A Doctor – Economist’s Solution for Health Reform

Posted on July 1, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

My Laundry Wish List for all US Healthcare Stakeholders

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]Fox News

As President Obama spoke, prodded and cajoled for Congress to pass HR 3200-3400 in 2008, I believe that for any healthcare reform effort to work successfully for the American people – for the long term – we need to consider the following in no particular prioritized order:

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

Assessment

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

Conclusion

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

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45% of Hospitals Have a Shortage of Primary Care Physicians

Posted on February 23, 2022 by Dr. David Edward Marcinko MBA MEd CMP™

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By Staff Reporters

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A recent American College of Healthcare Executives’ survey of 310 hospital CEOs shows:

 •  94% have personnel shortages in registered nursing field
 •  85% have personnel shortages in technicians field
 •  67% have personnel shortages in therapists field
 •  45% have personnel shortages in primary care physicians field
 •  43% have personnel shortages in physician specialists field
 •  31% have personnel shortages in physician extenders and specially certified nurses field

Source: American College of Healthcare Executives, “Top Issues Confronting Hospitals in 2021,“ February 4, 2022

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A Hospitalist Asks a CPA – “what happened to my paycheck?”

Posted on January 18, 2013 by Dr. David Edward Marcinko MBA MEd CMP™

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Law changes will result in smaller paychecks in 2013

DT&PA number of law changes go into effect in 2013 that will result in employees [like hospitalists, nurses, allied healthcare providers and some pHO members, etc] seeing smaller paychecks, including the expiration of the payroll tax cut, the increase in the Social Security taxable wage base, and the new 0.9% Medicare tax imposed on high wage earners.

The following law changes go into effect in 2013

  • The payroll tax cut, which temporarily lowered the Social Security withholding tax rate on wages earned by employees in 2011 and 2012 from 6.2% to 4.2%, has expired. Accordingly, employees will see a 2-percentage-point bump in the amount of Social Security tax withheld from their paychecks from 2012 to 2013.
  • The Social Security taxable wage base has increased by $3,600, from $110,100 to $113,700.
  • An additional 0.9% Medicare surtax is withheld from wages paid to an employee in excess of $200,000 in a calendar year.

Effect of these changes on paychecks

The following illustrations show the effect of these law changes on employees’ paychecks:

… Employees earning $50,000 in 2013 FICA wages will have $1,000 more in FICA taxes withheld ($50,000 × [6.2% – 4.2%]) than they would have in 2012, due to the 2-percentage-point increase in the Social Security tax rate.

… Employees earning $100,000 in 2013 FICA wages will have $2,000 more in FICA taxes withheld ($100,000 × [6.2% – 4.2%]) than they would have in 2012, due to the 2-percentage-point increase in the Social Security tax rate.

… Employees earning $300,000 in 2013 FICA wages will have $3,325.20 more in FICA taxes withheld than they would have in 2012. This includes $2,202 in additional Social Security taxes due to the increase in the Social Security tax rate ($110,100 × [6.2% – 4.2%]), $223.20 in additional Social Security taxes due to the increase in the Social Security taxable wage base ([$113,700 – $110,100] × 6.2%), and $900 in additional Medicare tax ([$300,000 – $200,000] × 0.9%).

… Employees earning $500,000 in 2013 FICA wages will have $5,125.20 more in FICA taxes withheld than they would have in 2012. This includes $2,202 in additional Social Security taxes due to the increase in the Social Security tax rate ($110,100 × [6.2% – 4.2%]), $223.20 in additional Social Security taxes due to the increase in the Social Security taxable wage base ([$113,700 – $110,100] × 6.2%), and $2,700 in additional Medicare tax ([$500,000 – $200,000] × 0.9%).

… Employees earning $1,000,000 in 2013 FICA wages will have $9,625.20 more in FICA taxes withheld than they would have in 2012. This includes $2,202 in additional Social Security taxes due to the increase in the Social Security tax rate ($110,100 × [6.2% – 4.2%]), $223.20 in additional Social Security taxes due to the increase in the Social Security taxable wage base ([$113,700 – $110,100] × 6.2%), and $7,200 in additional Medicare Tax ([$1,000,000 – $200,000] × 0.9%).

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Assessment

There is also a new 39.6% income tax withholding rate on high wage earners (previously, the highest withholding tax rate was 35%). This withholding rate is used for single taxpayers with annual wages greater than $402,200 and for married taxpayers with annual wages greater than $458,300.

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Conclusion

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Coordination, Switching Costs and the Division of Labor in General Medicine

Posted on June 13, 2010 by Dr. David Edward Marcinko MBA MEd CMP™

An Economic Explanation for the Emergence of Hospitalists in the United States

Submitted by Hope Rachel Hetico RN, MHA

[Managing Editor]

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From a white paper by David O. Meltzer, Jeanette W. Chung

NBER Working Paper No. 16040
Issued in May 2010

General medical care in the United States has historically been provided by physicians who care for their patients in both ambulatory and hospital settings.  Care is now increasingly divided between physicians specializing in hospital care (hospitalists) and ambulatory-based care primary care physicians.  We develop and find strong empirical support for a theoretical model of the division of labor in general medicine that views the use of hospitalists as balancing the costs of coordinating care across physicians in the hospitalist model against physicians costs switching between ambulatory and hospital settings in the traditional model.

Assessment

These findings suggest opportunities to improve care.

Link: http://papers.nber.org/papers/w16040

Conclusion

All ME-P readers are invited to opine.

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A Physician by Any Other Name

Posted on March 10, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Enter the Weekendalists and Laborists

[By Dr. David Edward Marcinko; MBA]

Publisher-in-Chief

dr-david-marcinko5More than a decade ago, in another career, I wrote a few articles for Richard L. Reece MD when he edited a print and emerging electronic trade publication for medical professionals. All very “fly”, at the time.

The Laborists

Now – according to Dr. Reece who cites the Boston Globe, in “The Birth of a Notion”, a Cape Cod and some other Massachusetts hospitals are hiring “laborists”; aka board-certified obstetricians to work regular shifts for the sole purpose of delivering babies.

www.MedicalBusinessAdvisors.com

New Causitive Drivers

What drives these new-wave specialists? The answer, of course, is the next-generation of physicians and their emerging new medical business and practice models. Much like my 12 year old daughter, it is a way of professionally breaking away from past generations, and asserting some independence and leadership. And, as Martha Stewart might say; “that’s a good thing.”

Many Reasonsbiz-book2

But, according to Reece, the real drivers are a combination of other things – the desire of doctors for regular hours, the shortage of specialists, physician burnout, the search for a safer hospital environment, the need for consistent, immediately available physician services, fear of dreaded malpractice suits, and consolidation of hospital-physicians services due to regulatory and economic pressures; etc.

Blended Generations

Dick is correct, of course, because it is not uncommon today to have three generations represented in healthcare. We have the Baby-boomers, Gen X and now, Gen Y. The Baby Boomer generation is saying with some sense of sadness that, “Medicine sure isn’t want it used to be!”, while Generation Xers are saying “It’s about time things changed!”, and the latest generation to enter the medical workforce, Gen Y’s, are saying “Ready or not, we’re here”.

http://www.BusinessofMedicalPractice.com

The Leadership Evolution

Each generation is extraordinarily complex, bringing various skills, expertise and expectations to the modern medical work environment. Determining the best method to unite such diverse thinking is one of the many challenges faced by physician executives and healthcare leaders. Is it any wonder that many medical leaders and executive in the Baby Boomer generation find themselves at a loss? The days of functional leadership are gone and suddenly, no one cares about the expertise of the Baby Boomers or how they climbed the corporate ladder, in medicine or elsewhere. Leadership in the era of Health 2.0 is no longer about command-control or dictating with intense focus on the bottom line; it is about collaboration, empowerment and communication. And, it is not about titles and nomenclature.

cmpLinguistic Evolution

As the linguistic evolution of terms progresses, the nomenclature of hospitalist was followed by that of intensivist, proceduralist, nocturalists, in-situ physician and even weekendalists. Think I’m kidding?

Link: http://medinnovationblog.blogspot.com/2009/02/hospital-based-doctorists.html

Assessment

I still like the causative analogy of my pre-teen daughter; it’s much simpler to understand. What do you think?  

References

1. Wachter, R and Goldman, R: “The Emerging Role of ‘Hospitalists’ in the American Health System’. In, New England Journal of Medicine; 335, 514-517, 1996

2. Kowalczyk, L: The Birth of a Notion: Hospitals Turning to Laborarists. Boston Globe, February 23, 2009

Conclusion

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Hospitalist Model Outcomes Study

Posted on November 29, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

The Human Resource Management Report

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According to a study published in Human Resource Management, hospitals that employ the hospitalist model-of-care delivered better patient outcomes.

The Study

The study explored the differences between hospitalists and traditional models of care, measuring performance outcomes in more than 6,000 cases at Newton-Wellesley Hospital in Massachusetts between July 2001 and July 2003. At the time of the study, hospitalists treated approximately one-third of the hospital’s patients, and private practice physicians treated the remaining two-thirds.

The Results

Compared to the traditional approach, researchers found that the hospitalist model:

  • Decreased the length of patient stay by about half a day and reduced costs to the hospital by $655 per patient;
  • Reduced the risk of re-admission by 41.8 percent, a key measure of quality performance in hospitals;
  • Improved coordination of care 13.2% by increasing the strength of relationships between physicians and other members of the care provider team.

Assessment

The study was reported in the Society of Hospital Medicine, on November 17, 2008

Conclusion

What do you think? As always, your thoughts and comments on this Executive-Post are appreciated.

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