• Member Statistics

    • 787,276 Colleagues-to-Date [Sponsored by a generous R&D grant from iMBA, Inc.]
  • David E. Marcinko [Editor-in-Chief]

    As a former Dean and appointed Distinguished University Professor and Endowed Department Chair, Dr. David Edward Marcinko MBA was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.

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

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

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

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

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

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

    Marcinko is “ex-officio” and R&D Scholar-on-Sabbatical for iMBA, Inc. who was recently appointed to the MedBlob® [military encrypted medical data warehouse and health information exchange] Advisory Board.

    entrepreneur

    Frontal_lobe_animation

  • ME-P Information & Content Channels

  • ME-P Archives Silo [2006 – 2020]

  • Ann Miller RN MHA [Managing Editor]

    ME-P SYNDICATIONS:
    WSJ.com,
    CNN.com,
    Forbes.com,
    WashingtonPost.com,
    BusinessWeek.com,
    USNews.com, Reuters.com,
    TimeWarnerCable.com,
    e-How.com,
    News Alloy.com,
    and Congress.org

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

    Product Details

    Product Details

    Product Details

  • CERTIFIED MEDICAL PLANNER® program

    New "Self-Directed" Study Option SinceJanuary 1st, 2018
  • Most Recent ME-Ps

  • PodiatryPrep.org


    BOARD CERTIFICATION EXAM STUDY GUIDES
    Lower Extremity Trauma
    [Click on Image to Enlarge]

  • ME-P Free Advertising Consultation

    The “Medical Executive-Post” is about connecting doctors, health care executives and modern consulting advisors. It’s about free-enterprise, business, practice, policy, personal financial planning and wealth building capitalism. We have an attitude that’s independent, outspoken, intelligent and so Next-Gen; often edgy, usually controversial. And, our consultants “got fly”, just like U. Read it! Write it! Post it! “Medical Executive-Post”. Call or email us for your FREE advertising and sales consultation TODAY [770.448.0769]

    Product Details

    Product Details

  • Medical & Surgical e-Consent Forms

    ePodiatryConsentForms.com
  • iMBA R&D Services

    Commission a Subject Matter Expert Report [$250-$999]January 1st, 2019
    Medical Clinic Valuations * Endowment Fund Management * Health Capital Formation * Investment Policy Statement Analysis * Provider Contracting & Negotiations * Marketplace Competition * Revenue Cycle Enhancements; and more! HEALTHCARE FINANCIAL INDUSTRIAL COMPLEX
  • iMBA Inc., OFFICES

    Suite #5901 Wilbanks Drive, Norcross, Georgia, 30092 USA [1.770.448.0769]. Our location is real and we are now virtually enabled to assist new long distance clients and out-of-town colleagues.

  • ME-P Publishing

  • SEEKING INDUSTRY INFO PARTNERS?

    If you want the opportunity to work with leading health care industry insiders, innovators and watchers, the “ME-P” may be right for you? We are unbiased and operate at the nexus of theoretical and applied R&D. Collaborate with us and you’ll put your brand in front of a smart & tightly focused demographic; one at the forefront of our emerging healthcare free marketplace of informed and professional “movers and shakers.” Our Ad Rate Card is available upon request [770-448-0769].

  • Reader Comments, Quips, Opinions, News & Updates

  • Start-Up Advice for Businesses, DRs and Entrepreneurs

    ImageProxy “Providing Management, Financial and Business Solutions for Modernity”
  • Up-Trending ME-Ps

  • Capitalism and Free Enterprise Advocacy

    Whether you’re a mature CXO, physician or start-up entrepreneur in need of management, financial, HR or business planning information on free markets and competition, the "Medical Executive-Post” is the online place to meet for Capitalism 2.0 collaboration. Support our online development, and advance our onground research initiatives in free market economics, as we seek to showcase the brightest Next-Gen minds. ******************************************************************** THE ME-P DISCLAIMER: Posts, comments and opinions do not necessarily represent iMBA, Inc., but become our property after submission. Copyright © 2006 to-date. iMBA, Inc allows colleges, universities, medical and financial professionals and related clinics, hospitals and non-profit healthcare organizations to distribute our proprietary essays, photos, videos, audios and other documents; etc. However, please review copyright and usage information for each individual asset before submission to us, and/or placement on your publication or web site. Attestation references, citations and/or back-links are required. All other assets are property of the individual copyright holder.
  • OIG Fraud Warnings

    Beware of health insurance marketplace scams OIG's Most Wanted Fugitives at oig.hhs.gov

Understanding Healthcare Conflicts of Interest

A Modern Ethical Dilemma

By Render Davis

www.BusinessofMedicalPractice.com

Conflicts of interest are not a new phenomenon in medicine. In the fee-for-service system, physicians controlled access to medical facilities and technology, and they benefited financially from nearly every order or prescription they wrote.  Consequently, there was an inherent temptation to over-treat patients.  Even marginal diagnostic or therapeutic procedures were justified on the grounds of both clinical necessity and legal protection against threats of negligence. 

Traditional Medical Care

While it can be construed that this represented a direct conflict of interest, it could also be argued that most patients were well served in this system because the emphasis was on thorough, comprehensive treatment – where cost was rarely a consideration.  It was a well known adage that physicians “could do well, by doing good.” 

Managed Medical Care

In managed care, the potential conflicts between patients and physicians took on a completely different dimension.  By design, in health plans where medical care was financed through prepayment arrangements, the physician’s income was enhanced not by doing more for his or her patients, but by doing less.  Patients, confronted with the realization that their doctor would be rewarded for the use of fewer resources, could no longer rely with certainty on the motives underlying a physician’s treatment plans.  One inevitable outcome was the continuing decline in patients’ trust in their physicians.  This has been exacerbated to some degree by revelations of significant financial remuneration to physicians by pharmaceutical and medical products firms for their services as researchers or active participants on corporate-funded advisory panels, calling into question the physician’s objectivity in promoting the use of company products to their peers or patients.

Higher Concerns

Conflicts of interest may also create concerns at a much higher level, as evidenced by the issues raised in 2008 litigation against Ingenix, a company that for more than a decade, provided information to the insurance industry on payments to out-of-network physicians for their “usual and customary rates (UCR).” As noted in court documents, Ingenix was a wholly-owned subsidiary of United Healthcare and the UCR information sold by the company to insurers may have been fundamentally biased in favor of the insurers, causing patients to pay larger out-of-pocket fees.  As a result, New York attorney general Andrew Cuomo filed suit against Ingenix.  This action was followed by suits brought against major insurers by the American Medical Association and several state medical groups for systematic underpayment to members, based on the biased data. 

Assessment

To date, there have been monetary settlements, but the issue continues to raise growing concerns regarding conflicts of interest among the key payers for health care.

Conclusion

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

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

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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

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

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

Product DetailsProduct DetailsProduct Details       

Journal of the American Dental Association [Letter to the Editor]

ADA Image Tarnished?

[By Darrell K. Pruitt; DDSpruitt]

Dear Editor,  

This is a sincere letter which I am sure you will agree should be published in the October 2009 edition of the JADA. Today is July 19, 2009. I am allowing for the six weeks minimum time it requires for letters to appear in print following their selection for publication. It will be posted on the Internet immediately. In spite of this, I trust you will eventually agree to publish it in spite of your archaic rules. Otherwise, by November, history could show that the editor of the JADA arguably denied representation of dental patients’ interests at a most critical time in the history of the profession. That would be regrettable for your own professional reputation as well as for the JADA’s. As an ADA member, if my concerns are ignored, I will hold you publicly accountable for an explanation for a long time.

Public Laundry

From now on, we will agree to wash our laundry in public because otherwise it doesn’t always come clean. You can call the pressure I bring unprofessional if you want, but following the ADA News’ public exhibition of their shoddy ethics this week, it would be foolish to use my methods as an excuse to deny my access to membership. As I am certain you are aware, there were three revisions of “ADA/idm to phase out service” on ADA News Online (7/10, 7/13 and 7/16). I not only welcome a wide-open public discussion about ethics in journalism with representatives of the JADA, but I encourage it. We both know that the ADA needs clean laundry now more than ever before in its history.

ADA Business Enterprises, Inc.

For members who haven’t heard, the 2 ½ year old joint venture of our ADA Business Enterprises, Inc. (ADABEI) with Intelligent Dental Marketing – a Utah-based private business – fell apart in late spring of this year. Months later, our ADA leaders are still less than transparent with membership about what went wrong. I’ve been in business long enough to know that if mistakes by employees are not revealed and discussed, they are bound to happen again and again. And, it’s not like the leaders of the ADA were not warned. They just didn’t take heed. By late 2007, many knowledgeable people involved in the dental industry easily recognized the faults in the partnership between our non-profit professional organization and a for-profit Utah advertising company. In hindsight, anyone can see that ADA/IDM’s slogan, “Image is everything,” clearly betrays an attitude inconsistent with both the mission of the ADA and the Hippocratic Oath. Nevertheless, even the spirit of the slogan was regretfully adopted by the leaders of the ADA’s Business Enterprises, Inc. Now it is the image of the entire ADA that is suffering the damage.

ADABEI

I personally began questioning the accountability of the tricky ADA/IDM business model over two years ago when the profits from ADABEI had officials excited about avoiding the need to raise membership dues last year. Not unexpectedly, in the atmosphere of euphoria, nobody in Chicago wanted to acknowledge the concerns of a handful of alert members. We were cast aside as troublemakers. So how critical is the risk? With massive, unprecedented health care legislation imminent, this is the worst time imaginable for our stoic, image-conscious officers to lead us to nation-wide embarrassment.

Following the Money

The surrender to such temptations for leaders of non-profit organizations is not unprecedented. Do you know why the dues for the American Association of Retired People (AARP) have been kept so low? Not unlike the ADA, the non-profit AARP reaps profits from insurance policies and other products that its leaders sell to membership – even using misleading ads in AARP dues-supported publications. However, unlike dues money, vendor “kickbacks” don’t depend on accountability to members. A few years ago, the profits derived from agreements with vendors predictably became the lifeblood for AARP’s self-perpetuating bureaucracy – eventually influencing their lobbying efforts. Since non-profits like the AARP and the ADA are traditionally respected by lawmakers who like huge campaign donations, a non-profit entity’s lobbyists can be tempted to quietly represent vendors’ interests at members’ expense. Sometimes they get caught.

Lost Confidence

Almost a year ago, the AARP lost valuable member confidence when the organization was forced to suspend sales of “limited benefit” health plans backed by UnitedHealth Group (of Ingenix fame). Sen. Chuck Grassley said the plans which leave policyholders vulnerable to tens of thousands of dollars in costs were sold by the AARP to naïve and trusting members using misleading marketing tricks – not unlike those used in the ADA’s promotion of ADA/IDM. Sen. Grassley sent a detailed letter to CEO Bill Novelli demanding answers to questions about health insurance plans promoted to over a million dues-paying AARP members. Grassley told USA Today reporter Julie Appleby that “Insurance is supposed to limit your exposure to the potentially high cost of a serious illness and these plans do the opposite.” (Nov 7 2008).

http://www.usatoday.com/news/health/2008-11-07-aarp-insurance_N.htm

Is AARP-level accountability as good as it gets?

I say no. Attention ADA members – It is my opinion that our leaders are losing the control of our professional organization. The recent failure of ADA/IDM isn’t the first glaring sign of trouble in Headquarters. Over a year ago, the executive director, Dr. James Bramson, was suddenly fired with no explanation. In fact, then President Dr. Mark Feldman commanded that the reasons for the firing will not be disclosed. Obediently, ADA leaders have so far maintained firm control of the top secret information which if released could somehow endanger dental patients (?). Because Bramson’s severance pay came from my dues and not out of Dr. Feldman’s pocket, I think I deserve to know more details. Otherwise, this mistake could happen again and again.

The ADA/IDM disaster is also not the only ADABEI embarrassment I see on the horizon. It is my opinion that CareCredit is also showing signs of silent desperation. On July 9, the officials of the wholly-owned ADA subsidiary purchased an ad on dentalblogs.com titled “Press Release: CareCredit Adds 24-Month, No-Interest [sic] Payment Plan” (no byline).

http://www.dentalblogs.com/archives/administrator/press-release-carecredit-adds-24-month-no-interst-payment-plan/

Even though I approve of the benevolence in the idea of extending credit to those with worsening dental problems – especially during these hard financial times for patients – the anonymous CareCredit (ADA) representative who posted the ad failed to respond to my timely and important question: “If the Red Flags Rule is not delayed for the third time in three weeks, how will it affect those who offer Care Credit?”

Assessment

Nor did he or she respond to my follow up response on July 13. “On July 9 at 4:54 pm, I submitted a sincere question concerning how the Red Flags Rules will affect ADA members who sign up for CareCredit. Instead of posting it with the promise of an answer, you regretfully chose to censor an ADA member. Today, July 13, I have a second and third question: Why did you ignore my first one and who is your boss?”

Conclusion

So far, I’m still waiting for responses to all three questions. I trust you will treat my concerns with more respect, Editor.

Conclusion

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

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

Channel Surfing
Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. 

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

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

Get our Widget: Get this widget!

Our Other Print Books and Related Information Sources:

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

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

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

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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

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

Sponsors Welcomed

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

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

Usual and Customary UnitedHealthcare?

Join Our Mailing List

More on “Sleazy” Healthcare Stakeholders

1-darrellpruitt

[By Darrell K. Pruitt; DDS]

If the leaders of the American Dental Association have the power and stoic determination to casually sweep aside trouble-making members who might tarnish their image, one would think that they could certainly avoid associating with sleazy healthcare stakeholders; such as UnitedHealthcare.

The Insurance Giants 

Have you ever suspected that insurance giants like UnitedHealthcare, WellPoint, Aetna and Cigna (and other members of the National Association of Dental Plans) lie to patients when the say a dentist’s fees are above “usual, customary and reasonable” levels?  You could be correct.  NY Attorney General Andrew Cuomo says UnitedHealthcare, WellPoint, Aetna and Cigna lie to physicians’ patients – understating New York state physician’s fees up to 28 percent.  Why would the crooks treat dentists’ patients any differently?

Employing Tapeworms to Control Fat

Cuomo caught UHC and others cheating their customers with smoke, mirrors and Ingenix – its wholly-owned data mining and consulting subsidiary.  Who would have guessed that UHC would tweak Ingenix to manipulate claims data to favor UHC and other insurance companies who subscribe to their services?  These are the same parasites who want to run the nation’s Pay-For-Performance (P4P) mandate – a cornerstone of President Bush’s healthcare reform ideas.  They want to tweak professional reputations for healthcare reform and the common good. 

And of Ingenix 

Ingenix is a full-service consulting business for insurers, backed with the credibility of 14 years of accumulated health claims it is privy to.  The “friend in the business” not only cooks the data to produce profit-enhancing Usual, Customary and Reasonable (UCR) fee schedules, Ingenix is also active in “pay-for-performance program assessment, strategy, planning, design, implementation, evaluation and improvement.” 

http://www.ingenixconsulting.com/about_history.html

So if you like the way UnitedHealthcare dental consultants treat you now, just wait until they are given authority to determine your worth to society using Ingenix leveraging tools.

P-4-P 

I first read about pay-for-performance [P4P] in dentistry in February 2006 in an email from Patrick Cannady who is an employee in the ADA Department of Dental Informatics.  He told me that nation-wide quality control in dentistry is an important benefit of having a HIPAA-compliant, paperless dental practice – and that the Department of Dental Informatics is very excited about the opportunity to help prepare US dentists for the future.  A month or so later, I learned that the NPI number the ADA still pushes on membership is the crucial legal link to government-approved P4P data-mills like Ingenix – a wholly-owned UnitedHealthcare profit center.  Do you think it is odd that the NPI is “voluntary,” yet irreversible?

AMA’s Award 

In January, the AMA was awarded $350 million in a lawsuit against UnitedHealthcare and Ingenix on behalf of physicians, and they plan to sue other major insurance companies as well.  So what has the ADA done to discourage UnitedHealthcare’s and other NADP members’ atrocious behavior that undeniably harms dental patients?  You won’t believe it when I tell you. Here’s more:  In a recent Associated Press interview, Sen. Jay Rockefeller, chairman of the Senate Commerce, Science and Transportation Committee, said UnitedHealthcare is nothing but a company of cheats.  He says, “They’re lowballing deliberately. They deliberately cut the numbers so the consumer has to pay more of the cost.”

http://www.google.com/hostednews/ap/article/ALeqM5gL4XFckx9sah3eFEMuHYD3V2WGhQD97763800

So if Cannady’s department is all for P4P and other benefits from interoperable digital records, the question on most ADA members’ minds should be:  What does the ADA think of UnitedHealthcare?

ADA News Online

Two weeks ago the ADA News Online posted an advertisement that looks like an article (with no byline) for the spring meeting of the American Association of Dental Consultants (AADC) on May 7-9 in Scottsdale, Arizona.

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3493

Since it is so well known that UnitedHealthcare is the major funding sponsor of the AADC, the word in the neighborhood says AADC, like Ingenix, is another UnitedHealthcare profit center awaiting the wrecking-ball.

Link: http://www.google.com/hostednews/ap/article/ALeqM5gL4XFckx9sah3eFEMuHYD3V2WGhQD97763800

Assessment

Last year’s annual meeting of the dental consultants – who deny dental claims to protect the ethics in dentistry – featured ADA Senior Vice-President Dr. John Luther as a guest speaker.  Dr. Luther is Cannady’s boss.  He oversees the Department of Dental Informatics.  Yep.  The ADA is tight with UnitedHealthcare. One can tell a person’s character by the company he or she keeps. 

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct DetailsProduct Details      

Reflections on Evidence Based Dentistry

Join Our Mailing List

My Search for Truth – 2009

[By Darrell Kellus Pruitt; DDS]pruitt4

Do the leaders of the American Dental Association [ADA] encourage critical thinking by membership?  Or; do they fear my opinion of what appears to be destructive and self-serving institutional bias in my ADA that favors businesses peripheral to the care of dental patients, and at patients’ expense?  I think it is clear that there are a few good ol’ boys imbedded in the fat ADA who prefer to hide behind a comfortable, but obsolete command-and-control ADA business model.  The mighty ostrich stuck its head in the sand. Then along came a noisy, gasoline-powered weed-whacker. Never saw it coming.

Evidence-Based Dentistry Champion Conference

On May 29-30, the First Annual “Evidence-Based Dentistry (EBD) Champion Conference” will be convened in ADA Headquarters in Chicago.  Just like last year, the meeting with a brand-new name is sponsored by Procter & Gamble and The Journal of Evidence-Based Dental Practice with Dr. Michael G. Newman as its Editor and Chief.  Even though this effort is enthusiastically supported by large corporations with products to sell, like P&G, managed care insurance companies such as Delta Dental, and electronic health records vendors such as Allscripts, the power of the reclusive stakeholders is further amplified by bureaucrats inside and outside the ADA – siphoning off my professional organization’s credibility.  That is my opinion based on actual contact with a few characters in this group. 

Evidence-Based Dentistry: 3rd International Conference

I attended the meeting last year when it was called “Evidence-Based Dentistry: 3rd International Conference” – I assume that in the last year, it lost its “international” status, and now caters only to “EBD Champions” (cheerleaders).  Last year, they were also looking for Champions for their EBD ideas, but the bias was better concealed.  I reported on the meeting in an article called “Evidence-Based Dentistry – My search for truth.”

http://community.pennwelldentalgroup.com/forum/topics/evidencebased-dentistry-my

Shortly into the meeting on May 4, 2008, I could tell by a show of hands from attendees that as a dentist who actually puts his hands in patients’ mouths as a regular part of his job; I was virtually alone in the auditorium.  This was confirmed by the volume of “Boo” directed at me later that day.  The Champions who had been selected months before the conference had already met that week and they were pumped. One could smell the zeal for EBD – whatever it means. 

Journal of Evidence-Based Dental Practice

In his introduction to last year’s conference, Dr. Michael G. Newman, Editor in Chief of the Journal of Evidence-Based Dental Practice, told attendees that P&G is providing all the information about EBD to all the dental schools in the nation. I will be honest with you.  Being booed last year for addressing what I think is the inferior quality of managed care dentistry during the final discussion period may have affected my attitude about EBD. In addition, being subsequently blocked from responding to a hurt and angry managed care discount dentistry broker by an ADA employee named Dr. Ron Zentz also disappointed me in my ADA.  Dr. Zentz told me “This is not the place for this” as he stood between me and the microphone. Later I could not get Zentz to concede the indisputable fact that quality is proportional to reward. When I pressed him for an answer to the managed care question, he stoically repeated exactly what the insurance representative said: “Whether the dentistry is managed care or not, it makes no difference in the quality of care.”  Here is something cute:  The event was an “Evidence-Based” conference on the second floor of the Headquarters of the ADA, and Dr. Zentz is employed in the ADA’s “unbiased” science department.  Get it?  Now that’s funny!

Trouble-Makers Don’t Get Invited Back

My bad behavior last year may have something to do with why I was not invited to attend this year, even though I worked hard on the prerequisite essays which I will share with you later.  Nevertheless, I have to warn that ADA-approved propaganda from P&G doesn’t strengthen this dentist’s confidence that our leaders are protecting the future of dentistry, friends. Take a look at what healthcare parasites have quietly done over the last decade or so to physicians’ practices with the blessing of the AMA, and counter to the interests of patients.  Those same parasites were in ADA Headquarters on May 4, 2008.  Our house at 211 East Chicago Avenue reeked. 

EDB Vagueness

Like the HIPAA Rule on which Newman’s favorite interpretation of EBD leans hard, the beauty of EBD is in its vagueness. Both HIPAA and EBD can mean damn well anything one needs them to mean, and stakeholders with lots of influence have their fingerprints and drool all over the plans.  For example, Dr. Robert Ahlstrom, a stakeholder and one of the speakers at last year’s conference uses HIPAA to support EBD and vice-versa according to closed-circuit, cause-I-said-so science that he evidently makes up as he goes.  It is difficult for me to imagine that Ahlstrom’s eleven reasons that HIPAA benefit dentistry – which he presented as testimony for HHS Secretary Michael Leavitt over a year ago – were approved by a committee. I think Ahlstrom made up his reasons while waiting in the hall for the NCVHS meeting to begin. If the reasons were indeed approved by an ADA committee, I extend my sympathy. It must be difficult for challenged people like that to safely find their way home from work every day. 

(See “HIPAA and Dentistry – About Ahlstrom’s Controversial HIPAA Testimony”) 

https://healthcarefinancials.wordpress.com/2009/01/08/hipaa-and-dentistry/

Where is the Evidence?

A few hours before Dr. Ahlstrom, an ADA NHII (National Health Information Infrastructure) Task Force member, took the podium, Dr. Newman pleaded with dentists to always ask, “Where is the evidence?”  I know Dr. Ahlstrom heard Dr. Newman’s words because Ahlstrom was sitting on the first row, next to ADA Senior VP Dr. John Luther, who is in charge of the ADA Department of Dental Informatics – a major beneficiary of EBD and HIPAA.

***

dental

***

Buzzwords 

I have come to the conclusion that EBD is a buzzword for a scheme supported by avaricious stakeholders who seek to regulate dentistry using healthcare IT.  I assume it will be left to Dr. Robert Ahlstrom to present the plan to the next administration in his special, fanciful way.  It is clear to me that the ADA is using Ahlstrom to lead American dentists down a computerized, cook-book path initially promoted several years ago at ADA Headquarters by none other than Newt Gingrich.  The path ends with the NPI, NPPES and Ingenix-style Pay-for-Performance instead of free-market competition and consumers’ desires.  Like Ahlstrom, EBD is little more than a tool.

Living with Rejection

I learned a couple of days ago that my application for this year’s conference was rejected.  A PDF letter signed by Dr. Michael Newman, Editor and Chief of the Journal of Evidence-Based Dental Practice stated that the competition for seats was intense this year, and that I just didn’t have what the selection committee was looking for in a “champion” – even though one can see by their essay questions that the EBD stakeholders desire dentists who can draw audiences. 

My Responses 

Below are my responses to this year’s questions that I posted on September 23, even before I hooked up with PennWell, and the ME-P.  I’m even more widely read now. 

Q: Are you involved in the treatment of populations with limited access to care?

Counseling people who have big problems and little money is part of the job. Almost every day I help patients make hard decisions that affect their appearance as well as health. Compromises are always difficult, especially when it involves children. I do my best to provide my patients with the information they need concerning their specific problems in a personal manner. In that respect, I am no different than almost all other dentists I know.

Q: Given the opportunity, how do you plan to disseminate the information and knowledge of EBD?

For dentistry-related news, I am arguably the most popular commentator on the Internet. If I am convinced that EBD is in patients’ best interest, I can promote the concept to a wider audience than anyone else in dentistry and it will not cost a thing. I can use any number of websites in addition to a private network of colleagues that has been in place for almost three years.  

If I leave the conference suspecting that stakeholders ambushed EBD to manipulate dentist-patient relationships for selfish reasons, I will work even more effectively to undermine it. Fair is fair.

Q: Are there any specific examples that demonstrate your ability to be a good disseminator?

Apart from having an increasingly popular column about healthcare matters on this ME-P https://healthcarefinancials.wordpress.com/?s=darrell+pruitt+dds ), I am always seeking new and innovative ways to attract attention to dentistry. I am very good at what I do.

Here is a simple demonstration of my talent: Googlesearch “Darrell Pruitt DDS.” You will discover that I’ve got what they call “googlejuice.” I create interesting content. People you need to reach read me.

The question is; does the ADA have the confidence to subject EBD to my critique? On the other hand, does the ADA have the courage not to?

Since I will not be allowed to keep colleagues in my neighborhood as informed in real-time and in detail as they should be, I invite one or more “EBD Champions” to describe what they learned following the Conference in May right here on this ME-P and PennWell forums.  And as always, I invite Dr. Robert Ahlstrom to discuss what he plans to do with my dental practice. 

Assessment

Tomorrow, as part of “Transparency and the ADA – a dissecting experiment,” I intend to post another question on the EBD link following my weekly report.  I will ask if Dr. Robert H. Ahlstrom will be addressing the audience before having my name put on a short-call list to replace late-cancellations.  Depending on the answer, I may go camping instead.

Channel Surfing the ME-P

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct DetailsProduct Details

On Ingenix and Delta Dental

Or, Birds of a Feather; etc. etc

By Darrell K. Pruitt; DDS

pruitt10

Introduction

Just a quick note while I’m working on other material. As anyone can see from reading Rabia Mughal’s DrBicuspid article, “Dentists or patients: Who should get the insurance check?” Delta Dental is simply a sleazy company that dentists should shun to protect their patients’ welfare.

http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=dis&ItemID=301436&wf=34

It is unethical to sign a contract with Delta Dental, and I will help Delta show you why. Here is a sample of Delta sleaze I intend to present:

Arlene Furlong on Delta Dental

On September 17, 2008, Arlene Furlong posted an article about Delta Dental on ADA News Online titled “Delta caps rates nationally for two networks.”

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3218

Furlong writes:

“A contract provision that holds dentists to Delta’s maximum allowed fee for non-covered services will affect all of Delta’s Premier and Preferred Provider Organization participating dentists throughout the country by January 2011.″.

The Upshot 

This means that if a Delta preferred provider wishes to make up for the profit lost from providing Delta customers 25% discounts on dentistry, which works out to over half the dentist’s pay after expenses are deducted, doing more cosmetic dentistry will no longer help keep the doors open.  Delta, like a sleazy dentistry broker, is telling its providers that it will demand discounts on everything for its customers. Think about it. It is beyond unfair business practice. It is tyranny.

Invading the Dental Homes 

And now, Mughal tells us that Delta Dental intends to break up dental homes – where patients enjoy the benefits of continuity of care from dentists they prefer.  Why does Delta harm their clients like that? 

Ari Adler, the communications administrator at Delta Dental of Indiana says it is a matter of dentists stealing something from the network:

“Direct reimbursement to out-of-network dentists is a problem because it allows them to enjoy the benefits provided by the network without following cost guidelines and quality control measures of the network”, [Adler] added.

Quality control; you mean like UnitedHealthcare’s Ingenix? 

When one thinks about it, since dentists will only be paid half of what they are paid today, no matter what they do for dental patients, quality control could indeed become a new issue, just like the appearance of black-market dentistry. 

My Beat 

I will be covering quality control by dental consultants soon. Did you know that they have their own national organization? It is called the American Association of Dental Consultants (AADC). I bet you didn’t know this: Less than a year ago, Dr. Gordon Christiansen as well as Dr. John Luther, Senior Vice-President of the ADA, spoke at their annual convention in Scottsdale, Arizona. Delta Dental was Dr. John Luther’s employer before he came to work for the ADA. Hmm, I wonder?

Wait, there’s more:  the AADC’s largest sustaining sponsor is UnitedHealthcare Dental. http://aadc.org/site/sponsors.php

The Ingenix Scandal

Have you heard of UnitedHealthcare’s company called Ingenix?  New York Attorney General Andrew Cuomo caught Ingenix being creative with physicians’ FOIA-disclosable data for cost-control purposes (profit), and calling it quality control.  Ingenix was marketing its professional number-cooking scheme to insurers across the nation before Cuomo saw through their deceit and recently demanded Ingenix to be dissolved. 

Transparent Feudal Mechanisms 

One can see that incest probably worked well for royalty in Europe until literacy and the free-market brought transparency to their self-perpetuating feudal machinations. I will be watching for a name and email address of an appropriate Delta Dental official to contact about Delta’s sleazy business practices.  At some point in this thread (which I can keep active for years), I intend to make someone from Delta Internet-famous among dentists, just like Trajan King, CEO of Intelligent Dental Marketing. Suggestions from readers and subscribers are always appreciated.  Please, no in-laws.

Assessment 

It is time to come out and defend yourself in front of a hostile audience, you good ol’ boys from Delta Dental … or not.  Your old command-and-control tricks don’t stand a chance in a transparent marketplace, and I will show you that silence is lame defense as well. Someone on your team is trapped. Please, let’s talk sooner than later.

Conclusion

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

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

DICTIONARIES: http://www.springerpub.com/Search/marcinko
PHYSICIANS: www.MedicalBusinessAdvisors.com
PRACTICES: www.BusinessofMedicalPractice.com
HOSPITALS: http://www.crcpress.com/product/isbn/9781466558731
CLINICS: http://www.crcpress.com/product/isbn/9781439879900
BLOG: www.MedicalExecutivePost.com
FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

Product DetailsProduct DetailsProduct Details

UnitedHealth Group Shenanigans

Join Our Mailing List

Ingenix’s Lack of Independence Cited

[By Dr. David Edward Marcinko; MBA]

dem2

According to Melissa Dahl, Jeff Rossen and Robert Powell of msnbc.com on Jan. 13th, 2009, UnitedHealth Group agreed to pay $50 million in a settlement after being accused of over charging millions of Americans for health care.

The Investigation

An investigation was launched after receiving hundreds of complaints about Oxford Insurance and its parent company, which claims to rely on “independent research from across the health care industry” to determine reimbursement rates.

Faux Independence

In actuality though, it relies on the well known firm, Ingenix, a research arm owned by UnitedHealth Group. The allegations are that Ingenix has been manipulating the numbers so insurance companies pay less.

Other Insurers under Investigation

Although UnitedHealth Group and Oxford Insurance were the only entities investigated, other major insurers use Ingenix, including Aetna, CIGNA and WellPoint/Empire BlueCross BlueShield.

CEO Bill McGuire

The $50 million UnitedHealth Group will pay as the settlement will be used to create a nonprofit organization that will determine reimbursement rates for patients. William W. McGuire MD was the CEO of United from 1992 until his ignominious resignation in 2006, because of his involvement in an employee stock options scandal. Hence, rise of the insider moniker; “Useless Healthcare.”

Assessment

According to blogger Robert Laszewski,

“The big losers here are the docs. The result is going to be about the same and their medical societies will now have less reason to challenge the customary and reasonable system than they did before.”

As a medical practitioner, I eschewed contracts with this company a decade ago. Relative to peers, I was never so happy! Some companies just can’t seem to learn, or change their culture. But, the more important question to ask: is this indicative of an isolated rogue company, or the entire health insurance industry?

Conclusion

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product Details  Product DetailsProduct Details

%d bloggers like this: