Education

There is another sentiment that may be applied in many of these cases; “hubris.” I mean, these CFP® people … just don’t know – how much they don’t know.”  The very real difference between training versus education is unknown to many wire-houses and FAs, isn’t it? And, please don’t get me started on the differences in pedagogy, heutagogy and androgogy. Moreover, it’s sad when we see truly educated youngsters become goaded by wire-houses into thinking that these practices are de-rigor for the industry. One such applicant to our Certified Medical Planner™ program, for example, had both an undergraduate degree in finance and a graduate degree in economics from the prestigious Johns Hopkins University – in my home town of Baltimore, MD [name available upon request]. He was told, in his Smith Barney wire-house training program, to eschew CMP™ accountability and RIA fiduciary responsibility, when working with potential physician and lay clients; but to get his CFP® designation to gather more clients. To mimic my now 12 year-old daughter; it seems that: SEC Suitability Rules – and – Fiduciary Accountability Drools. And, to quote Hollywood’s “Mr. T”; I pity the fools, er-a, I mean clients. But, T was an actor, and this is serious business.

cmp-logo1

Of CEU Credits and Ethics

Beside trade-marks and logos, we are all aware that continuing education, and a code of ethics, is another important marketing and advertising component of state insurance agents and CFP licensees. It’s that old “be” – or “pretend to be” – a trusted advisor clap-trap. Well, I say horse-feathers for two reasons. First, both my insurance and CFP® Continuing Educational Unit [CEU] requirements were completed by my daughter [while age 7-10], by filling in the sequentially identical and bubble-coded, multiple-choice, answer-blanks each year. Second, this included the mandatory “ethics” portions of each test. When I complained to my CEU vendor, and state insurance department, I was told to “enjoy-the-break.”  My daughter even got fatigued after the third of fourth time she took the “home-based tests” for me.  After I opened my big mouth, the exact order of questions was changed to increase acuity, but remained essentially the same, nevertheless. My daughter got bored, and quit taking the tests for me, shortly thereafter. She always “passed.”dhimc-book3

Thus, like Basu, I also find that far too many financial advisors are unwilling to devote the time necessary to achieve a sound education that will help attain their goals, and would rather sell variable or whole life products than simple term life, even when the suitability argument overwhelmingly suggests so, for a higher payday. We not only have met sale folks without undergraduate degrees, but also too many of those with only a HS diploma, or GED. Perhaps this is why a popular business truism suggests that the quickest way for the uneducated/under educated class to make big bucks, is in sales. Just note the many classified ads for financial advisors placed in the newspaper job-section, under the heading “sales.” Or, in more youthful cultural terms, “fake it – until you make it.”

Of the iMBA, Inc Experience

According to Executive Director Ann Miller RN MHA, and my experience at the Institute of Medical Business Advisors, Inc:

“Far too many financial advisors who contact us about matriculation in our online Certified Medical Planner™ program – in health economics and management for medical professionals – don’t even know what a Curriculum Vitae [CV] is? Instead, they send in Million Dollar Roundtable awards, Million Dollar Producer awards, or similar sales accomplishments as resume’ boosters. It is also not unusual for them to list some sort of college participation on their resumes, and websites, but no school affiliation or dates of graduation, etc. And, they become furious to learn that we require a college degree for our fiduciary focused CMP™ program, and not from an online institution, either. The onslaught of follow-up nasty phone-calls; faxes and emails are laughable [frightening] too.”  

www.MedicalBusinessAdvisors.com

Assessment

More often than not, it is the financial institutions that FAs and CFP™ certificants’ work for that reward sales behavior with higher commissions, rather than salaries; which encourage such behavior and create the vicious cycles that are now the norm.

THINK: ML, AIG, Citi, WAMU, Wachovia, Hartford, Prudential, etc.

Note: Original author of Restoring Trust in the CFP Mark, Somnath Basu PhD, is program director of the California Institute of Finance in the School of Business at California Lutheran University where he’s also a professor of finance. He can be reached at (805) 493 3980 or basu@callutheran.edu. We have asked him to respond further.

My Story: I am a retired surgeon and former Certified Financial Planner® who resigned my “marketing trademark” over the long-standing fiduciary flap. I watched this chicanery for more than a decade after protesting to magazines like Investment Advisor, Financial Advisor, Registered Rep, Financial Planner, the FPA, etc; up to, and even including the CFP® Board of Standards; to no avail. Feel free to contact me for a copy of a 43 page fax, and other supportive documentation from the CFP® Board of Standards – and their outsourced intellectual property attorneys – over a Federal trademark infringement lawsuit they tried to institute against me for innocent website errors placed by a visually impaired intern. Obviously, they disliked the launch of our CMP™ program. As a health economist and devotee of Ken Arrow PhD, I polity resigned my license, as holding no utility for me, to the shocked CFP Board. They later offered to consider re-instatement for a mere $600 fee with letter of explanation, to which I politely declined. Of course, my first thought after living in the streets of South Philadelphia while in medical school, during the pre-Rocky era, was to say f*** off – but I didn’t. Nevertheless, I still seem to be on their mailing list, years later. No doubt, the list is sold, and re-sold, to various advertisers for much geld. And, why shouldn’t they; an extra bachelor, master and medical degree holder on their PR roster looks pretty good. I distrust the CFP® Board almost as much as I distrust the AMA, and its parsed and disastrous big-pharma funding policies. Right is right – wrong is wrong – and you can’t fool all of the people, all of the time, especially in this age of internet transparency.

Shaking my Fist at Somnath … in Envy

And so, why do I shake my fist at Somnath Basu? It’s admittedly with congratulations, and a bit of schadenfreude, because he wrote an article more eloquently than I ever could, and will likely receive much more publicity [good or slings-arrows] for doing so. You know, it’s very true that one is never a prophet in his own tribe. Oh well, Mazel Tov anyway for stating the obvious, Somnath. The financial services industry – and more specifically – the CFP® emperor have no clothes! Duh!

ho-journal5

Good Guys and White Hats

Now that Basu’s article has appeared in Financial Advisor News e-magazine, the other industry trade magazines are sure to follow the CFP® certification denigration reportage, in copy-cat fashion. And, the fiduciary flap is just getting started. This is indeed unfortunate, because I do know many fine CFP® certificants, and non-CFP® certified financial advisors, who are well-educated, honest and work very diligently on behalf of their clients. It’s just a shame the public has no way of knowing about them – there is no white hat imprimatur or designation for same – most of whom are Registered Investment Advisors [RIAs] or RIA reps. For example, we know great folks like Douglas B. Sherlock MBA, CFA; Robert James Cimasi MHA, AVA, CMP™; J. Wayne Firebaugh, Jr CPA, CFP®, CMP™; Lawrence E. Howes MBA, CFP®; Pati Trites PhD; Gary A. Cook MSFS, CFP®, CLU; Tom Muldowney MSFS, CLU, CFP®, CMP™;  Jeffrey S. Coons PhD, CFP®; Alex Kimura MBA, CFP®; Ken Shubin-Stein MD, CFA; and Hope Hetico RN, MHA, CMP™; etc. And, to use a medical term, there are TNTC [too many, to count] more … thankfully!

Conclusion

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  Product DetailsProduct Details

Product Details

Impact of Size on Mutual Fund Performance

Vital Information for Doctors to Consider

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

[By Professor Hope Rachel Hetico; RN, MHA, CMP™]dave-and-hope3

The actual size of a mutual or index fund, in terms of amount of assets, and the growth rate of a fund are the two aspects of size to consider. The impact of size on mutual fund performance varies—it can be negative, neutral, or positive. Size affects different types of funds differently; it also affects the manager’s ability to achieve objectives. Monitor size changes and make investment decisions accordingly.

Economies of Scale

A relatively large amount of assets available to a portfolio manager presents various economies. The costs at most funds (e.g., expense ratios) are reduced as a percentage of net asset value as the fund grows. Expense ratios can have a major impact on performance. In addition to being an effect of size, low fees can cause size changes. Funds do at times waive some fees to attract assets.

Asset Base

A larger asset base provides more liquidity to a fund. With more assets, the manager can buy more shares and more stocks. Transaction costs are reduced if higher trading volumes are achieved. A larger asset base also can reduce relative tax costs. Realized but undistributed capital gain can be spread over more shares at the time of year-end distribution. A larger asset base and manager success attracts higher-caliber managers to the management team.

fp-book20

Fund Growth

Growth of fund assets impairs certain funds more than others. Generally, bond funds are less affected by asset growth and size than equity funds. Growth may have a positive impact on bond funds because buying bonds of similar characteristics further diversifies credit, event, and other risks. Equity funds that invest in larger capitalization stocks can be less affected than funds buying less liquid small-cap stocks. (This is so because funds usually limit their investments in a single company, i.e., many funds will not buy more than 5% of a specific company. Five percent of a small company uses up less cash than 5% of a large company. Therefore, a small-cap fund is more likely to exhaust its choice of available companies sooner than a large-cap fund. A large-cap fund could increase its investment to a 5% level, whereas a small-cap fund may already be fully invested in the companies the manager likes to own.)

Growth Rate

The rate of growth can affect performance. Rapid growth may mean that a large portion of the portfolio remains un-invested. A rapidly growing growth-type equity fund with a high percentage of cash earns lower returns in a rising market than a fully invested fund. With rapid growth, the fund may not provide pure exposure to the desired asset class. At a certain point, however, fund asset growth impairs the manager’s ability to achieve objectives. For this reason, funds often close to new investors or to new investment once they have reached a certain size. Growth affects managers in many ways. Many fund managers or teams of managers direct a number of funds and possibly even private accounts. As the fund grows, managers are spread thin and may have difficulty in reacting quickly or efficiently to changing market conditions. Managers may need to hire assistant portfolio managers or delegate work to analysts or other employees. As a result, the manager manages people, administration, or internal quality control systems rather than studying companies or investment strategies. Also, a manager may become complacent in periods of rapid asset growth. Such growth can mean their own compensation is substantially greater, which may in turn change the manager’s motivation. Rapid growth often changes a fund because there are not enough opportunities to invest in the targeted securities. For example, a fund can change from aggressive to conservative, small cap to large cap. Managers may have to slow trading or increase liquidity in the portfolio to prevent this occurrence.

Meaningful Positions Difficult

Rapid growth or a large asset base can prevent managers from taking meaningful positions in market sectors they believe will outperform others. Smaller funds are more flexible and may take advantage of opportunities or liquidate unwanted positions faster than larger funds. A large fund that owns a significant position will negatively affect a security’s market price if it unloads shares all at one time. Rapid growth also impairs research of funds, affecting an investor’s choice of funds. A fund with outstanding performance over the past 5 years and a $150 million asset base may be much different when its base grows to $1 billion; at that point, it may no longer be the “right choice” for an investor.

insurance-book9Asset Declinations

Just as rapid asset growth affects performance, a rapid decline of fund assets also may impact performance. Significant quantities of redemptions over short periods force managers to liquidate security positions, often at the wrong time (i.e., they would rather be buying in a declining market than selling to accommodate redemptions). To prevent this scenario, some funds have redemption charges to discourage investors from such short-term decisions. Such environments can negatively impact bond funds as easily as equity funds. Large redemptions compound the effect of declining fund net asset values.

What a Doctor-Investor Can Do?

What can physician-investors do to avoid negative effects on investment? Avoid overloading a portfolio with hot, rapidly growing funds, if possible. Generally, size should be a neutral factor for most bond funds. Small and/or aggressive equity funds can be affected by growth, however. Emphasize funds that promise to close to new investors after assets reach a certain size. Once a fund becomes large, monitor it closely for problems caused by the growth. If there is a better, smaller fund, it may be wise to change. Also, closed-end funds are always a possibility. These funds have a major advantage in that their asset base is a factor of growth in security values, not new investment (unless the fund makes a secondary stock offering). Closed-end managers work with a finite portfolio, which reduces the problem of sudden asset growth.

Assessment

To the extent that a lack of SEC and FINRA over-sight, and the recent financial, insurance and banking meltdown has affected the above; such investing is left up to the doctor’s discretion and personal situation.  When it comes to the financial services product sales industry; always remember “caveat emptor” or “buyer-beware.”

Disclaimer: Both contributors are former licensed insurance agents and financial advisors.

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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More JAMA [Hypocritical] Censorship on Big-Pharma Funding

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Janus-Like Opposing Views Becoming Contentious

[By Staff Reporters]

mac-runningAccording to Tracy Staton, the Journal of the American Medical Association may be fighting to keep long-running internal arguments over conflicts-of-interest with big pharma a secret. But, in public, it’s advocating strict limits on industry funding for medical associations.

JAMA Proposals

A set of proposals published recently in JAMA, calls for associations such as the American Society of Clinical Oncologists, to refuse general budget support from drug and device companies. Currently, many specialty physicians’ groups are partly funded by industry. Companies also sponsor conferences, physician fellowships and buy ads in the societies’ journals. The proposed guidelines would allow associations to continue to accept industry advertising and to allow industry-sponsored booths at conferences.

Distinction

The key distinction, the article’s lead author said, is that ads and booths are clearly presenting a company’s point of view. “You can read the ads, skip the ads, but there’s nothing hidden,” David J. Rothman, a professor at the College of Physicians and Surgeons at Columbia University, told the Wall Street Journal. “What I don’t like is when I can’t tell if what I’m hearing is science, or marketing in the guise of science.”

Opposing Viewpoints

But others disagree. For example, the American College of Cardiology’s chief allegedly told the paper that industry funding has “zero impact on the content of any program here.” And PhRMA said that the guidelines could limit the information doctors receive. “It’s important to realize that [doctors] have their own sense of integrity,” a PhRMA spokeswoman.

Assessment

ME-P publisher, Dr. David Edward Marcinko, on the other hand, believes that Columbia University’s torturous verbal parsing is

“merely a distinction with little substantive difference.”

Link:http://online.wsj.com/article/SB123854648226076095.html

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? Do you agree with the current – but aging medical establishment – or the emerging generation of young and idealistic medical students and physicians who increasingly abhor the big-pharma practices? Is this another example of tawdry JAMA censorship? Is the AMA running away from its moral ethos of professional integrity?

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Impact of Performance Fees on Mutual Funds and Physician Portfolios

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More Complex than Realized by Some Doctors

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

[By Professor Hope Rachel Hetico; RN, MHA, CMP™]dave-and-hope4

Physician-investors may find themselves paying advisory fees, brokerage commissions, and other sales charges and expenses. All of these layers of expense can reduce or eliminate the advantage of professional management, if not monitored carefully. Also, fees can have a major impact on investment results. As a percentage of the portfolio, they normally range from low of 15–30 basis points (or .15% to .30%, a basis point is one one-hundredth of one percent) to a high of 300–400 basis points or even higher.

Charges are Universal

All portfolio managers, mutual funds, and investment advisors charge fees in one form or another. Ultimately, they must justify their fees by creating value added, or they would not be in business. Value added includes tangibles, such as greater investment return, as well as intangibles, such as assurance that the investment plan is successfully implemented and monitored, investor convenience, and professional service.

Comparisons Required

Always compare investment performance of funds or managed accounts after fees are deducted; only then can adequate comparisons be made. Also, compare fees within asset classes. Management fees and expenses of investing in bonds or bond funds are much different than the fees of investing in, for example, small companies or emerging market stocks. Whereas 100–200 basis points of fees may be appropriate for an equity portfolio or fund, similar charges may offset the advantages of a managed bond portfolio. With managed bond portfolios, real bond returns have limited long-term potential, because returns are ultimately based on interest rates. For example, if a 3% real (i.e., after inflation) return is expected, 200 basis points in fees may produce a negative after-tax result: 3% real return minus 2% fees minus 10% taxes equals a negative 9% total return.fp-book22

Sales Charges

Mutual funds (and some private portfolio managers) charge sales charges to sell or “distribute” the product. Investors who buy funds through the advice of brokers or “commission based” financial planners will pay a sales load. The many combinations of sales charges fall into three basic categories: front-end, deferred (or back-end), and continuous.

Front-End Fees

Front-end fees are a direct assessment against the initial investment and are limited to a maximum of 8.5%. They usually are stated either as a percentage of the investment or as a percentage of the investment, net of sales charges. For example, a 6% charge on a $10,000 investment is really a $600 charge to invest $9,400 or a real charge of 6.4%. Many low-load funds charge in the range of 1% to 3%. Rather than pay brokers or other purveyors, these fund companies or sponsors use the charges to offset selling or distribution costs. Although rare, some funds charge a load against reinvested dividends.

Deferred Charges

Deferred charges (or back-end loads, or redemption fees) come in many forms. Often, the longer the investor stays with the fund the smaller the charge is upon fund redemption. A typical sliding scale used for deferred charges may be 5-4-3-2-1, where redemption in year 1 is charged 5%, and redemption in year 5 is charged 1%; after year 5, there are no sales charges. Sometimes deferred charges are combined with front-end charges.

Redemption Fees

Certain quoted redemption fees may not apply after a period, such as one year. Funds often use such fees to discourage the trading of funds. Frequently, these charges are paid to the fund itself rather than to the fund management company; or broker. Long-term physician investors actually benefit from this fee structure; short-term shareholders who redeem shares bear the additional liquidation costs to satisfy redemption requests.

Continuous Charges

Continuous sales charges, known as 12b-1 fees for the SEC rule governing such charges, represent ongoing charges to pay distribution costs, including those of brokers who sell and maintain accounts, in which case they are known as “trail commissions.” The fund company may be reimbursed for distribution costs as well. In the prospectus, funds quote 12b-1 charges in the form of a maximum charge. This does not mean that the full charge is incurred, however. For example, a fund with a .75% 12b-1 approved plan may actually incur much lower expenses than .75%. Compared to front-end charges, a .75% per year sales charge of this type could be more costly to investment performance, given enough time.

Sales Loads

Portfolio managers can charge sales loads as well, usually in the form of a traditional WRAP fee arrangement (the investor pays a broker an all-inclusive fee that covers portfolio manager fees and transactions costs). No-load funds can be purchased through brokers or discount brokerage firms. The broker charges a commission for such purchases or sales.

Management Advisory Fees

Private account managers and mutual funds charge a fee for managing the portfolio. These fees typically range between 25 and 150 basis points. Bond funds tend to charge in the range of 25 to 100 basis points, and equity funds charge 75 to 150 basis points. Fees charged by private account managers usually are higher because of the direct attention given to a single doctor client. These managers do not pass along additional administrative costs, however, because they pay them out of the management fee. These management fees come in many forms. Tiered fees can charge smaller accounts a higher fee than larger accounts. Mutual funds often charge “group fees”: a fund family may tier its fee structure to encompass all funds offered by the fund family or by a group of similar funds (such as all international equity funds). Performance fees, although subject to SEC regulations, may be charged as well. A performance fee may be charged if the manager exceeds a certain return or outperforms a particular index or benchmark portfolio.

Administrative Expenses and Expense Ratios

Most private managers are compensated with higher management fees, as mentioned above. Therefore, many private accounts usually do not incur separate administrative expenses. Some management firms charge custodial fees or similar account maintenance fees. Mutual funds incur a number of administrative expenses, including shareholder servicing, prospectuses, reporting, legal and auditing costs, and registration and custodial costs. Mutual funds report these expenses and management fees as an expense ratio—the ratio of expenses to the average net assets of the fund. Expense ratios also include distribution costs or 12b-1 charges.insurance-book10 

Brokerage Commissions

Almost all buyers and sellers of securities incur brokerage commissions. Private “wealth managers” usually provide commission schedules to prospective physician-investors or current clients. Some private managers charge higher management fees and a discounted commission schedule, while others charge lower fees and higher commissions. These combinations of management and commission fees make comparison of prospective managers’ cost structures a difficult task. Most portfolio managers obtain research from brokerage firms, which can affect the commission relationship between broker and manager. Reduced commission schedules exchanged for information are known as “soft dollar costs.” Mutual funds may negotiate similar reduced commission schedules. In this regard, more-competitive brokerage firms can charge lower fees to investors. Commissions are not part of the expense ratio, because they are a part of the security cost basis. Firms with higher portfolio turnover are more likely to have higher commission costs than those with low turnover. Asset class impacts such costs as well. For example, small-cap stocks may be more expensive than large-cap stocks, or foreign bonds may be more expensive than domestic bonds.

Total Cost Approach

To arrive at a relevant comparison of fees among funds and managers, and to see what the total effect of fees on investment performance is, analyze the various charges on a net present value basis. Begin with a given investment amount (e.g., $10,000) and factor in fees over time to arrive at the present value of those fees. Present the comparisons in an easy-to-use table.

Sources of Fee Information

Consult the mutual fund prospectus for fee information. The prospectus has a fund expenses section that summarizes sales charges, expense ratios, and management fees; it does not cover commissions, however. Expense ratios usually are reported for the past 10 years. Commission or brokerage fees are more difficult to find. The statement of additional information and often the annual report disclose the annual amounts paid for commissions. When the total commission paid is divided by average asset values a sense of commission costs can be determined. Private wealth managers disclose fee structures in the ADV I filed with the SEC. Managers must disclose these fees to potential and current clients by providing either ADV Part II or equivalent form to the investor.

Reporting Services

Reporting services, such as Morningstar and Lipper, provide similar information from their own research of mutual funds. These services can be extremely beneficial, because fee information is summarized and often accounted for in the reports’ investment return calculations. This helps the investor and planner make good comparisons of funds. Information services that cover private managers provide information, primarily about management fees.

Assessment

To the extent that online trading, deep discount brokerages, lack of SEC and FINRA oversight, and the recent financial, insurance and banking meltdown has affected the above, it is left up to your discretion and personal situation. Generally, all fess are, and should be, negotiable.

Disclaimer: Both contributors are former licensed insurance agents and financial advisors.

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Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? Reviews from current journal-guide subscribers are encouraged and appreciated.

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Is JAMA Censoring Physician Dissent?

Allegedly Stoops to “Name-Calling”

By Dr. David Edward Marcinko; MBA, CMP™dem24

According to the Wall Street Journal Health Blog, Jonathan Leo, a professor of neuro-anatomy from a small university in Tennessee, critiqued a study published in the Journal of the America Medical Association [JAMA], and pointed out an association between the study’s author and a pharmaceutical company. He posted his thoughts on the website of the British Medical Journal [BMJ].

JAMA Responds

According to the report, a none-too-happy Leo then received calls from JAMA’s executive deputy editor, one Mr. Phil Fontanarosa. And surprisingly, Editor-in-Chief Dr. Catherine DeAngelis, MD got involved by asking Leo’s superiors to retract his post from the BMJ’s site. Sound familiar ME-P readers? According to Keven Pho MD, the WSJ called Dr. DeAngelis for comment, and this is how the interview allegedly went:

“This guy is a nobody and a nothing.”

She said of Leo.

“He is trying to make a name for himself. Please call me about something important.”

She added that Leo

“Should be spending time with his students instead of doing this.”

When asked if she called his superiors and what she said to them, DeAngelis supposedly said,

“It is none of your business.”

Environmental Scanning

One can only wonder if the AMA has adopted the strategy of former CDC Director Julie Gerberding, of Atlanta, GA. Local gossip suggests that one initiative under her noxious leadership was her so-called policy on “environment-scanning” or, monitoring the news-media, internet space, blogs, wikis and other venues to identify “emerging threats to the agencies” reputation.” WOWSA!

Link: https://healthcarefinancials.wordpress.com/2009/02/05/goodbye-julie-gerberding-md/

An Alternative Theory

My alternative opinion is the AMA might be taking censorship lessons from Blue Cross and Blue Shield of New Mexico [BCBSNM], and its’ public-relations representative and former reporter, Ross Blackstone of the Health Care Service Corporation [Blue Cross and Blue Shield of Illinois, New Mexico, Oklahoma and Texas].

Monitoring the ME-P?

Or, perhaps they are reading [Think: monitoring] this Medical Executive-Post itself? They may even be teaming up with Becky Kenny [media relations specialist with Blue Cross and Blue Shield of New Mexico] who goaded [threatened?] the trade magazine ModernHealthcare. As ME-P readers know, ModernHealthcare is an advertiser-driven media outlet that removed a perfectly acceptable post of diverging eHR opinion from its blogsite?

Industry Shame

Such acquiescence is both a sign of shameful health insurance industry [BCBSNM] heavy-handedness, and poor journalistic ethos from ModernHealthcare’s leadership. The BCBSNM public relations hacks, and media representatives, also appear as clueless shills who are no-doubt glad they are employed in these troubling economic times.

In other words, do they do what they are told? Jump Rover! Fetch Fido; etc! Or; are they more like the innocent child who spills grape juice on a white carpet? Let’s simply forgive them for their brainless duplicity. Yet, MH capitulated; how unfortunate!

Link: https://healthcarefinancials.wordpress.com/2009/03/04/don%e2%80%99t-rush-ehrs/

Doctors Censoring Patients [The Retro-Evolution]

By the way:

“What’s up with all this censoring?

The Internet has been publically available to the masses since 1995, and I was using electronic bulletin boards [eBBs] years before then. The next thing you know, doctors will start trying to censor the opinion of their patients, much like customers rate restaurants.

Ops! My bad! This has already occurred. Sorry!

The ironic thing here is that patients don’t know about quality care. But, they do know if they’ve been kept too long in the waiting room; or, if the doctor’s office staff was surly; or, if the doctor had a miserable bedside manner. So, the doctors are really being rated on their personality; not their medical acumen. I pity the fools. These medical guys, and healthcare guru gals, just don’t seem to realize that “perception is reality.”  But, they sure feign outrage at poor patient reviews.

Link: https://healthcarefinancials.wordpress.com/2009/03/02/doctors-censoring-patients/

Assessment

From my perspective, this is another public-relations disaster for JAMA, and especially Dr. DeAngelis, who must have known she was on the record with a national newspaper. After all, she is the editor of JAMA. Maybe not however, as we have previously opined that professional experts are not necessarily professional journalists.

Link: https://healthcarefinancials.wordpress.com/2009/03/09/healthcare-experts-versus-health-journalists

Of Cover-Ups and Crimes

“But, one must still wonder aloud; is this cover-up becoming worse than the proverbial crime?”

Resorting to personal attacks is somewhat unbecoming of the editor-in-chief of a prestigious medical journal, and reflects poorly on JAMA; don’t you think? Then again, JAMA and the AMA itself, is not as prestigious as it once was; is it?

In fact, when I asked ME-P managing-editor and Professor of Health Administration, Hope Rachel Hetico; RN, MHA, CMP™ to opine on admitted third-party limited information; she graciously replied with the utmost gentleness:

“With less than 25% of the nation’s MDs in the AMA; JAMA is probably still somewhat prestigious to those who don’t know any better; but many of us do know better. The older generation just needs some-time to catch up to modernity, and transparency – or resign. The top-down and command-control model of leadership is long gone – please be patient with them.”

Link: www.CertifiedMedicalPlanner.com

Link: www.MedicalBusinessAdvisors.com

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Should Catherine DeAngelis MD resign over this incident? Please criticize or defend her actions. Is healthcare industry censorship on the rise – or is the industry just following-the-money? What do you think of ModernHealthcare or BCBSNM?

Is personal integrity – or scrutiny – the reason Joseph Biederman MD [Harvard’s controversial chief of pediatric psychopharmacology] ended his ties to the pharmaceutical industry recently for diagnosing bipolar disorder in children [as well as for the nature of big-pharma’s support behind his research]? Please opine.

Industry Indignation Index: 63

Disclaimer: I am not a member of the AMA. But, for a decade I was on the editorial staff of both a leading national medical, and surgical journal, back-in-the-day. I am currently the Editor-in-Chief of Healthcare Organizations [Financial Management Strategies] a 1,200 page, quarterly premium print-journal, available on a subscription basis.

Link: www.HealthcareFinancials.com

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About Sharkey, Howes & Javer

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Independent Medical Practitioner as Solo Primary Care Surrogate

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Doctors Facing a Bleak Future Business and Financial Planning Model

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dem2

According to Physicians News, on March 19, 2009, the demand for family physicians is growing. Proposals for health system reform focus on increasing the number of primary care physicians in America. Yet, despite these trends, the number of future physicians who chose family medicine dipped this year, according to the 2009 National Resident Matching Program. What gives?

NRMP

The National Resident Matching Program [NRMP] recently announced that a total of 2,329 graduating medical students matched to family medicine training programs. This is a decrease in total student matches from 2008, when 2,404 family medicine residency positions were filled.

Primary Care Demand Explodes

Meanwhile, demand for primary care physicians continues to skyrocket. For example, in its most recent recruitment survey, Merritt Hawkins, a national physician recruiting company, reported primary care physician search assignments had more than doubled from 341 in 2003 to 848 last year. 

The Decline of Solo Medical Practitioners

Regular readers and subscribers to this Medical Executive- Post are aware of the declining number of solo medical practitioners; we have been sounding the alarm here, in our books, journal, speaking engagements and elsewhere for years now.dhimc-book4

In fact, the statistic that we often cite is that more than 40% of the nation’s physicians are employed doctors; not employers as in the past. This business model shift has occurred over the past decade or so, and has accelerated of late. The decline in solo and independent doctors has occurred elsewhere as well, but much more slowly [i.e., dentistry, podiatry and osteopathy] as these specialties have been somewhat isolated from the traditional allopathic mainstream.

Going forward, this solitary model seems to be a good thing, and a fortunate result of the un-intended consequence of previously keeping these folks out of the healthcare mainstream.

The Decline of Independent Medical Practitioners

Now, in the March 2009 issue of Healthcare Finance News, we learn that the number of hospital owned physician practices has been climbing over the last four years, according to the Medical Group Management Association [MGMA]. Think: PHOs back-in-the-day. ho-journal3

And, while this trend only marginally affects patients and patient care, it is quite disruptive to physicians, their families, personal wealth accumulation, retirement and estate planning endeavors.

For example, according to Professor Hope Rachel Hetico, RN, MHA, CMP™ of our firm www.MedicalBusinessAdvisors.com

“The professional good-will valuation component of a medical practice is being decimated. Today, some practices are being bought and sold for tangible asset value, only.

Assessment

Therefore, allow me to identify this emerging trend which suggests independent medical practice as reflective of solo primary medical care. In other words, as independence goes the way of the “dodo-bird”, so goes primary care practitioners precisely at a time when the later is needed more than the former.

Why? Employed doctors stay that way by making money for their employer and hospital-bosses. Specialists make more money than primary care doctors. So, if you want to stay an employed doctor; which specialty would you pursue?

Answer: The NRMP class this year spoke out loud and clear. Any specialty but primary care!

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Conclusion

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This Time the Hospital Financial Crisis is Different

Oh Really … No so Fast!

Submitted by J. Wayne Firebaugh, Jr; CPA, CFP®, CMP™ho-journal2

Dr. Malcolm T. MacEachern, Director of Hospital Activities for the American College of Surgeons, presciently observed that:

… Our hospitals are now involved in the worst financial crisis they have ever experienced. It is absolutely necessary to all of us to put our heads together and try to find some solution. If we are to have effective results we must have concerted and coordinated immediate action. … Repeated adjustments of expenses to income have been made. Never before has there been such a careful analysis of hospital accounting and study of financial policies. It is entirely possible for us to inaugurate improvements in business methods which will lead to greater ways and means of financing hospitals in the future … It is true that all hospitals have already trimmed their sales to better meet the financial conditions of their respective communities. This has been chiefly through economies of administration. There has been more or less universal reduction in personnel and salaries; many economies have been affected. Everything possible has been done to reduce expenditures but this has not been sufficient to bring about immediate relief in the majority of instances. The continuance of the present economic conditions will force hospitals generally to further action. The time has come when this problem must be given even greater thought, both from its community and from its national aspect…

Source:  Steinberg, C. Overview of the US Healthcare System; American Hospital Association 2003.

Many hospital CXOs, healthcare administrators and physician executives would agree that Dr. MacEachern accurately describes today’s healthcare funding environment. However, they might be startled to learn that Dr. MacEachern made these observations in 1932! There is the old truism that there is nothing new under the sun.

American Hospital Association Statistics

Healthcare statistics suggested that the financial crisis is much the same today as it was for hospitals during the Great Depression. The American Hospital Association’s (AHA) reported gloomy statistics for hospitals include:

  • In 2001, 29% of hospitals had negative total margins.
  • Approximately $101.3 billion of uncompensated care was provided between 1997 and 2001 with an average annual increase of 16% during that time period.
  • Emergency departments in 62% of all hospitals report operating at, or over, capacity.
  • Technology costs are soaring as traditional technologies such as X-Ray machines, for $175,000, are being replaced by contemporary technologies such as CAT Scanners at $1 million that are in turn being replaced by CT Functional Imaging with PET Scans costing $2.3 million. Even such a “simple” instrument as a scalpel that costs $20, is being replaced by equipment for electrocautery costing $12,000, that is then being replaced by harmonic scalpels costing $30,000.
  • Between 2000 and 2002, 33% of hospitals reported increases in liability premiums of more than 100%.
  • The average age of hospital plants has increased 21% from 7.9 years to 9.6 years in just one decade.
  • In the four years ending 2002, hospital bond downgrades have outpaced hospital bond upgrades by almost 5 to 1.

Editor’s Assessment

As editor’s of the premium subscription, two volume, 1,200 pages, institutional print-guide Healthcare Organizations [Financial Management Strategies], we prefer engaged readers and contributors like Mr. Firebaugh, who demand and create compelling content like the above. Please review these links for same.

www.HealthcareFinancials.com

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Conclusion

Always beware the words: “this time it’s different;” as it rarely is. And so, your thoughts and comments on this Medical Executive-Post are appreciated. Please opine and subscribe to the ME-P here; it’s fast, free and secure.

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Consulting for the ME-P

Talk to Us

By Ann Miller; RN, MHA

[Executive Director]solo-consultant

We would like to better understand who is visiting the Medical Executive-Post, and what you like, or do not like, about our blog site, print journal and/or communications forum. Most of all, we wish to know who is just visiting versus who is posting, commenting and subscribing; and why?

Assessment

Your responses are confidential, and will only be used for internal use to improve the website blog. We will not sell your information to anyone, ever!

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Please send in your considered responses to me at: MarcinkoAdvisors.@msn.com

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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Healthcare Experts versus Health Journalists

Appreciating the Distinction

By Dr. David Edward Marcinko; MBA

Publisher-in-Chiefdr-david-marcinko2

As the healthcare reform, and eMR controversy unfolds, I am struck by the more-than-linguistic distinction between the terms “healthcare expert” and “health journalist.”

Link: www.HealthDictionarySeries.com

Historical Perspectives

Historically, as a peer-reviewed writer, editor, medical expert witness and now electronic publisher for almost four decades, I always sought the journalist’s title. I think the longing began in my formative years when I read that after the French Revolution, Sir Edmund Burke, looked up at the Press Gallery of the House of Commons, and said, ‘”Yonder sits the Fourth Estate, and they are more important than them all.”

Link: www.MedicalBusinessAdvisors.com

Expert versus Reporter

However, I no longer covet this title. Why? I’ve finally realized that it is far better to be a real subject-matter expert, than a journalist [read reporter]. The former creates news through knowledge, informed deeds and thought-leadership; while the later simply writes about various topics without same.

Link: www.HealthcareFinancials.com

Assessment

And so, in light of the eHR controversy, perhaps a word to the “wise” AMA, ADA, APMA, AOA and CCHIT leadership is sufficient; with apologies to Sir Edmund? Regardless of specialty, our guiding medical principles should always be; Omnia pro Aegroto [all for the patient].

Link: https://healthcarefinancials.wordpress.com/2009/01/31/about-the-ahcj/

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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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Debt Consolidation for Physicians

Advantages and Disadvantages

By Staff Reportersfp-book5

The main advantage of debt consolidation is that it allows a doctor to make one payment instead of many, and this helps avoid late fees for missed payments. The doctor may save time by having to make only one payment per month instead of many.

Other Advantages

Another advantage is that debt consolidation promotes self-discipline by transferring credit card debt (and other lines of credit) that does not require mandatory principal payments into a fixed-term loan – with mandatory payments that include both principal and interest. This is a useful tool for doctors who may find it difficult to make more than the minimum payments on their loans because they spend too much. It should be obvious that budgeting should go hand-in-hand with this process, because if the doctor continues to spend at the former level, yet now has a mandatory payment, the result can be financially devastating.

A final advantage to debt consolidation is it may result in a lower overall interest rate. This is, of course, conditional on the lender providing the consolidation.

Disadvantages

One disadvantage of debt consolidation is that it can lock a doctor into mandatory payments. Depending on the situation, this can be either a blessing or a curse. It becomes a curse when the fixed payments are so high that he/she can no longer make the full debt payments each month. Depending on the lender, and the terms of the consolidation loan, this could result in the loan being called. The effects of this are obviously detrimental to the doctor.

Other Disadvantages

A second disadvantage is that the doctor loses flexibility when he or she takes on a fixed payment that is larger than the combination of all smaller minimum payments. The fixed-payment schedule becomes detrimental when h/she has an unexpected reduction in income. The doctor without a fixed-payment schedule can increase payments to many small individual loans, and if income reduction occurs, drop the payments back down to the lower level. Then; when normal levels of income return, the higher payments can be resumed.insurance-book2

Assessment

Making larger payments requires discipline; because a lack of same was likely causative of the debt in the first place.

Conclusion

Your thoughts and comments on this Medical Executive-Post are appreciated. Have you ever been in this situation? Feel free to opine anonymously.

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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On Emergency Funds for Physicians

dr-david-marcinko3Cash Reserves Now More Important Than Ever!

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

CEO: www.MedicalBusinessAdvisors.com

This is a basic question in financial planning circles that has generated much activity in the medical community, of late. Previously considered so mundane – as to be dismissed by some haughty physicians – it has acquired increased urgency with the current financial meltdown.

What Security Level Desired?

Yet, the answer to this question is dependent upon the security level desired by the medical provider and his/her family. Traditionally, financial planners suggested most people with solid employment, and transferrable skills, have at least three months of living expenses (not including taxes) in a reserve fund that is easily accessible (i.e., liquid). The amount needed for a one-month reserve is equal to the amount of expenses for the month, rather than the amount of monthly income. This is because during no-income months – there is no income tax.

The Usual Checklist

We suggest the following questions as helpful in determining the amount of reserve needed by medical professionals:

1. How many incomes do you have in your household?

2. How secure is your current practice, or medical job?

3. Do you have other unrelated sources of income; medically or non-medically related?

4. How long would it take you to find another position in your specialty, if suddenly unemployed? [Hint: Assume one month per ten grand of income; at $150-k annually, this means searching for 15 months].

5. How much money do you spend, and save, each month?

6. Would you be willing [able] to lower your monthly [fixed or variable] expenses, if you were unemployed?

Many Factors to Considerinsurance-book1

But, many other factors come into play when determining how much money a particular physician and his/her family should have on hand. Does the family have one income or two? How stable is this income source? Does the doctor work for himself [managing partner], or is she employed [minority partner, associate, etc]? What kind of firm, company or hospital employs him; private, HMO, MCO, Federal or State entity? Does the family use all of the income each month? What about, life, health, disability or LTC insurance as fringe benefits? Does the family anticipate the possibility of large liability exposures and expenses occurring in the future (i.e., medical school or practice start-up debt, private tuition for the kids, medical expenses, liability suits etc.)? Are you willing to relocate for a new job?

Family Situation Appraisal

If the doctor is in a dual-income family – with stable incomes – and/or lives on a single income – the need for a liquid reserve is minimal; but still much more than for the average layman. On the other hand, if the doctor is a single individual, with an unstable income and she spends everything each month, the need for a liquid cash reserve is higher.

In the previous example, and in the stable past, the doctor may have opted for a six-to-nine month reserve if the need for security was high; and a three-to-six month reserve if the need for security was low. For the last five to seven years however, we have suggested to our medical clients that they expand this reserve cash corpus to 12-24 months; and as a blanket rule of thumb for all medical professionals. Of course, I was roundly criticized for it; until now.

Today, we are suggesting 3-5 years; with considerably less criticism. Cash is power, choice, swagger, potency, freedom and represents options. Acquire it!

Stashing the Cash

Once the amount of reserve is determined, the doctor should consider the appropriate investment vehicles for the reserve fund. At minimum, the reserve should be invested in a money market mutual fund with NAV @ 1.00 USD. Larger income earners may opt for tax-exempt money market mutual funds, as needed.  For larger reserves, an ultra-short term, no-low bond fund, might be appropriate for amounts over three months – in periods of deflation; not so during inflationary periods.

Assessment

Today, we recommend doctors keep 3-5 years of cash-on-hand. Yes, I am aware of the “paradox-of-thrift” conundrum. But, do you want to help the domestic GDP, or your family; you decide? Personally, my own concern is not the macro-economic milieu.

Full disclosure: I am a former insurance agent, registered investment advisor; board certified surgeon and Certified Financial Planner™

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How stressed out are you, right now? You are sleepless if previously considered cash, as trash.

But, if sitting on a little pile; you should be sleeping like a baby.    

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***

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

Front Matter with Foreword by Jason Dyken MD MBA

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“BY DOCTORS – FOR DOCTORS – PEER REVIEWED – FIDUCIARY FOCUSED”

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Enter our Writing Contest

You Must Submit – to Win

By Hope Hetico; RN, MHA, CMP™

Managing Editoridea2

Enter the Medical Executive Post submissions contest and just maybe you can become famous! Simply send in a written post about some aspect of the healthcare industrial complex, finance, administration, policy or health economics space that you are particularly knowledgeable about. Or, visit our topic channels for related ideas. Use you fertile imagination.

Rules

Submission must be original, not submitted elsewhere and under 1,000 words. Rest assured that grammar, spelling, citations and punctuation counts. Originality and thought-leadership is a must. Oh, you must be a subscriber and all copyright ownership will be transferred to us, as well. Your material may even be used in some iMBA, Inc print project or publication, now in-progress or in the future.

Grand Prize

Just think! You could become one of 3 finalists featured as an upcoming Medical Executive Post monthly column, with photographic byline, or even the grand prize winner who’ll receive our free best-selling hardcover textbook, the Business of Medical Practice.

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Contest Close

Submissions are due December 31, 2009. There are no limits to the number of times you may apply or the number of submissions you may send in. All results are final. The anonymous judges reserve the right of non-selection. And, we reserve the right to reject any content submission; for any reason perceived as reasonable, or unreasonable.

Conclusion

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Understanding Healthcare Competition

Funneling Porter’s Five Forces of Business

Staff Reporters

ho-journal12Michael Porter PhD, of Harvard Business School, is considered by many to be one of the world’s leading authorities on competitive strategy and international competitiveness.

In 1980, he published Competitive Strategy: Techniques for Analyzing Industries and Competitors, in which he argued that all businesses must respond to five competitive forces. And now, these thoughts have been condensed for the healthcare industrial complex by Robert James Cimasi; MHA, CMP™ of Health Capital Consultants, LLC, in St. Louis, MO. They are cited below from the print journal-guide www.HealthcareFinancials.com

1. The Threat of New Market Entrants

This force may be defined as the risk of a similar company entering your local marketplace and winning business. There are many barriers to entry of new market entrants in healthcare including: the high cost of equipment, licensure, requirement for physicians and other highly trained technicians, development of physician referral networks and provider contracts, and other significant regulatory requirements.

Certificate of Need (CON) laws, which require governmental approval for new healthcare facilities, equipment, and services that have been in place since they were federally mandated in 1974. State CON laws create a regulatory barrier to entry. New medical provider entrants commonly faced substantial political opposition by established interests, which is manifested in the CON review process.

2. The Bargaining Power of Suppliers

A supplier can be defined as any business relationship or vendor you rely on to deliver your product, service or outcome. Healthcare equipment is a highly technical product produced by a limited number of manufacturers. This reduces the range of choices for providers and can increase costs.

3. Threats from Substitute Products or Services

Substitute products or services are those that are sufficiently equivalent in function or utility to offer consumers an alternate choice of product or service.  An illustration of this in healthcare would be diagnostic imaging, or PET scans, as a substitute for surgery, which is often a more costly and risky option for patients. The threat of less invasive or less expensive diagnostic tests other than diagnostic imaging is relatively small for the near term future.

4. The Bargaining Power of Buyers

This force is the degree of negotiating leverage of an industry’s buyers or customers. The buyers of healthcare services are ultimately the patients. However, the competitive force of buyers is manifested through healthcare insurers including the US and state governments through the Medicare, Medicaid, TRICARE, and other programs; managed care payers (e.g., Blue Cross/Blue Shield affiliates); workers’ compensation insurers; and others. 

In addition to the government, many of these healthcare insurers are large, national companies, often publicly traded, commanding significant bargaining power over healthcare provider reimbursement.

5. Rivalry among Existing Firms

This is ongoing competition between existing firms without consideration of the other competitive forces which define industries. Healthcare providers face pressure from other existing providers to obtain favorable provider contracts; maintain the latest technology; increase efficiencies; and lower prices.

Link:

http://www.thehealthcareblog.com/the_health_care_blog/2009/02/making-price-competition-work-.html#comments

Assessment

And so, these forces should be considers by all new, mid-career, and mature independent medical practitioners. They should also be combined with an internal organizational SWOT analysis as well.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated.

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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