PODCAST: How Doctors are Really Paid in Fall 2022?

Learn the Incentives in Physician Compensation

BY ERIC BRICKER MD

RAND and Harvard University Researchers Recently Published a Study in the Journal of the American Medical Association Examining How Doctors are Paid by Hospital System-Owned Practices. The Study Found that only 9% of Primary Care Physician Compensation was Based on Value (Quality and Cost-Effectiveness) and only 5.3% of Specialist Compensation was Based on Value.

The Study Concluded: “The results of this cross-sectional study suggest that PCPs and specialists despite receiving value-based reimbursement incentives from payers, the compensation of health system PCPs and specialists was dominated by volume-based incentives designed to maximize health systems revenue.”

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MORE: https://medicalexecutivepost.com/2020/09/19/what-doctors-must-do-to-file-an-aetna-claim-to-get-paid/?preview_id=237387&preview_nonce=44f9028974&preview=true

RELATED: https://medicalexecutivepost.com/2008/09/12/how-doctors-get-paid/

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BUSINESS MEDICINE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

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HOSPITALS: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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PODCAST: Accounting Deception in Health Care

Examples of Exploitation and Deception?

BY ERIC BRICKER MD

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TERMS: https://medicalexecutivepost.com/2021/11/02/financial-terms-and-definitions-all-physician-should-know/

Triple Entry Accounting: https://medicalexecutivepost.com/2020/12/28/triple-entry-accounting/

HEALTH ECONOMICS CITE: https://www.r2library.com/Resource/Title/0826102549

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https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?s=books&ie=UTF8&qid=1287563112&sr=1-9

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https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCAST: Patient Centricity in Value Based Care?

By Eric Bricker MD

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Dr. Sachin MD MBA Jain wrote an outstanding article on Value Based Care in the April 12, 2022 issue of Forbes stating that the Patient Must Come First in Value Based Care.

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RELATED PODCAST: https://medicalexecutivepost.com/2021/12/13/podcasts-the-case-against-value-based-care/

RELATED: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

MORE: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

ADDITIONAL: https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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What is a Hospital CHARGE MASTER?

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By Dr. David Edward Marcinko MBA

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According to George Washington University, a hospital chargemaster is a comprehensive list of a hospital’s products, procedures, and services. Everything from prescription drugs to supplies for diagnostic tests has a unique price listing in the chargemaster, making it a go-to document for hospital administrators such as CFOs, clinical documentation improvement specialists, and revenue directors.

Chargemaster usage dates back to the mid-20th century. At that time, fee-for-service (FFS) health insurance plans, which allow patients to direct their medical care by choosing physicians and facilities and paying a portion of the billed total, had just emerged in the U.S. healthcare system. The chargemaster originally served as something akin to an FFS dictionary, with an entry for virtually anything billable under that economic model of healthcare.

CITE: https://www.r2library.com/Resource/Title/082610254

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Over time, FFS itself has evolved and been challenged by alternatives like value-based care (VBC). Chargemasters built for FFS have changed accordingly, and they remain fixtures of the modern hospital revenue cycle. A standard chargemaster is a large electronic file containing multiple elements for each entry. These attributes usually include:

  • The charge for a single unit of the service in question
  • A Current Procedural Terminology (CPT) code; CPT is the official medical code set of the American Medical Association
  • Potentially, a Healthcare Common Practice Coding System (HCPCS) code; HCPCS is based on CPT
  • Alternative CPT and HCPCS codes if needed, e.g. one corresponding only to specific payers
  • A revenue code associated with the charge
  • Flag(s) indicating if the entry is scheduled for deletion, active or inactive
  • An internal reference number within the ledger for accounting purposes

LINK: https://revcycleintelligence.com/features/the-role-of-the-hospital-chargemaster-in-revenue-cycle-management

COURT: https://www.msn.com/en-us/health/medical/colorado-supreme-court-rules-in-favor-of-woman-who-expected-to-pay-dollar1337-for-surgery-but-was-charged-dollar303709/ar-AAXlqNU?li=BBnbfcL

MORE: https://medicalexecutivepost.com/2013/09/26/some-modern-issues-impacting-hospital-revenue-cycles/

RCC: https://medicalexecutivepost.com/2013/03/06/a-better-approach-to-hospital-cost-estimation/

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FINANCE: https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

BUSINESS: https://www.amazon.com/Business-Medical-Practice-Transformational-Doctors/dp/0826105750/ref=sr_1_9?ie=UTF8&qid=1448163039&sr=8-9&keywords=david+marcinko

HEALTH INSURANCE: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

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PODCAST: Ochsner Value Based Care Saves $100-M

BY ERIC BRICKER MD

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Ochsner Health in New Orleans and Its EVP of Value-Based Care, Dr. David Carmouche, Have Had REAL Success with REAL Value-Based Care.

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CITE: https://www.r2library.com/Resource/Title/082610254

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PODCAST: Technology Enabled Behavioral Healthcare in 2022?

A Critical Strategy for Population Health Management

By Michael Vergare MD

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Value Based Care Definitions: https://www.r2library.com/Resource/Title/0826102549

High Value Care & Value-Based Care

PODCAST: https://www.healthsharetv.com/content/technology-enabled-behavioral-health-care-critical-strategy-population-health-management

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PODCASTS: The Case Against Value Based Care [VBC]

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And Now – The Other Perspective

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BY ERIC BRICKER MD

Your comments are appreciated.

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CITE: https://www.r2library.com/Resource/Title/0826102549

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https://www.amazon.com/Hospitals-Healthcare-Organizations-Management-Operational/dp/1439879907/ref=sr_1_4?s=books&ie=UTF8&qid=1334193619&sr=1-4

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https://www.amazon.com/Financial-Management-Strategies-Healthcare-Organizations/dp/1466558733/ref=sr_1_3?ie=UTF8&qid=1380743521&sr=8-3&keywords=david+marcinko

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PODCAST: VBC Financial Risks: https://medicalexecutivepost.com/2021/07/13/podcast-value-based-care-financial-risks/

ENJOY

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CMS Innovation Center Launches “Bold New” Strategy

BY HEALTH CAPITAL CONSULTANTS, LLC

CMS Innovation Center Launches “Bold New” Strategy


When President Joe Biden was elected in 2020, there was much anticipation and speculation regarding what his election would mean for the U.S. healthcare industry in the coming years.

CITE: https://www.r2library.com/Resource/Title/0826102549

Thriving in a value-based health care model - Biotricity

As an ardent supporter of the Patient Protection and Affordable Care Act (ACA) who campaigned on offering a public insurance option similar to Medicare, many in the healthcare industry assumed that the Biden Administration would be a strong proponent of continuing the shift to value-based care, which shift was largely spurred by his predecessor and former boss, Barack Obama, with the passage of the ACA. (Read more…)

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PODCAST: Low-Value Healthcare Remains Even Without Fee-for-Service Incentives

BY ERIC BRICKER MD

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MORE: https://medicalexecutivepost.com/2021/05/27/activity-based-medical-cost-accounting-and-management/

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PODCAST: Value-Based Care

Ochsner Health Has Real Hospital Success

By Dr. Eric Bricker MD

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Bundled Payment Model Success Unaffected by Type of Participation

BY HEALTH CAPITAL CONSULTANTS, LLC

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Bundled Payment Model Success Unaffected by Type of Participation


Historically, Medicare has offered value-based payment models to healthcare organizations on both a voluntary and a mandatory participation basis. Because voluntary participants could self-select into programs to reduce spending, it was assumed that they achieved greater savings than mandated participants, but until recently, no data had tested this.

However, a June 2021 study in the Journal of the American Medical Association (JAMA) found no difference in risk-adjusted episodic spending between voluntary and mandatory payment model participants. (Read more…) 

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PODCAST: Traditional Medicare Hospital Value Based Payments Explained

THREE CATEGORIES OF VBC

By Eric Bricker MD

Medicare Value-Based Payments (also Called Alternative Payment Models) to Hospitals Fall Into 3 Main Categories:

PODCAST: https://www.youtube.com/watch?v=YEqtpCNwzSg

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PODCAST: Medicare Launched the First VBC Initiative 40 Years Ago!

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See the source image

BY DR. ERIC BRICKER MD

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Value-Based Care Happened 40 Years

Why Was Medicare Able to Bring About So Much Value-Based Payment Change in 3 Years (’83-’86) Compared to the Relatively Little Change That Has Occurred in the 11 Years Since the Affordable Care Act?

Watch the Video to Find Out.

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PODCAST: Improving Healthcare Outcomes & Supporting Providers in Value-Based Care

BY NIHCM

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Value-based care has the potential to transform health care, improving quality and access for millions of people, while addressing COVID-19 related disparities. As a result of the pandemic, many rural communities and communities of color face significant reductions in access to health care.

More than 8% of practicing physicians nationwide closed during COVID-19 despite 82 million Americans living in “health professional shortage areas.” The financial strain and burnout experienced by providers has fueled interest in accelerating the adoption of value-based care. As of 2017, only 34% of health care dollars were the result of value-based care payments. This low rate of adoption exists despite evidence tying payments to patient health outcomes and rewarding higher quality care leads to reduced costs.

This webinar brought together experts who are driving innovative initiatives, achieving excellence in health outcomes, and uncovering more effective ways to implement value-based care.

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INVITE DR. MARCINKO: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

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PODCAST: Value Based Care Financial Risks

RURAL HEALTHCARE CENTERS & VBC

Learn about the financial risk associated with Value-Based Care models and mechanisms to deal with the financial risk.

By National Rural Health Resource Center

https://acehealthcaresolutions.com/wp-content/uploads/2018/09/Value-based-care-model.png

PODCAST: https://www.healthsharetv.com/content/financial-risk-value-based-care-models

RELATED: https://medicalexecutivepost.com/2021/04/29/payments-in-value-based-contracts-were-ffs-based/

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INVITATIONS: https://medicalexecutivepost.com/dr-david-marcinkos-bookings/

CONTACT: Ann Miller RN MHA

MarcinkoAdvisors@msn.com

Ph: 770-448-0769

Second Opinions: https://medicalexecutivepost.com/schedule-a-consultation/

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CEO ADMITS: Payments in Value-Based Contracts Were Actually Fee-For-Service Based

Fee-For-Service Physician Reimbursement Not to be Replaced Anytime Soon!

AN EXPOSE’

Image result for eric brixcker

By Eric Bricker MD

VALUE BASED CARE PROPONENTS?

Definition: Value-Based Care (VBC) is a health care delivery model under which providers — hospitals, labs, doctors, nurses and others — are paid based on the health outcomes of their patients and the quality of services rendered. Under some value-based contracts, providers share in financial risk with health insurance companies. In addition to negotiated payments, they can earn incentives for providing high-quality, efficient care.

VBC differs from the traditional fee-for-service model where providers are paid separately for each medical service. While quality care can be provided under both models, it’s the difference in how providers are paid, paired with the way patient care is managed, that provides the opportunity for health improvements and savings in a VBC environment.

DICTIONARY CITATION: https://www.amazon.com/Dictionary-Health-Insurance-Managed-Care/dp/0826149944/ref=sr_1_4?ie=UTF8&s=books&qid=1275315485&sr=1-4

MEDICAL EXECUTIVE-POST REVIEW:

Advocacy: https://medicalexecutivepost.com/2015/10/19/the-case-for-value-based-medical-care/

Status: https://medicalexecutivepost.com/2018/12/07/the-state-of-value-based-care-vbc/

Transition: https://medicalexecutivepost.com/2017/08/06/transitioning-to-value-based-medical-care-payments/

Physicians: https://medicalexecutivepost.com/2016/02/03/value-based-care-vbc-and-physician-performance/

THE SHOCKING EXPOSE’

But – During a Panel Discussion Captured on YouTube at the 2019 HLTH Conference in Las Vegas, Blue Cross Blue Shield of Arizona CEO Pam Kehaly Admitted that Only 10% of the Payments in Value-Based Contracts Were Value-Based.

So, what gives?

VIDEO: https://www.youtube.com/watch?v=PfAxOpyP-sA

Your thoughts are appreciated.

Product Details

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