A Doctor – Economist’s Solution for Health Reform

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

My Laundry Wish List for all US Healthcare Stakeholders

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]Fox News

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

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

Assessment

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

Conclusion

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

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THANK YOU

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The Surgeons Scorecard

Posted on July 14, 2015 by Dr. David Edward Marcinko MBA

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Coming Soon: ProPublica’s Surgeon Scorecard

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sergtech

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Millions of patients a year undergo common elective operations – things like knee and hip replacements or gall bladder removals.

But, there’s almost no information available about the quality of surgeons who do them. ProPublica analyzed 2.3 million Medicare operations and identified 67,000 patients who suffered serious complications as a result: infections, uncontrollable bleeding, even death.

We’ll be reporting the complication rates of 17,000 surgeons — so patients can make an informed choice.

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More coverage: Patient Safety: Exploring Quality of Care in the U.S.

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[Foreword J. Phillips MD JD MBA] [Foreword D. Nash MD MBA]

Conclusion

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Should We With-Hold Payment to Doctors, Financial Advisors and Others Who Make Mistakes?

Posted on October 24, 2013 by Dr. David Edward Marcinko MBA

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A Modified Reprint … and Different Perspective on “Never-Events”

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

Dr. MarcinkoOK; I admit it. I played HS baseball as a youth. Today, I am a doctor and financial advisor. I owned and operated a surgical center and did musculoskeletal surgery for two decades.

Later, as a health economist and financial planner, I acted as an SEC registered investment advisor to medical colleagues for almost 15 years.  I’ve been a reporter, writer and journalist for three decades and Editor-in-Chief of this ME-P for eight years. Along my career path several physician-partners were dual degreed lawyers.

I still am deeply involved in all these activities as a hobbyist, consultant, part-time practitioner, editor and educator. Occasionally, I do make mistakes. There … I admit it. I am not perfect!

For example; I remember the time when I ordered the wrong patient medication dose [noted and corrected by an astute RN] – Dropped an infield fly ball and lost the game – Used the wrong corporate EBIDTA, for an estimated financial calculation, which cost me and the client a few bucks – Referenced the wrong citation and made an author angry – Forgot to check a reference source which made my publisher mad at me – AND – Confused two different medical malpractice cases I was reviewing to the chagrin of my defendant doctor and his attorney; etc, etc.  You get the picture.

Mea culpa – mea maxima culpa!

The Encore Post

And so, it is with delight that the ME-P re-posts the following essay – on mistakes – by colleague Dr. Michael Kirsch who is a gastroenterologist that blogs at MD Whistleblower.

Medical Errors Earn Hospitals Money – Who Knew?

In brief, it goes something like this.

Never-Events

The argument to withhold payment for medical care that resulted from medical error is potent.  This is known as a never-event because it is not supposed to happen – ever! Giving a patient the wrong blood type during a transfusion is a good example of a never-event.

Unfortunately – Keep in mind that defining a medical error is not as easy as it sounds.  One can easily imagine how easy it would be too confuse a medical complication, which is a blameless event, from an error or a negligent act.

Consider This

If the patient develops a complication, should I, the hospital and those I consult not be paid for the additional care required?

Now, by extension, let us consider some other professions in the same way; especially those for which I am associated.

IOW: Would every profession consent to returning fees for mistaken advice or service?  So, do you agree with the following?

  • Financial advisors should return fees if investment performance is below a designated threshold or differs from their peers.
  • Attorneys that offered ineffective legal arguments at trial should surrender fees after appeal.
  • A professional baseball player who drops a fly ball should lose a day’s pay.
  • A newspaper publisher should offer a rebate to all readers if a news story is found to be inaccurate owing to a lack of proper editorial oversight; etc.

I think you get the picture! And, see how I personalized these examples.

More

We realize that mistakes of all types cost money, as do some of the hypothetical examples above.  We also accept that financial incentives can change behavior and can be an effective tool.

Medical-errors

Assessment

But, every human endeavor has a finite error rate and we should be cautious before using an economic drone attack against only the medical profession; or even the others mentioned above … and more.

Let’s use a scalpel here and not a sledge hammer.  And, those of you outside of medicine; please feel free to explain why your occupation should be spared from this health reform strategy?

The Reprint: Would every profession consent to returning fees for mistakes?

Conclusion

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

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Become a Whistle Blower in the Healthcare Industrial Complex

Posted on May 11, 2010 by Dr. David Edward Marcinko MBA

Have You Ever Worked in the Medical Profession?

By Ann Miller; RN, MHA

[Executive-Director]

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If you ever worked for a private medical practice, health insurance company, third party administrator or payer, hospital, public health clinic, VA or anywhere else in the healthcare space, we’d like to hear from you.

Tell the Medical Executive-Post about your work conditions, doctors or nurses, management shenanigans, or the politics and your observations of what is happening at your healthcare organization. Gossip, insider information, knowledge, personal opinion, insight or related hearsay – both positive and negative – is sought.

The clinical, financial, legal, insurance, pharma or administrative scenes are all fertile grounds for exposure and transparency. You may remain an anonymous tipster, or we will publish your identity upon request for additional credibility.

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Please contact us today: MarcinkoAdvisors@msn.com

Conclusion

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A [Another] Doctors’ Problem with Electronic Medical Records

Posted on March 7, 2010 by Dr. David Edward Marcinko MBA

ME-P in the Forefront of “Reasonable” Skepticism

By Staff Reporters

There is no doubt that paper medical records can cause harm. They are easily lost and damaged, they disappear during emergencies, and they are often incomplete. 

With incorrect or missing information, doctors end up duplicating tests, making uninformed decisions and delaying care. 

Another POV

Well true enough, but redundancy also reduces the instantaneous and widespread electronic dissemination of incorrect information. For example, we’ve all seen patients allergic to the drug ampicillin, being confused with the drugs penicillin, amoxicillin, dicloxacillin, ticarcillin and bicillin, etc.

Now, just suppose an eMR patient history was inputted incorrectly by a doctor, nurse, or some medical assistant or lightly trained technical aide?  Instant error dissemination – times a zillion!

So, paper notes and medical charting redundancy does involve a bit of double-checking, which is a good thing!

THINK: Wrong sided surgery, never-events, etc.

The Skeptics

Patients – and all of us – deserve better, of course. And, we are naturally skeptical here at the ME-P. But, are electronic charts really the answer?

Alexander Friedman MD [Fellow in maternal-fetal medicine at the University of Pennsylvania], author of this new WSJ essay, sure doesn’t seem to think so. He joins these other experts, opining both for and against eMRs on this ME-P.

Channel: https://healthcarefinancials.wordpress.com/category/information-technology/

Assessment

Link: http://online.wsj.com/article/SB126599531264644979.html

Conclusion

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

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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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