Medical Risk Management and Insurance Planning Practices of Leading CERTIFIED MEDICAL PLANNERS®

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

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SAMPLE: 21. Practice Risks

MORE: Risk Mgmt Leadership

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RISK MANAGEMENT, Liability Insurance and Asset Protection Strategies

FOR PHYSICIANS AND THEIR FINANCIAL ADVISORS

SPONSOR: http://www.CertifiedMedicalPlanner.org

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REVIEWS:

“Physicians who don’t understand modern risk management, insurance, business, and asset protection principles are sitting ducks waiting to be taken advantage of by unscrupulous insurance agents and financial advisors; and even their own prospective employers or partners. This comprehensive volume from Dr. David Marcinko and his co-authors will go a long way toward educating physicians on these critical subjects that were never taught in medical school or residency training.”
Dr. James M. Dahle, MD, FACEP, Editor of The White Coat Investor, Salt Lake City, Utah, USA


“With time at a premium, and so much vital information packed into one well organized resource, this comprehensive textbook should be on the desk of everyone serving in the healthcare ecosystem. The time you spend reading this frank and compelling book will be richly rewarded.”
—Dr. J. Wesley Boyd, MD, PhD, MA, Harvard Medical School, Boston, Massachusetts, USA

ASSESSMENT: Your thoughts are appreciated.

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RISK FACTORS COMMON TO PHYSICIANS

SOME COMMON RISK FACTORS FOR MEDICAL COLLEAGUES TO APPRECIATE

BY DR. DAVID E. MARCINKO MBA CMP®

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AN INCOMPLETE LIST = T.N.T.C.

  • Do you and or any family members drive a vehicle?
  • Do you have employees?
  • Do you have a professional malpractice exposure?
  • Do you have legal responsibility to protect medical, EMRs or personal and patient financial data?
  • Are you married and do you have assets not protected by a prenuptial agreement?
  • Do you have a current tax obligation?
  • Do you own a business?
  • Are you a board member, officer, or director of a corporation, foundation, religious or educational organization?
  • Do you engage in activities like hunting, flying, boating, etc?
  • Do you have business or domestic partners whose actions create joint and several liabilities for you?
  • Do you have personal guarantees on real estate or for business loans; or family members?
  • Do you have tail liability for professional services performed in the past?
  • Have you made specific legal or financial representations that others have relied upon in a business context?
  • What kind and what dollar amount of insurance and legal planning have you implemented against these exposures?

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FOREWORD BY J. WESLEY BOYD MD PhD MA

[Professor of Psychiatry Harvard and Yale University]

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ASSESSMENT: Your thoughts and comments are appreciated.

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OVERHEARD IN THE FINANCIAL ADVISOR’S LOUNGE

On Asset Protection FOR PHYSICIANS

From my perspective, asset protection is a team sport, and lawyers rely on financial advisers all the time to spot issues for clients. We do not all share the opinion that non-lawyers are incapable of giving good advice.

J. Chris Miller JD

Alpharetta, GA

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HUMANITARIAN WISDOM IN PATIENT CARE AS AN ETHICAL AND MORAL IMPERATIVE!

AND … RISK MANAGEMENT TOOL?

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BY DR. DAVID EDWARD MARCINKIO MBA CMP®

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To start, let us all recall the Canadian physician Sir William Osler MD, one of the founders of Johns Hopkins Hospital in my hometown of Baltimore Maryland, and where I played stickball in the parking lot as a kid. He left a sizeable body of wisdom that has guided many physicians in the practice of medicine. So, allow me to share with you some of that accumulated wisdom and the quotes that have served me well over the years.

From Dr. Osler, I learned the art of putting myself in the patient’s shoes. “The motto of each of you as you undertake the examination and treatment of a case should be ‘put yourself in his place.’ Realize, so far as you can, the mental state of the patient, enter into his feelings.” Osler further stresses that we should “scan gently (the patient’s) faults” and offer the “kindly word, the cheerful greeting, the sympathetic look.”1

“In some of us, the ceaseless panorama of suffering tends to dull that fine edge of sympathy with which we started,” writes Osler in his famous essay “Aequanimitas.”2 “Against this benumbing influence, we physicians and nurses, the immediate agents of the Trust, have but one enduring corrective — the practice towards patients of the Golden Rule of Humanity as announced by Confucius: ‘What you do not like when done to yourself, do not do to others.’”

Medicine can be both art and science as many physicians have discovered. As Osler tells us, “Errors in judgment must occur in the practice of an art which consists largely of balancing probabilities.”2 Osler notes that “Medicine is a science of uncertainty and an art of probability” and also weighs in with the idea that “The practice of medicine is an art, based on science.”3,4

Osler emphasized that excellence in medicine is not an inheritance and is more fully realized with the seasoning of experience. “The art of the practice of medicine is to be learned only by experience,” says Osler. “Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone can you become expert.”5

Finally, some timeless wisdom on patient care came from Osler in an address to St. Mary’s Hospital Medical School in London in 1907: “Gain the confidence of a patient and inspire him with hope, and the battle is half won.”6

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Osler has also imparted plenty of advice on the business of medicine. In “Aequanimitas,” Osler says there are only two types of doctors: “those who practice with their brains, and those who practice with their tongues.”7

In a valedictory address to medical school graduates at McGill University, Osler suggested treating money as a side consideration in a medical career.8 “You have of course entered the profession of medicine with a view of obtaining a livelihood; but in dealing with your patients let this always be a secondary consideration.”

“You are in this profession as a calling, not as a business: as a calling which exacts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow man,” explains Osler in the address to St. Mary’s Hospital Medical School.6 “Once you get down to a purely business level, your influence is gone and the true light of your life is dimmed. You must work in the missionary spirit, with a breadth of charity that raises you far above the petty jealousies of life.”

It is not easy for doctors to combine a passion for patient care, a knowledge of science and the maintenance of business, according to Osler in the British Medical Journal.9 “In the three great professions, the lawyer has to consider only his head and pocket, the parson the head and heart, while with us the head, heart, and pocket are all engaged.”

While some aspects of practice may fall short or be devoid of appropriate financial remuneration, the giving of one’s time, expertise and experience in improving patient outcomes and the quality of their lives may be the greatest gift. “The ‘good debts’ of practice, as I prefer to call them … amount to a generous sum by the end of each year,” says Osler.9

And so, as you practice medicine and reflect on your career, always remember the words and wisdom of Dr. William Osler, and keep patient welfare as your first priority.

References

1. Penfield W. Neurology in Canada and the Osler centennial. Can Med Assoc J. 1949; 61(1): 69-73

2. Osler W. Aequanimitas. Chapter 9, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 159

3. Bean WB. William Osler: Aphorisms, CC Thomas, Springfield, IL, p. 129.

4. Osler W. Aequanimitas. Chapter 3, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 34

5. Thayer WS. Osler the teacher. In: Osler and Other Papers. Johns Hopkins Press, Baltimore, 1931, p. 1.

6. Osler W. The reserves of life. St. Mary’s Hosp Gaz. 1907;13 (1):95-8.

7. Osler W. Aequanimitas. Chapter 7, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 124

8. Osler W. Valedictory address to the graduates in medicine and surgery, McGill University. Can Med Surg J. 1874; 3:433-42.

9. Osler W. Remarks on organization in the profession. Brit Med J. 1911; 1(2614):237-9.

10. Jacobs. AM: PMNews, April, 2015.

ASSESSMENT: Your thoughts are appreciated.

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A FRUSTRATED PHYSICIAN ASKS: How Much Insurance is Enough?

OVER HEARD IN THE DOCTOR’S LOUNGE

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I currently have no fewer than 10 separate insurance policies associated with my plastic surgery practice. I understand very little about the policies other than that somebody at some point told me I needed each and every one of them, and each made sense when I bought it. But, I often wonder:  

  • Am I over-insured and thus wasting money? 
  • Am I under-insured and thus at risk for a liability disaster? 

I never really had the means of answering these questions …. Until Now!

Lloyd M. Krieger; MD MBA

[Beverly Hills, CA]

***

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Physicians “FIRING” Patients?

ON TERMINATING PATIENT RELATIONSHIPS

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By Dr. David Edward Marcinko MBA CMP®

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Just as it is an acceptable and reasonable practice to screen incoming patients, it is acceptable and reasonable to know when to end relationships. Termination criteria are numerous and varied. Although not exhaustive, the following are situations in which termination may be appropriate and acceptable:

  • Treatment noncompliance—The patient does not or will not follow the treatment plan.
  • Follow-up noncompliance—The patient repeatedly cancels follow-up visits or is a no-show.
  • Office policy noncompliance—The patient uses weekend on-call physicians or multiple health care practitioners to obtain refill prescriptions when office policy specifies a certain number of refills between visits.
  • Verbal abuse—The patient or a family member is rude and uses improper language with office personnel, exhibits violent behavior, makes threats of physical harm, or uses anger to jeopardize the safety and well-being of office personnel with threats of violent actions.
  • Nonpayment—The patient owes a backlog of bills and has made no effort to arrange a payment plan.

YOU'RE FIRED! How to Switch Real Estate Agents | Barb Has ...

It is an acceptable practice to end a patient relationship under most conditions. There are a few situations, however, that may require additional steps or a delay of the termination. According to The Doctors Company, Laura A. Dixon JD RN,the following circumstances fall into this category:

  • If the patient is in an acute phase of treatment, termination must be delayed until the acute phase has passed. For example, if the patient is in the immediate postoperative stage or is in the process of medical workup for diagnosis, it is not advisable to end the relationship.
  • If the practitioner is the only source of medical or dental care within a reasonable driving distance, he or she may need to continue care until other arrangements can be made.
  • When the practitioner is the only source of a particular type of specialized medical or dental care, he or she is obliged to continue this care until the patient can be safely transferred to another practitioner who is able to provide treatment and follow up.
  • If the patient is a member of a prepaid health plan, the patient cannot be discharged until the practitioner has communicated with the third-party payer to request a transfer of the patient to another practitioner.
  • A patient may not be terminated solely because he or she is diagnosed with AIDS/HIV.

When the situation with the patient is such that terminating the relationship is appropriate and acceptable and none of the restrictions mentioned above are present, termination of the patient relationship should be completed formally. The patient should be put on written notice that he or she must find another health care practitioner. The written notice should be mailed to the patient by regular and certified mail, return receipt requested. Keep copies of the letter, the original certified mail receipt, and the original certified mail return receipt (even if the patient refuses to sign for the certified letter) in the patient’s medical record.

YOUR THOUGHTS ARE APPRECIATED

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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The CORPORATE PRACTICE of Medicine?

By Dr. David Edward Marcinko MBA CMP®

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CORPORATE PRACTICE OF MEDICINE (CPM) LAWS

OK – I admit that I am not an attorney. But, approximately half of states in the U.S. have made it unlawful for practicing physicians to be employees of corporations. This ban on the corporate practice of medicine (CPM) is intended to keep medical professionals independent and free from financial pressures and influence.

Most states have made exceptions allowing physicians to become employees of not-for-profit organizations and sometimes hospitals. States such as California, Iowa, and Texas, have declined to allow hospitals to employ physicians, although even those states have special exceptions. Iowa hospitals may employ pathologists and radiologists, and Texas public hospitals and California teaching hospitals may employ physicians. Ohio has no ban on the corporate practice of medicine.

ASSESSMENT: Anyone can own a physician practice in Ohio.

QUERY: So, who does the aggrieved patient sue?

YOUR THOUGHTS ARE APPRECIATED

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Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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THE ANATOMIC BASIS OF HUMAN PHYSIOLOGY AND BEHAVIOR?

BRAIN ANATOMY

By Dr. David Edward Marcinko MBA CMP©

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I am not a neurologist, psychologist, or psychiatrist. But, it is well known that emotional and behavioral change involves the human nervous system. And, there are two parts of the nervous system that are especially significant for holistic financial advisor; the first is the limbic system and the second is the autonomic nervous system. 

According to Dr. C. George Boerre of Shippensburg University of Pennsylvania, this is known as the emotional nervous system.

1. The Limbic System

The limbic system is a set of structures that lies on both sides of the thalamus, just under the cerebrum.  It includes the hypothalamus, the hippocampus, the amygdala, and nearby areas.  It is primarily responsible for emotions, memories and recollection. 

Hypothalamus

The small hypothalamus is located just below the thalamus on both sides of the third ventricle (areas within the cerebrum filled with cerebrospinal fluid that connect to spinal fluid). It sits inside both tracts of the optic nerve, and just above the pituitary gland.

The hypothalamus is mainly concerned with homeostasis or the process of returning to some “set point.”  It works like a thermostat:  When the room gets too cold, the thermostat conveys that information to the furnace and turns it on.  As the room warms up and the temperature rises, it sends turns off the furnace.  The hypothalamus is responsible for regulating hunger, thirst, response to pain, levels of pleasure, sexual satisfaction, anger and aggressive behavior, and more.  It also regulates the functioning of the autonomic nervous system, which means it regulates functions like pulse, blood pressure, breathing, and arousal in response to emotional circumstances. In a recent discovery, the protein leptin is released by fat cells with over-eating.  The hypothalamus senses leptin levels in the bloodstream and responds by decreasing appetite.  So, it seems that some people might have a gene mutation which produces leptin, and can’t tell the hypothalamus that it is satiated.   The hypothalamus sends instructions to the rest of the body in two ways.  The first is to the autonomic nervous system.  This allows the hypothalamus to have ultimate control of things like blood pressure, heart rate, breathing, digestion, sweating, and all the sympathetic and parasympathetic functions.

The second way the hypothalamus controls things is via the pituitary gland.  It is neurally and chemically connected to the pituitary, which in turn pumps hormones called releasing factors into the bloodstream.  The pituitary is the so-called “master gland” as these hormones are vitally important in regulating growth and metabolism.

Hippocampus

The hippocampus consists of two “horns” that curve back from the amygdala.  It is important in converting things “in your mind” at the moment (short-term memory) into things that are remembered for the long run (long-term memory).  If the hippocampus is damaged, a patient cannot build new memories and lives in a strange world where everything they experience just fades away; even while older memories from the time before the damage are untouched!  Most patients who suffer from this kind of brain damage are eventually institutionalized.

Amygdala

The amygdalas are two almond-shaped masses of neurons on either side of the thalamus at the lower end of the hippocampus.  When it is stimulated electrically, animals respond with aggression.  And, if the amygdala is removed, animals get very tame and no longer respond to anger that would have caused rage before.  The animals also become indifferent to stimuli that would have otherwise have caused fear and sexual responses.

Related Anatomic Areas

Besides the hypothalamus, hippocampus, and amygdala, there are other areas in the structures near to the limbic system that are intimately connected to it:

  • The cingulate gyrus is the part of the cerebrum that lies closest to the limbic system, just above the corpus collosum.  It provides a pathway from the thalamus to the hippocampus, is responsible for focusing attention on emotionally significant events, and for associating memories to smells and to pain.
  • The ventral tegmental area of the brain stem (just below the thalamus) consists of dopamine pathways responsible for pleasure.  People with damage here tend to have difficulty getting pleasure in life, and often turn to alcohol, drugs, sweets, and gambling.
  • The basal ganglia (including the caudate nucleus, the putamen, the globus pallidus, and the substantia nigra) lie over to the sides of the limbic system, and are connected with the cortex above them.  They are responsible for repetitive behaviors, reward experiences, and focusing attention. 
  • The prefrontal cortex, which is the part of the frontal lobe which lies in front of the motor area, is also closely linked to the limbic system.  Besides apparently being involved in thinking about the future, making plans, and taking action, it also appears to be involved in the same dopamine pathways as the ventral tegmental area, and plays a part in pleasure and addiction.

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2. The Autonomic Nervous System

The second part of the nervous system to have a particularly powerful part to play in our emotional life is the autonomic nervous system. 

The autonomic nervous system is composed of two parts, which function primarily in opposition to each other.  The first is the sympathetic nervous system, which starts in the spinal cord and travels to a variety of areas of the body.  Its function appears to be preparing the body for the kinds of vigorous activities associated with “fight or flight,” that is, with running from danger or with preparing for violence.  Activation of the sympathetic nervous system has the following effects:

  • dilates the pupils and opens the eyelids,
  • stimulates the sweat glands and dilates the blood vessels in large muscles,
  • constricts the blood vessels in the rest of the body,
  • increases the heart rate and opens up the bronchial tubes of the lungs, and
  • inhibits the secretions in the digestive system.

One of its most important effects is causing the adrenal glands (which sit on top of the kidneys) to release epinephrine (adrenalin) into the blood stream.  Epinephrine is a powerful hormone that causes various parts of the body to respond in much the same way as the sympathetic nervous system.  Being in the blood stream, it takes a bit longer to stop its effects, and may take some time to calm down again

The sympathetic nervous system also takes in information, mostly concerning pain from internal organs.  Because the nerves that carry information about organ pain often travel along the same paths that carry information about pain from more surface areas of the body, the information sometimes get confused.  This is called referred pain, and the best known example is the pain in the left shoulder and arm when having a heart attack.

The other part of the autonomic nervous system is called the parasympathetic nervoussystem.  It has its roots in the brainstem and in the spinal cord of the lower back.  Its function is to bring the body back from the emergency status that the sympathetic nervous system puts it into.

Some of the details of parasympathetic arousal include some of the following:.

  • pupil constriction and activation of the salivary glands,
  • stimulating the secretions of the stomach and activity of the intestines,
  • stimulating secretions in the lungs and constricting the bronchial tubes, and;
  • decreases heart rate.

The parasympathetic nervous system also has some sensory abilities:  It receives information about blood pressure, levels of carbon dioxide in the blood, etc.

There is actually another part of the autonomic nervous system that is not mentioned too often: the enteric nervous system.  It is a complex of nerves that regulate the activity of the stomach. 

For example, if you get sick to your stomach with a new financial advisory client – or feel nervous butterflies with your first patient encounter as a doctor- you can blame the enteric nervous system.

ASSESSMENT: Your thoughts are appreciated.

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ABOUT THE Institute of Medical Business Advisors, Inc

About iMBA, Inc

By Staff Reporters

iMBA Inc., is a healthcare consulting and financial planning analytics firm specializing in medical practice management and physician alignment.

Our mission is to empower physician colleagues and healthcare organizations to drive clarity, improve performance, and create accountability.

Our team combines a cross-section of skill-sets including public and population health, financial operations, business intelligence, and data science.

And, our diverse background of experience includes advanced academic training, economic and financial research, global marketing, management consulting, and entrepreneurial spirit.

INSTITUTE WEB: www.MedicalBusinessAdvisors.com

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SCHEDULE A MEDICAL PRACTICE & FINANCIAL PLANNING CONSULTATION TODAY!
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DR. DAVID EDWARD MARCINKO MBA CMP®

[Chief Executive Officer]

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CONTACT: MarcinkoAdvisors@msn.com
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Physician Characteristics Prone to Malpractice Claims

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Conclusion

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

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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  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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PHYSICIAN-EXECUTIVE LEADERSHIP AND RISK MANAGEMENT

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Human Nature, Medical Ethics and Modern Principles

  • By David Edward Marcinko FACFAS CMP® MBA MBBS
  • By Render S. Davis MHA CAE
  • By Hope Rachel Hetico RN MHA CPHQ CMP®
  • By Gary A. Cook EJD CFP® CLU RHU MSFS CMP®

In any textbook of gravitas on medical risk management, asset protection and insurance planning, a chapter on human nature is usually placed at the end of the book, or as an appendix, or an afterthought if included at all.

However, we elected to prominently place this material as the premier chapter of our textbook.

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 Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

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Why?

In the end, the success of any risk management endeavor ultimately comes down to changing human behavior – helping a doctor/nurse/technician alter whatever s/he was doing toward something that will better allow them to avoid errors and pursue quality care and practice management goals.

Yet, there is still remarkably little education or training for medical professionals focused directly on motivation or change theory, in any related area except psychiatry/psychology or perhaps professional liability.

Instead, doctors are increasingly turning to professional consultants to learn best practices on how to help them actually make the behavioral changes necessary to achieve their quality improvement and risk reduction goals; as we attempt to answer these questions.

The Queries:

  • Are you and your medical practice, or clinical, ready for change?
  • How to transition from [traditional] solo practitioner B-models to modern forms?
  • What are leadership, management and governance?
  • In group practices, how is leadership shared?
  • What issues need be considered when hiring a practice administrator or clinic CEO?
  • What is medical ethics and munificence? Why is it needed? How does it work?
  • What are the types of risk?
  • How are risks managed in the medical practice space?

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confirmation-bias

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Leadership Shortcomings

In addition, medical practitioners need to strive to avoid what Zenger and Folkman describe as the 10 most common leadership shortcomings based on a survey of 11,000 leaders. They include:

  • Lacks energy and enthusiasm
  • Accepts mediocre self performance
  • Lacks clear vision and direction
  • Poor judgment
  • Not collaboration
  • Not following standards
  • Resistant to new ideas
  • Doesn’t learn from mistakes
  • Lacks interpersonal skills
  • Fails to develop others.

Source: Zenger and Folkman: The Daily Stat: The 10 Most Common Failures of Business Leaders, Harvard Business Publishing, June 4, 2009. 

More:

Assessment

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Conclusion

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

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:

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HUMANITARIAN WISDOM IN PATIENT CARE AS A MORAL IMPERATIVE AND …

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…. A MEDICAL RISK MANAGEMENT TOOL in 2018!

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[Dr. David Edward Marcinko CMP™ MBA MBBS]

http://www.CertifiedMedicalPlanner.org

EDITOR-IN-CHIEF

***

In SECTION ONE, of our newest textbook, on medical practitioner personal risk management issues, let us all recall the Canadian physician Sir William Osler MD, one of the founders of Johns Hopkins Hospital in my hometown of Baltimore Maryland, and where I played stickball in the parking lot as a kid. He left a sizeable body of wisdom that has guided many physicians in the practice of medicine. So, allow me to share with you some of that accumulated wisdom and the quotes that have served me well over the years.

From Dr. Osler, I learned the art of putting myself in the patient’s shoes. “The motto of each of you as you undertake the examination and treatment of a case should be ‘put yourself in his place.’ Realize, so far as you can, the mental state of the patient, enter into his feelings.” Osler further stresses that we should “scan gently (the patient’s) faults” and offer the “kindly word, the cheerful greeting, the sympathetic look.”1

“In some of us, the ceaseless panorama of suffering tends to dull that fine edge of sympathy with which we started,” writes Osler in his famous essay “Aequanimitas.”2 “Against this benumbing influence, we physicians and nurses, the immediate agents of the Trust, have but one enduring corrective — the practice towards patients of the Golden Rule of Humanity as announced by Confucius: ‘What you do not like when done to yourself, do not do to others.’”

Medicine can be both art and science as many physicians have discovered. As Osler tells us, “Errors in judgment must occur in the practice of an art which consists largely of balancing probabilities.”2 Osler notes that “Medicine is a science of uncertainty and an art of probability” and also weighs in with the idea that “The practice of medicine is an art, based on science.”3,4

Osler emphasized that excellence in medicine is not an inheritance and is more fully realized with the seasoning of experience. “The art of the practice of medicine is to be learned only by experience,” says Osler. “Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone can you become expert.”5

Finally, some timeless wisdom on patient care came from Osler in an address to St. Mary’s Hospital Medical School in London in 1907: “Gain the confidence of a patient and inspire him with hope, and the battle is half won.”6

Osler has also imparted plenty of advice on the business of medicine. In “Aequanimitas,” Osler says there are only two types of doctors: “those who practice with their brains, and those who practice with their tongues.”7

***

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

***

In a valedictory address to medical school graduates at McGill University, Osler suggested treating money as a side consideration in a medical career.8 “You have of course entered the profession of medicine with a view of obtaining a livelihood; but in dealing with your patients let this always be a secondary consideration.”

“You are in this profession as a calling, not as a business: as a calling which exacts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow man,” explains Osler in the address to St. Mary’s Hospital Medical School.6 “Once you get down to a purely business level, your influence is gone and the true light of your life is dimmed. You must work in the missionary spirit, with a breadth of charity that raises you far above the petty jealousies of life.”

It is not easy for doctors to combine a passion for patient care, a knowledge of science and the maintenance of business, according to Osler in the British Medical Journal.9 “In the three great professions, the lawyer has to consider only his head and pocket, the parson the head and heart, while with us the head, heart, and pocket are all engaged.”

While some aspects of practice may fall short or be devoid of appropriate financial remuneration, the giving of one’s time, expertise and experience in improving patient outcomes and the quality of their lives may be the greatest gift. “The ‘good debts’ of practice, as I prefer to call them … amount to a generous sum by the end of each year,” says Osler.9

***

http://www.BusinessofMedicalPractice.com

***

MEDICAL Ethics for Challenging Times

[Finding Your Moorings in an Era of Dramatic Change]

Marcinko Ethics

By Render S. Davis MHA

By David Edward Marcinko

***

And so, as you read and reflect on the chapter of SECTION ONE, always remember the words and wisdom of Dr. William Osler, and keep patient welfare as your first priority.

Dr. David Edward Marcinko; CMP™ MBA MBBS [Hon]

[Chief Executive Officer]

iMBA Inc., Norcross, GA

References

  1. Penfield W. Neurology in Canada and the Osler centennial. Can Med Assoc J. 1949; 61(1): 69-73
  2. Osler W. Aequanimitas. Chapter 9, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 159
  3. Bean WB. William Osler: Aphorisms, CC Thomas, Springfield, IL, p. 129.
  4. Osler W. Aequanimitas. Chapter 3, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 34
  5. Thayer WS. Osler the teacher. In: Osler and Other Papers. Johns Hopkins Press, Baltimore, 1931, p. 1.
  6. Osler W. The reserves of life. St. Mary’s Hosp Gaz. 1907;13 (1):95-8.
  7. Osler W. Aequanimitas. Chapter 7, P. Blakiston’s Son and Co., Philadelphia, 1925, p. 124
  8. Osler W. Valedictory address to the graduates in medicine and surgery, McGill University. Can Med Surg J. 1874; 3:433-42.
  9. Osler W. Remarks on organization in the profession. Brit Med J. 1911; 1(2614):237-9.
  10. Jacobs. AM: PMNews, April, 2015.

***

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

  Risk Management, Liability Insurance, and Asset Protection Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™ Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

[Dr. Cappiello PhD MBA] *** [Foreword Dr. Krieger MD MBA]

***

Common Asset Protection Risk Factors for Physicians

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The “Issues” LIST

IKE

By Ike Devji JD

CHECKLIST

This check list is simple and by no means complete, but it helps explain the detail and variety of issues and exposures involved in preserving the assets you have at risk.

List of Exposures

• Do you and or any family members drive a vehicle?
Do you have employees?
• Do you have a professional malpractice exposure?
• Do you have a legal responsibility to protect medical and financial data?
• Are you married and do you have assets not protected by a pre-nuptial agreement?
• Do you have a current tax obligation?
Do you have children?
• Do you own a business?
• Are you a board member, officer, or director of a corporation?
• Do you have hobbies or engage in activities like hunting, flying, boating, etc?
• Do you have partners whose actions create joint and several liabilities for you?
• Do you have personal guarantees on real estate or for business loans?
• Do you have tail liability for professional services performed in the past?
• Have you made specific legal or financial representations that others have relied upon in a business context?
What kind and what dollar amount of insurance and legal planning have you implemented against these exposures?

Assessment

Knowledge is power, so use the links above to continue your exploration and act on these issues before an exposure threatens, while the widest and most effective array of options can be implemented to protect your success.

***

IRA Cecklists

***

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APPRECIATING PHYSICIAN EMPLOYEE BUSINESS CREDENTIALING RISKS

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LIABILITY FOR PHYSICIAN-EXECUTIVES AND MEDICAL EMPLOYERS

IKE[By Ike Devji  JD]

Many medical practice employees, including doctors, nurses, and various clinical assistants must be very specifically credentialed based on both the specifics of your practice and third-party payer contracts.

This additional condition of employment requires a variety of credentialing compliance best practices.

Why is This Such a Big Deal, What’s the Worst that Could Happen?

  • Once an error is identified in any one area of your billing practices, you should expect other areas, even non-related ones with lower compliance burdens, to be examined;
  • You face potential civil and criminal liability for billing third-party payers that contractually require specific credentialed care providers;
  • Your practice may face a loss of revenue due to failure to comply and substantial disruption of practice cash flow if an audit or questions arise;
  • You are subject to reputational damage, stress, and substantial legal fees easily in the six-figure or seven figure range;
  • Increased medical malpractice risk for potentially not providing the required reasonable standard of care if a non-credentialed employee is in the chain of treatment for an affected patient;
  • It may also potentially induce your liability insurance carriers to either completely exclude an event or reduce applicable coverage.

Although this process can be managed internally with the right training and by a variety of existing administrative staff, there is professional help available at nearly every scale, from small practices to hospitals. Many practices, especially smaller ones that don’t have full time HR managers, find that outsourcing this issue is a time and cost efficient form of risk management of this important issue. Outside professional resources are generally known as credentialing organizations (COs), which operate under the wider banner of HR and employee background-check services. Many of these services have accredited certified provider credentialing specialists that can work with your office and staff as outsourced compliance experts.

The biggest benefit a CO can offer is that the best of them go beyond providing just a snapshot of your current credentialing; they also offer a long-range plan to help you implement and maintain it.

***

Niche

***

Some Advantages of Outsourcing this Issue to a Credentialing Organization

  1. They manage credentialing proactively instead of reactively and can help avoid loss of time, efficiency and revenue when, for instance, doctors or staff are taken out of the office to complete massive amounts of CME all at once on a short deadline;
  2. COs are typically better equipped to respond quickly to staff changes including the on-boarding of new staff or doctors, and can help identify and verify what is required to bring any new staff into compliance;
  3. They typically have software systems that are more consistent and reliable than the self-created systems implemented by most practices internally, typically Excel spreadsheets that need to be manually updated and checked;
  4. Using CO software systems is often time and cost efficient in related areas, like insurance credentialing and can help manage a variety of functions including background check compliance, immunizations and hospital privilege policy compliance, as just a few examples.

Risk management in this area again requires that your practice is proactive and discovers and corrects any credentialing gaps in your office before they are an unwelcome surprise discovered by a third party. The liability and financial jeopardy is ultimately that of the practice owners and managers regardless of whether you outsource to a CO or not.

Proactively addressing this serious issue starts with a few simple steps:

  • Have a specific written plan to determine and verify all the required credentialing compliance of each employee and to maintain their compliance status. This applies to both statutory compliance required by law and any other credentialing required as a provider that bills third parties under specific and enforceable contractual requirements;
  • Make a specific person accountable for managing this process and check on that management at least quarterly;
  • Implement appropriate specialty insurance coverage where possible to help protect against any gaps or errors including RAC audit insurance.

  ***industry

***

Conclusion

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ABOUT

Mr. Ike Devji is Of-Counsel with Lodmell & Lodmell PC and is the firm’s former managing attorney. He is the Executive Vice-President of the Wealthy 100 ™, a Phoenix Arizona based wealth management and wealth strategy firm with a network of advisors across the United States.  Mr. Devji selectively consults and provides asset protection services to high-net worth, high liability clients nationwide. Ike has spoken to literally thousands of physicians, allied medical professionals and other high-net worth clients across the country. He provides continuing legal education on this subject to other attorneys and regularly lectures at the request of leading medical practice management and investment management groups, including most recently; MultiFinancial Securities, Greenbook Financial, ING, ING TRUST, Comprehensive Wealth Management, CFO Advisors, numerous banks, and both Lorman and the National Business Institute, among others.

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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***

[PHYSICIAN FOCUSED FINANCIAL PLANNING AND RISK MANAGEMENT COMPANION TEXTBOOK SET]

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***

Seeking Peer Reviewers for New Medical Risk Management Text Book

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***

RISK MANAGEMENT, LIABILITY INSURANCE, AND ASSET PROTECTION STRATEGIES FOR DOCTOR AND ADVISORS

[Best Practices from Leading Consultants and Certified Medical Planners™]

***

***

Skills Needed

If you are a physician, nurse, accountant, attorney, medical risk manager or healthcare executive, we need you.

Form below or contact us for details to peer-review, etc. MarcinkoAdvisors@msn.com

Assessment

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SEEKING AUTHORS: Risk Management, Liability Insurance, and Asset Protection Strategies for Doctor and Advisors [Book-in-Production]

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Contribute to Our Newest Textbook Project

By Professor Hope Rachel Hetico RN MHA CPHQ CMP®

[Managing Editor]

Prof. Hope R. HeticoDEAR ME-P READERS AND EXPERTS,

Here we go again: Now, we are just working on our newest text book proposal:

Risk Management, Liability Insurance, and Asset Protection Strategies for Doctor and Advisors: Best Practices from Leading Consultants and Certified Medical Planners™

Format and Style

This is the most academic styled book we’ve ever attempted. We’ve already completed about 10 chapters. They are all fascinating. So, it seems a shame to leave so much great stuff on the cutting room floor. Therefore, we are seeking about 12-15 additional de-novo chapters from you, our esteemed ME-P readers, experts and subscribers.

Crowd-Sourcing the Book

Therefore, for the next few weeks and months we will be soliciting author-experts and contributions via this on-line Crowd Sourcing campaign to either update existing chapters; or submit totally new chapters, success stories and essays.

Of course, the existing chapters are more traditional in nature; while de-novo contributions will be more new-wave, innovative and grounding-breaking in their thought leadership risk management ideas.

We are Hoping you Can Help Us

If you have deep knowledge, experience or education in medical risk management, asset protection, malpractice liability, medical office compliance, or insurance planning; or an amazing story about how these modern topics are transforming and changing your medical practice, clinic or hospital – or advisory/consulting practice – for the better/worse; please do let us know. Either by posting a comment or emailing Ann, directly.

Tenor and Tone

These kinds of chapters can help bring a subject to life.

Format Specs and Style Sheet: © IMBA, Inc. All rights reserved.

Author SPECS Risk Management

Recent ME-P Works: © IMBA, Inc. All rights reserved.

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Our Deep Healthcare Niche Notoriety

And, our books have used by professional organizations like the Medical Group Management Association (MGMA), American College of Medical Practice Executives (ACMPE), American College of Physician Executives (ACPE), American College of Emergency Room Physicians (ACEP), Health Care Management Associates (HMA), and PhysiciansPractice.com;

And by academic institutions like the UCLA School of Medicine, Northern University College of Business, Creighton University, Medical College of Wisconsin, University of North Texas Health Science Center, Washington University School of Medicine, Emory University School of Medicine, and the Goizueta School of Business at Emory University, University of Pennsylvania Medical and Dental Libraries, Southern Illinois College of Medicine, University at Buffalo Health Sciences Library, University of Michigan Dental Library, and the University of Medicine and Dentistry of New Jersey, among many others.

All books are archived in the Library of Congress, Institute of Health and Library of Medicine.

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Assessment

Regardless of your decision to contribute, we remain apostles promoting our mutual core interests whenever possible.  And, we are all doing our best to make it a fascinating and important book, and appreciate your help.

If interested in contributing, updating or as a peer reviewer; please contact Ann; or you may use the contact form below:

Ann Miller RN MHA [Project Manager]

Institute of Medical Business Advisors, Inc.

MarcinkoAdvisors@msn.com

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We have been publishing the Medical Executive-Post for more than eight years now. And, with almost 3,000 formal posts, by the nation’s brightest experts, we have a treasure trove of information available to you.

So now, for the first time, all this information – and more – has been codified, updated, copy-righted and copy-protected in print form for your purchase and use. All have been edited by our Publisher – Dr. David Edward Marcinko and Professor Hope Rachel Hetico.

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Business protection strategies for small medical practices

A study recently released by insurance specialist firm The Hartford reveals that small businesses continue to succeed despite challenging economic conditions.

In this video, Ray Sprague, senior vice president for The Hartford’s small commercial insurance segment, shares key takeaways from the study and discusses strategies that small medical practices can implement to protect their business.

VIDEO

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Gun control dialog

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How Doctors and Advisors are Defending Themselves Online

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Medical professionals, financial advisors and management consultants can now get instant results and find out about their reputation on the Internet.

Why?

Patients, people and clients are posting new content on the Internet every day. Keeping tabs on a personal or professional reputation, with this Internet monitoring service, may be vital to your reputation and practice success.

Why you may need Internet Monitoring

  • Finds existing posts about YOU online
  • Sends alerts whenever new posts appear
  • Finds exposed personal info in databases
  • Identifies and alerts you to damaging posts

Assessment

No one asks for job references, patient or client referrals, or background information anymore; they ask Google. And so, if your name turns up negatively in news or CRD reports, patient complaints, messy divorces, bankruptcies, legal filings, embarrassing photos or other questionable material, you’re likely to get passed over.

Check out www.Reputation.com and tell us what you think?

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Automobile Insurance Update for Medical Professionals

Some Need-to-Know [Not Boring] Information for Doctors, Nurses and CXOs

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

[Publisher-in-Chief]

As regular ME-P readers know, I held a property and casualty insurance license for more than 15 years; this included homeowners and automobile insurance.

BTW:  P&C also includes malpractice insurance [doctors and medical professionals] and E&O insurance [accountants, financial advisors, attorneys, etc]. Yep! Med-mal is classified under the property-casualty moniker. I even edited a handbook on the topic. But, I digress.

On the Importance of Automobiles

With the possible exception of the handgun, the automobile represents the greatest single item of ownership that is capable of inflicting death, injury and damage. I learned this first-hand after covering the ER for many years.

America’s fascination with the automobile has resulted in a marked increase in the power and potential speed of our vehicles.  The aging trend in Sports Utility Vehicles (SUVs) has also witnessed a substantial increase in damage due to their higher ground clearance and heavier frames.  The owners and operators of any vehicle must be financially able to respond to any resulting claims, or they need to transfer the risk through insurance.  All states require some minimal coverage for personal vehicles.

The F.A.P.

The most frequently used policy to insure individual private passenger vehicle risks is the Family Automobile Policy (FAP).   It provides two major types of coverage: liability and physical damage.

Liability coverage includes both bodily injury and property damage. Physical damage, on the other hand, includes comprehensive and collision coverage.

[A] Liability Coverage

The liability section of the FAP is contained within most policies as Part A – Liability and Part B -Personal Injury Protection.

[1] Bodily Injury

Bodily injury liability coverage generally includes sickness, disease and death, and is expressed in dual limits — per person and per occurrence.  Nearly half of the states require minimums of $25,000 per person and $50,000 per occurrence.  Higher limits of $100,000 per person and $300,000 per occurrence are often required for consideration of umbrella coverage.

[2] Property Damage

Property damage liability is coverage for damage or destruction to the property of others and includes loss of use.  Liability coverage limits usually include property damage limits as the third number, i.e., $100/300/25.  The coverage here would be for $25,000 of property damage.  As automobiles become more expensive, however, coverage to $50,000 is not considered excessive.

[3] Personal Injury

Personal injury coverage is provided for medical expenses, funeral expenses and loss of earnings for anyone sustaining an injury while occupying your vehicle, or from being struck by your vehicle while a pedestrian.

Liability insurance follows the vehicle, not the driver.  Coverage is extended to the vehicle owner and any resident in the same household.  It also covers anyone using the insured vehicle with the permission of the owner and within the scope of that permission.

Newly acquired vehicles are usually covered automatically for liability for 15-30 [getting shorter] days after acquisition, but physical damage must have been on all currently covered vehicles to be included.  Coverage is also typically extended to a temporary substitute automobile, but only if this vehicle is used in place of the covered automobile, because of its breakdown, repair, servicing, loss or destruction.

[B] Physical Damage Coverage

[1] Comprehensive

Comprehensive physical damage includes coverage for theft, vandalism, broken windshields, falling objects, riot or civil commotion, and even damage from foreign substances, such as paint.  Comprehensive is often described as coverage for all those hazards other than collision.

[2] Collision

Collision involves the upset of the covered vehicle and collision with an object, usually another vehicle, and not enumerated in the discussion of comprehensive.  Colliding with a bird or animal is considered under the comprehensive coverage.

The distinction between comprehensive coverage and collision coverage is more than technical.  The deductible provisions of the FAP often show a considerable difference in these areas, with the collision deductible typically being much greater.

Damage to tires can be covered by provisions in either comprehensive or collision.  Exclusions typically include normal wear and tear, rough roads, hard driving or hitting or scraping curbs.

[C] Repairs after the Accident

Following a collision, the insurance company will assign a claims adjuster to determine the extent of damage and the cost of repairs.  If these repairs exceed the estimated value of the vehicle, it may be “totaled.”  Experience tells me that the value of the vehicle to the owner nearly always exceeds that estimated by the insurance company.

[D] Uninsured / Underinsured Motorists Coverage

Uninsured motorist coverage provides protection from the other driver who is operating his/her vehicle without any insurance coverage.  It covers expenses resulting from injury or death as well as property damage.  There are currently a dozen states where it is estimated that over 20 percent of the vehicles on the highway are being operated without any insurance.  This is not coverage that should be rejected when buying automobile insurance.

Underinsured motorist coverage provides protection from the other driver who purchased only the state-mandated minimum liability insurance coverage.  Again, this is not coverage that the medical professional or healthcare practitioner should thoughtlessly reject when buying automobile insurance.

Assessment

The medical professional is strongly urged to consider purchasing replacement cost coverage rather than accepting actual cash value car insurance, which is the depreciated value of the vehicle. The cost may be higher for this coverage, but accepting a larger deductible will often make up the difference. Paying a little more towards the deductible could easily be worth it, if the damage is extensive.

Or, if you have a classic pristine Eurpean touring sedan [2000 pearl-white Jaguar, XJ-V8-L], built for the Queen in Coventry England, like I do. Jay Leno is my hero!

Conclusion                

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About LegallyMine.Org

The National Foundation for Asset Protection

[By Staff Reporters]

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Legally Mine is a new name for a company formally known as The National Foundation for Asset Protection. The name change reflects the fact that they are a for-profit company and always have been.

Company Focus

The focus of the company is the education of professionals on the best tools available in the US for the purpose of asset protection.

Healthcare

Medical practitioners have taken a particularly hard hit from trial attorneys, and for years the firm has been the nation’s largest champion in defending them. However; they are not alone and many other professionals find themselves staring down the barrel of a legal shotgun. According to their website, Legally Mine knows the right tools to use in order to stop the loss of assets to legal pariahs, as well as the tools needed to lower tax bills. They not only know the right tools and how to use them, but reportedly know how to teach these concepts to others.

Assessment

The purpose and goals of Legally Mine is to teach professional associations how and why these tools will work and how to implement them.

Visit: http://www.legallymine.org/index.html 

Conclusion

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Medical Negligence and the “Burden of Proof”

Understanding the Malpractice Trial Process

By Dr. Jay S. Grife; Esq, MAinsurance-book

In all civil trials, the plaintiff, as the accuser, has the burden of proving his case.  Much like a criminal defendant, a civil defendant has no burden and is presumed “innocent” of any claim by the plaintiff.  As a result, if the plaintiff presents no evidence, or insufficient evidence to support his claim, the defendant wins without having to present his case.  The burden the plaintiff carries is that he must prove his case by what is called a preponderance of the evidence.  In other words, the plaintiff must prove it is more likely than not that he should win.  The best way to visualize this burden is to imagine a set of scales.  If the scales are even, or tipped in favor of the defendant, then the plaintiff has not carried his burden, and loses.  In order to prevail, the plaintiff must tip the scales in his favor.

Proving Medical Malpractice

To prove a case of medical malpractice, a plaintiff-patient must present evidence that the defendant-doctor was negligent, and the plaintiff does this by proving the treatment provided was below the applicable standard of care.  The “standard of care” is the care and skill that a reasonably prudent practitioner would provide in treating a patient.  It is established by the medical community at large, and is constantly evolving.  Care that violates the standard of care today may not necessarily violate the standard of care several years ago.  This distinction is an important one, since most cases take several years to get to trial.  The standard of care is never based on the outcome of the case; a bad result does not necessarily mean a violation of the standard of care.

The Medical Expert Witnesses

Expert medical testimony is required to establish a violation of the standard of care in virtually all medical malpractice cases.  A plaintiff who fails to present the required expert medical testimony in a medical malpractice case will lose.  The plaintiff must also produce expert medical testimony that the alleged negligence caused the injury.

For example, suppose that a patient’s widow brings a medical malpractice case against a surgeon who admitted the patient for removal of an AO plate embedded in bone.  The plaintiff-widow alleges that the surgeon should have done something to prevent a pulmonary embolism, which occurred three days after the patient was dismissed from the hospital, killing him.  The patient might have an expert who would testify that she would not have removed the AO plate, but left it in place.  Such testimony does not carry the burden of proving care below the standard required of the surgeon.  Indeed, in most cases, the standard of care allows a practitioner to choose from a variety of treatment options within an acceptable range.  Mere testimony by an expert witness that “I would have treated this patient differently” is insufficient to establish a breach of the standard of care.  The bad result also is not itself proof of any negligence.  Nor is there any evidence that the doctor caused the patient’s death (i.e., that the embolism would not have occurred without the alleged negligence of the surgeon). Therefore, doctor wins on all elements.

Assessment

Have you ever been involved in a medical malpractice trial; or other healthcare litigation process? The Medical Executive-Post readers are interested in hearing your story.

Conclusion

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Lloyd M. Krieger; MD, MBA

FROM THE PREFACE

Risk Management, Liability Insurance and Asset Protection Strategies for Doctors and Advisors  

Insurance is an important part of all our lives. This is especially true for physicians, medical and healthcare executives.

For example, I currently have no fewer than 10 separate insurance policies associated with my plastic surgery practice. I understand very little about the policies other than that somebody at some point told me I needed each and every one of them, and each made sense when I bought it.   

  • Am I over-insured and thus wasting money? 
  • Am I under-insured and thus at risk for a liability disaster? 

I never really had the means of answering these questions, until now. 

Risk Management, Liability Insurance and Asset Protection Strategies for Doctors and Advisors is an essential textbook because it explains to physicians and insurance professionals the background, theory, and practicalities of medical risk management and insurance planning.  The insurance haze is lifted by-dual degreed editor, and Certified Medical PlannerDr. David Edward Marcinko MBA, and his team of contributing authors. 

Doctors, like most people, tend to experience losses more intensely than gains, and evaluate risks in isolation.  So it’s no surprise that goaded physicians might prefer vehicles like the guaranteed minimum death benefit of variable annuities, or the assurance that comes with disability or long term care insurance, or traditional cash value life insurance policies, despite their decidedly higher costs and commissions.  

Similarly, physicians may enter denial mode and eschew the potential business impact of HIPAA and Balanced Budget Act risks; self referral risks; OSHA, DEA, EPA, OCR, P&C or managed care risks; managed care contract capitulation risks; employee, expert witness, peer review and on-call risks; and even educational debt load risks, among so many others. 

For real insurance professionals on the other hand, this is an exciting time to be practicing medical risk management, because there is much research and creative enlightenment occurring in academic and practitioner communities.  

But, one must be willing to abandon ancient thoughts and remain open to new ideas that identify and provide solutions to the contemporaneous problems of physicians.  

As an example of this epiphany, the economist Christian Gollier revisits the raison detra’ of insurance, by asking: should one even buy insurance since the industry itself is so skilled at exploiting human foibles? Although this emerging work is descriptive, it is not yet time tested since some of it aspires to be normative, as developing modern models of savings and consumption hint that insurance may deserve a smaller role in personal risk management than previously believed.

Risk Management, Liability Insurance and Asset Protection Strategies for Doctors and Advisors  fulfill its promise as a peerless tool for physicians wanting to make good decisions about the risks they face.  

It is also ideal for financial planners, insurance agents and healthcare business advisors wishing to re-educate and help doctors by adding lasting value to their client relationships.  

With time at a premium for all, and so much information packed into one well-organized resource, this book should be on the desk of every physician, or financial advisor serving the healthcare space.   

Simply stated, if you read this compelling text with a mind focused on the future, the time you spend will be amply rewarded. 

Lloyd M. Krieger; MD, MBA

Rodeo Drive Plastic Surgery

The Rodeo Collection

421 North Rodeo Drive

Beverly Hills, CA  90210

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

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Book Reviews

“Physicians who don’t understand modern risk management, insurance, business and asset protection principles are sitting ducks waiting to be taken advantage of by unscrupulous insurance agents and financial advisors; and even their own prospective employers or partners. This comprehensive volume from Dr. David Marcinko, and his co-authors, will go a long way toward educating physicians on these critical subjects that were never taught in medical school or residency training.”
—Dr. James M. Dahle, MD, FACEP, Editor of The White Coat Investor, Salt Lake City, Utah, USA

“With time at a premium, and so much vital information packed into one well organized resource, this comprehensive textbook should be on the desk of everyone serving in the healthcare ecosystem. The time you spend reading this frank and compelling book will be richly rewarded.”
—Dr. J. Wesley Boyd, MD, PhD, MA, Harvard Medical School, Boston, Massachusetts, USA

“Physicians have more complex liability challenges to overcome in their lifetime, and less time to do it, than other professionals. Combined with a focus on practicing their discipline, many sadly fail to plan for their own future. They need trustworthy advice on how to effectively protect themselves, families and practice, from the many overt and covert risks that could potentially disrupt years of hard work.
Fortunately, this advice is contained within ‘Risk Management, Liability Insurance, And Asset Protection Strategies For Doctors And Advisors: Best Practices From Leading Consultants And Certified Medical Planners™’. Written by Dr. David Edward Marcinko, Nurse Hope Rachel Hetico and their team of risk managers, accountants, insurance agents, attorneys and physicians, it is uniquely positioned as an integration of applied, academic and peer-reviewed strategies and research, with case studies, from top consultants and Certified Medical Planners™. It contains the latest principles of risk management and asset protection strategies for the specific challenges of modern physicians. My belief is that any doctor who reads and applies even just a portion of this collective wisdom will be fiscally rewarded. The Institute of Medical Business Advisors has produced another outstanding reference for physicians that provide peace of mind in this unique marketplace! In my opinion, it is a mandatory read for all medical professionals.”
—David K. Luke, MS-PFP, MIM, CMP™, Net Worth Advisory Group, Inc., Sandy, Utah, USA

“This book is a well-constructed, comprehensive and experiential view of risk management throughout the entire medical practice life-cycle. It is organized in an accessible, high-yield style that is familiar to doctors. Each chapter has case models, examples and insider tips and useful pearls. I was pleased to see multi-degreed physicians sharing their professional experiences in a textbook on something other than clinical medicine. I can’t decide if this book is right on – over the top – or just plain prescient. Now, after a re-read, I conclude it is all of the above; and much more.”
—Dr. Peter P. Sidoriak, Pottsville, Pennsylvania, USA

“When a practicing physician thinks about their risk exposure resulting from providing patient care, medical malpractice risk immediately comes to mind. But; malpractice and liability risk is barely the tip of the iceberg, and likely not even the biggest risk in the daily practice of medicine. There are risks from having medical records to keep private, risks related to proper billing and collections, risks from patients tripping on your office steps, risks from medical board actions, risk arising from divorce, and the list goes on and on. These liabilities put a doctor’s hard earned assets and career in a very vulnerable position. This new book from Dr. David Marcinko and Prof. Hope Hetico shows doctors the multiple types of risk they face and provides examples of steps to take to minimize them. It is written clearly and to the point, and is a valuable reference for any well-managed practice. Every doctor who wants to take preventive action against the risks coming at them from all sides needs to read this book.”
—Richard Berning, MD, FACC, New Haven, Connecticut, USA

“This is an excellent companion book to Dr. Marcinko’s Comprehensive Financial Planning Strategies For Doctors And Advisors: Best Practices from Leading Consultants and Certified Medical Planners™. It is all inclusive yet easy to read with current citations, references and much frightening information. I highly recommend this text. It is a fine educational and risk management tool for all doctors and medical professionals.”
—Dr. David B. Lumsden, MD, MS, MA, Orthopedic Surgeon, Baltimore, Maryland, USA

“This comprehensive text book provides an in-depth presentation of the cyber security and real risk management, asset protection and insurance issues facing all medical profession today. It is far beyond the mere medical malpractice concerns I faced when originally entering practice decades ago.”
—Dr. Barbara s. Schlefman, DPM, MS, Family Foot Care, PA, Tucker, Georgia, USA

“Am I over-insured and thus wasting money? Am I under-insured and thus at risk for a liability or other disaster? I never really had the means of answering these questions; until now.”
—Dr. Lloyd M. Krieger, MD, MBA, Rodeo Drive Plastic Surgery, Beverly Hills, California, USA

“I read and use this book, and several others, from Dr. David Edward Marcinko and his team of advisors.”
—Dr. John Kelley, DO, Orthopedic Surgeon, Tucker, Georgia, USA

“An important step in the risk management, insurance planning and asset protection process is the assessment of needs. One can create a strong foundation for success only after all needs have been analyzed so that a plan can be constructed and then implemented. This book does an excellent job of recognizing those needs and addressing strategies to reduce them.
—Shikha Mittra, MBA, CFP®, CRPS®, CMFC®, AIF®, President – Retire Smart Consulting LLC, Princeton, New Jersey, USA

“The Certified Medical Planner™ professional designation and education program was created by the Institute of Medical Business Advisors Inc., and Dr. David Edward Marcinko and his team (who wrote this book). It is intended for financial advisors who aim specifically to serve physicians and the medical community. Content focuses not only on the insurance and professional liability issues relevant to physicians, but also provides an understanding of the risky business of medical practice so advisors can help work more successfully with their doctor-clients.”
—Michael E. Kitces, MSFS, MTAX, CFP®, CLU, ChFC, RHU, REBC, CASL, http://www.Kitecs.com, Reston, Virginia, USA

“I have read this text and used consulting services from the Institute of Medical Business of Advisors, Inc. on several occasions.”
—Dr. Marsha Lee, DO, Radiologists, Norcross, Georgia, USA

“The medical education system is grueling and designed to produce excellence in medical knowledge and patient care. What it doesn’t prepare us for is the slings and arrows that come our way once we actually start practicing medicine. Successfully avoiding these land mines can make all the difference in the world when it comes to having a fulfilling practice. Given the importance of risk management and mitigation, you would think these subjects would be front and center in both medical school and residency – ‘they aren’t.’ Thankfully, the brain trust over at iMBA Inc., has compiled this comprehensive guide designed to help you navigate these mine fields so that you can focus on what really matters – patient care.”
—Dennis Bethel, MD, Emergency Medicine Physician

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