HOW STOCKS WORK – In Brief?

IN SHORT

By FMG, LLC

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Financial Planning MDs 2015

How Will COVID-19 Change Healthcare Delivery?

How Will COVID-19 Change Healthcare Delivery?

By Health Capital Consultants, LLC

Spurred by how unprepared the American healthcare system was for a pandemic, the current COVID-19 emergency may present the conditions necessary to commence a healthcare delivery model paradigm shift.

In response to the public health emergency, the federal government, which has a record of reducing regulatory “burdens” under the Trump Administration, has taken aggressive actions to create regulatory flexibilities for healthcare providers and suppliers.

At least some of the various actions taken to reduce provider burden as they treat COVID-19 patients are likely to stay intact following the end of this pandemic, potentially revising the fundamental tenets of U.S. healthcare delivery. (Read more…)

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Assessment: Your thoughts are appreciated.

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On The State Licensing Process of Physicians

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By State Medical Boards

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By ROBERT JAMES CIMASI; MHA, ASA, FRICS, MCBA, AVA, CM&AA, CMP

By TODD A. ZIGRANG; MBA, MHA, ASA, FACHE

(C) Health Capital Consultants, LLC All rights reserved. St. Louis, MO USA

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USA

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Every state and the District of Columbia require the licensure of all allopathic (M.D.) and osteopathic (D.O.) physicians [1] Although the specific criteria for licensure vary by state, each state requires candidates to submit proof of completion of the requisite number of years of graduate medical education and passage of examinations verifying that “the physician is ready and able to practice competently and safely in an independent setting [2].

Moral Character

Additionally, a physician applying for licensure is typically required to have “good moral character,” absent his or her involvement in illegal activities [3] Most physicians satisfy the exam requirement by submitting proof of their successful completion of the United States Medical Licensing Examination (USMLE) or the Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) to the licensure board [4] However, as some practicing physicians may have been licensed under a previously administered exam, certain state licensing boards may consider a combination of other examinations sufficient to meet licensure requirements, so long as those exams were completed prior to 2000 [5]

Of State Medical Boards

The licensure of physicians is governed by a state medical board, the “primary responsibility” of which board, according to the Federation of State Medical Boards, is to “protect consumers of health care by ensuring that all physicians…are properly licensed and comply with various laws and regulations pertaining to the practice of medicine[6] To accomplish this goal, state legislatures have delegated certain powers to the state’s medical board, including the power to grant, suspend, and revoke licenses; conduct investigations into complaints against physicians; and, release guidelines related to best medical practices [7] State medical boards have traditionally consisted solely of physicians; however, there has recently been an increase in the number of non-physician board members on state medical boards [8].

History

Over the last 50 years, state medical boards have faced intense scrutiny regarding their commitment to disciplining physicians based on quality concerns [9] In 1960, the American Medical Association (AMA) heard “sobering” facts from the Federation of State Medical Boards that “much confusion over the definitions and objectives exists” related to state medical board enforcement of medical standards [10] From 1963 to 1967, 0.06% of all physicians were subject to discipline, while in 1981, 0.14% of all physicians were subject to discipline, due in large part to the problems identified by the AMA [11] Although the rate of physician discipline rose eightfold by the mid-1990s, to date, there are continuing concerns regarding state medical board enforcement of quality standards.

A March 2011 report by advocacy group Public Citizen found that over 55% of physicians who faced clinical privilege disciplines by hospitals from 1990 to 2009 did not have a corresponding action from a state medical board [12] Additionally, in 2011, state medical boards imposed 3.06 “serious disciplinary actions” (e.g., revocations, surrenders, suspensions, and probations of medical licenses) per 1,000 physicians, an increase from the 2010 rate of 2.97 per 1,000, but a decrease from the 2004 rate of 3.72 per 1,000 [13] Numerous reasons have been offered to explain the disparity in quality enforcement by state medical boards, the most prominent being that physicians are loath to report fellow physicians for major disciplinary actions such as licensure revocation[14]

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Assessment

Other reasons include a focus by state medical boards on “character-related misconduct” over clinical quality standards [15] as well as a lack of resources to investigate and enforce quality standards, which forces state medical boards to rely on physicians and hospitals to “police” themselves [16].

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 REFERENCES

[1]       “State Medical Boards: Future Challenges for Regulation and Quality Enhancement of Medical Care,” By James N. Thompson, Journal of Legal Medicine, Vol. 33, No. 9 (January-March 2012).

[2]       “State Medical Boards: Future Challenges for Regulation and Quality Enhancement of Medical Care,” By James N. Thompson, Journal of Legal Medicine, Vol. 33, No. 9 (January-March 2012); “Healthcare Valuation: The Four Pillars of Healthcare Value,” By Robert James Cimasi, MHA, ASA, FRICS, MCBA, AVA, CM&AA, Hoboken, NJ: John Wiley & Sons, Inc., 2014, p. 449-450.

[3]       “Medical Practice: Education and Licensure,” in “Legal Medicine,” By S. Sandy Sanbar et al., 6th Ed., Mosby, 2004, p. 81.

[4]       “Medical Licensure,” American Medical Association, 2014, http://www.ama-assn.org/ama/pub/education-careers/becoming-physician/medical-licensure.page, (Accessed 12/19/14); “COMLEX-USA,” National Board of Osteopathic Medical Examiners, 2014, http://www.nbome.org/exams-faq.asp (Accessed 12/19/14).

[5]       “Medical Licensure,” American Medical Association, 2014, http://www.ama-assn.org/ama/pub/education-careers/becoming-physician/medical-licensure.page, (Accessed on 12/19/14); “Healthcare Valuation: The Four Pillars of Healthcare Value,” By Robert James Cimasi, MHA, ASA, FRICS, MCBA, AVA, CM&AA, Hoboken, NJ: John Wiley & Sons, Inc., 2014, p. 450.

[6]       “What is a State Medical Board?” Federation of State Medical Boards, 2014, http://www.fsmb.org/policy/what-is-a-smb-faq (Accessed 12/19/14).

[7]       “What is a State Medical Board?” Federation of State Medical Boards, 2014, http://www.fsmb.org/policy/what-is-a-smb-faq (Accessed 12/19/14).

[8]       “What is a State Medical Board?” Federation of State Medical Boards, 2014, http://www.fsmb.org/policy/what-is-a-smb-faq (Accessed 12/19/14); “Character, Competence, and the Principles of Medical Discipline,” By Nadia N. Sawicki, Journal of Health Care Law & Policy, Vol. 13, No. 1, 2010, p. 291.

[9]       “Character, Competence, and the Principles of Medical Discipline,” By Nadia N. Sawicki, Journal of Health Care Law & Policy, Vol. 13, No. 1, 2010, p. 287, n. 7; “To Err is Human: Building a Safer Health System – Summary,” Institute of Medicine, 2000, http://www.iom.edu/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf (Accessed 12/19/14).

[10]     “Medical Licensure Statistics for 1960,” Journal of the American Medical Association, Vol. 176, No. 8 (May 27, 1961), p. 694.

[11]     “Medical Licensing Board Characteristics and Physician Discipline: An Empirical Analysis,” By Mark T. Law & Zeynep K. Hansen, Journal of Health Politics, Policy and Law, Vol. 35, No. 1 (February 2010), p. 66.

[12]     “State Medical Boards Fail to Discipline Doctors with Hospital Actions Against Them,” By Alan Levine et al., Public Citizen, March 2011, http://www.citizen.org/documents/1937.pdf (Accessed 12/19/14).

[13]     “Public Citizen’s Health Research Group Ranking of the Rate of State Medical Boards’ Serious Disciplinary Actions, 2009-2011,” By Sidney M. Wolfe, M.D., et al., Public Citizen, May 17, 2012, http://www.citizen.org/documents/2034.pdf (Accessed 12/19/14).

[14]     “Medical Boards are Too Lax, Critics Claim,” By Wayne J. Guglielmo, MA, MedScape, October 17, 2014, http://www.medscape.com/viewarticle/833141 (Accessed 12/3/14);

[15]     “Character, Competence, and the Principles of Medical Discipline,” By Nadia N. Sawicki, Journal of Health Care Law & Policy, Vol. 13, No. 1, 2010, p. 287.

[16]     “Medical Licensing Board Characteristics and Physician Discipline: An Empirical Analysis,” By Mark T. Law & Zeynep K. Hansen, Journal of Health Politics, Policy and Law, Vol. 35, No. 1 (February 2010), p. 90; “Medical Licensure Statistics for 1960,” Journal of the American Medical Association, Vol. 176, No. 8, May 27, 1961, p. 694.

NC Update: H543v2 – 04152015

Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)* 8

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Director of Hospital Quality Management Needed

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For A Hospital in Mississippi

Dear Dr. Marcinko,

Perhaps you can help a colleague?

I am conducting a confidential search for well qualified candidates to fill an immediate opening as a Director of Quality Management in a Mississippi hospital. Candidates must have hospital quality management experience and be willing to relocate if not already in the area.

This is an ideal opportunity for a strong Quality Manager to advance as Director in a modest size hospital which is a part of a growing national healthcare system.

To be considered, please email all resumes or candidates to me. Candidates may also contact me directly. If there appears to be a match, I’ll be able to disclose the location and discuss the details of the role.

So, please let me know if you know someone who may be qualified for this role.

Thank you.

Steve Haynes | Recruiting Manager
Avery Partners, LLC
steve.haynes@averypartners.com

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Team Quality

What Is Health 2.0?

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New-Wave Operative Definitions

By Jennifer Tomasik MS

Health 2.0 is participatory health care.

Enabled by information, software, and community that we collect or create, we the patients can be effective partners in our own health care, and we the people can participate in reshaping the health system itself.

   — Dr. Ted Eytan, Director, Permanente Federation, LLC

Potential

Health 2.0’s potential lies in enabling, catalyzing, and sustaining changes in the practice of healthcare.

Dr. Ted Eytan, a nationally recognized proponent of digitally-enhanced patient care with a particular interest in preventive care, has blogged the above “declaration of health care independence,” which we will use as our own working definition of Health 2.0.

A Human Space Defined by Engagement

We see Health 2.0 as a human space defined by engagement, aided by technology, in which information and accountability can flow between individuals and their care teams and between individuals and their social networks.

Assessment

The “practice” of healthcare can be understood as a set of “behaviors” that becomes embedded in daily life, plus the “supports” that provide the appropriate resources to achieve the desired outcomes.

Thus, changing a current practice (in pursuit of a different outcome) requires enabling the behavior you want to encourage by providing the necessary supports to make it happen. Health 2.0 has made new supports available for people to embed health-seeking behaviors and sustain practices that increase their involvement in their own health.

NOTES:


[i] Eytan T. “The Health2.0 Definition: Not just the Latest, The Greatest!,” Ted Eytan, MD (Blog).Online 13 Jun 2008. Accessed 1 Nov 2012. <http://www.tedeytan.com/2008/06/13/1089&gt;

[ii] Hawn C. “Take Two Aspirin and Tweet Me in the Morning: How Twitter, Facebook, and Other Social Media Are Reshaping Health Care.” Health Affairs 2009;28(2):361-8.

[iii] Moussa M, Tomasik JL. “Doctor-Patient Relationships in the Modern Era: Can We Talk—A Collaborative Shift in Bedside Manner.” Ch. 15 in Marcinko D.E. and Hope R. Hetico. The Business of Medical Practice: Transformational Health 2.0 Skills for Doctors. New York: Springer Pub. Co., 2011.

Conclusion

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The LLC Defined for Physicians

A Hybrid Business Entity

By Staff Reporters

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A limited liability company (LLC) is a form of business entity some physician use that can provide many advantages to a physician medical practice owner.

Definition

As the name indicates, there is limited liability to the physician. Therefore, the practice owner’s personal assets are protected from claims against the practice and also from practice business debts, unless of course, the owner personally guaranteed any business debts.

No Absolute Immunity

But, limited liability protection is not absolute. There are instances where a doctor owner’s personal assets can be reached.

Assessment

Limited liability protection is similar to that of a corporation. However, unlike a C corporations, an LLC is a “pass-though” entity for taxation purposes. The benefit of being a pass through entity is that there is only one level of tax imposed on the LLC’s earnings. With a C corporation, the earnings are taxed at the corporate level and taxed again at the shareholder level when the earnings are distributed to shareholder.

Thus, the LLC can be considered a hybrid between a corporation and a partnership.

Charitable Business Planning and the LLC

http://www.chslegacy.org/giftlaw/article.jsp?WebID=GL2007-1230&D=201010

Conclusion

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

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Defining Hospital Competitive Markets

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Clarifying Often Nebulous and Contentious Terminology

[By Staff Reporters]

According to Robert James Cimasi; MHA, CMP™ of Health Capital Consultants LLC in St. Louis, MO; the definition of a hospital’s “market” is often nebulous.

Ambiguous Terms

Some entities are defined by terms as ambiguous as “acute care inpatient hospitals,” “specialty hospitals,” or “anchor hospitals.” This ambiguity occurs because healthcare is increasingly provided on an outpatient basis, and general acute care inpatient hospitals face competition from a range of allied healthcare providers for the medical services they deliver.

Link: www.HealthcareFinancials.com

US Supreme Court Explains

For example, none other than the US Supreme Court has explained that the determination of relevant hospital product and geographic markets is “a necessary predicate” to deciding whether a hospital merger contravenes the Clayton Act (antitrust).

Assessment

For additional information, please see United States v. Marine Ban Corporation Inc., 418 U.S. 602, 618 (1974) (citing United States v. E.I. Du Pont De Nemours & Co., 353 U.S. 586, 593 (1957); Brown Shoe Co. v. United States, 370 U.S. 294, 324 (1962).

Conclusion

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Concierge Medicine – New Wave or Drought?

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Boutique Medical Practices – Wave of the Future or Mirage?

[By Dr. David Edward Marcinko; MBA, CMP™]dr-david-marcinko1

Briefly, a new-wave boutique, or concierge medical practice business model requires an annual retainer fee for personalized treatment that includes amenities far beyond those offered in the typical practice. And, as doctors may not accept Medicare patients for two years thereafter, there is no going back to the economic oasis if the model doesn’t pan out.

Rather, patients pay annual out-of-pocket fees for top tier service, but also use traditional health insurance to cover allowable expenses, such as inpatient hospital stays, outpatient diagnostics and care, and basic tests and physician exams.   

Typical annual fees can range from $1,000 to $ 5,000 per patient, to family fees that top $20,000 a year, or more.  The concept, initially developed for busy corporate executives, has now made its way to those desiring such service; but the masses have been slow to accept the new business model. 

Conclusion

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