The Time Costs of Internal HIPAA Complaints

On Hospital Compliance

By Staff Reporters

The privacy regulations of HIPAA require that each hospital have an internal process to allow an individual to file a complaint concerning the covered entity’s compliance with privacy policies and procedures. This requires hospitals to designate a contact person to be responsible for receiving and documenting the complaint as well as the disposition.

A formal response to the person is not required as part of this rule; therefore it is estimated that each complaint, even though rare, will take ten minutes to document.

Recent Data

Recent data reveals that the most frequent complaints received either by hospitals or ultimately by DHHS include the following:

  • impermissible use or disclosure of individual PHI (most occurrences were curiosity or accidental, yet were reported);
  • lack of safeguards to protect PHI;
  • refusal or failure to provide an individual with access to or a copy of his or her record;
  • disclosure of more information than is minimally necessary; and
  • failure to have the individual’s valid authorization for a disclosure that requires one.

Assessment

Most hospitals have documented and logged such complaints; have reviewed the situation; and have resolved the problem internally.

Conclusion

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Hospital Capital Formation, Harry Markowitz and Modern Portfolio Theory

Strategic Risk Considerations for Physician-Executives and Healthcare CXOs

[By Calvin W. Wiese; MBA, CPA, CMA]

To most all financial advisors, wealth managers and stock-brokers, the work of Harry Markowitz and Modern Portfolio Theory [MPT] is not usually discussed in terms of hospital capital formation. But, perhaps it should!

Capital Investments Create Risk

Capital investments create risk. Risk is the uncertainty of future events. When hospitals make capital investments, they commit to costs that affect future periods. Those costs are known and relatively fixed. What are unknown are the benefits to be realized by those capital investments.

Defining Risk

For capital investments, risk is the certainty of future costs coupled with the uncertainty of future benefits. In some cases, while the future benefits are uncertain, there is a high degree of certainty that the benefits will exceed the costs. In these cases, risk can be very low. Risk may be better defined as the degree to which the uncertainty of unknown benefits will exceed the known and committed costs.

Asset Burdens and Benefits

When capital assets are purchased, both the burdens and the benefits of ownership are transferred to the owner. The burdens are primarily the costs associated with acquisition and installation. The benefits are primarily the revenues generated by operating the capital assets. Risk of ownership is created to the degree that the benefits are uncertain.

Understanding Risk

Hospital managers need to be skilled at putting hospital assets at risk. Without clear knowledge and understanding of the benefits and the burdens, hospitals can quickly find themselves at unacceptably high levels of risk. Risk must be continually assessed and evaluated in order to successfully put hospital assets at risk. Hospitals require many varied capital investments; their capital investments represent a risk portfolio. An effective combination of risky assets can often create risk that is less than the sum of the risk of each asset.

Modern Portfolio Theory

Of course, financial managers have know this for years as a basic principle of Modern Portfolio Theory (MPT), first introduced by Harry Markowitz, PhD, with the paper “Portfolio Selection,” which appeared in the 1952 Journal of Finance. Thirty-eight years later, he shared a Nobel Prize with Merton Miller, PhD, and William Sharpe, PhD, for what has become a broad theory for securities asset selection; and hospital assets may be viewed as little different.

Prior to Markowitz’s work, investors focused on assessing the rewards and risks of individual securities in constructing a portfolio. Standard advice was to identify those that offered the best opportunities for gain with the least risk and then construct a portfolio from them. Following this advice, a hospital administrator might conclude that a positron emission tomography (PET) scanning machine offered good risk-reward characteristics, and pursue a strategy to compile a network of them in a given geographic area. Intuitively, this would be foolish. Markowitz formalized this intuition.

Detailing the mathematics of diversity, he proposed that investors focus on selecting portfolios based on their overall risk-reward characteristics instead of merely compiling portfolios of securities, or capital assets that each individually has attractive risk-reward characteristics. In a nutshell, just as investors should select portfolios not individual securities, so hospital administrators should select a wide spectrum of radiology services, not merely machines.

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Assessment

Savvy hospital managers will mitigate ownership risk by constructing their portfolio of risky assets in a manner that lowers overall risk

Conclusion

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Understanding Hazard Communication Labeling

An OSHA Requirement

By Staff Reporters

www.HealthcareFinancials.com

 

 

The Hazard Communication Standard

The OSHA Hazard Communication Standard requires proper labeling of all chemicals present in the workplace. Labels are usually provided on chemicals that are found in a healthcare practice, but when a substance is transferred from its original container to a different container, a label must be affixed to the secondary container to inform any employee who uses it of the contents and their potential risks.

Assessment

The Standard also requires education for employees regarding any chemical present in the workplace to which they may be exposed under normal conditions of use or in a foreseeable emergency.

Conclusion

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Access Management in the Hospital Check-In and Admissions Setting

The Role of Operational Activity Based Cost Management

By Dr. David Edward Marcinko; MBA, CMP™

[Editor-in-Chief]

www.HealthcareFinancials.com

In order to be paid and maintain cash flow, hospitals and clinics set up levels of specialization. The result is usually more handoffs, delays, eroding financial positions, and a frustrated set of patients and physicians. Much seems out of control. When you factor in the maze of Health Insurance Portability and Accountability Act (HIPAA) technologies, it becomes overwhelming. Now, consider these operational inefficiencies in light of Obama Care?

Access Management

At the hub of the patient hospital or clinic experience is admitting or registration. This department collects information for clinicians treating the patient, meets Joint Commission standards and other requirements, facilitates medical record documentation, patient flow, revenue capture, billing and collections, and ultimately begins to settle accounts. The access management area has numerous customers in addition to the doctor, patient, or family member sitting across from them.

Increasing HR Complexity

Without the benefit of relevant information, managers attempt to staff access management departments based on past history — namely, if patient and physician complaints are not too high, there is probably enough staff. However, staffing in access management has not kept up with the increased demands and complexity of the process, and other hospital areas often suffer. Clinicians and medical records personnel must often deal with incomplete or incorrect information, and take up the slack.

Beware Un-Happy Stakeholders

All of these deficits make for an unhappy set of customers (physicians and patients) as they continually live with the repercussions of inaccurate and incomplete information. This does not go unnoticed by patients and physicians, as these situations erode confidence in the hospital’s ability to get things done correctly.

Emotional Touch Points

Access Management is the clinic or hospital’s first chance to create an “emotional contract” with the customer. It is here that the tone is set for the patient on the issues with respect to his or her hospitalization. And it is here that the provider has the chance to begin working on the patient’s behalf so that clinical outcomes are appropriate. All of this must happen in an environment that minimizes the likelihood of an unfavorable occurrence, and outside the realm of the complex legal requirements established by state and federal officials.

Tips from the Manufacturing Sector

So why are there unresolved issues in the access management area? In a manufacturing environment, if there are problems on the front-end design, huge problems ripple downstream in terms of recalls, warranty-related expenses, lawsuits, and customers that abandon the company’s products. world -class manufacturers dealt with these issues with their ISO-9000, Total Quality Management (TQM), and Six Sigma programs during the ’80s and ’90s. Hospitals, however, have allowed issues in their access management process to fester and create huge and costly problems in the downstream process. 

Assessment

In an effort to help solve access management issues, every provider must take a proactive role in dealing with the trend. The first step in this journey is healthcare administrator and physician-executive assessment.

This assessment is not a management engineering set of time studies aimed at micro-costing every second of work. The critical path information needed for this plan is reasonable and collected in a few days by talking to the people performing the work. Estimates are gathered based on workers’ views about how they spend their time. This information is combined with available workload measures and general ledger cost information, and activity-based reports are produced.

Conclusion

Going forward, ABCM it is an exercise in operational planning. Activity-based information is used to look at areas where work can be restructured so errors and rework can be eliminated. New technologies that target problematic activities are selected and implemented. Outside companies that can perform complex activities more economically can be used (e.g., www.ICMS.net).

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Healthcare Organizations [A Journal on CD-ROM]

Journal of Financial Management Strategies

By Ann Miller; RN, MHA

[Executive-Director]

ADVERTISEMENT

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All hospitals, healthcare systems and organizations use a variety of teaching, educational and didactic techniques to bring value to patients, payers, providers, governments and third-party intermediaries. This Intellectual Capital is the sum total of all knowledge and expertise used to serve society and stakeholders. Leaders, CXOs and employees provide almost all of this Intellectual Capital.

Our Beliefs 

We believe that Healthcare Organizations: [Journal of Financial Management Strategies] adds to this Intellectual Capital by guiding you, empowering your organization, and creating value for your patients, employees, investors and clients by bridging the intersection of medical mission and profit margin.

Our Vision

To be the pre-eminent interpretive guide for financial management strategies, and the enduring business analytics guide for all healthcare organizations; and to promote related enterprise-wide health economics initiatives.

Our Mission

Healthcare Organizations: [Journal of Financial Management Strategies] promotes and integrates academic and applied research, and serves as a multi-disciplined forum for the dissemination of economic, financial, business, management, IT and administration information to all healthcare organizations; both emerging and mature.

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Assessment

Our goal is: “Bridging the Intersection of Medical Mission and Profit Margin”

Conclusion                                               

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Capital Formation for Hospitals

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Understanding Strategic Expenditures

[By Calvin W. Wiese; MBA, CMA, CPA]

[By Dr. David E. Marcinko MBA CMP]

Some of the most important strategic decisions hospital executives make are related to capital expenditures. Almost every hospital has capital investment opportunities that are far in excess of their capital capacity. Capital investments are bets on the future. How these capital bets are placed has long-lasting implications. It is of utmost importance that hospitals bet right.

Strategic Importance of Capital Investing

Hospitals are capital intensive businesses. Hospital buildings are unique structures that require large amounts of capital to construct and maintain. Inside these buildings are pieces of expensive equipment that have fairly short lives. Technological innovations continually drive demand for new and more expensive equipment and facilities. The ability to continually generate capital is the lifeblood of hospitals. In order to compete and succeed, it’s imperative for hospitals to continually invest in large amounts of capital equipment and expensive facilities.

Profit Driven

Capital investment is fueled by profit. In order to continually make the necessary capital investments, hospitals must be profitable. Hospitals unable to generate sufficient profit will fail to make important capital investments, weakening their ability to compete and survive.

Capital Opportunity Selection

Hospital managers bear important responsibility in choosing which capital investments to make. There are always more capital opportunities than capital capacity. In many cases, capital opportunities not taken by hospitals create openings for others with capital capacity to fill the vacuum. By not taking such opportunities, hospitals are weakened, and their operating risk increases.

Stewardship

Stewardship is a term that aptly describes the responsibility borne by hospital managers in making capital investments. The New Testament parable of the talents describes this kind of stewardship. In this story, a merchant entrusted three managers with money to invest. One manager was given five units, another two, and a third one. At the end of the investment period, the two managers given five units and two units reported a 100% return. The manager given one unit reported zero return — he was fired and his unit was given to the first manager.

This is stewardship — and hospital managers are stewards of their organizations’ assets. Too often, not-for-profit hospital managers hold an erroneous view of the returns expected of them. Like the third manager in the parable, they think zero return on equity is acceptable. They understand capital investment funded by debt needs to cover the interest on the debt, but they view capital investments funded by equity as having no cost associated with the equity. From an accounting perspective, they are right. From a stewardship perspective they are dead wrong — just like the third manager in the parable.

Here’s why: as stewards, they are responsible for managing the entrusted assets. They can either put these assets at risk themselves, or they can put those assets in the market and let other managers put them at risk. If they choose to put them at risk themselves, and then they have the mandate of creating as much value from putting them at risk as they would realize if they put them in the market for other managers to put at risk. They have the duty to realize returns that are equivalent to the returns they could realize in the market; otherwise, they should just put them in the market. They can either invest in hospital assets or work the assets themselves, or they can invest in financial market assets so others can work the assets. When they choose to invest in hospital assets, the required return is not zero. That’s the return they get fired for. The required return is equivalent to market returns.

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Assessment

Thus, when evaluating performance of hospital management teams, the minimum acceptable performance level is return on equity that is equivalent to the return that could be realized by investing the hospital assets in the market. And when evaluating a capital investment opportunity, it is important to apply a capital charge equivalent to the hospital’s weighted cost of capital — a measure that imputes an appropriate cost to the equity portion of the capital along with the stated interest rate for the debt portion of the capital structure.

CASE MODEL: CASE MODEL

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Conclusion

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Understanding Hospital Community Essentiality

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Views Differ on this Important Concept

[By Calvin W. Wiese; CPA, CMA, MBA]

An important component of hospital financial analysis is essentiality. Hospitals are unusual businesses that many times possess some form of essentiality to their communities. Healthcare is important to the economic vitality of every community. Many hospitals have served their communities for many years; it is not uncommon to find hospitals that have been continuously operating for more than 100 years in the same community.

Many Hospital Types

As we have discussed here and elsewhere, most hospitals are not-for-profit. In not-for-profit hospitals, no private party actually “owns” the hospital; control is vested in various boards, but no one explicitly “owns” a not-for-profit hospital. In a broad sense, communities own not-for-profit hospitals. They are considered “charities” with a “charitable purpose.” Though a not-for profit hospital may not have owners, it has many” stakeholders,” parties that have vested interests in the continuing success of the hospital.

Many Diverse Stakeholders

Many hospitals have broad and vast webs of stakeholders. Stakeholders are why hospitals rarely close or are shut down. Too many stakeholders have interests in the continuing successful operation of hospitals.

Hospital stakeholder relationships need to be considered in the analysis of essentiality. How strong are these relations? How many are there? How important is the continuing success of this hospital to these stakeholders?

Health Services Analysis

Another dimension of the essentiality is medical service analysis. For examples, how significant are the hospital’s services? If the hospital shuts down, what population segments would suffer? How significant is the population that would suffer? How much would they suffer?

Assessment

Analysis of hospital’s stakeholders and services should provide a credible view of the degree of essentiality associated with a hospital. Higher degrees of essentiality suggest higher likelihoods that hospitals, one way or another, will meet their commitments, particularly their payment commitments.

Conclusion

So, tell us what you think about your hospital’s essentiality? 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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Introducing our New Name

Or … What’s in a Formal Name?

By Ann Miller; RN, MHA

[Executive-Director]

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Some ME-P readers have already noted our new moniker so it seems appropriate to formally announce our new name … domain name that is.

The Complete Migration

We’ve migrated from the rather unwieldy www.HealthcareFinancials.wordpress.com extension to the more facile and relevant www.MedicalExecutivePost.com

The first domain name refers to our companion institutional journal: Healthcare Organizations [Financial Management Strategies], located at www.HealthcareFinancials.com. Of course, the synergy there is perfect.

But, we were searching for something more expansive for the entire healthcare 2.0 universe for this rapidly growing blog, and had the epiphany to simply rename the site using our existing MEP tagline; and voila www.MedicalExecutivePost.com was born.

Confusing?

Not at all, since either name will get you to the same place via “domain sub-name pointing” technology.

What’s a Reader to Do?

So, what’s a reader to do about this name change; nothing! Just be aware and join us by reading and subscribing as you have always done … and we’ll do the rest. Fast, free and secure. Oh, and be sure to comment, too. Your opinion counts!

Conclusion

So, tell us what you think about our new name. Then, be sure to subscribe to the MEP. A rose by any other name … smells as sweet.

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Health Administration Terms: www.HealthDictionarySeries.com

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Hospital Materials Management Information Systems [Part 2]

Fundamentals of Software Implementation

By David J. Piasecki; CPIM

By Hope Rachel Hetico; RN, MHA

Dr. David Edward Marcinko; MBA

www.HealthcareFinancials.com

The singular focus of any Hospital Materials Management Information System (HMMIS) is to deliver significant improvements in the ability of hospital facilities, networks, and other healthcare organizations to optimize the processes and work flows associated with materials management systems and reduce the costs related to inventory, durable medical equipment, pharmaceuticals and supply chain management (SCM).

Understanding Strategies

Strategically, hospitals must exploit contemporary technologies and connectivity with suppliers and trading partners to:

  • improve patient care and safety,
  • increase efficiency,
  • drive down costs, and
  • optimize inventory levels.

Software Implementation

As with the selection process written about previously, ERP software implementation may also require outside assistance.  Whether you use consultants from the software vendor, a business partner, or an independent firm, the implementation plan will likely be the same.  It’s very important to listen to consultants and be prepared to dedicate the resources outlined in the implementation plan.  A common mistake made by healthcare entities going through their first major implementation is to underestimate the complexity of their operations, the extent of system setup and testing, and the impact the implementation will have on their operation.

ERP Implementation

Here is an outline of a common scenario in single-hospital ERP implementations.

  • The consultants warn of the consequences of not dedicating adequate resources.
  • Management publicly agrees but privately thinks the consultants are crying wolf.
  • Implementation fails or goes poorly.
  • Management claims “how could we have known?”

Don’t let this be you.  The only thing to assume about the implementation is that it that it will be much more difficult than expected, it will take longer than you expected, and it will cost more than expected.

Like most other projects, the success of a software implementation will be based upon the skill of the people involved, training, planning, and the effort put forth.  Plan to have the most knowledgeable employees heavily involved in the system setup and testing.  

Testing Programs

Adequate time should be dedicated to make sure every aspect of every process is thoroughly tested.  An example of a detailed testing program is listed below:

  • Does the purchase order [PO] receipt screen have all the information needed to perform the receipt such as vendor item number, item description, unit of measure?
  • What happens when we receive more than the PO quantity?
  • What happens when we receive less than the PO quantity?
  • What happens when we enter multiple receipts against the same line?
  • What happens if someone tries to change the PO quantity after we have entered a receipt?
  • What happens if one changes the PO quantity at the same time we are entering a receipt?
  • What happens when we reverse a receipt?
  • What happens when we reverse a receipt after it has been paid?
  • What happens if the ordered unit of measure is different from the stocking unit of measure?
  • What happens when we receive an early shipment?
  • What happens when we try to receive against a cancelled PO?
  • What happens when we change the receipt location?

After the system has been thoroughly tested, employee training begins. Remember, dealing with unexpected issues is the norm; you don’t also need to be training employees after the system is supposed to be operating.

Hands-On Training

The training should consist of hands-on training and include written procedures for the tasks performed.  For most positions, make sure that each employee has entered the equivalent of at least a full day’s transactions during the training.  Using an actual day’s transactions is a good way to make sure the variety of transactions an employee is likely to encounter have been experienced. The most common mistake made in training is a lack of adequate repetition. Just because someone was able to perform the task once, during a training session on a Saturday three weeks prior to “going-live” does not mean they will be able to perform the task with system start-up. If they have repeated the task many times over a series of training sessions, they are much more likely to remember how to do it. 

Assessment

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Watch the data. During and immediately after the implementation it is incredibly important to watch the data and make sure everything is working as planned. Monitor the status of orders, purchase orders, and delivery orders paying specific attention to “stuck orders” or other exceptions. Conduct some aggressive cycle counting of fast-moving items to make sure transactions are working correctly. 

Conclusion

So, tell us what you think about your hospital’s SCM software implementation? 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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Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Hospital Materials Management Information Systems [Part 1]

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Fundamentals of Inventory Software Selection

By David J. Piasecki; CPIM

By Hope Rachel Hetico; RN, MHA

By Dr. David Edward Marcinko; MBA

The singular focus of any Hospital Materials Management Information System (HMMIS) is to deliver significant improvements in the ability of hospital facilities, networks, and other healthcare organizations to optimize the processes and work flows associated with materials management systems and reduce the costs related to inventory, durable medical equipment, pharmaceuticals and supply chain management (SCM).

Understanding Strategies

Strategically, hospitals must exploit contemporary technologies and connectivity with suppliers and trading partners to:

  •  improve patient care and safety,
  •  increase efficiency,
  •  drive down costs, and
  •  optimize inventory levels.

Software Selection

Software selection and implementation services have become big business for consulting firms as well as the software vendors themselves.  Even with outside assistance, selecting the right software for hospital operations and having a successful implementation can be an extremely difficult undertaking. Horror stories of failed enterprise resource planning (ERP) system implementations are unfortunately very common.  Anyone who frequently reads business publications have read stories where large healthcare corporations, posting smaller than forecasted profits, cite problems associated with the implementation of a new software system as one of the causes.  Whether these claims are legitimate or not is up to debate. What is true is that hospitals are highly dependent on information systems and failures in the selection and implementations of systems can result in anything from a minor nuisance to a complete operational shutdown.

Those unfamiliar with business inventory management software should be prepared to be bombarded with acronyms and buzz words.  E-business, web-enabled, E-procurement, E-fulfillment, E-manufacturing, collaborative, modular, and scaleable are just a sampling of the terms used to describe (sell) hospital software inventory products.

Inventory Tracking Software

Healthcare enterprise inventory tracking software with implementation ranges in price from a few thousand dollars to millions.  In fact, up until recently, if you were a medical clinic with annual revenues of less than $200 million, many of the top enterprise software vendors didn’t even consider you a potential customer.  Fortunately, this arrogance has been tempered recently due to economic conditions (primarily the software vendors’ cash flow). Unlike five years ago, when the software vendors felt they held all the cards, today it is truly a buyer’s market. No matter how big or small an entity, many vendors will be vying for software dollars. That’s the good news. The bad news is that you must sift through all these products to find the one that best meets your business needs.

Process Definition

The most important part of the software selection process is defining the processes within your health organization and determining functionality that is critical to your medical operation.  Many times clients get distracted by the bells and whistles and forget about their core healthcare business functions.  As a healthcare entity in the DME distribution fulfillment business – focus on functionality related to order processing, as well as warehouse and transportation management. Be wary of the software vendor that claims packages that work equally well in all environments.  Most software packages are initially designed with specific situations in mind; asking the vendor about their biggest customers will often give you an idea as to the type of operation the software was designed to work in.

Product Functionality

When you look at the detailed functionality of a product it will be important to have listed detailed functionality requirements of your healthcare operation.  This is where hospitals often make mistakes by emphasizing functionality that they currently don’t have, but would like, and overlooking core healthcare processes that their current system handles well.

Example:

For example, if you are awestruck with functionality that allows remote access to a medical charting system from an Internet browser on an ambulatory device – and as a result – overlook critical functionality related to order entry or demand planning, you may end up with a system that provides great visibility to the fact that patient revenues are failing. Never assume a software package “must” be capable of handling something considered a standard function.  Some examples of detailed functional requirements are as follows:

  • E-commerce capabilities
  • Multi-facility demand planning
  • Postponement and configure-to-order functionality
  • Forecasting and demand planning
  • Back-order processing
  • Lot or serial number tracking
  • Forward pick location replenishment
  • Batch or wave order picking
  • Returns processing
  • Back flushing DME inventory
  • Co-product processing
  • Outsourcing specific operations
  • Multiple stocking units of measure
  • Product substitutions
  • Blanket orders
  • Shipment consolidation
  • Multi-carrier rate shopping and manifesting
  • First-in first-out processing

documents

Assessment

Don’t settle for “yes, we can do that” responses from the software vendor. It’s your responsibility to verify that not only can they do it, but also that they can do it to the level required. Ask detailed questions as to exactly how it works in their system. Look at the specific programs used to achieve the task and verify that the data elements required to achieve the task are present. Don’t allow the software vendor to sidestep your questions by retreating into obfuscating technical jargon

Conclusion

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Understanding the Healthcare Integrity and Protection Data Bank

Healthcare Fraud and Abuse Data Collection Program

By Patricia Trites; MPA, CHBC, CPC

The Healthcare Integrity and Protection Data Bank (HIPDB) were created to coordinate information with the National Practitioner Data Bank (NPDB). Currently, health plans, health maintenance organizations, and federal and state agencies are required to report final adverse actions taken against healthcare providers on a monthly basis.

The NP Database

The database operates under the auspices of DHHS, the Health Resources and Services Administration, and the Bureau of Health Professions. The Secretary of DHHS is responsible for operating this data bank in the same fashion as the NPDB.

Adverse Actions

Five types of final adverse actions against a healthcare provider, supplier, or practitioner are reported into this data bank:

1. civil judgments in federal or state court related to the delivery of a healthcare item or service;

2. federal or state criminal convictions related to the delivery of a healthcare item or service;

3. actions by federal or state agencies responsible for licensing and certification;

4. exclusions from participation in a federal or state healthcare program; and

5. any other adjudicated actions or decisions that the secretary of DHHS establishes by regulations.

Assessment

These actions must be reported, regardless of whether the subject of the report is appealing the action. Federal and state agencies, hospitals, and health plans are permitted to query the HIPDB. This will also lead to increased activities by other federal agencies, including the Internal Revenue Service and the Federal Trade Commission, which can lead to civil and criminal penalties.

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FINANCE: Financial Planning for Physicians and Advisors
INSURANCE: Risk Management and Insurance Strategies for Physicians and Advisors

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Understanding the Healthcare Fraud and Abuse Control Program

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A Joint Project Between the OIG and DOJ

PT

By Patricia Trites; MPA, CHBC, CPC

The Healthcare Fraud and Abuse Control (HCFAC) program is a joint project between the Office of Inspector General [OIG] and the Department of Justice (DOJ).

Functions

The primary functions are to coordinate federal, state, and local enforcement in controlling healthcare fraud, and to conduct investigations relating to delivery and payment of healthcare services, and oversee Medicare and Medicaid exclusions, civil money penalties, and the anti-kickback law. The program is also designed to provide opinions, alerts, and a means for reporting and disclosing final adverse actions against healthcare providers.

HIPAA Policies

HIPAA established the Health Care Fraud and Abuse Control Account within the Medicare Part A Trust Fund and funds DOJ and DHHS activities for operation of the HCFAC. In addition to federal appropriations, the fund receives a portion of funds collected from healthcare fraud and abuse penalties and fines. HIPAA also authorizes funds from general revenues for the Federal Bureau of Investigation (FBI) to combat healthcare fraud and abuse.

Assessment

Anti-fraud and abuse provisions were also included in the Balanced Budget Act of 1997 and the Deficit Reduction Act [DRA] of 2005, and annotated and

Conclusion

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Notice of Healthcare Privacy Practices Explained

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NPP “Game Changer” Replaced Use of Consents

Dr. Mata

[By Richard J. Mata; MD, MS]

In its most visible change, the privacy regulations of HIPAA require covered health entities to provide patients with a Notice of Privacy Practices (NPP).

The NPP replaces the use of consents, which are now optional, although they are recommended.

The NPP outlines how PHI is to be regulated, which gives the patient far-reaching authority and ownership of their PHI, and must describe, in general terms, how organizations will protect health information.

THE NPP Specifics

The NPP specifies the patient’s right to the following:

  • gain access to and, if desired, obtain a copy of his or her own health records;
  • request corrections of errors that the patient finds (or include the patient’s statement of disagreement if the institution believes the information is correct);
  • receive an accounting of how their information has been used (including a list of the persons and institutions to whom/which it has been disclosed);
  • request limits on access to, and additional protections for, particularly sensitive information;
  • request confidential communications (by alternative means or at alternative locations) of particularly sensitive information;
  • complain to the facility’s Privacy Officer if there are problems; and
  • pursue the complaint with DHHS’s Office of Civil Rights if the problems are not satisfactorily resolved.

A copy of the NPP must be provided the first time a patient sees a direct treatment medical provider, and any time thereafter when requested or when the NPP is changed. On that first visit, treatment providers must also make a good faith effort to obtain a written acknowledgement, confirming that a copy of the NPP was obtained. Health plans and insurers must also provide periodic Notices to their customers, but do not need to secure any acknowledgement. Most Health Information Management departments that oversee the clinical coding of medical records also manage the NPP documentations and deadlines, but this may vary from hospital to hospital, or office to office.

Assessment

HIPAA requires no other documentation from the patient in order for information to be used or disclosed for basic functions, like treatment and payment, or for a broad range of other core healthcare operations. State laws may nonetheless require some kind of consent/authorization form from the patient for these purposes [It is common for institutions to claim, incorrectly, that HIPAA does].

Conclusion

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Strategic Modern Portfolio Theory Considerations in Hospital Capital Formation

Understanding Risk for Doctors and Financial Advisors

By Calvin W. Wiese; MBA, CPA

www.HealthcareFinancials.com

Hospital capital investments financial create risk. Risk is the uncertainty of future events. When hospitals make capital investments, they commit to costs that affect future periods. Those costs are known and relatively fixed. What are unknown are the benefits to be realized by those capital investments. For capital investments, risk is the certainty of future costs coupled with the uncertainty of future benefits. In some cases, while the future benefits are uncertain, there is a high degree of certainty that the benefits will exceed the costs. In these cases, risk can be very low.

Risk Re-Defined

Risk may be better defined as the degree to which the uncertainty of unknown benefits will exceed the known and committed costs. For example, when capital assets are purchased, both the burdens and the benefits of ownership are transferred to the owner. The burdens are primarily the costs associated with acquisition and installation. The benefits are primarily the revenues generated by operating the capital assets. Risk of ownership is created to the degree that the benefits are uncertain.

Managing Risk

Hospital managers and physician executives need to be skilled at putting hospital assets at risk. Without clear knowledge and understanding of the benefits and the burdens, hospitals can quickly find themselves at unacceptably high levels of risk. Risk must be continually assessed and evaluated in order to successfully put hospital assets at risk. Hospitals require many varied capital investments; their capital investments represent a risk portfolio. An effective combination of risky assets can often create risk that is less than the sum of the risk of each asset.

About MPT

Of course, financial managers have know this for years as a basic principle of Modern Portfolio Theory (MPT), first introduced by Harry Markowitz, PhD, with the paper “Portfolio Selection,” which appeared in the 1952 Journal of Finance. Thirty-eight years later, he shared a Nobel Prize with Merton Miller, PhD, and William Sharpe, PhD, for what has become a broad theory for securities asset selection; and hospital assets may be viewed as little different. Prior to Markowitz’s work, investors focused on assessing the rewards and risks of individual securities in constructing a portfolio. Standard advice was to identify those that offered the best opportunities for gain with the least risk and then construct a portfolio from them.

Following this advice, a hospital administrator might conclude that a positron emission tomography (PET) scanning machine offered good risk-reward characteristics, and pursue a strategy to compile a network of them in a given geographic area. Intuitively, this would be foolish. Markowitz formalized this intuition. Detailing the mathematics of diversity, he proposed that investors focus on selecting portfolios based on their overall risk-reward characteristics instead of merely compiling portfolios of securities, or capital assets that each individually has attractive risk-reward characteristics. In a nutshell, just as investors should select portfolios not individual securities, so hospital administrators should select a wide spectrum of radiology services, not merely machines.

Assessment

Savvy hospital managers will mitigate ownership risk by constructing their portfolio of risky assets in a manner that lowers overall risk.

Conclusion

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Our Newest ME-P Milestone

Growing and Thriving – Thanks to You!

By Ann Miller; RN, MHA

[Executive Director]Congratulations

This month we passed the 145,000 reader mark. As you know, the ME-P was launched in 2007 and initially reached about a thousand Internet pioneers. It has grown exponentially, from our initial list-serve, to more than one hundred thousand readers and subscribers today.

A Thriving Community

The ME-P is now a thriving online and onground community that connects physicians with financial advisors and management consultants.

Our goal in the modern Health 2.0 era is to: “bridge the gap between medical mission and profit margin.”

Since inception, we have become one of the most popular and influential electronic networks in the healthcare administration, economics and financial planning space. 

Assessment

ME-P would like to thank all of our devoted readers, zealot subscribers, authors and participants as well as our advertisers for making this publication possible:

Channel Surfing

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Criticizing Electronic Medical Records?

By Brent A. Metfessel; MD, MS

By Staff Writers

www.HealthcareFinancials.comHOFMS

Despite ARRA and the HITECH initiatives, eMRs are not without drawbacks. And, with apologies to USCTO Aneesh Chopra, we list the following.   

List of Drawbacks

The following are some of the more notable negatives:

  • Operator dependenceThe term “garbage in, garbage out” applies to eMRs as well. The computer only works as well as the data it receives. If one is resistant to computing and works begrudgingly, is not well-trained, or is rushed for time, the potential exists for significantly incomplete or error-prone documentation.
  • Variable flexibility for unique needs — When one sees a single hospital, one sees just that — a single hospital, with unique needs unlike any other facility. A “one size fits all” approach misses the target. Even within a hospital, needs may change rapidly over time given the continued onslaught of external initiatives and measurement demands. Systems vary in flexibility and the ease with which they can customize options. More flexible systems exist but cost much more.
  • Data entry errors — Although data items normally only have to be entered once, data entry errors may still occur and be propagated throughout the system. Most notably, patient data can more easily be entered into the wrong chart when there is an error in chart selection. In general, simple double-checking and “sanity checks” in the system usually catch these errors, but if the error goes through the system the impact can be significant.
  • Lack of system integration — Interconnectivity of systems becomes more important with eMRs than with any other system. Personnel use the data in many different areas. If there are isolated departmental systems without connectivity, redundant data entry occur leading to confusion in the different departments. Appropriate and intelligent clinical decision support systems can make the job of the physician easier through education, real-time feedback, and through the presentation of choices that allow for clinical judgment.
  • Costs of implementation — Intelligently applied eMR implementations may also be cost saving; long term. For example, one large east coast hospital found that eMRs saved $9,000 to $19,000 annually per physician FTE. This savings was achieved through a decrease in costs for record retrieval, transcription, non-formulary drug ordering, and improvements in billing accuracy. And, in radiology, storage of digital pictures and the use of a picture archival and communication system significantly [PACS] decreased the turnaround time for radiology image interpretation — from 72 hours to only 1 hour. However, there is significant front-loading of costs prior to achieving such costs savings. 

Link: WSJ_Letter_3M_Company_2009-10-16

Assessment

At the American Health Information Management Association [AHIMA] October 2006 conference,  panelists suggested that developing, purchasing, and implementing an EMR would cost over $32,000 per physician, with an outlay of $1,200 per physician per month for maintenance.  This is larger in economic scope, today. Also, there exists no national standard that would require compatibility between the numerous competing eMR vendor systems that may need to communicate with each other, which can escalate costs and frustration in systems that attempt to integrate the features of multiple vendors.

Some recent HIT fiascos:

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=3090

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=1905

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=5286

 Link: http://psnet.ahrq.gov/resource.aspx?resourceID=3891

 http://sanfrancisco.bizjournals.com/sanfrancisco/stories/2009/10/12/newscolumn3.html#

Conclusion

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Championing Electronic Medical Records?

By Brent A. Metfessel; MD, MS

By Staff Writers

www.HealthcareFinancials.comHOFMS

eMRs involve accessibility at the bedside either through bedside terminals, portable workstations, laptops, wireless tablets, and hand-held computers and personal digital assistants (PDAs), (e.g., 3ComtmPalm Pilot®). The inputs can either be uploaded into the main computer system after rounds or transmitted immediately to the system in the case of wireless technology. Bedside technology obviates the need to re-enter data from notes after rounds are complete. This improves recall and avoids redundancy in the work process, saving time that can instead be devoted to patient care. 

Usual eMR Features

Common features of an eMR include the following:

  • history and physical exam documentation, progress notes, and patient demographics;
  • medication and medication allergy information;
  • CPOEs and laboratory results;
  • graphical displays of medical imaging studies including X-rays, CT, and MRI;
  • ordering of drugs, diagnostic tests, and treatments, including decision support and drug interaction alerts;
  • clinical practice guidelines (evidence-based) to aid diagnostic and treatment decisions;
  • alerts that can be sent to patients reminding them of appointments and necessary preventive care;
  • scheduling of appointments;
  • processing of claims for payment; and
  • a GUI, which may include secure Web-based and wireless technologies that allows providers or other authorized healthcare personnel access to health information from remote sites, including outside offices and home.

Assessment

There are also other benefits, as well. For example, instead of calculating fluid balance off-line, the computer can perform calculations immediately, once again saving time and ensuring accurate values. Medication orders can also be entered in real-time, giving the provider the option to react to alerts at the bedside rather than waiting to load the orders into the system in “batch” mode.

Conclusion

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New-Wave ME-P Sponsorship Opportunities

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[Executive Director]Doctor-Business

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First Annual iMBA, Inc Educational Cruise

Meet, Greet, Lunch and Learn from the Experts

By Ann Miller; RN, MHA

[Executive-Director]

CruiseSome time ago, a CPA, CFP® and fellow Certified Medical Planner™ suggested that we hold annual meetings, or education seminars, for all our colleagues. As a nascent organization at the time, this was considered a “pipe dream.” But, it may now become a reality depending on your response. All interested stakeholders are invited. 

 

The Cruise

Currently, we are soliciting interest in a – Princess – Caribbean cruise [Southern] for 2010. This would afford us the opportunity to meet  you on both a formal or informal basis. Educational and other activities would then be scheduled,  as-needed or requested. Departure from Ft. Lauderdale, Florida. All info subject to change without notice, at this time.

www.CertifiedMedicalPlanner.comcmp-logo

For example, activities could be arranged for CMP™ program credits in health economics and medical management; or simply on an ad-hoc [audit] informational basis. We will also attempt to individualize and accommodate personal situations and professional needs. 

Seeking Interest and Input

And so, your thoughts, ideas and comments on this Medical Executive-Post cruise idea and opportunity are appreciated. Please email me your ideas; or contact us for more information with details. Serious inquiries only:

MarcinkoAdvisors@msn.com

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Seeking Sponsors

Ship Solstice

We are also seeking sponsors for this cruise, and other iMBA corporate engagements.

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Off-Road Touring with Dr. Marcinko [Final Part 2009]

Hello Everyone and Thank You!

By Ann Miller; RN, MHAOff Road Touring '09

To all of you who made it to one of our venues for an Off Road Tour segment with our Publisher Dr. David E. Marcinko, or to those who just read his posts, we wanted to thank you for your support and for supporting each other!

Our mission – is to bridge the gap between financial planning and medical practice management, and to serve as a networking resource for medical, managerial and financial advisory colleagues who possess the ethics and intellect to serve in a fiduciary capacity.

The Next Step

Ready for the next step? Just visit www.HealthcareFinancials.com and subscribe to the Journal of Financial Management Strategies, to create a roadmap to success for your healthcare organization.

Thanks with a Shout-Out

Finally; we give a hearty shout-out to www.MedicalBusinessAdvisors.com who made the book “signing and opining” tour possible. We are so proud of our partnership with an institute whose team learning approach creates such rich success for students, both in the virtual and real-world classroom and in their personal and professional lives www.CertifiedMedicalPlanner.com

Online Certified Medical Planner Program

Interested in becoming a Certified Medical Planner ™ or to learn about how your broker-dealer, advisory firm or company can build an educational partnership with us? Call me at 770.448.0769 (9am – 5pm EST).

Channel Surfing

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. 

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Assessment

Thanks so much for your interest in our Summer 2009 tour, and the ME-P. We hope it, and all our books, texts, dictionaries, products and educational formats serve you well!

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: MarcinkoAdvisors@msn.com 

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Sponsorship Opportunities

Advertise on the Medical Executive-PostSyringe

Let’s get right to the point!

Reach out and impress more than 100,000 physician and nurse-executives, financial advisors, CEOs and medical management consultants in the Health 2.0 space.

Our premium institutional e-journal: www.HealthcareFinancials.com and complimentary companion www.MedicalExecutivePost.com  has limited sponsorship and advertising opportunities available; So, be sure to act now!

Advertise with us!

Reserve your space today.

For more information please contact:

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Sponsors Welcomed

Credible sponsors and like-minded advertisers are always welcomed.

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Health Administration Terms: www.HealthDictionarySeries.com

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On Healthcare Inventory Management

Understanding Fundamental Principles

By Staff Reporters

www.HealthcareFinancials.com

According to industry inventory management expert Mr. David Piasecki, healthcare inventory is a term that describes medical items used in the delivery of healthcare services or for patient use and resale. Much like Durable Medical Equipment, a certain safety margin of stock should always be available. Inventory ranges from normal administrative office supplies to highly specialized chemicals and reagents used in the clinical laboratory. It should be distinguished from capital supplies, such as major equipment, instruments, and other items that are not used up faster than inventory or related inventory wastes.

Historical Review

Historically, asset utilization ratios provided information on how effectively the enterprise used its inventory assets to produce revenues, or deplete its cash. For example, the inventory turnover ratio (ITR) determines the total volume of inventory turnover (change) during a pre-determined accounting period (month or quarter). It is defined as cost of inventory purchased for the period, divided by average inventory (AI) at cost.

Consulting Firms

Dunn and Bradstreet, the supply chain management – consulting firm and others, do not provide exact comparatives for private healthcare ITR. Nonetheless, ITR is useful as an internal performance indicator of inventory turnover speed and cash flow enhancement. Currently however, for public hospitals, 60 – 75 days is estimated to be the average time for inventory turnover.HOFMS

www.HealthcareFinancials.com

The main problem with traditional ITR, similar analyses such as AI and ICP, and the usual inventory costing methods (e.g., last-in first-out, first-in first-out, specific identification, average costs), and even just-in-time inventory costing, is that they do not embrace Supply Chain Inventory Management. This occurs because sources of profit or loss are not recognized in the traditional inventory cost accounting equation:

Assessment

Cost of goods sold = beginning inventory + net purchases – ending inventory

Conclusion

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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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

The VistA Client Server System

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What it is – How it works

By ME-P Staff ReportersME-P Rack Servers

According to Dr. Richard Mata MS, a client-server system configuration occurs when one or more “repository” computers [ known as “servers”] store large amounts of data but perform limited processing. Communicating with the server(s) are client workstations that perform much of the data processing and often have graphical user interfaces (GUIs) for ease of use.

High Functionality

Both customizability and resource use is high, depending on the desired sophistication. Many clinical medical information systems that process data directly related to patient care use this configuration.

VA Example

For instance, the Veterans Health Administration, which has implemented what is likely the largest integrated healthcare information system in the United States, uses client-server architecture. Known as the Veterans Health Information Systems and Technology Architecture (VistA), this system provides technology infrastructure to about 1,300 care facilities, including hospitals and medical centers, outpatient facilities, and long-term care centers. VistA utilizes a client-server architecture that links together workstations and personal computers using software that is accessed via a graphical user interface.

Assessment

Overall, for hospitals that have the financial and manpower resources for a significant investment in IT, client-server architectures are the fastest-growing and typically the most preferred of the system architectures, due in large part to their local adaptability and flexibility to meet changing hospital and medical center needs.

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.

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Hospital Automated Data Collection

Understanding Data Capture Technologies

By David J. Piasecki, with
Hope Hetico; RN, MHA

Automated data collection (ADC), also known as automated data capture, automated identification (AutoID) or automated identification and data capture (AIDC), consists of many different technologies. Bar codes, voice systems, RFID, OCR, laser scanners, vehicle mounted and wearable computers are all part of ADC management and hospital inventory activities.

www.HealthcareFinancials.comHO-JFMS-CD-ROM

Six-Figure Projects

However, the fear of six-figure project costs often prevent many small to mid-sized hospitals and healthcare systems from taking advantage of these technologies. The key to implementing cost-effective ADC systems is to know what technologies are available and the amount of integration needed to implement them. Applying this processing knowledge in a healthcare organization will help in developing the scope of any project. Limiting projects to or prioritizing by those applications that have a high benefit/cost ratio allows these operational improvement technologies within a reasonable budget. 

Example:

For example, adding a keyboard-wedge bar-code scanner to an existing personal computer (PC) or blade terminal in a nursing station is a very low-cost method for applying ADC to existing hospital reporting applications. This type of hardware is inexpensive and the only real programming required is to add a bar code to the proper form (work order, pick and delivery slip, etc).

Review of the ADC Technologies

Some of the current hospital data capture technologies include the following:

a. Bar Codes

b. Bar-Code Scanners

Laser or CCD 

Auto-Discrimination

Keyboard-Wedge Scanners 

Fixed-Position Scanners

c. Portable Computers

d. Batch versus Radio Frequency

e. Hand-Held Devices

f. Vehicle-Mounted Devices

g. Wearable Systems

h. Voice Technology

i. Optical Character Recognition

j. Light Systems

Assessment

Driven by a need for improved data capture, asset management, staff mobility and standardized medication administration to name a few benefits, hospitals are likely to invest much more heavily in ADC and Wi-Fi technologies over the next five years, according to this new research report.

Link: http://www.eweek.com/c/a/Health-Care-IT/WiFi-Healthcare-Systems-to-Hit-49B-878082/

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Tell us what you think. Can you think of any other hospital data capture technologies? 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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Health Administration Terms: www.HealthDictionarySeries.com

Physician Advisors: www.CertifiedMedicalPlanner.com

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Medical Inventory Management Methodologies

Understanding Traditional Costing Methods

By David J. Piasecki, with
Hope Rachel Hetico; RN MHA, CMP™cmp-logo1

A good inventory management system offers opportunities for improved efficiency in any healthcare organization. The following traditional methods of inventory cost accounting and management are useful when one is calculating the cost of supplies (as opposed to medical items for resale and DME).

a. LIFO

The last-in first-out (LIFO) inventory costing method means the last items purchased are the first to be used (at least for cost calculations if the inventory consists of identical units). In times of rising prices, a lower total cost inventory is produced with a higher cost of goods sold. The last items purchased are most often the most expensive, and used first for the calculation. This happens because LIFO increases an expense (cost of goods sold) and decreases taxable income. Given the same revenue, higher expenses mean less profit. Deflation has the opposite effect.

b. FIFO

The first-in first-out (FIFO) inventory costing method means the first items purchased are the first to be used (at least for cost calculations if the inventory consists of identical units). In times of rising prices, a higher total cost inventory is produced with a lower cost of goods sold. This happens because FIFO decreases an expense (cost of goods sold) and increases taxable income. Deflation has the opposite effect.

Note: Any switch from FIFO to LIFO does not change reality, and although a decrease in reported incomes occurs, it does not increase cash outflows. However, for a taxable healthcare entity, after-tax net cash flow does increase.

c. Specific Identification

Specific identification is used for larger pieces of equipment, as it traces actual costs to an identifiable unit of product and is usually applied with an identification tag, serial plate, or radio frequency identification device (RFID) scanner. It does not involve flow-of-cost analysis. It does, however, permit the manipulation of income because healthcare entities state their cost of goods sold, and ending inventory, at the actual cost of specific units sold.

d. Average Cost

Average costing calculates ending inventory using a weighted average unit cost. When prices are rising, cost of good sold is less than under LIFO, but more than that under FIFO, and hence income manipulation is also possible.

e. Just-in-time Management

Although technically not a costing technique, JIT inventory management means that inventory supplies like DME are delivered as soon as needed by the healthcare organization, the prescribing doctor, or the patient. In JIT, inventory is “pulled” through the flow process. This is contrasted to the “push” approach used by conventional IM. In the push system, DME is already on-site, with little regard to when it is actually needed. In the JIT “pull” system, the overriding concern is to keep a minimum cost inventory, so that means having a system in which inventory is obtained on an as-needed basis.

The key elements of JIT consist of six parts:

1. a few dependable vendors or suppliers willing to ship with little advance notice;

2. total sharing of demand information throughout the supply chain;

3. more frequent orders;

4. smaller size of individual orders;

5. improved physical plant (hospital or clinic) layout to reduce travel flow distance; and

6. use of a total quality control system to reduce flawed medical products.

Using the JIT method, inventory is delivered when needed, rather than in advance, saving handling and storage costs. The healthcare entity never needs to stockpile inventory, and cash flow is enhanced. JIT is further characterized as follows:

  • little or no work orders;
  • little or no tracing of materials;
  • fewer inventory accounts or accounts payables;
  • reduction or elimination of work-in-progress or handling activities; and
  • no tracing of overhead and direct labor costs

JIT requires a dependable working relationship with suppliers and the precise calculation of inventory needs, especially for the following:

  • sterile surgical packs;
  • gastro-intestinal and gastro-urinary instrumentation;
  • orthopedic and OB-GYN inventory;
  • invasive heart and lung equipment;
  • radio isotopes and trace radiographic materials; and
  • equipment for almost all pre-schedule medical interventions and procedures.

Assessment

This means that, when JIT inventory monitoring is used, healthcare managers are better prepared with the proper inputs to control and reduce inventory, including when dramatic bursts or declines occur. This means a more rapid and higher cash flow balance, rather than inventory balance. Each of these traditional methods of inventory cost accounting is adequate for most healthcare facilities, but as inventory orders and costs continue to increase, economic order quantity [EOQ] costing may be the most effective means of accounting for inventory in DME-intensive organizations.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. Can you think of any other inventory management technologies?  Tell us what you think. 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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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About MeaningfulUse.org

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A Dedicated Terminology Website

By Staff Reporters

Understanding and defining the new era of healthcare information technology in America.

The ARRA and HITECH concept of “meaningful use” for e-MRs is nebulous and ill defined. This new website is intended to be a collaborative destination site in order to promote the national dialogue and education around the term, “meaningful use”, by providing the HIT community a single-central location to access resources, influence and discuss the definition of “meaningful use” and learn how to take advantage of the HITECH stimulus funds.

HDSAssessment

According to the site, registration for the www.MeaningfulUse.org discussion board is only used for the purpose of posting and will not be used for any marketing purposes. The site is supported by the Association of Medical Directors of Information Systems (AMDIS) and sponsored by Compuware Corporation.

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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Government-Enabled Patient “Bounty Hunters”

Spider Webbing Technology May Trip-Up Miscreant Doctors

By Dr. David Edward Marcinko; MBA CMP™

HO-JFMS-CD-ROMUnder the Health Insurance Portability Accountability Act (HIPAA), the U. S. Department of Health and Human Service (HHS) have operated an “Incentive Program for Fraud and Abuse Information.”

In this program, HHS pays $100 – $1,000 to Medicare recipients who report abuse in the program.

To assist patients in spotting fraud, HHS has published examples of potential fraud, which include:

  • medical services not provided;
  • duplicated services or procedures;
  • more expenses, services, or procedures claimed for than provided (upcoding/billing);
  • misused Medicare cards and numbers;
  • medical telemarketing scams; and
  • no-medical necessity.

Real Health Fraud Exists

There is no question that real fraud exists. The Office of Inspector General of HHS saved American taxpayers a record $32 billion in 2006, according to Inspector General Glenn A. Fine.  Savings were achieved through an intensive and continuing crackdown on waste, fraud, and abuse in Medicare and over 300 other HHS programs. To discourage flagrant allegations, regulations require that reported information directly contribute to monetary recovery for activities not already under investigation.  For the DRA in 2009, this includes the following:

  • promoting state False Claims Acts (section 6032);
  • enhancing the Fair and Accurate Credit Transaction Act, with “red flags” (PL 108-159); see http://www.gpo.gov/fdsys/pkg/PLAW-108publ159/content-detail.html
  • employee education about false claims recovery (section 6033);
  • augmenting the Medicaid Integrity Program (section 6034);
  • enhancing third party recovery (section 6035); and
  • “mining” medical claims for potential fraud with the help of sophisticated computer technology algorithms – called “spider-webbing” – which locate a common insurance claim denominator and then follow the thread throughout claims review. Indicators of  possible fraud include doctors charging more than peers; providers who administer more tests or procedures per patient; providers who conduct medically “unlikely” procedures; providers who bill for more expensive procedures and equipment when there are cheaper options; and patients who travel long distances for treatment.

Assessment

CMS and private companies are able to save far more money by detecting fraud before claims are paid than recovering the money after the factAnd so, a further erosion of patient confidence can be expected as CMS, and private insurers, assume the “bounty hunter” view of healthcare providers.

Conclusion

Of course, your thoughts and comments on this Medical Executive-Post are appreciated. Do you feel like the hunter; or the hunted? Tell us what you think? Do you ever – or never –  fear the spider? 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 Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

Our Other Print Books and Related Information Sources:

Practice Management: http://www.springerpub.com/prod.aspx?prod_id=23759

Physician Financial Planning: http://www.jbpub.com/catalog/0763745790

Medical Risk Management: http://www.jbpub.com/catalog/9780763733421

Healthcare Organizations: www.HealthcareFinancials.com

Physician Advisors: www.CertifiedMedicalPlanner.org

Subscribe Now: Did you like this Medical Executive-Post, or find it helpful, interesting and informative? Want to get the latest ME-Ps delivered to your email box each morning? Just subscribe using the link below. You can unsubscribe at any time. Security is assured.

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Sponsors Welcomed

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For details about how to report an abuse, see www.usdoj.gov/oig/FOIA/hotline.htm.

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On Healthcare Intranets and Extranets

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A Primer for Physicians and Medical Executives

Dr. Mata

By Richard J. Mata; MD, MS, CMP™ [Hon]

According to the “Dictionary of Heath Information and Technology”,

“An intranet is a private network that uses Internet Protocols, network connectivity, and possibly the public telecommunication system to securely share part of an organization’s information or operations with its employees”.

Sometimes the term refers only to the most visible service, the internal website.  The same concepts and technologies of the Internet, such as clients and servers running on the Internet protocol suite, are used to build an intranet.

Uses in Healthcare

An intranet is commonly used to provide communication and application services.  The advantages of using an intranet in the healthcare setting include the following:

  • Medical Workforce productivity: Intranets can help employees quickly find and view information and applications relevant to their roles and responsibilities.  Via a simple-to-use web browser interface, users can access data held in any database the organization wants to make available, anytime and  subject to security provisions — from anywhere, increasing employees’ ability to perform their jobs faster, more accurately, and with confidence that they have the right information.
  • Time: With intranets, healthcare organizations can make more information available to employees on a “pull” basis (i.e., employees can link to relevant information at a time that suits them) rather than being deluged indiscriminately by e-mails.
  • Communication: Intranets can serve as powerful tools for communication within a healthcare organization; vertically and horizontally.

Vulnerability and Security Protection

Intranets, like other IT systems, need to be protected by security systems. Any intranet is vulnerable to attack by people intent on destruction or on stealing corporate data. The open nature of the Internet and TCP/IP protocols expose a corporation to attack.  Intranets require a variety of security measures, including hardware and software combinations that provide control of traffic; encryption and passwords to validate users; and software tools to prevent and cure viruses, block objectionable sites, and monitor traffic.

Multiple Lines of Defense

The first line of defense is a firewall and these are commonly set up using proxy servers, which allow system administrators to track all traffic coming in and out of an intranet. Another layer of sophistication is added by using a bastion server firewall, configured to withstand and prevent unauthorized access or services. It is typically segmented from the rest of the intranet in its own subnet or perimeter network. In this way, if the server is broken into, the rest of the intranet won’t be compromised.

Authentication Systems

Authentication systems are an important part of any intranet security scheme. They are used to ensure that anyone trying to log into the intranet or any of its resources is the person they claim to be. Authentication systems typically use user names, passwords, fingerprints and iris scans, and various encryption systems.

Protection and Monitoring

Server-based software is used to protect an intranet and its data. Virus-checking software can check every file coming into the intranet to make sure that it is virus-free, and site-blocking software can bar people on the intranet from getting objectionable material. Monitoring software tracks where people have gone and what services they have used, such as HTTP for Web access.

Filtering Systems and Routers

One way of ensuring that the wrong people or erroneous data can’t get into the intranet is to use a filtering router. This is a special kind of router that examines the IP address and header information in every packet coming into the network, and allows in only those packets that have addresses or other data, like e-mail, that the system administrator has decided should be allowed into the intranet. Increasingly, intranets are being used to deliver tools and applications, e.g., collaboration (to facilitate working in groups and for teleconferences) or sophisticated corporate directories, sales and customer relationship management (CRM) tools, project management, etc, to advance productivity. Intranets are also being used as Health 2.0 culture change platforms

Metrics

Intranet traffic, like public-facing website traffic, is better understood by using web metrics software to track overall activity, as well as through surveys of users. Intranet User experience, editorial, and technology teams work together to produce in-house sites. Most commonly, intranets are owned by the communications, HR or IT areas of large healthcare organizations, or some combination of the three.

Assessment

When part of an intranet is made accessible to customers, partners, suppliers, patients, or others outside the healthcare organization – that part becomes part of an extranet.

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.

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On Growing Tensions in Healthcare Services Markets

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Stressors Affecting all Stakeholders

[By Robert James Cimsai; MHA, AVA, ASA, CMP™]

http://www.HealthCapital.com

The changes in reimbursement for Medicare services through the introduction of prospective payment systems and physician reimbursement cuts for professional services, as well as the increased focus on patient quality and transparency initiatives and health 2.0 collaboration have forced healthcare providers to look for more efficient ways to provide services, as well as additional sources of revenue and margin-producing business.

Additionally, with the rise of corporate healthcare provider networks and health systems, together with rising healthcare costs, competition among providers has become prevalent in the healthcare industry.

Assessment

Strict control of reimbursement costs from payers and consistent decreases in physician professional component fee reimbursement yields; reduction in traditional hospital inpatient use; and higher costs of capital have all contributed to the trend of physician investment in outpatient (and inpatient) specialty provider enterprises [ASCs, specialty hospitals and clinics, etc] , which often compete with general acute care community hospital providers.

Conclusion

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Medical Accounts Receivable and Related Formulae

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Understanding Rationale and Formulae

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

[By Dr. Gary L. Bode; CPA, MSA, CMP™]

HO-JFMS-CD-ROMMedical practices, clinics and hospitals generate a patient account or an account receivable (AR) at the same time as they send the patient a bill or the insurance company a claim. ARs are treated as current assets (cash equivalents) on the healthcare entity balance sheet, and usually with a percentage mark-down to reflect historic collection rates.

The Balance Sheet

The balance sheet is a snapshot of a medical practice or healthcare entity at a specific point in time. This contrasts with the income statement (profit and loss), which shows accounting data across a period of time. The balance sheet uses the accounting formula:

Assets (what the entity owns) = Liabilities (what the entity owes) + Entity Equity (left over).

AR Aging Schedules

HDSAccording to the Dictionary of Health Economics and Finance, an AR aging schedule is a periodic report (30, 60, 90, 180, or 360 days) showing all outstanding ARs identified by patient or payor, and month due. The average duration of an AR is equal to total claims, divided by accounts receivable. Faster is better, of course, but it is not unusual for a hospital to wait six, nine, twelve months, or more for payment. Each of these measures seeks to answer two questions:

1) How many days of revenue are tied up in ARs?

2) How long does it take to collect ARs?

More Formulae

An important measure in the analysis of accounts receivable is the AR Ratio, AR Turnover Rate, and Average Days Receivables, expressed by these formulae:

1. AR Ratio = Current AR Balance / Average Monthly Gross Production
(suggested between 1 and 3 for hospitals)

2. AR Turnover Rate = AR Balance / Average Monthly Receipts

3. Average Days Receivable = AR Balance / Daily Average Charges
(suggested < 90 days for medical practices)

And Even More Measures

Other significant measures include:

1. Collection Period = ARs / Net Patient Revenue / 365 days

2. Gross Collection Percentage = Clinic Collections / Clinic Production
(suggested > 40-80% for hospitals)

3. Net Collection Percentage = Clinic Collections / Clinic Production – (minus) Contractual Adjustments (suggested > 80-90% for medical practices)

4. Contractual Percentage = Contractual adjustments / Gross production
(suggested < 40-50% for hospitals).

Assessment

Often, older ARs are often written off, or charged back as bad debt expenses and never collected at all.

Conclusion

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Doctor – Are You on Your Way to $5.5 Million?

Update 2015

[By Staff Reporters]

[Initially Published on September 16, 2008]

As a physician, how much do you need in your retirement kitty to finance your golden years?

It was a vexing question when this article was first written by Physician’s Money Digest’s Editor-in-Chief, Gregory J. Kelly, and is an even more vexing dilemma in 2009. It is also one that most physicians tend to ignore; hence the reprint.

Assessment

And so, for those doctors curious about whether they’ll be living on Easy Street, or Skid Row, when they hang up their stethoscope, it helps to do some basic math and to review this link:

Read: http://www.hcplive.com/print.php?url=http://www.hcplive.com/publications/pmd/2005/95/4030

Channel Surfing the ME-P

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More:

  1. More on the Doctor Salary Conundrum
  2. Doctor Salary v. Others [Present Value of Career Wealth]
  3. Are Doctors Members of the Middle Class?
  4. Taxing the [not so] Rich [doctors]
  5. Doctor – Are You on Your Way to $5.5 Million?

Conclusion

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Financial Planning MDs 2015

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

Hospital Loses Twenty-Five Million Dollar Investment

Investment Losses Cited

By Staff Reportersho-journal8 

www.HealthcareFinancials.com

According to Brian Bandell, of the South Florida Business Journal on May 20 2009, Baptist Health South Florida [BHSF] could not climb out of the red in the fiscal second quarter that ended March 31, 2009. Its investment losses wiped out operating income, according to a report the nonprofit issued to its bondholders.

Investment Losses Nix Operating Income

The Miami-based health care provider lost $24.8 million on operating revenue of $530.2 million in its second quarter. That’s improved from a loss of $26.8 million on operating revenues of $470.2 million in the same quarter of 2008.

Link: http://www.bizjournals.com/southflorida/stories/2009/05/18/daily47.html

Assessment

Perhaps the BHSF CFO and CEO should read Tab 8, Chapter 3 on: Hospital Endowment Fund Management, by J. Wayne Firebaugh, Jr; CPA, CFP® CMP™ in Healthcare Organizations [Financial Management Strategies]?

T.O.C. Link: toc_ho[1]

Conclusion

And so, your thoughts, post and comments on this Medical Executive-Post are appreciated; especially from hospital CEOs and major health institutional CFOs and CIOs, etc. 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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Beware the Faux Medical Journals

When is a “Journal” … not a Journal?

By Dr. David Edward Marcinko; MBA, CMP™

Publisher-in-Chiefdem23

Allow me to begin this post by making the unusual disclosure that I was the Editor-in-Chief of a print guide in healthcare finance and economics [aka periodical or journal].

Formally, the title was: Healthcare Organizations [Financial Management Strategies]. At 2 volumes, and more than 1,200 pages, it was quite a job to update it quarterly. And, with more than two dozen contributing authors, it was a labor of love indeed. Alas … no more!

ho-journal9

Varying Levels of Credibility

Now, we doctors know that medical journals are not all alike. There are different levels of “credibility.” Some are peer-reviewed, others not. Some are trade magazines. Frankly, some “real” journals are better, and more respected than others. Some entrenched journals are in decline, while other emerging journals are leading-edge in the health 2.0 space. Still others, like the formerly esteemed Journal of the American Medical Association [JAMA], have been accused of outright censorship.

Link: https://healthcarefinancials.wordpress.com/2009/04/02/is-jama-censoring-physician-dissent/

Adventures

Of course, doctors also know that pharmaceutical companies routinely offer us reprints of articles from medical journals that are favorable to their products. But, news of a Merck-sponsored publication for doctors in Australia has come to light in a personal injury lawsuit over Vioxx. It raised more than a few eyebrows in international medical publishing circles. It may have even crossed the line of journalistic, not to mention medical, ethics.

Read: Merck Paid for Medical ‘Journal’ Without Disclosure; by Natasha Singer, May 13, 2009.

Link: http://www.nytimes.com/2009/05/14/business/14vioxxside.html?_r=1&adxnnl=1&adxnnlx=1242313549-xaAEwW4MCd7pJh9OdgWdUQ

Mis-Adverntures

Tracy Staton wrote more about these mis-adventures in a story, dated May 14, 2009, in FiercePharma.

Analysis and Apology

Analysis in the Pipeline: http://seekingalpha.com/article/136942-merck-and-elsevier-cross-the-line-in-joint-medical-journal?source=yahoo

Libology Mea Culpa: http://www.libology.com/blog/tag/excerpta-medica

Assessment

Perhaps; Merck ought to read our Medical-Executive Post on health journalists?

Link: https://healthcarefinancials.wordpress.com/2009/03/17/battered-health-journalists

Or, our Medical-Executive Post on medical experts, reporters and journalists?

Link: https://healthcarefinancials.wordpress.com/2009/03/09/healthcare-experts-versus-health-journalists

Conclusion

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Understanding Periodic or New Employee Practice Compliance Audits

Perform and Improve as Needed

By Patricia Trites MPA, CHBC; with Staff Reporters 

www.HealthcareFinancials.comho-journal12

There are several types of compliance audits that a medical practice, clinic or healthcare organization might need to perform. The starting point, discussed elsewhere on this ME-P, is to obtain a baseline audit. The next step is periodic audits or reviews that are performed after information is obtained from the baseline audit.

Periodic Audits

Periodic audits are performed on an on-going basis. Depending on the volume of billing, these may occur weekly for a large multi-specialty ambulatory clinic to quarterly for a small medical practice. These periodic audits can be random or scheduled. Sometimes in the process of seeing how things run, a surprise review can be informative to staff and practitioners.

New Employee Audits

New employees require regular training and reviews until there is confidence in their capabilities. Background checks are often helpful to find out whether there are any potential conflicts. In hospitals, health plan offices, surgery centers, and other regulated facilities, background checks are a normal part of the credentialing process. This process typically includes Medicare violations, which would show up on the National Practitioner Data Bank report. However, independent medical practices do not have access to this type of information and may have to rely on other organizations to obtain the information. The OIG and the General Services Administration both maintain a database of excluded persons and entities that can be accessed through the Internet. As part of the organization’s initial and periodic audits, queries of these two databases should be performed for all employees and independent contractors (like locum tenens physicians). Failure to do so can put the practice at risk of large civil money penalties ($10,000 for each occurrence) and liability for refunds of all claims the excluded individual had part in providing or billing.

Assessment

Additional audits can be performed whenever new employees are added, or if there are complaints or issues that arise in the course of business; prn.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? What interesting, informative or strange tidbits have you uncovered in your auditing processes?

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American Recovery and Reinvestment Act Primer for Physicians

Free ARRA Webinar Series

By Staff Reporters

Resident LaptopAre you ready to maximize American Recovery and Reinvestment Act (ARRA) opportunities in your medical practice?

The Webinar Series

This webinar series is designed to support physician practices as they prepare for a new health care environment. As new information becomes available, experts and health care leaders representing diverse sectors will review key components of ARRA and offer insights on the impact to the physician community.

Topic: Stimulus 101: Basics of the Health Information Technology Provisions

When: Thursday, May 21, 12:00 PM CST

Presenters:

  • Glen Tullman, Chief Executive Officer – Allscripts
  • Margaret Garikes, Director of Federal Affairs – AMA

Assessment

Plus, hear from practices using eHR systems and how they made the transition.

Registration: https://cc.readytalk.com/cc/schedule/display.do?udc=1ip8sqjax7frw

Conclusion

And so, your thoughts and comments on this Medical Executive-Post, and webinar series, are appreciated; especially from seminar participants. 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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Physician [Fee] Schedule Augmentation

Organizing and Analyzing Financial Data

[By Christy Clodwick; MHA]

biz-book1After all medical practice management data has been gathered, organize it onto a spreadsheet or chart.  This analysis report will help to determine the codes and/or health plans that should be targeted for process improvement.

Focus … Focus … Focus

The focus should be on the highest volume and dollar value codes. Does this mean patients with unusual conditions or low dollar value codes are not treated? Hopefully it will not; but it will push this process forward and the practice will see the greatest benefit from these categories. When you review the report and find that a fee is being paid at a much lower rate, this would be indicative of a necessary negotiation with the payer for an increase for that procedure. Most health plans are committed to preventing disease. Maybe, but they are still actually aimed at treating diseases; not preventing them. If this is true of many payers then they should be willing to provide the incentives for those services to be carried out. You will find that some payers’ fee schedules are very much out of line with a percentage of Medicare payments, therefore the practice administrator should focus on those payers and bring evidence of the inadequacies to their attention.

The Specialists

Specialists are, for the most part, paid at a higher rate than primary care physicians not usually for the same service! And, with GPs as gatekeepers, the specialty doc incomes may have actually decreased in some instances, while the GPs may have increased. There was a time when Medicare had two conversion factors, and this was the result. This inequity could also be used as a tool for better reimbursement rates.

Finalizing the Fee and Revenue Analysis

When the final preparations of the fee analysis have been completed, it is time to react to the results of the findings. There are several options to choose from when it has been determined that a health plans fee schedule is not in tune with the practice’s financial growth. The practice should act on these results as soon as they are discovered, to avoid the loss of any more revenue.

No longer Accepting Health Plans

During the analysis phase, you may determine that a health plan’s payment levels are extremely low. You will have to determine whether the plan is worth negotiating or the practice administrator should consider dropping out of the plan altogether at the end of the contract period. It will have to be carefully determined by the local market. If the practice is in a highly competitive market, this process should not be considered as first choice. However, if the market is very slim, the health care purchaser will be responsible for complaining to the health insurance plan provider that there is simply not enough physician coverage for their employees for the area. This could be a very effective way to force a negotiation with the health care company. If this were the case, the area would have less managed care and more MC/MD.

Not Accepting New Patients from Low Paying Health Plans

One option would be to not accept any more patients from the health plan that is reimbursing the practice with low rates. Although this may initially lower your patient count, over time the practice will benefit from new patients with health plans that have a better reimbursement policy. Include snapshot of what the final analysis or report should look like and the details of what it should include. This can be used in any specialty to assist in putting together the individual practice analysis to achieve the same results. But is it noble or ethical? What about any willing provider laws?

dhimc-book1The Future for Health Care Reimbursement

The health care purchasers who pay most of the bills, such as employers and the government, will soon be challenging the annual increase and the overall cost of health care. The cost increases of the hospital and pharmacy sectors of healthcare are far higher than that of the physician. However, the pressure for cost containment is being felt across the board. This will eventually depress future reimbursement for all healthcare providers.  In the future it will be hard for practices to keep up with the demands of labor, malpractice and supply cost increase. All medical providers need to plan for this future paradigm. To offset this trend, physicians will need to get the most out of the work that they are doing today as well as look to new revenue generating procedures for their practice that will be cheaper and more convenient to the patient.

Process Improvement

The biggest benefits will come from continually improving the process of the daily operations of the practice, as well as ensuring accurate diagnostic coding. This will enable a practice to keep up with charge capturing through the explanation of benefits (EOB) when the charge has been processed and paid by the health insurance provider. When this process identifies that there is room for negotiation, the provider should proceed for a better reimbursement rate. If the provider is in a dominant market, the payers will be more likely to issue sweeping fee increases and so can you give me an example of this ever happening? By completing a Practice Fee Analysis, any practice should be able to use this tool to demonstrate the inequities and negotiate a better reimbursement rate for the practice.

Assessment

The first step in the negotiation process would be to contact a representative of the health insurance company that is in question. If you can produce compelling evidence to the representative, the negotiation process should be the next meeting. These folks may be fired if they do what you suggest, too frequently. Continually updating the practice fee schedule will help the practice stay on top of the contracts that it practices under. Practices that present a well-documented argument may (almost never) be rewarded with positive payer response. Again, proper planning will make for great future performance in any health care practice.

Conclusion

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Physician Use of the Internet

The Slow Evolution of a Healthcare Tool

[By Carol S. Miller; RN, MBA]biz-book15

The Internet is a constantly evolving service that continues to grow at an exponential rate, especially in physician practices. Primarily, the Internet is used as a means to electronically and expeditiously transfer data via e-mail as well as obtain information from a variety of sites.  Initially, in the physician’s office, the primary use was e-mail communications with peers, hospitals and others. Next providers linked to hospitals and managed care organizations to obtain more direct connectivity for clinical information and benefit coverage. Today physicians are finding other beneficial avenues to expand their utilization of the Internet. Several examples include:

 

  • Direct e-mail inquiries from the patient to the physician.
  • Patient educational newsletters and links to other healthcare educational web sites.
  • Continuing medical education (CME).
  • Chat room consultations, conferences or presentations with other providers.
  • Nurse to patient e-mail connectivity.
  • Immediate data on lab results with alerts for abnormal high or low values.
  • CPOEs (Computerized Purchase Order Entry Systems).
  • Radiology images.
  • EMR (Electronic Medical Records).
  • Monitoring of patients blood sugars or EKGs via the Internet.
  • Appointment scheduling on-line by patients.
  • Patient appointment reminders via the Internet.
  • Secure physician portals such as Medicity, located at www.medicity.com, which allows access to pertinent and prioritized data from a wide range of sources and vendors to include, labs, imaging centers, hospitals, payers and others.
  • HIPAA compliant Application Service Providers (ASP) for dictation, recording, routing and speech recognition and transcription services, such as Speech Machines at http://www.speechmachines.com.

Access Management

Besides the value to the patient and the physician, the physician can utilize his or her Internet connection with software firms such as NextGen to automate the registration, scheduling, eligibility verification, billing and “clean” claims processing via innovative Web-base solutions in real-time scenarios. All the physician’s office needs is a PC, a standard Internet browser, and a connection to the Internet to take advantage of this service.

Assessment

snow-highway1These resources and more, via the Internet super highway, enable physicians to have quicker and easier access to clinical information and improve productivity. Furthermore, these tools will quickly assist providers with accurate and timely medical decision making, thus improving patient care and outcomes.

Conclusion

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***

ADSL – DSL Primer for Physicians

Asynchronous Data Subscriber Line versus Digital Subscriber Loop

By Carol S. Miller; RN, MBAbiz-book20

Asynchronous Data Subscriber Lines

ADSL is a very fast digital line provided by the telephone company. If available in your area, the ADSL provides fast connections, but generally not as fast as cable. There are various choices, beginning around 256 kbps (about five to six times the speed of a fast modem) going up to 7 Mbps.  Prices begin around $60 per month (including Internet service). There is also a set-up charge and a card needs to be inserted in your computer.

Digital Subscriber Lines

DSL is a high-speed direct line that can be 20-100 times faster in communication over the modem, depending on the type selected. Prices for the DSL begin at approximately $30-$40 per month and that includes Internet access. In addition, there is a set-up charge and a network card will need to be installed into the computer. Office workstations can usually share DSL circuits over their existing local area network (LAN).

Internet Connection

To connect with the Internet, as a rule of thumb, the faster the better; therefore, the office should have at least 56 kbps.  DSL normally runs over the same line as a basic telephone voice circuit and provides Internet access from speeds of 384 kbps all the way up to 1.54 mbps (megabits per second). The advantage of this configuration is you not only have high-speed access to the Internet, your telephone is still free to make and receive calls at the same time.

Integrated Services Digital Network   

A digital telephone line that allows voice and data to be transmitted on the same line in a digital format – instead of analog – and at a relatively high speed, usually around 64 to 128 kbps.  When reviewing this service, make sure the ISP has an ISDN connection. If not, you will be charge more by both the telephone company and the ISP. Prices for the ISDN average around $300 plus, with an extra fee to install the telephone line and a monthly service charge of $25 to $100 plus to maintain.

Wireless Network (WiFi – 802.11b)

The biggest change to happen to computers in the last ten years has undoubtedly been the Internet. Close on its heels in importance may just be the adoption of the wireless network access.  Wireless Fidelity, or Wi-Fi, is now cost effective and available at the computer store.  It is no longer necessary to re-wire buildings with Category 5 wire to provide LAN connectivity and resource sharing to multiple computers. Wi-Fi, or IEE standard 802.11b, enables small offices to connect up to four computers to a single network for less than the cost of a single computer.  This means the days of multiple analog lines to offer Internet access to every computer, or a printer on every desktop, are going away. Now a single cable modem or DSL line and a centralized printer can service four users. This can save a small business hundreds of dollars a year.

www.HealthDictionarySeries.comdhimc-book28

Limited Connectivity

For limited connectivity, computer stores are stocked with wireless vendor products that are cost effective, easy to install, and very robust that will push even the most cautious computer user to take the leap to wireless computing.  Not only does it make the initial cost to install a network cheaper than it has ever been before, it eliminates the cost to remodel or move computers within a building since instead of requiring data wiring at each proposed desktop all you need now is an electrical outlet to power the PC itself. 

Satellite

This is a more modern device. In the past, satellite connections were at 400K bps or fourteen times faster than the average modem.  As an example, a 2MB file would be downloaded in 30-40 seconds.  Benefits of the satellite connection are:  The connection is always on; it is reliable; there is a secure connection; office can have multiple e-mail addresses; the web space is free; and there is tech support coverage nationwide.  Costs include around $300 for the equipment, $150 plus to install the equipment, and around $30 to $50 per month for service.  Web site reference is satcast.com (DirecWay Satellite Dish).

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? Who can update the above post for modernity?

Link: https://healthcarefinancials.wordpress.com/2009/03/13/rip-retail-financial-services-industry/

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On Baseline Medical Practice Compliance Audits

Establishing a Reference Point is Key to Success

Submitted by Pati Trites; MPA, CHBC with Staff Reporters 

www.HealthcareFinancials.comho-journal11

There are several types of compliance audits that a medical practice, clinic or healthcare organization might need to perform. The starting point is to obtain a baseline audit. The next step, discussed elsewhere on this ME-P, is periodic audits or reviews that are performed after information is obtained from the baseline audit.

Baseline Audits

Baseline audits are preliminary assessments to develop a reference point. Until a medical practice or healthcare organization establishes a track record with items such as coding accuracy or documentation to support medical necessity, it is difficult to determine any performance issues. In the spirit of Total Quality Management [TQM], the information that is shared should be done in a non-punitive manner to demonstrate that the intent of the process is to create a positive environment geared towards fixing the problems. A baseline audit can help any organization understand where the program is and establish a reference for future activities.

Assessment

Additional audits can also be performed whenever new employees are added, or if there are complaints, or issues that arise in the course of business.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated? Have you ever discovered an untoward past event, or interesting prior fact, with your baseline audit?

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Defining and Understanding “Boutique Medicine”

What it is – How it Works

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By Dr. David Edward Marcinko MBA 

http://www.CertifiedMedicalPlanner.org

According to colleague Robert James Cimasi of Health Capital Consultants LLC in St. Louis MO, concierge or boutique medical practices began in the mid-1970s, and are now in many major metropolitan areas. Concierge medicine is described as a “return to old-fashioned medicine,” where physicians limit their client base and devote more time to each patient. Patients can usually get in to see their physician within a day, and most have 24-hour access to their physician by beeper or cell phone.

The Doctor’s Perspective

Physicians who turn to concierge medicine are typically tired of not having enough time with their patients and dealing with overbooked caseloads, and are looking for a way of balancing their lives while still providing quality care for their patients. Patients who have physicians in this type of practice appreciate the “perks” they get for paying a yearly fee — similar to “annual membership dues.” These fees can range anywhere from $1,000 per year to $10,000 per year depending on the patient’s age, benefits received, area of the country, and practice.

Patient Amenities

Amenities vary by practice, but some include longer physician office visits, increased access to physicians, e-mailed “newsletters” or condition-specific information, physicians accompanying patients on visits to specialists, and house calls. In order to provide more attentive care and amenities to patients, physicians often decrease their patient load to approximately 10-25% of their managed care load. Thus, most of their patients must find other physicians, leading to potential increases in the patient load of managed care physicians.

Elitist Patients

Although concierge medicine may provide many benefits for patients (including more, and in some cases, nearly unlimited access to their physicians), it has been met with some scrutiny. Some say that this type of medicine is elitist, that it is available only to wealthy patients who can pay the annual fees. Medicare beneficiaries who are members of a concierge practice have received political attention, because many politicians have said that the annual fees patients pay is a lot more than the Medicare rate and thus is illegal billing.

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Critics

Critics also emphasize that healthcare needs to be first-rate for everyone, something that the current managed care system prevents. The implication that managed care means second-class medicine has also been a fear cited by critics.

Assessment

However, concierge physicians portray their clients as mostly middle-income people who are willing to pay more for this kind of care. Concierge medicine is not a substitute for health insurance. Patients typically keep their traditional insurance to pay for any tests or scans ordered by the physician.

MORE: https://medicalexecutivepost.com/2009/10/26/customer-relationship-management-and-the-nascent-concierge-medical-practice/

MORE: https://medicalexecutivepost.com/2009/10/26/customer-relationship-management-and-the-nascent-concierge-medical-practice/

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.

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