More about Healthcare Organizations [Financial Management Strategies]

Our Print-Journal Preface

By Hope Rachel Hetico; RN, MHA, CMP™hetico1

As Managing Editor of a two volume – 1,200 pages – premium quarterly print journal, I am often asked about our Preface.

A Two-Volume Guide

As so, our hope is that Healthcare Organizations: [Financial Management Strategies] will shape the hospital management landscape by following three important principles.

What it is – How it works

1. First, we have assembled a world-class editorial advisory board and independent team of contributors and asked them to draw on their experience in economic thought leadership and managerial decision making in the healthcare industrial complex. Like many readers, each struggles mightily with the decreasing revenues, increasing costs, and high consumer expectations in today’s competitive healthcare marketplace. Yet, their practical experience and applied operating vision is a source of objective information, informed opinion, and crucial information for this manual and its quarterly updates.

2. Second, our writing style allows us to condense a great deal of information into each quarterly issue.  We integrate prose, applications and regulatory perspectives with real-world case models, as well as charts, tables, diagrams, sample contracts, and checklists.  The result is a comprehensive oeuvre of financial management and operation strategies, vital to all healthcare facility administrators, comptrollers, physician-executives, and consulting business advisors.

3. Third, as editors, we prefer engaged readers who demand compelling content. According to conventional wisdom, printed manuals like this one should be a relic of the past, from an era before instant messaging and high-speed connectivity. Our experience shows just the opposite.  Applied healthcare economics and management literature has grown exponentially in the past decade and the plethora of Internet information makes updates that sort through the clutter and provide strategic analysis all the more valuable. Oh, it should provide some personality and wit, too! Don’t forget, beneath the spreadsheets, profit and loss statements, and financial models are patients, colleagues and investors who depend on you.ho-journal9


Rest assured, Healthcare Organizations: [Financial Management Strategies] will become an important peer-reviewed vehicle for the advancement of working knowledge and the dissemination of research information and best practices in our field. In the years ahead, we trust these principles will enhance utility and add value to your subscription. Most importantly, we hope to increase your return on investment [ROI] in some small increment.

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And so, your thoughts and comments on this Medical Executive-Post, complimentary e-companion are appreciated. If you would like to contribute material or suggest topics for a future update, please contact me. Subscribers, have we attained our goals and objectives, as a work-in-progress in this preface statement?


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

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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™


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?


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

“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.


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!

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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.

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:


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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™]


[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?


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?


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.”





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.



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:

Additional References

1. Getting “the CCHIT Question” Wrong, by


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



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:


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