How to Take Care of Your Eyes

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In celebration of National Eye Health Week we at Ultralase have immersed ourselves in the world of vision in order to produce this handy graphic containing facts and tips to help encourage you, and the rest of the world to Love Your Eyes. Brought to you by www.ultralase.com

 

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Sample HMO Disenrollment Appeal Letter

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

By Hope Rachel Hetico; RN, MHA, CPHQ, CMP™

[Publisher-in-Chief and Managing Editor]dave-and-hope7

Dear Medical Director,

As a current non-member of your managed car plan, I would like to take this opportunity to inform you of the activities we have pursued during this past year in order to gain acceptance into your plan.

For example, I have received X hours of clinical continuing education, which is X more than the state requires. Topics included recently developed techniques for pain control, non-hospital and non-surgical based therapy, more effective drug utilization, and a host of other methods of practice to reduce costs and increase patient welfare and mobility. Moreover:

  • I have received  X hours of medical business management training aimed at reducing office overhead expenses, increasing office efficiency and capacity, and improving patient flow and communications.  For example, our computerized call-back system is designed to ensure the continuity of patient care.
  • We have completed a patient survey that demonstrates that the average patient can receive a regular appointment within X days and urgent appointment within X days. Of course, we are fully staffed for immediate care of the emergent patients.  Our patient satisfaction rating is high. Most patients spend less than X minutes in the waiting room and are discharged in a timely fashion, with appropriate instructions in order to return them to work efficiently and comfortably.
  • We have expanded our office hours to improve access and enhanced the barrier free design of our office infrastructure. We are OSHA, CLIA, MSDS, PA, Sar-Box and HIPAA compliant, etc.
  • Since we believe in preventative care, our diabetic patients are continually screened and evaluated to reduce the potential for infections and other complications. This includes the liberal use of random accu-check blood sugar readings, with neurologic and circulatory assessment, with prompt reporting of aberrant values and findings to their primary care physicians or endocrinologists.
  • I will be taking my specialty board certification examination on X 2010. Of course, my results will be forwarded to you immediately.
  • I will become ABQAUR (American Board of Quality Assurance and Utilization Review) certified and/or a Certified Physician in Healthcare Quality (CPHQ) this year, after successful completion of all educational requirements and examinations.

Assessment

Although I realize that this is a challenging time for all concerned, we strive to make every patient’s visit to our office a medically and socially positive one. More specific suggestions regarding our practice would be appreciated. Therefore, we hope you will consider the probationary inclusion of our practice into your managed care plan, for the coming enrollment period.

Fraternally,

Joseph A. Smith; MD/DO  

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About: Healthcare Organizations [Financial Management Strategies]

Our Print Mission Statement

[By Dr. David Edward Marcinko; MBA, CMP™]

Publisher-in-Chief

dem25As Editor-in-Chief of a two volume – 1,200 pages – premium quarterly print journal, I am often asked about our mission statement; or the journal’s raison d’etra.

A Two-Volume Guide

As so, Healthcare Organizations: [Financial Management Strategies], with its quarterly updates, will promote and integrate academic and applied research, and serve as a multi-disciplined communications forum for the dissemination of financial, managerial, business and related economic information to decision makers in hospitals, outpatient centers, clinics, medical practices and all mature and emerging healthcare organizations. 

Target Market and Ideal Reader

Healthcare Organizations [Financial Management Strategies] and its quarterly updates should be in the hands of all:

* CFOs, CEOs, COOs, CTOs, VPs and CIOs from every type of hospital and healthcare organization including: public, federal, state, Veteran’s Administration and Indian Health Services hospitals; district, rural, long-term care and community hospitals; specialty, children’s and rehabilitation hospitals; diagnostic imaging centers and laboratories; private, religious-sponsored, and psychiatric institutions.

*  Physician Hospital Organizations, Management Services Organizations (MSOs), Independent Practice Associations (IPAs), Group Practices Without Walls (GPWWs), Integrated Delivery Systems (IDSs) and their administrators, comptrollers, cost accountants, budget directors, cash managers, auditors, healthcare attorneys and consultants,  and actuaries, and all endowment fund directors, executives, consultants and strategic financial managers.

*  Ambulatory care centers, hospices, and outpatient clinics; skilled nursing facilities, integrated networks and group practices; academic medical centers, nurses and physician executives; business school and health administration students, and all economic decision-makers and directors of allopathic, dental, podiatric and osteopathic healthcare organizations.

Assessment

After publication, my suggestion is to read, study and act upon the guide in this way:

1. First, browse through the entire text.

2. Next, slowly read those chapters and sections that are of specific interest to your professional efforts.

3. Then, extrapolate portions that can be implemented in specific strategies helpful to your healthcare setting.

4. Finally, use its’ ME-P updates as a reference manual to return to time and time again; and enjoy!

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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.

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Impact of Size on Mutual Fund Performance

Vital Information for Doctors to Consider

[By Dr. David Edward Marcinko; FACFAS, MBA, CMP™]

[By Professor Hope Rachel Hetico; RN, MHA, CMP™]dave-and-hope3

The actual size of a mutual or index fund, in terms of amount of assets, and the growth rate of a fund are the two aspects of size to consider. The impact of size on mutual fund performance varies—it can be negative, neutral, or positive. Size affects different types of funds differently; it also affects the manager’s ability to achieve objectives. Monitor size changes and make investment decisions accordingly.

Economies of Scale

A relatively large amount of assets available to a portfolio manager presents various economies. The costs at most funds (e.g., expense ratios) are reduced as a percentage of net asset value as the fund grows. Expense ratios can have a major impact on performance. In addition to being an effect of size, low fees can cause size changes. Funds do at times waive some fees to attract assets.

Asset Base

A larger asset base provides more liquidity to a fund. With more assets, the manager can buy more shares and more stocks. Transaction costs are reduced if higher trading volumes are achieved. A larger asset base also can reduce relative tax costs. Realized but undistributed capital gain can be spread over more shares at the time of year-end distribution. A larger asset base and manager success attracts higher-caliber managers to the management team.

fp-book20

Fund Growth

Growth of fund assets impairs certain funds more than others. Generally, bond funds are less affected by asset growth and size than equity funds. Growth may have a positive impact on bond funds because buying bonds of similar characteristics further diversifies credit, event, and other risks. Equity funds that invest in larger capitalization stocks can be less affected than funds buying less liquid small-cap stocks. (This is so because funds usually limit their investments in a single company, i.e., many funds will not buy more than 5% of a specific company. Five percent of a small company uses up less cash than 5% of a large company. Therefore, a small-cap fund is more likely to exhaust its choice of available companies sooner than a large-cap fund. A large-cap fund could increase its investment to a 5% level, whereas a small-cap fund may already be fully invested in the companies the manager likes to own.)

Growth Rate

The rate of growth can affect performance. Rapid growth may mean that a large portion of the portfolio remains un-invested. A rapidly growing growth-type equity fund with a high percentage of cash earns lower returns in a rising market than a fully invested fund. With rapid growth, the fund may not provide pure exposure to the desired asset class. At a certain point, however, fund asset growth impairs the manager’s ability to achieve objectives. For this reason, funds often close to new investors or to new investment once they have reached a certain size. Growth affects managers in many ways. Many fund managers or teams of managers direct a number of funds and possibly even private accounts. As the fund grows, managers are spread thin and may have difficulty in reacting quickly or efficiently to changing market conditions. Managers may need to hire assistant portfolio managers or delegate work to analysts or other employees. As a result, the manager manages people, administration, or internal quality control systems rather than studying companies or investment strategies. Also, a manager may become complacent in periods of rapid asset growth. Such growth can mean their own compensation is substantially greater, which may in turn change the manager’s motivation. Rapid growth often changes a fund because there are not enough opportunities to invest in the targeted securities. For example, a fund can change from aggressive to conservative, small cap to large cap. Managers may have to slow trading or increase liquidity in the portfolio to prevent this occurrence.

Meaningful Positions Difficult

Rapid growth or a large asset base can prevent managers from taking meaningful positions in market sectors they believe will outperform others. Smaller funds are more flexible and may take advantage of opportunities or liquidate unwanted positions faster than larger funds. A large fund that owns a significant position will negatively affect a security’s market price if it unloads shares all at one time. Rapid growth also impairs research of funds, affecting an investor’s choice of funds. A fund with outstanding performance over the past 5 years and a $150 million asset base may be much different when its base grows to $1 billion; at that point, it may no longer be the “right choice” for an investor.

insurance-book9Asset Declinations

Just as rapid asset growth affects performance, a rapid decline of fund assets also may impact performance. Significant quantities of redemptions over short periods force managers to liquidate security positions, often at the wrong time (i.e., they would rather be buying in a declining market than selling to accommodate redemptions). To prevent this scenario, some funds have redemption charges to discourage investors from such short-term decisions. Such environments can negatively impact bond funds as easily as equity funds. Large redemptions compound the effect of declining fund net asset values.

What a Doctor-Investor Can Do?

What can physician-investors do to avoid negative effects on investment? Avoid overloading a portfolio with hot, rapidly growing funds, if possible. Generally, size should be a neutral factor for most bond funds. Small and/or aggressive equity funds can be affected by growth, however. Emphasize funds that promise to close to new investors after assets reach a certain size. Once a fund becomes large, monitor it closely for problems caused by the growth. If there is a better, smaller fund, it may be wise to change. Also, closed-end funds are always a possibility. These funds have a major advantage in that their asset base is a factor of growth in security values, not new investment (unless the fund makes a secondary stock offering). Closed-end managers work with a finite portfolio, which reduces the problem of sudden asset growth.

Assessment

To the extent that a lack of SEC and FINRA over-sight, and the recent financial, insurance and banking meltdown has affected the above; such investing is left up to the doctor’s discretion and personal situation.  When it comes to the financial services product sales industry; always remember “caveat emptor” or “buyer-beware.”

Disclaimer: Both contributors are former licensed insurance agents and financial advisors.

Conclusion

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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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Independent Medical Practitioner as Solo Primary Care Surrogate

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Doctors Facing a Bleak Future Business and Financial Planning Model

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]dem2

According to Physicians News, on March 19, 2009, the demand for family physicians is growing. Proposals for health system reform focus on increasing the number of primary care physicians in America. Yet, despite these trends, the number of future physicians who chose family medicine dipped this year, according to the 2009 National Resident Matching Program. What gives?

NRMP

The National Resident Matching Program [NRMP] recently announced that a total of 2,329 graduating medical students matched to family medicine training programs. This is a decrease in total student matches from 2008, when 2,404 family medicine residency positions were filled.

Primary Care Demand Explodes

Meanwhile, demand for primary care physicians continues to skyrocket. For example, in its most recent recruitment survey, Merritt Hawkins, a national physician recruiting company, reported primary care physician search assignments had more than doubled from 341 in 2003 to 848 last year. 

The Decline of Solo Medical Practitioners

Regular readers and subscribers to this Medical Executive- Post are aware of the declining number of solo medical practitioners; we have been sounding the alarm here, in our books, journal, speaking engagements and elsewhere for years now.dhimc-book4

In fact, the statistic that we often cite is that more than 40% of the nation’s physicians are employed doctors; not employers as in the past. This business model shift has occurred over the past decade or so, and has accelerated of late. The decline in solo and independent doctors has occurred elsewhere as well, but much more slowly [i.e., dentistry, podiatry and osteopathy] as these specialties have been somewhat isolated from the traditional allopathic mainstream.

Going forward, this solitary model seems to be a good thing, and a fortunate result of the un-intended consequence of previously keeping these folks out of the healthcare mainstream.

The Decline of Independent Medical Practitioners

Now, in the March 2009 issue of Healthcare Finance News, we learn that the number of hospital owned physician practices has been climbing over the last four years, according to the Medical Group Management Association [MGMA]. Think: PHOs back-in-the-day. ho-journal3

And, while this trend only marginally affects patients and patient care, it is quite disruptive to physicians, their families, personal wealth accumulation, retirement and estate planning endeavors.

For example, according to Professor Hope Rachel Hetico, RN, MHA, CMP™ of our firm www.MedicalBusinessAdvisors.com

“The professional good-will valuation component of a medical practice is being decimated. Today, some practices are being bought and sold for tangible asset value, only.

Assessment

Therefore, allow me to identify this emerging trend which suggests independent medical practice as reflective of solo primary medical care. In other words, as independence goes the way of the “dodo-bird”, so goes primary care practitioners precisely at a time when the later is needed more than the former.

Why? Employed doctors stay that way by making money for their employer and hospital-bosses. Specialists make more money than primary care doctors. So, if you want to stay an employed doctor; which specialty would you pursue?

Answer: The NRMP class this year spoke out loud and clear. Any specialty but primary care!

Channel Surfing the ME-P

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

Conclusion

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

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

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CCHIT is Prejudiced and Lacks Diversity – An Indictment Until Proven Otherwise

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Searching for “The Lost Medical Providers”

[By Dr. David Edward Marcinko; FACFAS, MBA, former CPHQ™, CMP™]

[Publisher-in-Chief]

[Hope Rachel Hetico; RN, MHA, former CPHQ™, CMP™]

[Managing Editor]

dave-and-hope6Right up! Let us state that, sans increased transparency and requested information to the contrary, we believe that CCHIT is a prejudiced and seriously non-diverse outfit. No. we don’t mean racial prejudice or any lacking in ethnic or gender diversity – We mean professional diversity. Why and how did this happen – we don’t know, but please allow us to explain our thought process in arriving at this opinion and formal indictment?

CCHIT Website

According to its website, the Certification Commission for Healthcare Information Technology [CCHIT] was founded to help physicians answer key questions about eHR software, such as: a) what components should be included, b) where do you begin with over 200 products in the ambulatory eHR market?

Link: http://www.cchit.org/index.asp

Certification Commission Composition

CCHIT is a private nonprofit organization accelerating the adoption of robust, interoperable health information technology [HIT] by creating a credible, efficient certification process.

The Commission is made up of at least two representatives each from the provider, payer, and vendor stakeholder groups, and others from stakeholder groups that include safety net providers, health care consumers, public health agencies, quality improvement organizations, clinical researchers, standards development and informatics experts and government agencies.

Currently, CHIT is composed of these commissioners, serving in two-year staggered terms:

  • Mark Leavitt, MD, PhD [Chairman]
  • Abha Agrawal, MD, FACP
  • Steve Arnold, MD, MS, MBA, CPE
  • Karen Bell, MD
  • Richard Benoit
  • Sarah T. Corley, MD, FACP
  • John F. Derr, RPh
  • Linda Hogan
  • Michael L. Kappel
  • Joy G. Keeler, MBA, FHIMSS
  • Jennifer Laughlin, MBA, RHIA
  • Christopher MacManus
  • David Merritt
  • Susan R. Miller, RN, FACMPE
  • James Morrow, MD
  • Rick Ratliff
  • David A. Ross, ScD
  • Don Rucker, MD
  • Michael Ubl
  • Jon White, MD
  • Andrew Wiesenthal, MD

What about the “Others”

Now, here’s the rub; what about the other medical professionals? The list above contains allopathic physicians, a nurse and a pharmacist; and that’s fine. But, where are the DDSs, DPMs, DOs and ODs? Should these folks assume they are included as CCHIT stakeholders, as most all dentists and even the ADA seemingly – and apparently erroneously – believed?

Link: www.HealthcareFinancials.com

See CCHIT’s answer below, when one intrepid [fearless or naïve] dentist inquired about his profession’s inclusion in the CCHIT initiative.

Dr. Pruitt,

“As noted in my email to you, the Commission has not yet taken up the development of certification for software products used in dentistry. While one cannot deny the value of dental information in the management of health, it is not currently within the scope of the Commission’s work to undertake the development of criteria and test scripts that inspect the data compatibility between physician office eHRs and dentistry records. As our work progresses, it may become a future consideration.”

Regards

-S

CCHIT 

Link: https://healthcarefinancials.wordpress.com/2008/12/19/the-case-against-inter-operable-ehrs/#comments

According to our best estimates, CCHIT left out input from these medical professionals:

  • Osteopaths: 50,000
  • Dentists: 150,000
  • Podiatrists: 10,000
  • Optometrists: 40,000

And so, we ask, where are the:

”two representatives each from the provider … groups”

 as stated and mandated, in their own CCHIT charter? Where is the outrage from the American Osteopathic Association [AOA], American Podiatric Medical Association [APMA], American Optometric Association [AOA], and the American Dental Association [ADA]? Are these folks disenfranchised; and do they know it, or not?

Board of Governors – Public Comments Desired

The CCHIT website does list Dr. Brian Foresman; DO, MS as a physician juror in 2006. And, the complete list is included below for your review: 

The CCHIT regularly requests public comment. The public comment period for ePrescribing Security, for example, is currently open until March 4, 2009.

Industry Indignation Index: 65

Hopefully, we can shame – “flame with emails” – CCHIT into finally including dentists, podiatrists, more osteopaths and optometrists in this initiative and in their larger enterprise wide goals, objectives and plans.

Link: http://www.cchit.org/participate/public-comment

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Please call, write, fax, email or send in your opinions to CCHIT and tell them what you think! Mark, we give you benefit-of-doubt and are on your side, but what did we miss; do tell? What sort of bureaucrat apparently overlooked these full, and limited-licensed, medical practitioners with their special skills; or do they actually have direct-indirect input? Don’t they count for anything? Where is the diversity? Where is the outrage? Stop the prejudice! Call us, let’s do lunch and discuss.

Full disclosure: We are members of AHIMA, HIMSS, MS-HUG and SUNSHINE. We just released the Dictionary of Health Information Technology and Security, with Foreword by Chief Medical Information Officer Richard J. Mata; MD MS MS-CIS, of Johns Hopkins University and the second edition of the Business of Medical Practice with Foreword by Ahmad Hashem; MD PhD, who was the Global Productivity Manager for the Microsoft Healthcare Solutions Group at the time: www.MedicalBusinessAdvisors.com

Additional References

1. Getting “the CCHIT Question” Wrong, by

Link: http://www.thehealthcareblog.com/the_health_care_blog/2009/02/getting-the-cchit-question-wrong.html#comments

2. CCHIT dissolved involuntarily in April 2008 for failure to file annual report in Illinois.

Link: http://www.hcrenewal.blogspot.com/2009/02/cchit-dissolved-involuntarily-in-april.html

Conclusion

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

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

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

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

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

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